'Ageing is not the problem. Our failure to adapt is': Founder of the largest home care provider in Ireland on the issue of ageing
Putting the care of our elderly in private hands is a touchy subject. But Paul Hogan believes that the State alone can’t cope with a demographic timebomb, he tells Paul O’Donoghue
As soon as the issue of whether senior care should be privatised is mentioned, Paul Hogan smiles slightly. He probably expected this question to arise and doesn't bother getting worked up.
Although many social campaigners would argue that everyone should be well cared for by the State in old age, the founder of Home Instead Senior Care (HISC) takes a more pragmatic view.
"I don't think that there is anything wrong with the ideology that people shouldn't be left behind, but ideology has to catch up to reality."
He points out the ageing population in many countries, with Ireland being a prime example. Barely a week goes by without some variation of the so-called elderly "financial timebomb" story: the estimated spiralling cost of caring for our ever-increasing number of elderly citizens.
A forecast from the Central Statistics Office in 2013 estimated that over the next three decades the number of over-65s could almost triple to 1.4 million.
By 2046 there could be up to 560,000 more older people than under-14s compared to 2011 when there 976,600 young people compared to 531,600 older. This phenomenon is not unique to Ireland: Western populations are aging as workers who retire are living longer and an ever-shrinking pool of younger workers is coming through to replace them.
"Government can't possibly keep up with the need. There's just not enough social funding," said Hogan. "But it has opened up huge opportunities for the private sector. We need to adapt. Ageing is not the problem, our failure to adapt is the problem."
His answer was HISC, a multinational network of franchises that provides non-medical in home care for the elderly with the aim of letting them live at home for as long as possible. After starting in the US a little over 20 years ago, HISC has built up a worldwide network with more than 1,000 franchise outlets.
In Ireland the firm employs about 300 full-time staff across more than 20 outlets. It also has about 3,500 employees who work an average of 15 hours a week and is now celebrating its tenth year on our shores.
As he touts HISC as a practical solution to a practical problem, the natural assumption would be that Paul would have started the chain after seeing a gap in the market and seizing on it. However, he said that the genesis of the company came about when his family had to care for his 88-year-old grandmother.
"She was living down the street and started getting so weak that she couldn't get out of her own chair any more. She was in a state where she looked like she was very near the end," he said.
"My mom and her siblings got together and decided on two things: one, that there would be no nursing home. It was sort of a promise, that you raised us in a home, we're gonna make it possible for you to age in yours. The second thing we decided was that my mom would bring her home and we would all chip in and keep her comfortable at home."
He said that when she moved into their home, the family thought that she might live for another year or so.
A decade later and she was still in the house.
"That one year turned into 11 years. She regained her strength [and] her independence. We saw first hand that you didn't have to be a doctor or a nurse to have a huge impact on someone's health," he says. "We saw it first hand that it worked: she got a whole other decade of life and regained her will to live. So we set out to do for others what my family did for my grandmother." Paul and his wife Lori started HISC several years later from their home in Nebraska.
Paul had already worked at a Merry Maids residential cleaning outlet; a subsidiary of one of the world's largest service networks the ServiceMaster Company, and so had some previous franchising experience. After first proving that the business was viable with a location in Omaha, the couple then awarded Lori's uncle the first franchise licence for the business one year later.
"I also had two of my college roommates who were very interested in the business and several Merry Maids franchise owners approached me. The business concept and the idea of serving senior citizens attracted attention sort of organically, [so] we expanded a bit more through a handful of those people and then it went on from there and inquiries started coming in from all across the country," Hogan said.
The franchise now has well over 500 locations in the US alone, has a presence in 16 countries and generates almost $1bn in revenue. Hogan said that one of the key differences between the Irish and US markets is the fact that it is possible to claim tax relief on the cost of employing a carer, up to a maximum amount of €75,000 which he says makes the service more affordable.
"We don't have that in the US. I'd like to see it in the US to provide some release for families who are paying for this type of care because we know from our research that better care at home leads to lower medical expenses," he said.
In regards to international measures that could benefit Ireland, Paul said the Government should look at introducing measures that would allow seniors to decide for themselves how best to spend necessary funds.
"Australia has implemented a programme where the government doesn't tell seniors what they need, they give them resources to spend on their own care and they decide how to spend it," he said.
"Sometimes the family needs the funds for medication, sometimes for homecare and they can choose which measure best fits them. There is not that degree of choice in Ireland."
The issue of cost is one that comes up frequently when discussing home care for elderly people. Earlier this week the charity Alone, which provides services for older people in need, said that over one third of older people in long-term nursing homes have low or medium dependency needs, saying that funding for home help has been cut by €1.6m since 2011.
However, Paul is convinced that State funding is not the answer despite saying that an average customer of HISC would spend "about €1,400-€1,800 a month".
When it is put to him that the cost could be a barrier to some senior citizens, he conceded: "Sure, this is a stretch for many seniors, but for many of our clients it is the family working together to make this happen.
"Sometimes we have a senior who can afford to pay for it themselves and sometimes there is a family member who says that they will pay for it.
"Maybe a couple of family members will pool their money to get enough care for some respite [because] we don't replace the family, we supplement the family."
Despite the cost Paul is convinced that private care for the elderly is a viable part of the solution to aging populations. So much so that he plans on availing of it himself.
When asked if he will use senior home care when he hits old age he leans forward with a grin and asks "Why do you think I started the company?
"Home is where it's at. We cannot underestimate the value of familiar surroundings. I may not be able to remember that I had a peanut butter and jelly sandwich today, but I know where I can find the bread. That's the value of familiar surroundings."