The number of home healthcare providers has soared, resulting in an increase in abuse of the system, including scams such as time sheets submitted for patients who have died.

Kim Wilson, the Minister of Health, revealed the figures last week but said that the incidence of abuse was “low”.

She added: “We are looking at further regulations down the line — there is some abuse happening.”

Home-care benefits were introduced in 2015 against a backdrop of soaring healthcare costs and rest homes packed to capacity.

Seniors in the old continuing care unit at King Edward VII Memorial Hospital were costing the system nearly $14,000 per patient each month.

Ms Wilson told The Royal Gazette: “The ethos behind it was to help encourage people to age well at home, and not in the hospital or long-term care facilities. There is a shortage of places and it is expensive for the family.”

The minister said that there had been an “exponential” increase in registered carers over the past four years.

“It was not anticipated that it would grow quite as fast as it did.

“It was clear that it was very necessary, but the level of demand generated was much greater than was expected.”

Ms Wilson’s remarks came after a town hall meeting on April 15 at Alaska Hall, the Progressive Labour Party headquarters, where she faced questions from carers hoping for an increase in rates.

A single mother told her the $15 rate was “crazy”. She added: “I don’t know how I am going to survive.”

She also told the meeting that Bermudians were losing out to foreign workers who were “seen as cheap foreign labour”.

The minister said last week: “There is a perception that it is employment. But it is not a job — it’s part of the benefit of that particular individual that’s on the Health Insurance Plan or FutureCare.”

Ms Wilson said “abuses” had crept in, but that people going on to the programme were being assessed, and that re-registration and greater oversight would cut down on misuse or errors.

The ADS register of personal home-care benefit registrants has four categories, with the most basic — personal caregiver — receiving $15 an hour, up to 40 hours a week.

Skilled caregivers, able to assist with dementia patients and help with personal care, get $25 an hour to a maximum of 14 hours a week. Registered nurses are eligible for $75 an hour, capped at 12 visits annually.

Daycare programme carers, who assist with social activities and recreation, receive $25 per half day or $50 per day, up to $200 a week.

Ministry figures up to April 24 show the steep climb in numbers for the first two categories, with the number of new registrants rising virtually every year.

There were two personal caregivers registered in 2015, which soared to 299 by this year, with 2018 showing the steepest increase — a jump of 147 new applicants.

For skilled caregivers, the nine registered in 2015 has risen to 272 this year.

There are 15 registered nurses, as well as 15 home-care agencies, and 20 carers registered for the adult daycare programme.

Ms Wilson said it was “an expensive programme to maintain” for those paying the premiums, and emphasised that insurance, not the Government, was footing the bill.

But she added: “People are getting cared for that in the past might not have been, and could have ended up in the hospital as a result.”

Patients receiving the benefit are assessed first for eligibility, then for the level of care required.

She said misuse included examples of time sheets filed that showed suspect hours spent with patients.

“You may see a situation where someone has knocked off at 8.30pm in one parish and then started at 8.30pm with another patient all the way down the country.

“There have also been situations where the recipient of the care has actually passed away.”

Ms Wilson said oversight had proved “challenging”, but that “cases are isolated — there is no view that it’s rampant”.

She added: “When persons are reassessed, that is when things can get disclosed.”

The register of carers is maintained by ADS, and Ms Wilson said there were moves to make it “more readily available for people to search”.

She said: “Eligibility criteria are also being reviewed to make sure that the funding available goes to persons most in need.

“We will be doing that during this fiscal year.”