An elderly disabled woman was forced to endure the indignity of wearing a nappy and having it changed by her brother because a home help was too busy to visit her.
The Sligo woman's plight was revealed following a Health Service Executive (HSE) investigation earlier this year.
A confidential investigation report, obtained by the Irish Independent
, detailed how a concerned relative wrote a harrowing letter to the HSE highlighting the woman's hardship.
Details of the case come against a background of cuts in home-help hours to vulnerable people and mounting concerns over the quality of the service on offer.
Home helps are paid for by the HSE and visit mostly elderly or disabled people who live in their own houses but need support with various basics tasks for a short time every day -- or several days a week.
There were 41 complaints about the service last year, 26 of which were upheld, and campaigners fear these figures could be surpassed this year due to cutbacks.
The average number of hours provided by many home helps have gone from 23 to 20 per week, with the HSE having to slash the overall number of home-help hours from 11.9 million to 10.7 million for 2012.
More than 31,500 people had their service reviewed in December -- and the number of people receiving home help was reduced from 54,000 to 50,000.
A lack of monitoring also means it is unclear if each client is getting the time they have been allotted or if they have been visited as scheduled.
The Sligo woman was found by her relative "sitting inside a window, where she sits for hours, wearing a nappy, as going to the toilet is a struggle for her". When asked if her home help had visited that day, the woman admitted she had not come in a week.
The poignant letter revealed how "she had started to wearing nappies on a permanent basis indoors where her brother has been changing them for her".
The HSE's public health nursing department, which investigated the case, told the woman's relative the home help had a "very full case load" and was sometimes unable to call due to pressure of work.
The report said "this was unsatisfactory" and a new home help was assigned to her.
Meanwhile, a separate anonymous complaint filed against a home help in Donegal this year claimed an elderly woman was unable to cope with basic needs such as getting out of bed and making breakfast.
However, the home help would just sit with her during visits, rather than helping with practical tasks.
When HSE staff visited the woman as part of the investigation, she admitted the home help did not make her bed sometimes or wash dishes.
Thousands of home helps employed by the HSE are currently involved in a campaign to resist moves to outsource the service, posing a threat to jobs.
Many claim their working conditions offer no security and they are under pressure to reduce the length of their visits, which is impacting on the quality of care they can give.
The Labour Court recommended in June that the HSE enter into meaningful discussions about contracts and offer security of earnings.