Marie Sherlock (Dublin Central, Labour)

I move:

That Dáil Éireann:

notes that:

— investigative journalism by RTÉ has again exposed distressing and unacceptable practices and conditions in private Irish nursing homes, 20 years on since the Leas Cross scandal;

— the failure of the State to provide sufficient public long term residential care places has led to the growing privatisation of nursing home care, while the State picks up the majority of costs through the Fair Deal scheme;

— 30 per cent of nursing homes were privately owned 20 years ago, rising to nearly 80 per cent now, with Emeis Ireland one of the largest operators, with 27 nursing homes;

— research by the Economic and Social Research Institute, since the Covid-19 pandemic, outlines the consolidation of the sector into larger operator groups, and the decline of independently owned, family run nursing homes;

— there are serious shortcomings in the inspection and enforcement regime by the Health Information and Quality Authority (HIQA), with inadequate regulatory oversight, ambiguity in the application of existing powers, and a lack of appropriate powers beyond the power to stop admissions or remove a license;

— there are no minimum staffing levels required in nursing homes, or binding guidance provided to operators;

— there is no sectoral pay agreement in place, and the 2023 PwC report entitled "Challenges for Nursing Homes in the Provision of Older Persons Care - Private and Voluntary Nursing Home Sector", documents a staff turnover rate in the private nursing home sector of up to 38 per cent for nurses, and 54 per cent for healthcare assistants; and

— the Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, updated in 2024, documents that over 1,200 people under 65 remain in nursing homes due to a lack of appropriate alternatives;

recalls that:

— the French parent company of Emeis Ireland, formerly known as Orpea, required a State-led bailout in 2022, after the publication of Gravediggers, a book exposing the mistreatment of care residents, where the company maximised its profits and dividends to shareholders, based on a complex strategy of drastic cost cutting and the maximum use of public funding; and

— the Law Reform Commission published a comprehensive report on A Regulatory Framework for Adult Safeguarding in April 2024, and the Programme for Government commits to a new national policy in the health and social sector;

recognises that:

— the nursing home sector has become dominated by big business, and a for-profit model will not provide the standard of care demanded by families and carers;

— with an increased role for home care support for older persons in future years, the profile of nursing home patients will become more complex, more dependent, and in need of greater levels of specialised care in the future;

— increased powers and resourcing for HIQA alone will not resolve concerns about a profit-led model of care;

— the Covid-19 pandemic exposed the vulnerability of residents in private nursing homes; and

— the Commission on Care for Older People is examining the provision of health and social care services and supports for older people; and

calls on the Government to:

— take clear steps to ensure the State takes over the 27 nursing homes controlled by Emeis Ireland;

— prioritise the quality and safety of care of older persons in overhauling how nursing homes are funded and regulated, and provide HIQA with stronger enforcement powers;

— fundamentally reform the Fair Deal funding model for nursing homes – public, private and voluntary, starting with an end to the individualised negotiation process between the National Treatment Purchase Fund and provider, the introduction of service level agreements, ringfencing of funding for labour costs, and the introduction of specific rules relating to the control of the nursing home property and operating company;

— legislate to ensure minimum safe staffing levels, and implement the outstanding recommendations in the Covid-19 Nursing Homes Expert Panel report, and the 2022 Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants;

— require nursing home operators, in receipt of public funding, to recognise trade unions and engage in collective bargaining, to ensure competitive rates of pay, terms and conditions;

— ensure nursing home operators provide professional development education for staff within working hours, including mandatory safeguarding, infection prevention and control, and dignity at work training;

— limit all new nursing homes operations to 84 beds, and set out a schedule for all existing nursing homes to transition to an agreed appropriate size with HIQA;

— ensure the revised National Development Plan includes a funded programme to develop new public long term residential care, through community nursing homes, to meet the needs of our aging population;

— implement the Law Reform Commission report, by passing the required legislation as a priority in the autumn and establishing an independent national agency;

— introduce a new Fair Deal for care by implementing the long delayed statutory Home Support Service for Older People scheme, to support older people to age positively in their own home and community;

— adequately resource the home care sector, to deliver more care in the community and introduce a Fair Deal one-stop-shop, to support families and reduce red tape; and

— finally implement the recommendations of the 2021 Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, and commit to fully funding the under 65s programme office.

We have spent considerable time in recent weeks talking about nursing homes and I want to move that conversation on today. I do not doubt for a moment the personal commitment of the Minister of State, Deputy O'Donnell, to reforming the nursing home sector. However, when I read the amendment that was put down to the Labour Party motion, a motion that we designed to improve the nursing home sector, frankly, the amendment is disgraceful. It is completely devoid of any sense of urgency. It is complicit in endorsing a model of care run by big business in Ireland that we believe has to change.

Everything about the response to nursing homes in recent weeks since the “RTÉ Investigates” revelations screams of painfully slow caution. The kid gloves have to come off. We owe it to the older people in this country. I have spoken before about the very difficult decisions that families make to put a loved one into a nursing home. It is an admission that the needs are too great and the capacity in the home or the community is too small. As one woman said to me, for many families, it feels like it is an admission of failure.

Our motion, which I am proud to be proposing on behalf of my colleagues in the Labour Party, seeks to do a number of things but, principally, to mandate the Government to respond with a sense of urgency to the frightening issues that we are now seeing in a number of Emeis nursing homes. I will speak shortly of what was published last night. We want fundamental reform of the fair deal pricing scheme. To be frank, how that scheme is structured and the loose controls around it are driving some of the appalling practices that are currently going on in our nursing homes and in the care of the elderly in this country. Critically, we need legislation to ensure safe staffing levels and protections for staff in nursing homes.

I will ask the Minister of State a question. He has read HIQA’s final report into the 27 Emeis nursing homes and, by the way, he knows that the report is incomplete because a number of reports still have to be progressed. He knows that HIQA had previously found things were fine when they were not. He has seen the alarming findings for Blainroe, The Residence Carton, Brentwood, Kilminchy and Athlunkard. What is he going to do? With all of the information at his disposal, all of the information about the protected disclosures that have been sitting there for two years and all of the information that HIQA effectively failed in its duties, is he prepared to sit around and wait for the nursing homes to transform themselves? The safety and welfare of residents should not be made to wait.

It is worth recalling that protected disclosures were made two years ago about nursing homes that were not covered in the “RTÉ Investigates” programme, where residents were made to sit on commodes unattended for a significant period of time, where kitchen staff were let go and home care assistants diverted into the kitchens away from their tasks looking after residents, and where there was an increase in the number of admissions and no proportional increase in the number of staff. All of that was effectively ignored, and I do not know what happened with HIQA, but it was not addressed. There were failings.

If we are to be honest, if we had a doubt about the care of any of our family in a nursing home, we would not stand around and wait. We would do something immediately. There is a precedent in that the HSE went in to directly operate and manage 13 nursing homes during the pandemic. It was possible then and it should be possible now that the Minister would direct the HSE to go in and directly manage those Emeis nursing homes that have given rise to serious concerns. If we are serious about affording dignity and respect to older people, and providing assurances to them and their families, we need to see decisive action from the Government.

The pedestrian pace of the response from the Government speaks to a wider issue of the gaping holes in how the nursing home sector is regulated and inspected, gaping holes that are no accident. Our parties differ in that we in the Labour Party believe there must be no role for big business in the running of nursing homes in this country, no role for prioritising profit over resident safety and care. Few other sectors have a guaranteed source of income, a regulator that gives a wide berth and the certainty that demand is going to grow enormously in the coming decades. This sector gets €67.5 million from the State in the fair deal nursing home scheme and it is demanding hundreds of millions extra, with very few conditions attached.

The reality is that we have little or no oversight because many of those companies are unlimited companies. It is a sector where almost half of the beds, 48%, are now in the hands of just 15 operators, seven of which are Irish, four French and the rest German, Spanish, Dutch and Chinese. They are not here for the good of their health.

They are here because they see a serious investment opportunity. They were the figures in 2023 according to CBRE. The situation would be even more concentrated now. This is a sector that saw 26 nursing homes close between 2020 and 2023, the vast majority of them with fewer than 40 beds, while the growth is now in nursing homes with 100 beds or more. Of the 16 nursing homes under construction in 2023, nine had 100 beds or more. Three had 146 beds, 150 beds and 151 beds, respectively. That is not a nursing home; that is a warehouse. All of those have no minimum staffing levels.

This is a sector where the business model has profoundly changed over the last number of years and become increasingly financialised and where REITs will own the building and leech sizeable rents from the operating company. Then we wonder why there is no money for incontinence sheets, gloves and the basic resources to provide some degree of dignity to people in their old age. This is not the type of sector we want to have caring for older people in this country. The State absolutely has to step in and drive the growth of nursing home places, but we cannot take our eye off the ball with regard to private operators. We in the Labour Party believe there has to be a fundamental overhaul of the fair deal pricing scheme. The opaque non-transparent negotiation between operators has to end. We need service-level agreements specifying the precise level of care. We need tight restrictions on who owns and controls the operation and building of nursing homes, and we need legislation on minimum levels of staffing care.

In some ways, nursing homes are a misnomer. They are not staffed by nurses. The care is provided by healthcare assistants, yet there are people working in nursing homes who do not have QQI level 5 qualifications. I could rock up to a nursing home in the morning, start work there and then get my qualifications accordingly. That has to change. There are recommendations from the Leas Cross report going back to 2006 that have yet to be implemented. I believe this could be a watershed moment with regard to the revelations we have seen relating to Emeis. This needs to be a watershed moment in how we dramatically and fundamentally overhaul how nursing homes are run in this country. It is within the Minister of State's gift. An awful lot is riding on his efforts. We need, for the dignity and respect of older people in this country, to see a dramatic change in how they are regulated and inspected.

See this speech in context