Colm Burke (Cork North Central, Fine Gael)
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I wish to discuss the need for additional supports for private nursing homes. As the Minister of State is aware, 16 private nursing homes have closed over the past 12 months alone. There are more than 30,000 residents between public and private nursing homes. Approximately 7,000 of them are in public nursing homes, with in excess of 23,000 in private ones. The cost base of each nursing home varies, but the average for a public nursing home is approximately €1,650 per bed per week whereas the average for a private nursing home is in excess of €1,100 per bed per week.

I will cite a study done on a nursing home. In 2020, the wage and salary costs there were €710 per bed per week. In quarter 2 of 2022, they were €864. Direct costs increased from €56 per bed per week to €71 and the cost of lighting and heating increased from €17 per bed per week to €55. According to the analysis of this single nursing home, the overall cost increased from €912 per bed per week in 2020 to €1,134 per bed per week in quarter 2 of 2022. That was an increase of €222. Additional supports are needed. Importantly, they must be introduced early.

There is an issue that many people are not aware of, in that private nursing homes are paying for a number of items that are not paid for by public nursing homes. Despite that, the public nursing homes' cost per bed per week is in excess of €1,650. For example, commercial rates are paid by private nursing homes whereas public ones do not need to pay them. The average cost of commercial rates for a 50-bed private nursing home is more than €40,000 per annum. That cost is substantially higher in the Dublin area. Some €40,000 per annum is going to the local authority from a private nursing home whereas the public sector is not required to pay.

Likewise, there are a whole host of costs, including light and heat. The cost of wages in order to retain staff is extremely difficult. If we want to prevent further nursing home closures in the next six months, additional supports need to be put in place at the earliest possible date.

When a person is admitted to a private nursing home, there is an assessment of the fee that will be paid and the supports the person will get under the fair deal scheme. I understand that does not vary even if the patient needs a greater standard of care two or three years later, whereas in a public nursing home that changes. Public and private nursing homes provide the best standard of care to their patients. It is extremely important that we put in place the additional supports at the earliest possible date.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this issue. I am taking this matter on behalf of my colleague, the Minister of State, Deputy Mary Butler. The Government is conscious of the financial challenges faced by the nursing home sector, in particular inflationary cost increases. The Department of Health is bringing forward appropriate responses.

The Minister of State is aware that a number of nursing homes have closed this year. The closure of any nursing home reduces bed capacity and puts pressures on other local health and social care facilities, including acute hospitals. Ensuring the welfare and safety of residents is secured when a nursing home closes is the most important thing and work to alleviate the concerns of residents must continue. There is a legal requirement that providers must give at least six months' notice to HIQA if they intend to close. This provides residents, families and the public health authorities the appropriate time to respond efficiently.

As of 10 October, 16 nursing homes had closed, or had officially notified HIQA of their intention to close, since the start of 2022. Over the same period, four new nursing homes have opened. Gains in capacities this year have been effectively offset by the closures. However, the Minister of State understands more capacity is expected to come on stream before year-end. It is imperative that nursing homes manage potential cost pressures in line with regulatory and contractual responsibilities, maintaining the quality of care to the residents' lived experiences and comfort is not affected.

The Minister of State announced, prior to budget day, that her priority over the past weeks had been to secure additional funding for budget 2023 to ensure the continuation of all services to high standard. Long-term residential care will be supported through €47 million in additional funding for the nursing home support scheme to maintain services and manage inflationary increases.

The Government has provided substantial supports to the private and voluntary nursing sector over the course of the pandemic. As the Deputy is aware, the Covid-19 temporary assistance payment scheme, TAPS, has been in place since the start of the pandemic and over €144 million has been made available to date under the scheme. The scheme has now been extended to the end of 2022 and will be refocused on inflationary energy costs, while continuing to support nursing homes that experience Covid-19 outbreaks. Details have been finalised and these will be communicated in the coming days.

A €100 million inflationary fund in the Department of Health was announced in the budget, which is a once-off payment designed within the Department. It will be rolled out before year-end to nursing homes. In addition to TAPS, direct support has been provided by the HSE to private nursing homes in many areas, including the provision of PPE, serial testing and support with staffing. In response to the strategic workforce challenges in nursing homes and healthcare sectors, a cross-departmental strategic workforce advisory group has been established. The group has worked to a tight timeline and is currently finalising a report which will outline a set of recommendations for the consideration of the Minister of State, Deputy Butler.

In the time I have left, I wish to advise the Deputy that I will bring his conversation on what public patients are receiving compared to what private nursing homes, on average, receive to the Minister of State, Deputy Butler. He spoke about his constituency. The average in my constituency for public nursing homes is €1,450, whereas the private providers are lucky to achieve €1,100. There is a clear disparity between what is received in the public and private sectors. To be very fair to the Minister of State, Deputy Butler, that is why she secured €47 million in funding and will go back into negotiations.

Colm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State. I very much appreciate the work Deputy Butler has done since she became Minister of State regarding making sure funding is available. The current pressure means that nursing homes would like if the Department came forward with proposals at the earliest possible date.

We are discussing the opening of four new nursing homes, but 16 have closed. The major change that is coming is that there are currently 760,000 people aged over 65 years but within eight years that figure will be 1 million, an increase of one-third. If we are using the same comparable, we technically need 40,000 nursing home beds by 2030 if we want to increase the number of places by the same proportion. I am not saying that we necessarily need to go down that road. We also need to ensure we have adequate supports in respect of home care.

I have come across a few families in the past number of weeks where family members have been in public hospitals for over six months, despite the fact that they should be in a nursing home. No nursing home is prepared to take on particular patients. The cost per bed per week in a public hospital is around €7,500 to €8,000. It is something we need to examine. We also need step down facilities within hospital grounds. We have a significant problem with respite care and as a result people stay in hospitals for longer. Step down facilities within the confines of hospital grounds mean that people can leave a hospital bed and enter a step down bed. The cost of running such facilities is lower which means there is a saving to the State. It is something the Department should take on board.

It is important that we try to put in place additional supports for the private sector at the earliest possible date in order to make sure that we do not have any further closures over the next few months.

Anne Rabbitte (Galway East, Fianna Fail)
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Ensuring the welfare and safety of residents is secured when nursing homes close is the most important thing. They and their families remain the continued focus of the Minister of State, Deputy Butler. Maximum prices for individual nursing homes are agreed with the National Treatment Purchase Fund, NTPF, following negotiations based on NTPF cost criteria. It carries out this role independently and there is no role for Ministers or the Department in these negotiations.

Aside from the script from the Minister of State I genuinely think the NTPF needs to consider inflation, the cost of living and the crisis of retention in the sector. To be honest, while I know there is no role for Ministers in the NTPF, it would be great if it listened to Ministers and articulated the need to take on board the cost of living, inflation and the retention crisis. We know the biggest costs for nursing homes at the moment are food, energy and the wage retention.

However, the Department has made significant additional support available to nursing homes, predominantly through the €144 million paid out under the temporary assistance payment scheme. The scheme continues and will now be refocused towards supporting inflationary costs as well as helping nursing homes mitigate Covid-19. A budgetary uplift of €47 million has been secured for nursing home funding in 2023. That has to be welcomed. It is a positive indication of funding that will go into the NTPF and the workload the Minister of State, Deputy Butler, has taken on to address this matter.

Given the importance of nursing homes and the NHSS to the wider health and social care sector, with a budget of over €1 billion and over 22,000 residents supported, it is essential that policy measures are examined with due care in order to ensure that Government objectives are delivered and to avoid unintended consequences. I will take what the Deputy said about step down facilities back to the Minister of State.

Perhaps we should be giving more respite beds to the nursing homes so that they can facilitate people in the community.