Dáil debates

Wednesday, 17 May 2023

Saincheisteanna Tráthúla - Topical Issue Debate

Nursing Homes

9:32 am

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I want to raise the issue of the discrimination that is occurring in the moneys being allocated for private nursing homes compared with public nursing homes. As the Minister of State is aware, we have a situation in Cork where a nursing home with 73 beds has decided to withdraw from the fair deal scheme. It is interesting to go through the figures on this. The average cost of a public nursing home bed per week is €1,823. The average cost of a private nursing home bed is €1,079 per week, so the difference is €744. One of the figures I have come up with is that in County Laois, the average cost of a public nursing home bed is €2,585 per week whereas a private nursing home is only getting €1,039 per week, a gap of €1,546. In three counties, namely, Laois; Longford; and Westmeath, the amount paid for a public bed in a public nursing home is double what is allowed under the fair deal scheme to a private nursing home. In Cork the average cost per week is €1,734 for a public nursing home and for a private nursing home it is €1,073, a gap of €661.

What is frightening is that in the last round of adjustments, percentage-wise as regards the increases allowed, in Cork the public nursing homes were allowed a 10.4% increase and the private nursing homes were allowed a 2.7% increase. This cannot continue. Private nursing homes cannot continue in the current way that fees are calculated. It is also important to realise that a private nursing home has additional costs that a public nursing home does not have. For instance, there is public liability insurance, which on average costs well over €50,000 to €60,000 per nursing home. They also have to pay commercial rates to the local authority, which a public nursing home does not have to pay. Private nursing homes have to calculate the cost of building into what can be collected in fees as well. Private nursing homes have a huge amount of additional costs that are not there for the public nursing homes and we are finding that nursing homes are going out of business. A number of smaller nursing homes closed last year and this trend will continue with the present structure. The average increase allowed recently for public nursing homes across the country was an 8.9% increase in fees, whereas in the private sector the average was 3.1%.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Not correct

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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Those are the figures and I have a full table for every county. Unless this matter is tackled we will have fewer beds available for people. In the past three months I have been trying to get people out of Cork University Hospital.

People were in that hospital three to four months longer than they should have been because they could not get an appropriate bed in a step-down or nursing home facility. That is costing time for everyone. We need hospital beds and there are huge pressures in that regard. If we cannot get people out in a timely manner, we will have even more congestion in our hospitals. I ask that this matter be reviewed.

9:42 am

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this matter. I note his interest in the private nursing home sector. The fair deal scheme was designed to protect and support vulnerable older people and to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families. To be very clear, Government funding for the fair deal scheme aims to support vulnerable older people at a time in their lives when full-time care is essential. This is a very difficult decision for families and their loved ones that often takes place at a time of crisis. That is why I, as Minister of State with responsibility for older people, find it essential to ensure that the budget for the scheme, to which a massive almost €1.5 billion has been allocated this year, will last from 1 January to 31 December for the 22,700 people who may need nursing home care.

It is imperative that nursing homes manage potential cost pressures in line with their regulatory and contractual responsibilities, maintaining quality care so that residents’ lived experience and comfort is not affected. However, the Government and I are conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups. I note that 15 companies control 10,700 beds in Ireland. The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. More than €149 million in financial support has been provided to private and voluntary nursing homes through the Covid-19 temporary assistance payment scheme. The provision of free personal protective equipment and oxygen to private nursing homes continues - not that I hear that very often - and has cost approximately €75 million to date. In light of inflationary cost pressures, a new €10 million scheme was established last year to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home over the period from July to December 2022. At that stage, a nursing home could claim up to €31,500. I extended that scheme up to the end of March. It is now under review for extension for a second time up until the end of June 2023.

Both the Department of Health and I have regular interaction with the National Treatment Purchase Fund, NTPF. I met its representatives last week to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed. Some 425 private nursing homes negotiate with the NTPF. Anyone who has a scheduled renegotiation of their deed of agreement with the NTPF this year has seen a significant uplift. I have met many of these nursing home operators. Neither I, nor the Minister, Deputy Stephen Donnelly, have any role in this negotiation process. Other options to support nursing homes are being explored, particularly in respect of the often costly nature of compliance for nursing homes under necessary HIQA regulations. Budget 2023 saw more than €40 million in additional funding for the scheme, which will provide an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

When the Deputy spoke about cost differential, he did not mention that the HSE is the statutory provider of last resort and will always step in when a resident’s needs are sufficiently complex that he or she cannot be cared for anywhere else in the community. The HSE needs to be equipped to deliver that kind of complex care. As the Deputy is aware, Nursing Homes Ireland has lodged a state-aid complaint against the Government with the European Commission regarding the State's subvention scheme for nursing home care. That is as much as I am prepared to say at present.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I fully accept the Minister of State's commitment to this area, and that of the Government, but there now is a problem. In the Cork area, for example, the amount paid for public nursing home beds is one of the lowest in the country. I fully accept that. However, the increase allowed in Cork for public nursing home beds was 10.4%, whereas the increase for private nursing homes was 2.7%. The Minister of State and I both know that costs have increased substantially as regards wages, salaries and insurance. All those costs have gone up substantially, certainly by more than 2.7%. I am worried about the Cork area. As I said, the issue that has come to a head concerns getting people out of Cork University Hospital where, in many cases, we cannot now get beds. We have had five or six ongoing cases at the hospital over the past three to four months where we physically could not get a facility to take a person who no longer needed hospital care but did need nursing home care. This really needs to be looked at.

I am now very concerned that one of the facilities, which has 73 beds, has stated it is withdrawing from the fair deal scheme. A number of other facilities are also considering their position. This issue needs to be looked at. An average increase of 2.7% in Cork will not deal with the increased costs that have occurred over the past 12 to 18 months. I ask the Minister of State to sit down with the group that adjudicates on increases to review this issue, with a view to getting people out of hospital at a faster pace than currently.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The closure of nursing homes can put pressure on other local health and social care facilities. It is vital that the welfare of residents is ensured. The Deputy spoke about the concerns he has about the Cork region, but the fair deal scheme has to work and support 22,700 elderly and vulnerable people who, at a very difficult time in families' lives, may need nursing home care. I have to ensure that the budget does not run out in October or November. There was a situation a few years ago when access to the fair deal scheme took between eight and 12 weeks because the budget was not there. I will not let that happen. When somebody applies for the scheme now, when all the papers are in place and all the details documents are there, we are turning it around in four weeks. The Deputy spoke about not being able to find beds for people but transitional care funding is in place. Last year, it was used 10,000 times to support people who need to leave an acute level 3 or level 4 hospital and find a bed someplace else. In January and February this year, that fund has been allocated several thousand times. The budget for that is substantial.

The Department published a review of the NTPF in June 2021. Its review of the pricing system found it was carried out in long-term residential care facilities under the oversight of a steering group, with representation from various Departments and agencies. The group made four recommendations: the formal assessment of using a formulaic approach in the pricing system; the formal assessment of amending the approach to the assessment of local market price to reflect prices in other nursing homes within a certain distance; engagement by the NTPF with nursing homes and their representatives on enhancing the internal NTPF review process; and amendment of the process for allowing for high-dependency residents where the necessary systems are in place.

The Deputy asked if I would meet with the group that adjudicates on price increases. As I and the Deputy understand, neither I, the Minister nor the Department has any role to play in the amount of money negotiated between the NTPF and any private nursing home that is providing support for older people. As I understand it, engagement continues between the private provider referenced in the details supplied and the NTPF.

Cuireadh an Dáil ar fionraí ar 9.49 a.m. agus cuireadh tús leis arís ar 10.03 a.m..

Sitting suspended at 9.49 a.m. and resumed at 10.03 a.m.