Vincent P Martin (Green Party) | Oireachtas source

Cuirim fáilte roimh an Aire Stáit. We all accept that nursing homes play a vital role in our society. They house and provide homes to some of the most vulnerable people in our society. The Minister of State quite correctly reminded us of the significant and important presence of nursing homes in our lives when she said that 562 nursing homes exist in Ireland, accommodating almost 32,000 registered beds. The Minister of State also said that there are approximately 35,000 people employed in private and voluntary not-for-profit nursing homes across a range of clinical and support roles. The HSE employs approximately 22,000 healthcare assistants who work as members of multidisciplinary teams.

Considering the significant challenges, it behoves us to support and protect nursing homes at what is a most difficult time due to demographic changes, including the latest census figures, which I will refer to shortly. We have to ensure that those providing this invaluable service to our society are, first and foremost, encouraged to stay in the business. At the moment, something is wrong because they are leaving, a fact to which I will refer later in my remarks.

The population context is a clarion call to us all because the census figures for 2022 show that there are 768,000 people over the age of 65, and they account for 15% of our population of 5.1 million. The 89,000 people aged over 85 years account for 1.7% of the population, an increase of 20.6% since 2016. By 2031, it is expected that our population of over 65s will be 1 million, an increase of 30%, and 165,000 of them will be 85 years or older, an increase of 85%. It is great news that we are living longer, but those facts require a seismic review. The Minister of State is very hard-working and is respected in the sector. Demographics are a challenge for us all at this defining time.

By 2031, the nursing home sector expects to have a total bed requirement of 45,000. There are 26,561 private and voluntary beds and they comprise 84% of the total stock, with public beds comprising the other 16%. Inflationary pressures are part of this problem. Nursing homes operate on an around-the-clock basis and have experienced an exorbitant increase in costs, principally energy and food, and receive little recognition from the State. That is what stakeholders say; these are not my words.

Approximately 82% of nursing home residents are supported by the fair deal scheme. Ultimately, nursing homes depend on the scheme for how they operate day-to-day and for their survival. The Department of Health's review in 2015 stipulated that pricing mechanisms should be reviewed within 18 months to ascertain their capacity to ensure, among other issues, that residents with a higher level of need and more complex care needs are supported by the scheme. Six years on, stakeholders will tell us that the scheme's faults identified in the 2015 report have not been rectified.

The closure of smaller centres is an issue of serious concern. The nursing home regulator, HIQA, has expressed concerns about the closure of smaller nursing homes for successive years because the fees payable under fair deal are not commensurate with the reality of the costs incurred. The combination of increased regulatory requirements, inflationary pressures and fair deal rates will continue to decrease the bed capacity available to older people in Ireland, predominantly in the private family-owned and family-operated cohort, resulting in local people not being able to access nursing home services in their own communities.Sadly, there have been a number of these closures in the nursing home sector. Simon Carswell, in his piece in The Irish Timesin October, wrote:

Two more nursing homes are closing their doors as rising costs, increased regulatory pressures and insufficient State subsidies for care continue to threaten the survival of smaller care homes.

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Nursing Homes Ireland (NHI), the representative group for private nursing home owners, said the closure of 12 nursing homes in recent weeks was a “wake-up call that can no longer be ignored”.

Tadhg Daly, the chief executive of NHI, said, "It is incumbent upon the Government to finally deliver a long-term strategy to secure the financial sustainability of the sector".

The energy crisis is most acute and nursing homes will feel the energy crisis because they are required to maintain temperatures at a certain level and have medical equipment running 24 hours a day. On a positive note, I am pleased that part of the costs will be met by Government interventions. The additional energy supports were announced as part of budget 2023. A total of €10 million in funding will be made available specifically for nursing homes, drawn from the €100 million once-off fund that has been allocated to support community-based health and social care service providers with 2022 cost increases related to energy. The Minister of State made reference to a number of schemes that will be of assistance to private nursing homes. She referred to the TAPS and TIPS, along with the provision of PPE to nursing homes. Stakeholders would say that it was the absolute necessity to ensure acute hospitals were not overrun with the transfer of residents from nursing homes that drove that generosity, much as it is to be welcomed. There would have been a bigger crisis if those schemes were not forthcoming and there would have been ramifications for the acute hospitals.

As part of the new Government supports for 2022 and 2023, all private and voluntary nursing homes that have an agreement with the NTPF for the fair deal scheme can apply for this additional support for July to December 2022. Each nursing home can apply for up to €31,500 in vouched energy increases. Nursing homes can claim for heating and electricity increases of up to €7,000 per month, with 75% year-on-year cost increases to be reimbursed up to a maximum of €5,250 per month per nursing home, backdated to 1 July 2022. The aim of the new temporary inflation payment scheme is to alleviate the pressures put on nursing homes by an increase in energy prices. It will run parallel to the temporary assistance payment scheme and the Covid outbreak assistance, which has been extended to the end of the year, and which has made more than €145 million available to date.

All this will change utterly due to circumstances beyond the policy of Government, due to demographic changes and census figures. The last thing we want is private nursing homes leaving the sector. We have to have a fundamental review. I know the Minister of State is very hard-working and is respected as a very competent Minister of State. If she cannot do it, I worry who will. We cannot afford to haemorrhage any more private nursing homes from the sector, especially given the population projections and the requirements when we reach the next decade.