Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I am glad to have the opportunity to take part in statements on private nursing homes. I will begin by outlining the factual situation regarding the sector before turning to the issue of reform. There are 562 nursing homes in Ireland, which accommodate 31,867 registered beds. Approximately 20% of these are publicly-run HSE facilities or community nursing units, approximately 3.7% are run by not-for-profit organisations funded by the State under sections 38 and 39 of the Health Act, and the remaining 77% are homes run by private providers. The majority of residents in long-term residential care are, therefore, cared for in private nursing homes. The nursing home sector has changed in recent decades from a predominantly State-led service to a situation today where approximately 80% of nursing home services are provided by the private sector.

Approximately 22,500 nursing home residents are supported by the State through the nursing homes support scheme - the NHSS or fair deal - of whom approximately 80% reside in private facilities. Some €1.4 billion has been allocated for the fair deal in 2022, including approximately €350 million of contributions from residents.The net cost to the State is over €1 billion annually, or just under one twentieth of the overall health budget in 2022. This will increase to nearly €1.5 billion for 2023. Private nursing homes received nearly €1 billion in payments under the fair deal scheme in 2021, including contributions from residents. The funding that is allocated per NHSS-participating resident to each private nursing home is agreed between each nursing home and the National Treatment Purchase Fund, NTPF, and prices are renegotiated when agreements expire, which is usually after between one and three years.

The average size of private nursing homes is increasing year on year. This is particularly evident in Dublin, where the average size of new nursing homes is close to 100 beds. There is a trend in nursing home ownership away from small or single-facility operators towards larger corporate groups with multiple facilities. Irish-owned nursing homes accommodate approximately two thirds of nursing home beds. The latest figures indicate that the top 15 private providers, all of whom own or operate five or more nursing homes, contribute 40% of nursing homes beds, which is 10,700 beds.

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 also employs approximately 22,000 healthcare assistants, who work as members of multidisciplinary teams. The agreed cost of care charged to the NHSS for publicly-run HSE nursing homes in 2022 is €1,698 per resident per week, and the latest average price for private nursing homes is €1,073 per resident per week. As expected, this rate varies across the country. Public nursing homes are often staffed at a higher nursing ratio per patient level that allows public HSE-run community nursing units, CNUs, to deliver more complex care where required. CNUs have a higher average cost of care than private nursing homes. The difference between average public and private nursing home costs has widened in recent years and was exacerbated during the pandemic. The difference between average costs of care is kept under review by the Department. Last year, 4,500 residents were in HSE-run community nursing units. The HSE will always step in where a resident's needs are sufficiently complex that they are not able to be cared for elsewhere in the community. That is important. The HSE needs to be staffed to deliver that kind of complex care. It is the Department of Health's aim is to move, over time, towards a needs-based model of funding and pricing for the nursing home sector.

State funding for the nursing home sector is at its highest ever. Despite this increased Exchequer investment in recent years, the sector faces a number of urgent challenges including funding, governance, staff recruitment and retention and the overall stability and sustainability of the market. Looking to the future, it is essential that all future plans for the nursing home sector continue to prioritise the best interests of residents while seeking value for money for the Exchequer. The programme for Government commits to a range of reforms, including integration of the nursing home sector into the wider health service; clarifying clinical governance arrangements; enacting legislation to support fair deal for farmers and businesses, which has been done; ensuring no residents are charged for services they do not use; extending the remit of the patient advocacy service to residents of nursing homes; and enhancing safeguarding within the long-term residential sector.

In response to the acute shortage of care workers against a background of rising demand for care, I established a cross-departmental strategic workforce advisory group in March 2022. The advisory group was tasked with examining and formulating recommendations to address the challenges in front-line carer roles in the home support and long-term residential care sectors. The report of the strategic workforce advisory group on home carers and nursing home healthcare assistants was published in October. It presented 16 key recommendations related to recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. I strongly endorse all of the recommendations and I can confirm that their implementation has commenced.

In 2014, a task force on staffing and skill mix for nursing was established to support the determination of safe nurse staffing and skill mix across the health and social care sectors. Phase 1 of this initiative focused on general and specialist medical and surgical care settings in adult hospitals in Ireland while phase 2 focused on emergency care settings. In February 2021, a task force was established to develop a safe staffing and skill mix framework for residential care, work on which is ongoing. A staffing model based on resident need is being piloted across nine sites, including private, public and voluntary nursing homes, with a view to developing and rolling out on a national basis in 2023.

Looking at the pricing of long-term residential care, the 2015 review of the nursing homes support scheme recommended that a review of the pricing mechanism used by the NTPF in relation to the NHSS should be undertaken. The NTPF review of pricing system for long-term residential care facilities was published last year, and it made four initial recommendations. The first was that the NTPF undertake a formal assessment of the use of a formulaic approach. Second, the NTPF should undertake a formal assessment of the approach to the assessment of the local market price. Third, the NTPF should engage with nursing homes and their representatives in relation to enhancing the internal NTPF review process. Fourth, it recommended the development of an approach to funding that is cognisant of service users' level of care need. A steering group chaired by my Department has been established to oversee the delivery of these recommendations. While the NTPF is advancing the first three recommendations, the fourth recommendation is being progressed by my Department in the context of the development of a resource allocation model that will cover the continuum of long-term care. This work is complemented by the ongoing implementation of the wide-ranging recommendations of the Covid-19 nursing homes expert panel report and the 2021 value for money review of nursing home costs.

I would like to discuss the issue of nursing home closures. The closure of nursing homes can put pressure on other local health and social care facilities and it is vital that the welfare of residents is ensured. As of today, 17 nursing homes have closed or have officially notified the Health Information and Quality Authority, HIQA, of their intention to close since the start of 2022. Over the same period, four new nursing homes have opened, which translates to an approximate net loss of 50 beds. It is important to note that nursing home owners may choose to exit the market for a variety of reasons, for example, due to retirement. I wrote to the HSE in early September to request that it engage with any nursing homes that have informed HIQA of their intention to deregister as a private nursing home and to investigate whether any viable solutions could be found.

In addition to addressing policy challenges in the medium and longer term, the Government has responded to the challenges nursing homes have faced during and since the pandemic. To date, over €145 million in funding has been delivered to private and voluntary nursing homes through the temporary assistance payment scheme, TAPS. TAPS Covid-19 outbreak assistance has been extended to the end of this year. If any nursing home is currently in an outbreak situation, it can claim funds. Private and voluntary nursing homes have also received a substantial package of non-financial assistance throughout the pandemic, including the provision of free PPE, staff accommodation, training, Covid response teams and more. Access to supply lines for PPE, medical oxygen etc. is still provided free of charge by the HSE to all nursing homes, on both a precautionary and outbreak basis. As of 31 July 2022, private and voluntary nursing homes had received €67.5 million of PPE from the State. More recently, the Minister for Health and I launched the temporary inflation payment scheme, TIPS, with €10 million in funding to support private and voluntary nursing homes with their increased energy costs. All private and voluntary nursing homes that have an agreement with the NTPF under the fair deal scheme can apply for up to €31,500 in vouched energy increases from 1 July 2022 to the end of December. Nursing homes will be able to claim 75% of their year-on-year energy cost increases, up to a maximum payment of €5,250 per month.

The Government will continue to support the nursing home sector. We remain committed to ensuring that long-term residential care for older people continues to place residents' care, well-being, standards and best interests at the centre of development.