Thursday, 13 October 2011
Nursing Home Services
I wish to share time with Senator Michael Mullins. I welcome the Minister of State, Deputy Kathleen Lynch.
This is a straightforward case of asking the Minister for Health to outline why the relocation of a nursing home in order to meet HIQA standards should be classified as a start-up case or a new build and not as a current operation. The nursing home has been in operation since October 2002 and must move because of HIQA requirements because the building it is in is under a preservation order. Just because it is moving premises, the Department of Health wants to classify it as a new build. This is blatantly unfair and I am bringing the case to the attention of the Minister of State.
The nursing home is Pointe Boise in Salthill, which is located in a small streetfront site with a preservation order on the building limiting any development. In 2002, when it commenced operation, it was described in the local press as state-of-the-art, but by 2005 it had become apparent that as standards and expectations improved, it did not have the resources to upgrade the fixtures, fittings and facilities because the 24-bed home was only breaking even.
In 2007, the draft national standards were published and the nursing home first became aware of medium-term difficulties with the building. In June 2009, the national quality standards were introduced which require all homes to provide a range of facilities by June 2015, including a treatment room, a quiet space, a private meeting room, communal toilets, additional wheelchair toilets for visitors, an assisted toilet per floor and a number of other physical facilities. These are not available in the nursing home and cannot be because of the tightness of space and a preservation order. Some rooms may be unsuitable and contrary to the regulations owing to the loss of usable floor space from sloping ceilings and steps into rooms.
The environmental health officer also requires building works to be completed to include separate catering facilities, staff changing facilities and fitting mechanical ventilation. An important point is that on 8 March 2011, the fire officer, having inspected the building, presented a comprehensive action plan for completion which, among other actions, involves sizeable building works. The entire situation makes the future of this nursing home in the building unviable. However, the future of the nursing home as a running operation for patients and families is viable.
The building occupied by the nursing home is on a lease which expires in nine months time. The lease includes an option to vacate, renew or purchase. The sensible option for the business is to relocate. Since 2007 it has been exploring opportunities to provide better care facilities in line with the new standards, and this has resulted in the building of a new home on the grounds of St. Mary's college, which is a large secondary school. This would provide a nursing home for some of the priests. Since 27 August, it has been registered with the Health Information and Quality Authority, HIQA, as a nursing home specifically designed to comply with new regulations and at a scale of economy to be viable at the average Galway city fair deal rates. Those involved are pleased with the HIQA report.
The HIQA registration process included a two-day inspection on 12 and 13 July. The report states that the inspection covered both nursing homes - the current Pointe Boise and the new location on the grounds of St. Mary's - because all of the residents and staff will relocate to the new home. In their reports, the fire officer and environmental officer noted that the old nursing home needed substantial work.
The home was scheduled to open its new nursing home on the grounds of St. Mary's college on Saturday, 24 September. It is unique, in that a nursing home relocating premises to comply with legislation and care standards has not occurred previously. The building was completed in June, the home was registered by HIQA on 27 August and 24 September was selected as the opening date, as it would best suit residents and their families in moving. However, the National Treatment Purchase Fund, NTPF, negotiates the fair deal cost-of-care rates with individual nursing homes on behalf of the Minister for Health. On previously presenting the situation to Mr. Joe Carroll of the NPTF, the fund signalled that the home could be considered as a current operation. However, the home engaged with Ms Fiona Walsh for all of last week. At a meeting last Friday, she refused to agree to continue the current fair deal cost-of-care rates.
This is a problem. The home is unable to move and has no idea as to whether it will ever be able to do so. The collateral damage is significant. The home would have created 33 new jobs as a result of the move and has already recruited the first group, with induction training and human resources work completed. The home has the unwelcome task this week of informing those people that there are no jobs available.
Some 31 extra beds will be available in the new premises, with ten admission assessments already completed and a further 15 older people scheduled to be so assessed. Many of the latter are in Galway hospitals or the Galway Hospice. The home must inform them that it can no longer provide care. Unless the new home gets the NTPF's subvention of the current operation, it cannot afford to make the move. The irony is that the home could have solved the problem with the University College Hospital, Galway, UCHG, accident and emergency unit and saved the Department of Health a considerable sum had the right decision been taken by the NTPF on Friday. Some 36 people occupying a ward in UCHG are awaiting fair deal funding.
Will the Minister of State decide to have the operation classified as a current operation rather than a new build or a start-up, which it clearly is not?
I welcome the Minister of State to the House and support Senator Healy Eames's case. Additional jobs would be created and extra beds would help the awful accident and emergency unit situation we are reading and hearing about in the national media every day as well as the lack of available beds in UCHG. The home will not be viable unless it can get the rates it expected as an existing business. The situation is cut and dry. The home informs me that it cannot afford to open unless it gets that rate. If it does not open we will lose jobs and fail to free up beds in UCHG. It would be a shame to see a fine facility lying idle when the community needs it. Will the Minister of State discuss the issue with the NTPF to resolve it? As the home has been operating for the past ten years, it seems strange that it cannot be classified as an existing business to give it a competitive edge and enable it to open the new facility.
Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible or, where not possible, to support access to quality long-term residential care. The facility referred to by the Senators is a new, purpose-built private nursing home. It will replace another 28-bed private nursing home in the vicinity. It will also provide additional capacity in the area.
The provider of the nursing home being replaced has notified the chief inspector of the plans to conduct an orderly wind down of operations. All of its residents have chosen to transfer to the new nursing home. The new home will accommodate 60 residents and incorporate an integrated day-care service with places for a maximum of 12 residents daily from the local community. The new nursing home was registered by HIQA on 27 August.
To be an approved nursing home for the purposes of the nursing homes support scheme, a private nursing home must be registered as a designated centre with HIQA under the Health Act 2007, have agreed a price for long-term residential care for the purposes of the scheme with the NTPF and hold a valid tax clearance certificate. The agreed price criterion is necessary because of the commitment by the State to meet the full balance of the cost of care over and above a person's contribution.
The NTPF has statutory responsibility for the negotiation of prices with private nursing homes. It is independent in the performance of this function and, in carrying it out, must ensure value for money for the individual and the State. It negotiates with each nursing home individually and may examine the records and accounts of nursing homes as part of the process. This method of negotiation is necessary to ensure that the State obtains the best value for each individual in a nursing home and to comply with competition law. I understand that negotiations between the nursing home referred to by the Senators and the NTPF are ongoing.
That the business plan was based on the old rate is understandable. People could find themselves in some difficulty because they did not get the rate they assumed they would. It is a good facility that will meet standards and increase capacity. I will take the Senators' concerns to the Minister.
I appreciate that. Were I running Pointe Boise Nursing Home in Salthill and I moved my operation to Pointe Boise on St. Mary's grounds, I would have a legal case to ask to be classified as an ongoing operation as opposed to a start-up or new build. The Minister of State has acknowledged that what the home is prepared to provide is necessary. It seems like an open and shut case. Will the Minister of State bring the matter to the Minister of Health's attention? Can he intervene with the NTPF or is it independent?
Yes. The NTPF is independent in its negotiations. The situation poses difficulties. As I outlined, the winding down of one operation and the starting of another would be a clear separation, although I am not saying that this is justification. I do not dispute the Senator's assertion, but there must be other instances of the like around the country. We do not want to set a precedent by entering into a special arrangement with one provider, as all other providers would expect the same treatment.
No. While I am not certain this is the first instance around the country, let us assume it is. However, it will not be the last. I am not opposed to setting precedents, as I believe things are only done when precedents are set. However, we need to be careful. The fair deal scheme is an expensive one, rightly so, as it seeks to provide care for vulnerable older people and because we expect the best. Negotiations are ongoing. I will bring the Senator's concerns to the attention of the Minister, although I am not certain there is much he can do. Through negotiation a resolution can be achieved.