Nursing Homes Ireland has called on the government to act urgently on concerns about the closure of small nursing homes voiced by HIQA this week.
Smaller nursing homes are under pressure with regard to financing and resources and are citing these as reasons for potential closure. HIQA stated that the loss of these should be considered in the context of a loss of a particular model of care.
Such a loss would have implications for older person care, it said, with nursing homes being removed from particular communities, resulting in people having to travel further to avail of care and issues arising with regard to visitor access, GP and pharmaceutical care.
NHI chief executive Tadhg Daly said: “There’s an immediate and a longer term issue at play here. The current cost environment is intensively acute for all nursing homes. Smaller nursing homes are finding it extremely difficult and, for some, impossible to cope. Some have said it is just not viable to operate a nursing home and have closed their doors.
“We have engaged with the minister for older people, Mary Butler, and her officials on the extremity of the cost pressures and the emergency presenting for nursing home care over a period of months. The minister has acknowledged the cost environment now presenting for nursing homes is unprecedented.
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“However, it is disappointing, despite the months of engagement, no measure has been brought forward by the government to alleviate the pressures upon nursing homes. There is a requirement for an immediate intervention by the state, through the rollout of a mechanism that will support nursing homes, which are around-the-clock operators, in alleviating pressures emanating from the likes of energy and food costs.
“We are talking about the extraordinary inflationary environment and its consequences on the care of the older person.”
The representative body added that 14 private and voluntary nursing homes with 411 registered beds (average 30 each) have closed their doors in the past two years, with a further three following suit in the weeks ahead.
Fees for nursing home resident care are set by the National Treatment Purchase Fund on behalf of the state.
“Nursing homes are operating under fees that were agreed two or three years ago in an entirely different cost environment,” said NHI.
Daly added: “On a longer-term basis, nursing homes are operating under a funding model that the state itself realises is not fit for purpose. In 2015, the review of the Fair Deal stated a requirement to move towards an evidence-based cost of care model, citing the application of fees on a geographical and historical basis as not being commensurate with the reality of resident care costs.
Fair Deal fees
“In 2020, the Comptroller and Auditor General criticised the NTPF for having no model to explain how it determined Fair Deal fees for resident care. Nursing homes are subject to a price-setting mechanism administered by the state that is removed from resident care being the defining criteria for cost determination.
“HIQA has warned for many years regarding the closure of smaller nursing homes. The consequences of long-standing Fair Deal failings are now driving smaller nursing homes from care and our communities.”
According to HIQA: “Over the last few years, we have seen the number of nursing homes offering less than 40 beds reducing. In 2018 there were 217 such centres, and by 2021 this reduced to 188. This trend is continuing this year; so far in 2022 we have seen four nursing homes offering around 40 beds close.
“When ceasing operations, smaller nursing homes cite difficulties in terms of financing and resources. Undoubtedly the COVID-19 pandemic and regulations on premises which came into effect at the end of 2021 have also had an impact.
“At the same time, the sector is not seeing a loss in the number of beds, as the new nursing homes opening are much larger, offering more than 40 beds in the centres. This often balances the loss of beds associated with such closures.
“However, HIQA believes that the closure of smaller nursing homes should be considered in the context of a loss of a particular model of care and not just in terms of bed numbers. Smaller nursing homes that are embedded in the local community offer person-centred care in a very homely environment.”
