Nursing Homes Ireland’s CEO, Tadgh Daly, discusses why the Government’s Temporary Inflation Scheme has left the NHI in “bitter disappointment.” After significant engagement with the Department of health, Tadgh calls again for recognition.

As I write, an unprecedented crisis and emergency for nursing home care now presents in Ireland. Seventeen nursing homes have now closed their doors in 2022 to date, and the state of emergency shows no sign of abating. Every nursing home closure is heartbreaking for residents, families, staff and providers. We are a sector in crisis.

During early November, the Government announced the Temporary Inflation Scheme (TIPS), seeking to acknowledge the exceptional costs presenting for nursing home care in the current environment.

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It is of bitter disappointment the scheme is completely removed from the reality of the huge hike in costs that nursing home resident care has incurred this past year. Exacerbating the disappointment, we in NHI have engaged with the Department of Health throughout 2022, with all parties recognising the requirement for State funding of nursing home resident care to be enhanced – given the extremity of the increase in the cost environment now in effect.

“The Department and Government just does not recognise the crisis that is presenting for nursing home care.”

As part of the discussions, the Department requested from NHI an analysis to inform of the extent of the pressures presenting. The independent analysis, undertaken by JPA Brenson Lawlor and submitted in June, determined at a minimum the cost increase per resident, per week, was at least €194 year-on-year.

Yet the €10 million TIPS announced by Government across 400+ private and voluntary nursing homes pans out at approximately €15 per resident, per week. It defies belief and logic that the Department and Government just does not recognise the crisis that is presenting for nursing home care.

TIPS is limited to energy costs. Yet, as per broader society, the increase in energy costs has translated into increases in costs across the board, including food, staffing, laundry and all consumables.

Compounding the disconnect, State operated (HSE) nursing homes are provided with a fee, per resident, per week, that is on average just short of €700 more than that provided for resident care in private and voluntary nursing homes.

This discrimination is being applied as providers within our sector are communicating with us on a daily basis regarding excessive cost pressures given the failure of Fair Deal fees to reflect the reality of costs incurred. Nursing homes are struggling for survival.
Factors have aligned to bring into effect an unprecedented emergency for nursing home care in Ireland. Successive independent and Government own reports over a number of years have categorically stated that fees payable under the Fair Deal scheme do not recognise the reality of resident care costs.

The sector was already under severe pressure, with the regulator HIQA stating concern publicly successive years regarding the implications for nursing homes due to fees payable not recognising the reality of care costs. Over 40 nursing homes have closed over the past four years and regrettably the extremity of the cost environment now presenting has proved a tipping point.

The crisis and emergency has very serious implications for Irish health and social care. Nursing home care is absolutely integral to a proper functioning health system, supporting the timely discharge of older people back into communities for rehabilitative, respite or long-stay care.

“We need immediate increased funding for all residents to stem the tide of closures.”

But, we are facing into what could be the worst winter for hospital overcrowding. Against this backdrop, 500 nursing home beds have been forced to close and have been taken out of our healthcare system this year alone. These nursing homes were in particular communities, serving long and short-stay specialised care needs of people within dedicated home-from-home healthcare settings, with hospitals reliant upon them to facilitate discharges of people back into their community.

The sad reality is more nursing homes are going to close in the weeks and months ahead. TIPS will not bring into effect the necessary stopgap measure that was needed to save further nursing home closures. It represents a short-term measure, with it scheduled to cease in December. Still living with the cost implications of the pandemic, which remains a present threat to nursing home residents and staff, in the coming months the nursing home cost base will be required to absorb introduction of a living wage, a sick pay scheme, and a likely continued increase in energy and associated costs.

To be clear, the introduction of a living wage, sick pay scheme and pensions for employees is a positive step. However such measures have to be adequately funded.

Within NHI we remain committed to engagement with the State to bring into effect a fit for purpose scheme to address the immediate emergency. We need immediate increased funding for all residents to stem the tide of closures, secure the homes of nursing home residents and inject badly needed confidence into our sector.

Beyond that, Government has to grasp the requirement to change Fair Deal and its fundamental failings with regard to its primary purpose to fund resident care. The State has to stop long-fingering the problem and start to have sustainable policies for long-term care for older people.

It is entirely unreasonable to continue to operate the mechanism currently applied within Fair Deal which is manifestly not fit for purpose. This current emergency must provide impetus to bring into effect a fit for purpose person centered funding scheme to recognise the reality of nursing home resident care costs.

A failure to intervene will have a serious and grave impact on the residents cared for in nursing homes, their families and our staff. A failure to intervene will result in far more closures of private and voluntary nursing homes in the New Year. A failure to intervene will overwhelm the public hospital system

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