Hiqa wants to oversee all care homes

All health and social care services, including home care, respite care, day care, and hospice care, should be regulated, and not just residential services, the health watchdog has said.

Instead of regulating “buildings and centres”, Hiqa wants to switch to a model of regulating “services”.

This would afford greater protection for the many potentially vulnerable people receiving care, who are not protected by our current regulatory framework.

Hiqa’s call for a review of how we regulate services is against a backdrop of their rapidly changing nature and in the wake of the publication of two research papers examining older people’s services and services for those with disabilities.

Both Hiqa reports contend that our legal definition of a “designated centre” does not capture all of the current and emerging models of care in Ireland for older persons and people with disabilities.

Hiqa’s inspection powers are limited to “designated centres”, which include nursing homes, congregated settings, and community residential services for adults and children with disabilities.

However, this definition does not extend to hospices, acute care facilities or centres registered with the Mental Health Commission. Nor do they include day care, sheltered housing/assisted living, or home care. The Government is currently considering regulation of home care.

The papers point out that all models of care “have potentially vulnerable and dependent service users” who have “the same right to high-quality care and protection as those currently living in designated centres”.

In preparing the papers, Hiqa looked at regulation of services in Britain, Australia, New Zealand, and British Colombia in Canada.

The regulatory systems in all of the regions reviewed included, to varying degrees, non-residential care.

Hiqa said there is consensus among the discussion groups party to the research that a service-based model of registration — coupled with a suite of regulations specific to each model of care — represents the best course for regulation into the future. Under such a system, a provider, rather than an individual centre, would be registered with the regulator, with the provider able to provide multiple services at identified locations.

Hiqa has brought its proposals on broadening the scope of regulation — and addressing the over-reliance on long-term residential care for older people — to the attention of the Joint Oireachtas Committee on Health and Health Minister Simon Harris.

Chief inspector of social services and director of regulation with Hiqa, Mary Dunnion, said they hope the findings and recommendations arising from their research “will inform the public debate on the best way to regulate services for vulnerable people into the future”.

Hiqa is also seeking to change the current registration process for designated centres from every three years, which is “administratively burdensome”, to registering once and monitoring for compliance on an ongoing basis.

While removal of the registration cycle would affect the €300,000 per year in registration fees Hiqa collects, it proposes replacing this loss with an annual payment equivalent to the registration fee or an increase in the pre-existing annual fee that is based on bed numbers.

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