Nursing home bed shortage looms as construction of new facilities stalls, experts warn

New nursing home builds stall as experts warn of care crisis and pressure mounts on the fair deal scheme. File picture: iStock

Few new private nursing homes are expected to be built for the foreseeable future, leading construction experts have warned, as a shortage of beds looms.

Members of the construction industry and the nursing home care sector have predicted bed shortages, which could lead to price hikes in private nursing homes, with further questions hanging over the State’s €1bn-a-year fair deal scheme.

Officially known as the nursing home support scheme, the means-tested scheme helps people pay for basic care in private nursing homes.

Home Care Direct chief executive Michael Harty said: “Any shortage of beds in private nursing homes will force people either to pay over the odds for a bed, or will force them to look closely at home care.

“Private operators will dedicate less beds to the fair deal scheme and more to customers who can pay above the odds.”

The Irish division of the world’s largest commercial real estate services and investment firm, CBRE, has also flagged a “very worrying” scenario for the Irish nursing home sector.

CBRE research senior director Maureen Bayley has heard of plans for two new private nursing homes.

One of the homes will be built in Kerry, while the other will be built in Dublin.

“They have yet to get off the ground,” she said.

“Other than those, there are no new private nursing homes due to be built for the foreseeable future.”

She believes the Government needs to create more incentives for the development of homes, undertaking a “long overdue” reform of the fair deal scheme.

More should also be done, she believes, to help people grow old in the villages, towns, and cities where they have lived for most of their lives or settled in before they retired. Ms Bayley, whose updated nursing home report is due later this year, said: “We don’t have a well-established senior living sector.

“There are some retirement villages outside of towns and cities, but people should be supported to ‘age in place’ in the towns, suburbs, cities where they spent their lives, so they still have the community support around them.”

Officially known as the nursing home support scheme, the means-tested scheme helps people pay for basic care in private nursing homes

The CBRE statement comes as the HSE confirmed just 160 extra beds will be provided from new public nursing homes, which are due to open fully this year under the State’s community nursing unit investment programme in 2025.

A HSE spokesperson told the Irish Examiner: “For beds to be completed in 2026, the national service plan for 2026 has yet to be finalised — which would include the planned beds.

“It is also too early in the cycle to provide firm details on beds to be completed due to various factors which affect construction projects, for example: Design progression, availability of resources, market constraints, and weather conditions.”

Age Action head of advocacy Camille Loftus cautioned that nursing homes alone are not the answer.

“While we are all living longer, it doesn’t automatically mean we are getting sicker. We believe more emphasis should be given to not just building on existing home supports, but also building age-friendly housing,” she said.

In the meantime, the existing nursing homes and home care models are all facing the same crisis: A lack of staff.

Mr Harty said: “Nursing homes and home care are incredibly lucrative businesses. Perversely, they don’t provide [financially] attractive careers.”

The ESRI has estimated that about 4.5% of all people aged over 65 will require a nursing home bed.

Meanwhile, the number of people aged 65 and over is estimated by the CSO to have risen by over 40% between 2013 and 2023 — from 569,000 to 806,000.

In its January 2024 snapshot of the lives of older people in Ireland, the CSO stated this figure is expected to double again to 1.6m by 2051. The HSE runs 127 community nursing units that have a total of 6,563 short and long-term beds, just over 16.3% of the total available beds.

These include beds provided by the 10 homes run by the voluntary Section 38, HSE-funded bodies.

The average State-funded paid cost of care, per bed, per week in public and voluntary nursing homes is €1,931 — up from €1,865 last year and €1,698 in 2022.

By contrast, the average figure for what private nursing homes — in a sector that supports around 415 homes and 26,000 beds — receive in 2025 on the fair deal scheme is a little north of €1,206.

The home care sector, which represents 60,000 people whose home care is up to around 21 hours a week, receives around €850m State aid annually.

‘Hiqa is not short of laws, it is short of ambition’ 

Former minister of state John McGuinness has said Hiqa has to explain “exactly” why it has never held a statutory investigation into nursing homes.

The watchdog has, he said, initiated statutory investigations under the 2007 Health Act into hospitals at the request of ministers or the HSE, and it has also initiated its own investigations.

The former Public Accounts Committee chairman said: “Hiqa is not short of laws. It is short of the ambition to ensure nursing homes are up to standards and residents are treated fairly.

“Hiqa needs to be made accountable for not using the laws it already has.” His comments follow the airing last week of the RTÉ Investigates documentary Inside Ireland’s Nursing Homes.

It showed shocking scenes — recorded by two healthcare assistants operating under cover — of older people being mistreated.

Former minister of state John McGuinness has said Hiqa has to explain “exactly” why it has never held a statutory investigation into nursing homes. File photo

Hiqa is due next week before the Oireachtas health committee where members are expected to grill the watchdog.

Colm Burke, a former minister of state at the Department of Health, will be at the meeting.

He said: “Hiqa has questions to answer.” Social Democrats TD Pádraig Rice, who is another committee member due to attend, said: “Hiqa has serious questions to answer at next week’s Oireachtas health committee meeting.

“The RTÉ programme exposed serious failings in inspection, oversight, and intervention in the nursing home sector.

“The problems with the State’s over-reliance on this private model were laid bare during the pandemic, and after that an inquiry should have taken place.

“We need a regulator with teeth, long-promised safeguarding legislation, statutory homecare, and an urgent review of our hyper-privatised model of elder care.” 

In response to Mr McGuinness’s criticism, a Hiqa spokesperson said the body looked forward to answering questions in the Oireachtas next week.

They also pointed out that Hiqa has begun a review of all nursing homes operated by Emeis Ireland, which runs the two nursing homes — Beneavin Manor and The Residence Portlaoise — that featured in the recent RTÉ exposé.

It also said that, once that is finished, Hiqa will then review how it inspects and regulates nursing homes and use the learning to “strengthen how we do our inspections”.