External review recommends fines and stronger Hiqa powers over nursing homes

Changes to how the six-monthly review of each registered nursing home is carried out were also advised. Picture: iStock

An external review of how Hiqa inspects nursing homes has found its regulatory approach is "effective", but concluded that changes to the enforcement of warnings and increased staffing levels are needed, among other reforms.

Concerns raised by whistleblowers should be acted upon more quickly, and the Department of Health should consider introducing a system of fines to penalise homes or providers that do not act on warnings from Hiqa, the review by Mazars recommended.

It also recommended that the department progress the development of adult safeguarding legislation.

The consulting firm’s review was commissioned by the Government last year following public shock at what RTÉ found in two nursing homes owned by Emeis Ireland.

The broadcast showed unsafe practices, staff shortages and, in some cases, vulnerable older people left without basic care.

Both centres had been inspected by Hiqa. It had found repeated examples of non-compliance at The Residence Portlaoise, but the home was still taking new residents. It had found care in Beneavin Manor in Glasnevin was "of a good standard".

On Thursday, Mazars published its review, setting out recommendations for Hiqa and the Department of Health.

It recommended "a review of the staffing capacity and capability" within Hiqa so it can better respond to changes in the nursing home sector. It also advised changes to how whistleblowing information and protected disclosures are handled, particularly regarding response times.

Changes to how the six-monthly review of each registered nursing home is carried out were also advised.

Registered providers should report additional indicators, including their financial capacity, staffing levels and the type of resident living in the home.

The review found Hiqa already effectively collects feedback from residents. However, it recommended greater use of technology to help identify patterns in concerns or complaints received.

It said: “We recommend that the inspection approach to culture and staff behaviour within nursing homes be strengthened, particularly in relation to its impact on the lived experience of residents.” 

Mazars said residents and families should have more information available about each nursing home on the Hiqa website.

This should include details of any regulatory work in progress that has not yet been published, along with relevant additional information.

Hiqa registers all nursing homes. Centres that fail to meet the required standards are warned and told what improvements are required, with the potential loss of registration in the most serious cases.

Mazars asked Hiqa to examine whether there is a way to update families and residents about inspections or changes in registration, possibly through alerts on its website.

The review also examined how the nursing home sector is changing. Whereas most homes were previously family-run or standalone, many are now part of large groups, some of which are owned by international entities.

Mazars recommends: “The parent companies within such group structure cannot be held to account by the Chief Inspector under current legal arrangements.

“A key recommendation is a legal requirement for the Chief Inspector to be able to hold parent companies of registered providers to account.” 

It also highlighted an emerging trend of delays in providers informing Hiqa when companies are sold. This can mean some or all of the directors have changed without Hiqa's knowledge.

Overall, Mazars made six recommendations for implementation.