Increase in private sector care for older people 'happening without appropriate debate or analysis'

Health minister Jennifer Carroll MacNeill; Minister of State for Older People Kieran O'Donnell, and Professor Alan Barrett at the launch of the first report of the Commission on Care for Older People. Picture: Karl Hussey

The rise in the number of private companies caring for older people is “happening without appropriate debate or analysis”, warns the chair of the Commission on Care for Older People.

The commission also questioned an over-reliance on nursing homes in general, saying more people are being placed there for short-term care but often end up staying permanently. 

It linked this to pressures in hospitals, saying there is an "inappropriate incentive" arising from funding used to free up hospital beds by moving older patients to nursing homes. 

Nursing homes and homecare are among the services examined in the commission’s first report, published on Friday. 

Chairman Alan Barrett of the ESRI said: “Over time a greater reliance is being placed on a model of public funding being placed in private provision.

Over 80% of long-term residential care and over 60% of home support is now provided by the private sector.  

He noted the prevalence of for-profit agencies over voluntary groups. "This isn’t necessarily a bad thing but we do raise concerns,” said Prof Barrett. 

The commission found many new nursing homes are built on greenfield sites, meaning residents can be isolated from their communities.

“It seems to the commission that this movement towards greater private provision and the consolidation of provision is happening without appropriate debate or analysis,” said Prof Barrett.

“There are substantial issues with unmet demand for community-based care in Ireland."

The report refers to “substantial waiting lists for public community-based care for all key services delivered by the HSE". 

Enhanced Community Care programme success

Prof Barrett welcomed growth in supports for local programmes such as the Meals on Wheels and improvements made under the Enhanced Community Care programme.

At the launch of the report in Dublin, minister of state for older people Kieran O’Donnell insisted the Government is committed to opening more public nursing home beds.

He described the market as “blended” between public and private homes.

“Within the programme of government there is a specific policy for increasing the number of beds in public nursing homes,” he said, adding that a new nursing home will open in Killarney next week.

This is one of a group of seven built under a public-private partnership which had been expected to be compete in 2024.

Mr O'Donnell said work on a statutory homecare funding scheme remains ongoing, but offered no timeline for when it might come into force. 

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The proposal has been under consideration by successive governments since 2017.

“We’re looking to recruit 257 additional home support workers within the HSE system,” he said. 

“So for me it’s about looking at the waiting lists and we want to bring them down even more."

• Niamh Griffin, Health Correspondent