The empty homes: How a €250m promise is failing older people who need care now
St Finbarr’s Hospital in Cork. Picture: Chani Anderson
Older people desperately in need of nursing home beds are being sent far from home and family while a €250m project for seven new nursing homes has stalled, leaving observers baffled.
The new buildings appear ready, some with beds in place, but despite being promised for completion by November 2024, not a single resident has moved in yet.
Only two of the seven have been handed over to the HSE to start preparing for opening.
When the issue was reported this week by the Irish Examiner and Radio Kerry in a joint investigation, shock was expressed locally, where the individual delays are part of a bigger problem.
Units in Killarney, Midleton, Cork City and Clonmel, as well as Thomastown, Athlone and Ardee, will deliver 530 beds. However, it is believed few are additional beds in a system already pushed for space — but rather replace older homes.
The innovative public-private partnership between the HSE and a joint venture company consisting of John Sisk & Sons with Equitix was launched with great fanfare in December 2022.
It was backed with €250m from the European Investment Bank, Bank of Ireland and NORD/LB.
The HSE nationally will lease the homes from the company for an annual payment of €24m over 25 years — totaling €600m.
It will not pay for the use of the facility until the building is handed over, HSE Southwest confirmed.
Homely features include family overnight stay rooms, hairdressing space, sun-rooms and a focus on dementia care.
In May 2023, the project won an award at the prestigious Global Partnership Awards for innovation and meeting targets.
The largest units are in Killarney, with 130 beds, and St Finbarr’s in Cork City, with 105 beds.
Maria Moloney, Labour councillor for Killarney, has been asking about local delays for months.
“I’ve been pushing for information on that, but when I heard there are seven of them I thought ‘what are they doing’,” she said.
“This should be a good news story for Government but it’s turning into a nightmare.”
She asked the HSE just weeks ago at its Regional Health Forum if fire safety issues were behind the delay.
Its written response said: “The information requested in regard to issues causing delays is deemed commercially sensitive and therefore this information cannot be released.”
In one case, a family told her a relative was sent to Tipperary for care.
“They do send people out of the county,” she said, adding she knows the HSE tried to keep people within a county, saying “Kerry is a vast county”.
She knows another older person living “a stone’s throw” from the new unit, who travels more than 24km instead to Castleisland to visit a relative. This person does not have a car.
These are replacement beds for nursing and respite care at Columbanus hospital and the district hospital. The HSE has told her it is doing a feasibility study for a new primary care centre at these sites.
Social Democrats councillor for Kinsale-Bandon Ann Bambury has been aware of the delays through discussions at the forum.
She pointed out bed shortages across the whole county are “an urgent public health” need.
In one case, an elderly man living seven miles from a public nursing home had to move 25 miles away to another home due to shortages, she said.
“We have 25 beds in Bandon, four of which are for respite and there is fierce demand as well for respite,” she said.
She is bringing forward a council motion calling for more community nursing home beds next week.
She raised staffing as another concern for the new units, saying already: "Nursing directors [in homes] are telling me agency staff are 30% to 40% of their staff now."
The ESRI this month estimated Ireland needs between 2,456 and 3,287 extra nursing home beds by 2040.
Another forum member, Labour's Peter Horgan, was told by the HSE it had just 80 short-stay beds this month for Cork.
These offer respite, dementia respite, rehabilitation, convalescence, palliative care, assessment and transitional care.
There are only four in Castletownbere community hospital and two at Cois Abhainn in Youghal.
Demand is so high the HSE also pays privately for beds in Cobh, Mallow and St Luke’s home in Cork City.
Mr Hogan said older patients could be stuck in hospital longer than necessary because of the shortages.
“It’s a lack of dignity for the person and family seeking respite,” he said. “I know there are measures to ramp up but we need to utilise all sections of older care now in preparation for the inevitable aging population.”
Delays also add to bed pressures in hospitals, he said. “People want to enter respite facilities and nursing home support in or as close as possible to the areas they’ve lived in and known. Sending someone from the city to Fermoy, for instance, when there’s no familial link isn’t a runner for the family,” he said.
Nursing Homes Ireland has long campaigned for more nursing home beds, especially in rural areas and small towns.
Chief executive Tadhg Daly said: "People are leaving their own communities.
"If you have a resident who is 85, the chances are their spouse or partner is of a similar vintage, so expecting them to travel 30 or 40km is a stretch as well."
He believes the ESRI projections mean 1,000 additional beds are needed every year.
Of the €250m project he said: "The big issue really I think is these are not new beds and the cost is not cheap."
"It’s an expensive way of providing the beds, there’s no doubt”, noting the cost per bed is high.
“We would argue if the Fair Deal was adjusted and if it addressed the true cost of care, you would get more built by the private and voluntary sector,” he said.
“You won’t see that in the short-term. It is costing the State multiples of that, and the delays as well.”
Dementia care will also be offered by these new homes, with residents in groups. Thomastown will offer two 10-bed groups, for example.
Mr Daly welcomed this smaller unit living as “definitely a positive”.
Despite the units being offered as a package, it seems each HSE region faces different delivery dates.
In Cork and Kerry, none have been handed over yet.
The handover is “a complex commercial and legal process and remains under active management by the HSE nationally”, a spokeswoman said.
Each nursing home has to be registered with Hiqa as a first step. Hiqa advises this should be applied for six months before residents are expected.
The HSE spokeswoman could not say when residents would move in, but staff planning has started.
Minister of state for older people Kieran O’ Donnell told an Oireachtas committee recently he expected to see residents in Killarney by March.
The Midleton unit is expected to be complete by the end of December, health minister Jennifer Carroll MacNeill told Noel McCarthy, Fine Gael TD for Cork East.
She also said: "There have been delays in completion of the overall CNU PPP programme and all parties are engaging to address the outstanding items."
Construction at Clonmel is expected to finish by March and open for residents by June, HSE Dublin and Southeast said.
However, it also said this was “an estimate based on current progress and is subject to change”. Staff interviews have taken place.
At Thomastown, it is “actively working” with the PPP company for access before the end of December. Hiring has started.
The unit at Ardee was handed to HSE Dublin and Northeast on November 17.
“The plan is for the community nursing unit to be operational by mid-2026,” a spokesman said.
The Athlone unit was handed to HSE Dublin and Midlands on October 30. Final snagging will run to December 5, it said.
Residents are expected to move in by June. It had a pre-registration meeting with Hiqa on Monday.
A spokeswoman for Equitix said it had “no comment to make”. A spokesman for John Sisk & Sons also said for now it was not commenting.
These individual nursing homes might not carry the financial impact of the new children’s hospital, however, the need for care is just as urgent for older people.
The delays come on top of the long wait for changes to funding homecare, another source of frustration for families. The PPP plan was widely welcomed when announced, but the question is when can older people move in?
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