Niamh Griffin: Our elderly nursing home residents deserve a fair deal

The curtain has been pulled back on the harsh financial realities affecting residents and their families, says Niamh Griffin

Families and friends of Beaumont Residential Care residents protesting at the constituency office of Tánaiste Micheál Martin in Cork. Picture: Jim Coughlan

Conversations about nursing homes usually focus, rightly, on the care given.

This week, though, the curtain has been pulled back on the harsh financial realities which directly affect elderly residents and their families.

For most families, when a crisis affects an older person, perhaps due to a sudden fall or a hospital doctor saying it is not safe for someone to return home after a stroke, they want a safe, local solution.

The first thought that comes into their head is not ‘is this home private, public, or voluntary?’

The Fair Deal payment scheme, the Nursing Home Support Scheme, was meant to remove that question from consideration; homes apply for funding per resident and families pay a proportion of that.

However, now, private operators are arguing funds are not distributed in a fair way, with higher amounts going to HSE-run homes, leaving them struggling.

This dates back to a time when public homes took in people with more complex needs, including advanced dementia and complex health conditions.

However, as the number of private and voluntary homes increased, now making up 80% of the total, this balance of care has shifted.

This week, Nursing Homes Ireland (NHI) said increased operational costs per resident of around 36% over the last five years, including for electricity and food, have not been matched by equal increases in Fair Deal payments.

Among the financial gaps the report found renovation in public homes is funded separately to the Fair Deal through the Health Information and Quality Authority (Hiqa) Regulatory Compliance Programme, within the HSE capital plan.

Lower wages

The report also acknowledged lower wages paid to private staff with one home quoted as saying 55% of their leavers went to work for the HSE.

NHI indicated all of this has led to the closure of 31 nursing homes, particularly smaller rural centres over three years with 915 beds.

However, a Department of Health spokesman said that last year saw a net addition of 88 beds and this year so far a net extra 161 beds. He said some new homes which opened are larger than those which closed and other homes expanded.

Department figures show 18 homes notified Hiqa last year that they planned to close, but not all have yet done so and four homes did so this year. Against this, four new centres opened in 2022 and one this year.

This comes against a backdrop of many nursing homes having suffered tragically through the pandemic, with an expert panel report finding, for some sites, deaths were “a devastating reality”.

This week in Cork, the Beaumont Residential Care site, part of the CareChoice chain, decided it can no longer cover the gap in costs for Fair Deal residents. It will only accept residents who can personally cover the full cost of their care.

CareChoice met with the NTPF on Friday, and a spokeswoman said: 

"CareChoice agreed to stay in the scheme for another month in the hope that there can be fruitful engagement."  

The Irish Examiner’s Pádraig Hoare met some affected families who protested at Tánaiste Micheál Martin’s office.

Anne Rogers, whose mother Bríd Rogers is an 88-year-old resident with severe dementia, said they want to galvanise families and politicians.

“The staff in Beaumont have become like family,” said Anne. “My mother Bríd has been there for seven years, she is non-verbal and doesn’t recognise family members like me anymore, but she absolutely knows she is safe with Beaumont staff.”

Yesterday, it emerged that minister of state for mental health and older people Mary Butler has lifted a moratorium on former nursing homes operating as refugee centres. A spokesman said this can only happen after the normal six-month notification to Hiqa plus an 18-month cooling-off period, meaning a two-year lapse between change of use.

The question is whether this will lead to further closures if owners think this is a more lucrative way to make money.

Reliance on private homes

In parallel, there is growing concern at reliance on private homes and voluntary organisations by the State, as seen in submissions to the covid-19 Nursing Homes Expert Panel.

“I think if you look at outsourcing of healthcare generally, we have become far too dependent in some areas on the private sector,” said Sinn Féin health spokesman David Cullinane.

“You could make that argument in relation to dentistry, in relation to homecare and nursing and residential care facilities. I think across all of those areas it is well-known that we’ve become very dependent on the private sector, mainly because we haven’t built community nursing homes or we haven’t invested in public dentistry.”

He called for change across these sectors.

“We need to be building up public capacity to reduce reliance on the private sector, and that is not going to be done overnight.”

In the meantime, families are looking anxiously at the decision by the Cork nursing home and wondering if their local nursing home might go next.