Nursing homes: Securing a Sustainable Future
â– Opening the door to happiness, kindness & activity focussed living â– Inspirational care requires a planned approach in association with
â– Nursing: Emphasis on professional development within rewarding roles 12 page guide to the private & voluntary nursing home sector
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Celebrating Excellence in Care
8 facts you should know about nursing home care
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Over 440 private and voluntary nursing homes in communities across Ireland are providing specialist, dedicated healthcare and a ‘home from home’ for over 22,000 people.
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OPENING A WELCOMING DOOR TO HAPPINESS, KINDNESS AND ACTIVITY-FOCUSED LIVING The residents of five nursing homes tell us about living lives of happiness, comfort, enjoyment, peace and safety within these activity-focused high-standard settings
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MEETING RESIDENTIAL CARE REQUIREMENTS Tadhg Daly, NHI CEO, warns of the consequences of not bringing together a strategy to ensure we meet residential care requirements
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FULFILLING RESPONSIBILITIES WITHIN REWARDING NURSING ENVIRONMENT Nurses in nursing homes outline the responsibilities and varied skills required to fulfil their roles within dedicated healthcare settings, which place strong emphasis upon continuous professional development
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PLANNING FOR A CARING FUTURE Nursing home care is intrinsic for healthcare delivery. It is imperative the State recognises our older population will require gerontology nurses to meet present and future clinical care requirements for our older population
09 & 10 NHI NEWS
The latest updates on the private and voluntary nursing home sector
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NURSING HOMES IRELAND CARE AWARDS 2015 The winners of the sixth NHI Care Awards, which celebrated the roles of nurses, carers, activity co-ordinators, chefs and ancillary workers within nursing home communities
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Approximately 24,000 people are directly employed by the private and voluntary nursing home sector, directly contributing over €190m annually to the Exchequer through taxation paid.
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80 per cent of long-term residential care is provided by private and voluntary nursing homes.
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Nursing home fees are circa €1,000 per week compared to an average weekly cost of over €6,000 in the acute hospital sector.
One-in-five persons aged 85 and over require the continuous, specialist care provided by nursing homes. The CSO (Central Statistics Office) is predicting this demographic will increase by 46 per cent up to the year 2021.
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The Department of Health Review of the Fair Deal Scheme states private and voluntary nursing homes provide care for fees that are an overall average 58 per cent below those being paid to HSE nursing homes.
“Long-term-care is simply a means to ensure that older people with a significant loss of capacity can still HSE Performance Reports reveal experience healthy ageing,” stated the that approximately 80 per cent of World Health Organisation in the ‘World persons clinically fit for discharge Report on Ageing and Health’, September in our acute hospitals are awaiting long2015. “The integration of healthcare and term nursing care. long-term care services will be crucial to maintaining the functional ability and dignity of older people.”
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Planning for the
future
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elcome to Nursing Homes: Securing a Sustainable Future, a Nursing Homes Ireland/Irish Independent supplement, that informs regarding nursing home care. This 12-page publication outlines the very significant challenges facing the private and voluntary nursing home sector in care provision. With our population rapidly ageing, and the requirement for the specialist care provided by nursing homes growing in tandem, the State must bring stakeholders together to ensure we appropriately plan for this considerable growth in healthcare. From a social and health perspective, we must address the significant challenges facing Ireland in providing nursing home care. Addressing these obstacles with a suitable strategy will ensure the health and social care nursing homes specialise in providing is available to the increasing numbers requiring it. This will create thousands of high-skilled jobs in our urban and rural communities. Nursing Homes: Securing a Sustainable Future provides an insight into life within these dedicated health and social care ‘home-from-home’ settings from the people at the heart of nursing home care: nursing home residents.
Read also of the experiences of nurses who are providing this person-focused care and how imperative it is we plan now for our increasing gerontological care requirements. More than 370 NHI members are committed to achieving best practice in care provision. The high standards delivered in NHI member homes are celebrated on an annual basis at the NHI Care Awards. Read about our 2015 celebrations and winners in this supplement. This publication will provide you, the reader, with an insight into the speciality that is nursing home care. It also provides strong ‘food for thought’ for persons with an interest in how we, as a society, fulfil the challenges facing us in meeting the health and social care needs of our aging population.
Tadhg Daly, NHI CEO For more information, visit www.nhi.ie, www.nhicareawards.ie or www.careersinnursinghomes.ie
A BeCreative Editorial Production www.becreative.ie
www.nhicareawards.ie
The front cover features pictures from, (l – r), Moorehall Lodge Ardee, Co Louth; Ferndene Nursing Home, Blackrock; Marymount Care Centre, Co Dublin; Orwell House, Co Dublin and Sonas Nursing Home, Co Westmeath
CREDITS
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EDITOR: Michael McGlynn CONTRIBUTORS: Eric Davidson, Colm Hayes, Clodagh Dooley ADVERTISING: Terri Byrne (01) 705 5469 tbyrne@inmsales.ie DESIGN: Susan McClean, INM Design Studio REPRO: Independent Newspapers (Ireland) Limited 27-32 Talbot Street, Dublin 1
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Opening a welcoming door to happiness, kindness and activity-focused living The residents of five nursing homes provide an insight into what their life entails. They tell us about living lives of happiness, comfort, enjoyment, peace and safety within these activity-focused high-standard settings “My independence was everything to me. I had led an idyllic life in Cyprus up until Christmas 2013 – swimming every day, walking and sailing, playing bridge. I was completely immersed in the Cyprian lifestyle. I suffered a stroke and to learn I could no longer maintain a free and independent life was a shock. The realisation that I could not return to live alone in Cyprus was horrendous. “But the welcome and kindness extended to me here at Craddock House Nursing Home was astonishing. For an independent person like me, their support medically and emotionally made the transition all the easier.
Whilst I needed practical and medical support, I was encouraged to pursue my previous hobbies. I swim every week and twice weekly I head out to play bridge. There are so many activities to do here. Now I feel comfortable and safe but with a degree of independence. I have made many good friends here and enjoy a healthy social life.” Marjorie Sheppard, Resident, Craddock House Nursing Home, Co Kildare
“I am very happy at Millbury Nursing Home and I hope by sharing my experience, it might help someone who has difficulty with nursing homes in whatever way. A great sense of security prevails in the nursing home which is most important. Fears and anxieties are eliminated
because the residents know they can call on staff day or night if necessary. “It is a very peaceful place to be - no strain or anxiety. The whole atmosphere speaks of comfort, warmth, safety and flexibility. The staff are very kind and committed. They provide us with a great service that is deeply appreciated by the residents.” Sister Camillus O’Reilly, Millbury Nursing Home, Co Meath
“At Brindley Manor, I have made many good friends. There is great company here and I’d also count the staff as my friends. There are also plenty of activities to enjoy. A shopping trip to Derry and an annual holiday were two of the most recent highlights, while other trips are also organised by the nursing home. “I would highly recommend nursing home care if you are feeling down or not very well. The food is delicious and all the chores are done for me. Living here, I am not frightened. The staff are here to
call on and it is better security wise as there is always somebody here. It has been a good decision for me and has worked out very well.” Betty Vance, Resident, Brindley Manor, Co Donegal
“When old father time sends you a message that you can no longer live alone, you reluctantly agree to live in a nursing home. You imagine you will be one of the old people sitting around, and hope you are lucky enough to find a place where things are different to your imagination. “After six years living here, I personally find time is not boring and it flies with the plentiful activities. Here we have wonderful staff – nurses, carers and a great Director of Nursing. We have two or three Masses a week which is
great and we have extended exercises every day organised by Marie, our activities co-ordinator, along with many other entertaining activities. “We also have outdoor entertainment. In the summer we can enjoy the beautiful garden when the flowers are in bloom. We also go on trips to various places of interest, on group outings to the theatre and concert hall. I regard Leeson Park as my home now and its staff as my family and friends.” Josephine Walsh, Resident, Leeson Park, Co Dublin
MAIN PHOTO With residents, staff and visitors forming special bonds, nursing homes are real community settings. Pictured are the staff, residents and visitors to Oak View Nursing Home, Co Cavan at a recent celebration
“I am 96 years old and celebrated 76 years of consecrated life in August. I was a very independent lady but unfortunately I had a very bad fall, which resulted in me having to make the decision to avail of nursing home care. This was a very daunting experience but the care I receive on a daily basis is second to none. For me, it’s like a home from home. The staff nurses are very compassionate. I feel so safe and secure when the healthcare assistants, who are extremely supportive, assist me with showering and daily activities. The standard of cleanliness is excellent and the choice of menus is varied each day. “Our activities co-ordinator is so
accommodating to my spiritual needs and on a fine day I am brought out for a walk to admire the gardens and views. Once a week our resident chef hosts a cookery demo. This gives me further opportunity to meet the other residents, to have a chat and a cup of tea, and sample what he has baked on the day. “I believe that older people are not aware of the high standards in nursing homes nowadays. The mention of a nursing home frightens them. I am more than happy that I have found such a wonderful home to live out the remainder of my years.” Sister Emma Moyles, Flannery’s Nursing Home, Co Galway
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Celebrating Excellence in Care
Health service will face repercussions if we fail to grasp evidence and plan now
Our ageing demographic and bountiful evidence is pointing to a rapid increase in the growth in requirement for nursing home care. Tadhg Daly, NHI CEO, warns of the consequences of not bringing together a strategy to ensure we are positioned to meet our residential care requirements
“Let us not seek to fix the blame for the past. Let us accept our own responsibility for the future” - John F Kennedy.
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t’s a maxim that the art of politics is about managing the present and dealing with issues arising for constituents: ‘delivering’ their ‘requirements’, avoiding controversy, generating the necessary goodwill that will secure re-election. It might be considered a generalisation but much of the reality of politics is about surviving the present and leaving future policy and planning in the hands of those forthcoming. JFK also stated: “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction.” The massive growth in our ageing demographic is well-versed both in political and societal discussions. It does appear on the political horizon. Within discussion surrounding health policy, the ‘ageing demographic’ and ‘challenges’ this presents are often cited. The evidence is presented, but are we facing up to the challenges? Are we living within the present and not planning appropriately for the future? Nursing home care fulfils an intrinsic role in healthcare delivery. Presently, more than 22,000 people require the specialist care provided within the dedicated ‘home from home’ settings that are nursing homes within our communities. It is a small minority of the population and older persons who require this continuous care. Approximately one in 25 people who are classified as older persons – those aged 65+ - presently require nursing home care. As outlined by HSE, at present 90 per cent of frail older people in Ireland live at home, with 80 per cent of them living well and independently. It is our ‘older-old’ population who are significantly dependent upon nursing home care. Approximately one in five persons aged 85+ reside in a nursing home. These persons have high-dependency healthcare needs. The Dementia Services Information and Development Centre (DSIDC) informs that the prevalence and incidence of dementia rises exponentially with age and dramatically so in those over 80 years. The CSO is projecting for every two persons who were aged 85 or beyond in 2011, there will be a third person living in this age category by 2021. It is fantastic that people are living longer and our older
population must always be embraced and celebrated. However, we cannot overlook the enormous challenges this will present for health services in the medium term. Requirement for the specialist roundthe-clock health, clinical and social care provided by nursing homes will grow exponentially. “Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significantly in the next decade,” the Centre for Ageing and Research and Development in Ireland (CARDI) has stated. “There will always be a significant requirement for long-term residential care,” says the Department of Health’s review of the Fair Deal Scheme. The Department and Minister Varadkar are well briefed on the major challenges we face in meeting the requirement for nursing home care. “On balance it would appear that a minimum of an additional 7,600 beds (over 1,000 beds per year) will be required between now and 2021,” the Department stated in its briefing to the Minister upon his appointment to the health portfolio in July 2014. Such projection is supported by research undertaken by independent agencies such as the ESRI, CARDI and BDO. The Department has estimated that €200m additional spending will be required per annum to meet health needs of an ageing demographic. The Nursing Homes Ireland Annual Survey 2014/2015 revealed a significant slowdown in provision of new beds in the past five years and decrease in the number of nursing homes. State commitment of €200m to bring the physical environments of public nursing homes up to HIQA standards will be very inadequate, when you
consider that the HSE stated two years ago that €834m would be required. Minister Varadkar and Minister with Responsibility for Older Person Care, Kathleen Lynch have recognised the importance of ensuring timely access to nursing home care by reducing waiting period to access funding to four weeks. Speaking in Dáil Éireann on the 10th November Minister Varadkar said it has enabled 265 new beds to be freed within the acute hospital sector, “which is a capacity increase equivalent to a medium-sized hospital”. The ‘evidence’ is bountiful. Back to the question posed: ‘Are we living within the present and not planning appropriately for the future?’ Worryingly, with this Government now moving into its final lap, it has failed to publish a clear and cohesive policy and national strategy for the long-term care of our older population. We need to plan a healthcare model that provides a continuum of care for our older population and enables them to avail of the most appropriate care at the most appropriate stages. In its report, ‘Quality and Standards in Human Services in Ireland: Residential Care for Older People’, published three years ago, the National Economic and Social Council (NESC) recommended the establishment of a “problem-solving group” to enable services in residential care to be provided at an optimum level for older people. The ‘evidence’ serves a stark warning that if we fail to plan now, we will be facing a health and social care crisis of significant magnitude in the coming years. Despite the warning coming from the Department of Health regarding additional bed requirement, there remains a strategic
Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significantly in the next decade
policy vacuum. NHI continues to push for the establishment of an appropriate forum to bring stakeholders around the table to advise the Government about appropriate planning, policy and strategy to support nursing home care provision. What could such a strategy entail? There is a critical requirement for the introduction of an evidence-based cost of care funding model that recognises the complexity of care for persons who require long-term residential care. DSIDC and the Oireachtas Health Committee have identified the shortcomings of the scheme in this regard. “Payments made through the NTPF need to be commensurate with level of care, staff training and skill mix and type of non-pharmacological interventions expected to be delivered,” DSIDC’s national survey of dementia care published in January stated. Recognising the lead role the private sector is fulfilling in provision of specialist dementia care, the report added: “A new funding model is required if the private sector is to be further incentivised, with more funding allocated to private nursing homes in recognition of the specialist services needed to support persons with dementia, including those with behaviours that challenge.” In its Report on End of Life & Palliative Care in Ireland, the Oireachtas Health Committee stated: “In reviewing the current Fair Deal scheme, an evidence-based cost of care model could be used in assessing the real cost of residential nursing home care in Ireland.” Very disappointingly, the Review of the Fair Deal scheme ‘kicked for touch’ in this regard. Its recommendation was a review of the pricing model be undertaken by the NTPF within an 18 month period. It is inappropriate that the current commissioners are tasked with such a review and it should be independently undertaken. The importance of ensuring staff are available to provide the person-focused specialist care befitting of persons with dementia should also be a key consideration for any strategy. The national and indeed international crisis in nurse recruitment is not confined to acute services, with serious issues surrounding the recruitment and retention of nurses threatening bed capacity in nursing homes. Engagement with stakeholders can deliver a workforce plan for the entire health
service – public, private and voluntary – that would place the substantial growth in requirement for gerontological and dementia care at the centre of it. A shortage of nursing home beds is presenting severe problems for our acute sector. Hospitals are being affected because an undersupply of nursing homes beds is preventing the discharge of patients who have completed acute hospital care. There is no quick fix or one defined solution. But two outstanding issues arising are inhibiting the ability of the sector to meet the required need at present. These are the appropriate pricing model to encompass the true costs of providing nursing home care and very serious issues
surrounding recruitment of nurses. The Department’s review of the Fair Deal stated: “Given projected demographic trends and continuing public expenditure constraints, it appears probable that there will be an expanded role for the private sector in the future nursing home market.” The private and voluntary nursing home sector are willing to play their part. 63 per cent of specialist dementia care units are presently provided by the private sector but there is a national shortfall. The Department must take control and bring stakeholders together to plan with immediacy. The trouble at the door of this Government is not going away. It should not be left to others to address.
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KEY ACTIONS REQUIRED ■ The sector requires a clear time-defined commitment to deliver an evidence-based cost of care payment model that acknowledges the true cost of providing nursing home care. The price negotiated between the NTPF – acting on behalf of the State - and individual nursing home operators must take account of the true cost of providing high quality person-centred care. This must include cost of capital and the ability of operators to generate an appropriate return on investment. ■ Operators who are dissatisfied with the rate proposed by the NTPF must be afforded the opportunity for right of appeal to an independent third party. There is clearly a need for an independent appeals mechanism that becomes applicable where the negotiators (NTPF and nursing home) fail to agree a fee for care provision. ■ The Minister and Department of Health must develop a clear and unambiguous policy that gives certainty to the private and voluntary nursing home sector. This must address requirements to ensure the sustainability of current nursing home provision. There is urgent and imperative requirement to bring stakeholders around the table through a forum that would advise Government in relation to appropriate planning and policy to meet present and growing demand for nursing home care.
Tadhg Daly, NHI CEO: Independent research states importance of evidence-based cost of care payment model to support nursing home care
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Celebrating Excellence in Care
Strong emphasis upon professional development within busy, rewarding nursing environment The reality is in stark contrast to the perception; Nurses in nursing homes outline the responsibilities they fulfil and the varied skills required to fulfil their roles within dedicated healthcare settings that place strong emphasis upon continuous professional development
Linda O’Connor, Registered Nurse in Intellectual Disability, Killure Bridge Nursing Home, Co Waterford
Linda O’Connor, Registered Nurse in Intellectual Disability, Killure Bridge Nursing Home
“The most fulfilling part of my role is getting to know each resident in the nursing home. Care of the elderly differs from roles in other areas of the health service as I feel more autonomous in my position. I can have an imperative input into clinical decisions with doctors, dieticians, psychiatrists, and occupational therapists. “Continuous professional development is strongly encouraged in the nursing home. I have been on numerous courses which have developed my knowledge to a high level. These courses include challenging behaviour, elder abuse, medication management, palliative care and dementia care. End-of-life-care is a major part of my role; I have gained considerable experience in this area that I would have not acquired in another area of nursing. “There are constantly new residents coming into the home with many different conditions and diagnoses, so my knowledge and experiences are always expanding. “Once I became more confident as a nurse in the nursing home, I was given the role of being nurse in charge on a number of occasions. This carries great responsibility and provides fantastic managerial experience - climbing the ladder into clinical nurse management is a very realistic goal if desired. “The perception of nursing in a nursing home can be outdated. All residents are treated holistically and any medical intervention that will improve their quality of life is provided. By using the most up to date evidence-based best practices, we are constantly striving to improve care while adhering to strict regulations. “I would advise any new graduate or qualified nurse interested in elderly care to ignore perceptions and consider embarking on a new nursing career path where they will gain an excellent, life-changing experience, as well as rewarding employment that combines flexible rosters, continuous professional and clinical development and work within a team with a positive morale.”
Deirdre Tiernan, Assistant Director of Care, Sonas Cloghanboy, Athlone
Deirdre Tiernan, Assistant Director of Care, Sonas Cloghanboy, Athlone
“Many perceive nursing homes to be quiet places with very little happening; this could not be further from the truth. Our nursing home is a busy place that is very involved in the community. I work with dieticians,
physiotherapists, occupational therapists, doctors, hospitals and regulators, while working closely with my colleagues, the residents and their families. Everyday there is something different happening. “There are so many positives that I find rewarding. I love working closely with new healthcare assistants and watching them grow into the role. I am involved in training staff, which is very enjoyable. “I have journeyed with many families as their loved one reaches the end of their life. This is a very privileged position. Although it is a very sad time for a family, it can be a positive experience to celebrate the achievements of their loved one’s life and ensure that journey is as comfortable and pain free as possible. “What skills do I utilise? On the nursing side, treatment preparation, personcentred care planning, end-of-life care and case management are crucial to the role. On the medical side, infection control, syringe drivers, subcutaneous fluids, peg feeds, infectious diseases, wound management and nutrition are everyday skills needed to fulfil it. On the management side you need skills in conflict resolution, policy development, training skills and dealing with regulation. There is considerable paperwork, documentation, and standards to follow and it is crucial to manage this and maintain your high standards of care. “I think elderly people deserve to have young nurses working in nursing homes. You get a vast amount of experience of a wide range of medical conditions of older people. You have huge responsibility, working with residents with complex needs. “My advice to graduates? Jobs in nursing and residential care facilities are expected to grow in Ireland, so you will have a long-term future working in a nursing home. This is a challenging job. You get so much positive feedback. You’ll work one-on-one with the same residents and get to know everyone’s needs. You build personal relationships. It’s a job that allows you to experience things spiritually, emotionally and physically. It enables you to connect to others. “You’ll share laughter, hardships, and spend quality time with residents. You are not always rushing and busy and dealing only with one aspect of a person’s care. You get to practice holistic care - taking time to talk to a resident is just as much part of the care as any medical intervention. If you want to move up in the medical field and increase your skills, most nursing homes will help to pay your education costs. There is huge variety in the job – it is never boring.”
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Bernita McDonnell, Staff Nurse, St Attracta’s Nursing Home, Co Mayo “Working at St. Attracta’s is truly fulfilling my expectations of my chosen career as a staff nurse. The ability to work with our residents - forming and building trusting relationships with residents who view the care facility as their home, as well as promoting quality of life to our elderly population - is so rewarding. “St. Attracta’s is a fast-paced, challenging environment with fantastic learning opportunities. On a daily basis we manage large volumes of medications and complex medical conditions. We are constantly communicating with a wide multi-disciplinary team. “I am being continuously encouraged to upskill and have attended many courses funded by the nursing home. I would highly recommend this work as it is a fantastic experience, especially for graduates. It also offers great support from senior staff nurses.”
Philomena Walsh, Registered General Nurse, Innis Ree Lodge, Co Roscommon “The greatest satisfaction I get from fulfilling my role is knowing that residents entrusted in my care feel safe and secure in an environment that is person-centred with staff who are diligent, devoted and dedicated to the personal needs of each and every resident. With upskilling and professional development, staff are enabled to recognise and have a deeper awareness and understanding of residents with dementia and cognitive impairment. By promoting and implementing the skills acquired through training, staff are empowered
A TEAM ENVIRONMENT: Bernita, left, is pictured with colleagues James Walsh, Clinical Nurse Manager, and Rebecca King, Staff Nurse to enrich the lives of the residents. “Responsibilities entrusted to me in my daily duties include the administration and documentation of medication, writing reports and keeping all records up to date, liaising with GP’s in making appointments and referrals for residents, admission of new residents to include
Applying specific skills and competencies drawn from the art & science of nursing “To care for those who once cared for us is one of the highest honors” - The Inspired Caregiver Nurses specialising in gerontological care fulfil a very special role within Irish society. These nurses work within dedicated healthcare settings designed to encompass the health and social care requirements of our population requiring long-term residential care. They provide clinical care and are part of teams that meet the holistic care requirements of people living in nursing homes. The teams incorporate nursing directors/persons in charge, assistant directors of nursing, registered general nurses, carers, chefs and activity coordinators. “These men and women work within highly-regulated professional settings and require key skills, enhanced competencies and considerable expertise to meet particular health and social care requirements of older people,” Mary Burke, Chair of NHI Nursing Committee explains. “Nurses within residential care settings have
responsibility for administering complex, skilled procedures and have more responsibility than counterparts within acute settings. They work within a sector that places continuous emphasis upon skill development to meet the increasingly complex care requirements of older people.” Gerontological nursing requires the advancement of knowledge, skills, competencies and expertise that are particular to meeting the complex health and social care needs of older people. “NHI is immensely proud of the highly-skilled gerontological nurses working within our sector in communities across Ireland,” Mary adds. “Many see the role they fulfil as a vocation. These people are making an immeasurable difference to the lives of the older people in their care. They are empowering the older people and enabling them to live life to their potential.”
www.careersinnursinghomes.ie - Promoting careers in the Irish nursing home sector
NHI’s dedicated recruitment website promotes career opportunities within health settings across Ireland. Graduate to senior management posts are promoted, with excellent, competitive packages being offered. Take a step towards a career that can fulfil like no other.
assessments on activities of daily living, dietary requirements, and implementing a personalised and individualised care plan. “My role allows me the privilege of making a difference in the lives of my residents. Graduates often decline to work in the nursing home sector as they have preconceived ideas of what
it entails. Nurses that work in nursing homes must be knowledgeable, have excellent observation and assessment skills, believe in their abilities and be able to communicate effectively. Nurses just out of college can gain invaluable experience. Our residents deserve the best and it is my honour to work with them.”
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Planning for a Caring Future “It’s impossible to underestimate the importance of nurses and midwives to the Irish health service.” - Minister for Health Leo Varadkar, April 2015 It was the most famous nurse of them all, Florence Nightingale, who described the art of nursing as “the finest of fine arts.” In 2015, the HSE launched an overseas recruitment campaign to attract nurses to the Irish health service. At the beginning of the year, in response to Minister Kathleen Lynch’s comments regarding the looming crisis for HSE because of shortage in nurse personnel, Nursing Homes Ireland warned that the “very considerable challenges facing the wider health sector in respect of nurse recruitment and retention must not be overlooked.”
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ealthcare delivery within the community is a primary objective of our Government. Deterring unnecessary admissions to acute hospitals is in the interest of the ‘patients’ within our health service and enables hospitals to focus on delivering the care they specialise in: acute care. In 2013, the All Ireland Gerontological Nurses Association (AIGNA), in conjunction with Nursing Homes Ireland, published the research report ‘Exploring Nursing Expertise in Residential Care For Older People in Ireland’. It highlighted the critical contribution nurses make to the lives of older people in residential care settings. Yet it found these nurses feel both undervalued and constantly under threat. “Gerontological nurses are both social and clinical advocates for older people in residential settings,” states Professor Brendan McCormack, former AIGNA President. “It is the integration of these two perspectives into their daily work that maintains both the health and the social and personal wellbeing of the older person. It is the job of policy makers and managers alike to ensure that gerontological nursing is viewed as a challenging and healthy career choice with a bright and rewarding future.” The nursing home sector does not exist in isolation. We must plan for the care requirements of our rapidly ageing population. Persons aged 65 plus account for almost 50 per cent of total bed days in Irish hospitals. Approximately 75 per cent of persons awaiting discharge from our hospitals are waiting on long-term nursing care. Nursing home MAIN PHOTO Art is an excellent therapeutic activity that nursing homes and their residents embrace. Residents of Ferndene, Co Dublin, are pictured with their creations before recently hosting exhibition of their works.
care is primary care being delivered in communities across Ireland. These dedicated health settings meet the clinical care requirements of persons requiring long-term residential care. There is at present a shortage of nurses to fill posts. This problem pertains not just to Ireland but also to the UK and internationally. Throughout 2015, NHI has been pushing for a resolution of the crisis in delays in registration of overseas nurses to work within Irish health settings. On 9th November 2015, 1,927 candidates to fulfil nursing posts were awaiting the processing of their applications with the Nursing and Midwifery Board of Ireland, the nurse regulator.
On balance it would appear that a minimum of an additional 7,600 beds [long-term residential care] (over 1,000 beds per year) will be required between now and 2021.
meet our population’s clinical care needs is recognised by the policy stakeholders. “One of the most important aspects arising from this study is the imperative of establishing the value of expertise in nursing in residential care of older people,” the research report states. “Consequently, nursing colleagues in settings outside nursing, society and policy makers need to appreciate such value and expertise. Gerontological nursing needs greater recognition as a speciality in its own right at all levels of nursing education.” The World Health Organization has stated: “Acting both as individuals and as members and coordinators of inter-professional teams, nurses and midwives bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost effectiveness of services… In spite of their contribution, nurses and midwives are not often identified as key stakeholders at the health policy table.”
A man who does not plan long ahead will find trouble at his door. Confucius The Government must lead so we can ensure a sustainable plan for our clinical care requirements is implemented. This must strive to ensure that we have an adequate supply of gerontology nurses to meet the increasingly complex healthcare requirements of an ageing population. Nursing programmes must incorporate more gerontology input so we have graduates positioned to meet ageing demographics’ clinical care needs. Workforce planning and workforce development are essential factors in the delivery of high quality care. Recruitment and retention, training and qualifications, continuous learning and skill development all have to be part of a workforce plan for the nursing home and wider health service to meet current and future needs.
- Department of Health Briefing to Minister Varadkar upon appointment to health portfolio, July 2014 The growth in requirement for gerontological nursing care will only escalate in the coming years. The population most dependent upon nursing home care - persons aged 85 plus - is to grow by 46 per cent to year 2021 according to the Central Statistics Office. The requirement for 7,600 additional beds means thousands of nurses will be needed within nursing homes. Longevity is a public health and societal achievement. The present considerable pressures upon acute hospitals will multiply if the significant challenges in meeting the care requirements of our ageing population are not confronted. It is imperative that the necessity for gerontological nurses to be available to
THE ARTS: There is strong emphasis upon developing the artistic talents within nursing homes. Pictured are the creative writing group at St Elizabeth’s Nursing Home, Co Meath. The writing brings the imagination of residents together to create new poetry and stories.
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Cost of care in public nursing homes 58 per cent greater than private and voluntary counterparts
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espite being the majority providers of specialist dementia care, the average fee payable to private and voluntary nursing homes for care provision is 58 per cent less than that provided to HSE counterparts. The Department of Health commissioned review of the Nursing Home Support Scheme, commonly known as Fair Deal, states: “The average weekly cost of care in a public facility was €1,390 and in a private or voluntary facility was €893 at the end 2014. The headline price differential in the average cost of care between public and private facilities is approximately 58 per cent.” The fees paid to HSE nursing homes under the Fair Deal scheme were last published over four years ago, in March 2011. The review, published in July 2015, stated the HSE should be required to publish the fees on an annual basis. By contrast, private and voluntary nursing home fees are published consistently, every few months. Tadhg Daly, NHI CEO said publication of the HSE fees on an annual basis would “apply a level of transparency that has been absent from State homes on a long-standing basis.” Previous Minister for Health, James Reilly, publicly questioned why a 50 per cent fee differential pertained between public and private facilities and the Comptroller and Auditor General also questioned the cost differentials. The ‘Irish National Survey of Dementia in Long-Term Residential Care’, published by the Dementia Services Information and Development Centre in January 2015, stated: “Despite the fact that the private sector provides the main bulk of specialist dementia care, current weekly rates agreed with the National Treatment Purchase Fund (NTPF) are not differentiated on the basis of individual residents’ dependency needs and private providers receive significantly lower average weekly fees per resident compared to public
GREAT MINDS: Residents have fantastic knowledge that they are encouraged to share within the nursing home. Oak View, Esker Lodge, Castlemanor and Sheelin nursing homes, Co Cavan pictured at an inter-county pub quiz. providers. This policy is inherently unfair and flawed and needs to be reformed.” The issue has been raised in Dáil Éireann, with Minister for Older People, Kathleen Lynch, previously stating under the auspices of Haddington Road Agreement, costs are being examined in State nursing homes and HSE intends to publish the revised costs before the end of 2015.
To date they remain unpublished. In its submission to DKM Economic Consultants, who have been tendered by the Department of Health to assess potential measures to encourage provision of nursing homes, NHI stated in reference to private and voluntary fees: “The NTPF enjoys a dominant position in its ‘negotiations’ with nursing home operators on the price
to be paid for nursing home care. In the majority of cases, operators must accept the rate proposed by the NTPF, with little or no room for real negotiation. In determining the price with nursing home operators, the NTPF does not use formal costing models which reflect the nature of the service provided and the acuity of the resident’s care requirements.”
Nursing home sector requires clear policy and proper pricing framework to meet requirement
T
he private and voluntary nursing home sector has ‘stepped up to the plate’ to meet the growth in requirement for residential care in recent years but the absence of a clear and cohesive national policy and strategy for the sector is stifling providers’ ability to meet the growing requirement for this specialist care, NHI has informed a Department of Health review. DKM Economic Consultants have been commissioned by the Department to analyse potential
measures to encourage the provision of nursing home and community nursing units. Private and voluntary nursing homes provide more than 22,000 nursing home beds, over 80 per cent of the total provision. “The lack of a clear and cohesive policy and national strategy for the long-term care of our older population, combined with uncertainty around current and future funding arrangements, poses one of the biggest challenges to the long-term sustainability of the
nursing home sector,” NHI stated. “A sustainable and viable nursing home sector has a key role to play in addressing the well-documented difficulties in our acute hospital emergency departments and addressing the challenges of meeting the residential care requirements of our ageing population. “The sector requires a clear timedefined commitment to deliver an evidence-based cost of care model that acknowledges the true cost of providing residential nursing home
care. This essential element is currently absent from the framework for ‘negotiations’ between the NTPF and individual nursing homes. “The procedures applied to negotiations with nursing home providers must be fair, transparent and consistent. The State, as a monopolistic purchaser of nursing home care under the Nursing Home Support Scheme (Fair Deal), has a fundamental role in establishing clear and sustainable policies which can provide greater certainty for funders and providers alike.”
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A sector on the cusp of an emergency NHI has warned that we are on the cusp of an emergency in the provision of nursing home care
“T
he Department of Health itself has stated 7,600 additional beds are required to meet nursing home care requirement to year 2021,” states Tadhg Daly, NHI CEO. “In what NHI described as political influence in the independent regulation process, the Department of Health announced on 4th November a ‘revised policy’ was being applied to public nursing homes to extend their deadline to meet physical environment requirements a further six years, from 2015 to 2021. “Two years ago the HSE projected an €834 million investment was needed to address outstanding works in public nursing homes. What specifically is the Government planning around meeting the rapid growth in requirement for nursing home care? Where are the additional 7,600 beds going to come from? What of the outstanding €834 million required to undertake physical environment works in public nursing homes?” Mr Daly says the evidence is pointing to a crisis emerging on a grand scale, with private and voluntary nursing homes being stifled in extending care services by the unsuitability of the current pricing model to negotiate fees and the
‘take-it or leave-it’ attitude of the NTPF during the fee negotiation process. He pointed to State nursing homes receiving average fees that are 58 per cent beyond private and voluntary counterparts, as revealed in the Department of Health’s commissioned review of the Fair Deal scheme. Mr Daly says the introduction of an “evidence-based” cost of care funding model is imperative, and has been recommended by both the Dementia Services Information and Development Centre and Oireachtas Health Committee. “There is an appetite amongst our members to continue stepping up to the mark to meet healthcare requirements of persons requiring the continuous care nursing homes provide,” he says. “What we are asking for is fairness for our sector. An appropriate, fit-for-purpose support framework that recognises the complexity of care challenges for persons requiring nursing home care must become an immediate priority. We’re already in emergency mode within our acute services - let’s not move the nursing home sector onto such a footing. This Government still has the chance to leave a lasting legacy in the care of the older persons. We urge them to embrace this opportunity.”
NATURE: Supporting residents to enjoy the open air and nature is intrinsic to nursing home care. Residents of Harvey Healthcare in Churchview meandering through the Botanic Gardens.
Quality Living, Quality Care – Living in a Nursing Home What exactly does nursing home care entail? NHI’s ‘Quality Living, Quality Care – Living in a Nursing Home’ booklet provides the necessary and important advice for anyone considering nursing home care. It informs of the independence of nursing home living, designated care plans for residents, nursing home facilities, activities, and the food served within these homes from home. As well as informing on nursing home living, the user-friendly booklet also advises of the rights of persons living in nursing homes, complaints procedures, and accessing nursing home care via the Nursing Home Support Scheme (Fair Deal) or through paying privately and availing of tax relief. Residents and staff living within nursing homes write of nursing home care and living. This valuable booklet has been utilised by nursing homes, within the wider health service and information services, and has seen considerable demand from the general public.
SILVER SURFERS: Nursing Homes facilitate and support residents to use modern communications means to bring connection, knowledge and entertainment.
Copies are available by contacting NHI at (01) 4292570 or it can be downloaded at www.nhi.ie via the publications section of the website (visit the Guide to Living in a Nursing Home section)
NHI Care Awards 2015 Over 500 people from the nursing home and wider health and older person sectors gathered at the Double Tree by Hilton Hotel on 12th November. They assembled to celebrate the superb care being provided by NHI Members in nursing homes across the country. The sixth NHI Care Awards recognised the diversity of nursing home care, celebrating the roles of nurses, carers, activity co-ordinators, chefs
and ancillary workers within nursing home communities. Nursing homes were also recognised for their roles within their local communities and for excellent practice in dementia and end-of-life care. Pat Durcan was recognised for his outstanding contribution to the sector and Henry Delaney of Powdermill Nursing Home, Co Cork, was honoured with the 2015 Resident Achievement Award.
Celebrating Excellence in Care
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Nursing Home Director of Nursing/Person in Charge Award Sponsored by Homecare Medical Supplies WINNER Carol McLoughlin of Moorehall Lodge, Ardee, Co Louth, is pictured third from left receiving the Nursing Home Director of Nursing/Person in Charge Award with, L-R; Tadhg Daly, NHI CEO; Mike Cosgrove, Homecare Medical Supplies; Gráinne Seoige, Event MC; Simon McGuinness, Homecare Medical Supplies.
FINALISTS Maura O’Sullivan St. Gobnait’s Nursing Home, Ballyagran, Co Limerick Rizalyn Silacan Ferndene Nursing Home Blackrock, Co Dublin
Nursing Home Registered Nurse of the Year Award Sponsored by First Choice Purchasing WINNER Laura Sheridan of Maypark House Nursing Home, Maypark Lane, Co Waterford is pictured third from left receiving the Nursing Home Registered Nurse of the Year Award from, L-R; Colm Lucey and Eoghan Donnellan, First Choice Purchasing; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Eimear Carney TLC Centre, Maynooth, Co Kildare Jackie Edwards Moorehall Lodge Ardee, Co Louth
Nursing Home Carer of the Year Award Sponsored by AIB WINNER Veronica Birchall, TLC Centre, Maynooth, Co Kildare, is pictured third from left receiving the Nursing Home Carer of the Year Award, L-R; Cathal O’Connor and Anne Bannon, AIB; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Marta Nowakowska Bartosik Ferndene Nursing Home, Blackrock, Co Dublin Lynn Keyes Esker Lodge Cathedral Road, Co Cavan
Nursing Home Social & Recreational Programme Award Sponsored by Miele WINNER Kathleen Hanrahan, Clarenbridge Nursing Home, Craughwell, Co Galway, is pictured second from left receiving the Nursing Home Social & Recreational Programme Award from; L-R; Martina Jennings, Miele Professional; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Maria Brady St. Elizabeth’s Nursing Home, Athboy, Co Meath Ann Crowley St. Luke’s Home, Mahon, Co Cork
Nursing Home Catering and Nutrition Award Sponsored by Fresenius Kabi WINNER Laurentia Vaughan of the Catering & Hospitality Team of Knightsbridge Nursing Home, Trim, Co Meath, is pictured, third from left, receiving the Nursing Home Catering & Nutrition Award on behalf of the catering & hospitality team from, L-R; Diana Dihmis and Shiofra O’Malley, Fresenius Kabi; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Pascal Desmet Brindley Healthcare Convoy, Co Donegal Marie Gaynor Sonas Nursing Home Cloghanboy Athlone, Co Westmeath
NURSING HOMES IRELAND CARE AWARDS
2015 www.nhicareawards.ie
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Celebrating Excellence in Care
Nursing Home Ancillary Worker Award Sponsored by iD Expert WINNER Fergal Dunne of Knightsbridge Nursing Home, Trim, Co Meath, is pictured, second from left, receiving the Nursing Home Ancillary Worker Award from, L-R; Jacinta McCamley, iD Expert; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Mary B McMahon Ennis Nursing Home Ennis, Co Clare Ollie Stapleton Maypark House Maypark Lane, Co Waterford
Nursing Home Community Initiative Award Sponsored by Bank of Ireland WINNER Breege Conlon & Michelle Watters of Moorehall Lodge, Ardee, Co Louth, are pictured second and third from left receiving the Nursing Home Community Initiative Award from, L-R; Hilary Coates, Bank of Ireland; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Physiotherapy Department TLC Centre Maynooth, Co Kildare Katie Uí Chúlain Aras Chois Fharraige Spiddal, Co Galway
Nursing Home Innovations in Dementia Care Award Sponsored by BDO WINNER Eileen Kenneally, Angela Ryan & Theresa Horgan of the Social Care Team of Oaklodge Nursing Home, Cloyne, Co Cork are pictured receiving the Nursing Home Innovations in Dementia Care Award from, L-R; Brian McEnery, BDO; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO.
FINALISTS Shirley Larkin Sonas Nursing Home Cloverhill Cloverhill, Co Roscommon Viva Life Team TLC Centre Santry, Co Dublin
Nursing Home End of Life Care Award Sponsored by The Irish Hospice Foundation WINNER Sinead Beirne of Annabeg Nursing Home, Ballybrack, Co Dublin is pictured, second from left, receiving the Nursing Home End of Life Care Award from, L-R; Sharon Foley, Irish Hospice Foundation; Gráinne Seoige, Event MC; Tadhg Daly, NHI CEO. FINALIST
NHI Lifetime Achievement Award
NURSING HOMES IRELAND CARE AWARDS
2015 www.nhicareawards.ie
Pat Durcan, former proprietor Dalkey Lodge Nursing Home, receives the NHI Lifetime Achievement Award, from, back-row L-R; Tadhg Daly, NHI CEO; Gillian Durcan; Marie Williams; Gráinne Seoige, Event MC.
Dr. Eileen Courtney Hamilton Park Care Centre Balbriggan, Co Dublin
Nursing Home Resident Achievement Award 2015 Sponsored by CPL Healthcare Henry Delaney, Powdermill Nursing Home, Ballincollig, Co Cork, is pictured, second from right, receiving the Nursing Home Resident Achievement Award from, L-R; Tadhg Daly, NHI CEO; Helen O’Dwyer, CPL Healthcare; Eleanor Magunnigle, Director of Nursing, Powdermill Nursing Home; Gráinne Seoige, Event MC.
NHI CARE AWARDS 2015 JUDGING PANEL CHAIRPERSON Dr Amanda Phelan, Co-Director, National Centre for the Protection of Older People JUDGING PANEL Mr Rodd Bond, Director, The Netwell Centre, Dundalk Institute of Technology Ms Margot Brennan, Former PRO, Irish Nutrition & Dietetic Institute Ms Sharon Foley, CEO Irish Hospice Foundation
Ms Susan Kent, Deputy Chief Nursing Officer for Women’s Health & Primary Care Services Department of Health Mr Eamon Timmins, Chief Executive Officer, Age Action Ireland We also wish to acknowledge the very kind assistance of Mary Flanagan, HSE, with the judging process. Thank you to Calor Gas for sponsorship of NHI Care Awards welcome reception.