NHI News Spring 2015 by Nursing Homes Ireland

NEWS NHI News published by: Nursing Homes Ireland, Unit A5, Centrepoint Business Park, Oak Road, Dublin 12. Tel: 01 4292570 | Fax: 01 4291845 | E-mail: info@nhi.ie Visit us online: www.nhi.ie

SPR I N G

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GERONTOLOGICAL NURSING FAILURE TO PLAN PRESENTING HEALTH CRISIS

DEMENTIA CARE EXPERTS WANT ENHANCED FUNDING MODEL

FAIR DEAL ASSESSMENT DRAMATIC SLOWDOWN IN SUPPORT

COMMENT

Department of Health must lead and support NHI in addressing Gerontological Nursing crisis P As recommended by independent experts, nursing home care requires a ‘Fair Price for Care’ payment model that recognises true costs for provision of multidisciplinary care that supports nursing homes to meet the increasingly complex healthcare requirements of our older population.

Tadhg Daly, Chief Executive Officer, Nursing Homes Ireland “Acting both as individuals and as members and coordinators of interprofessional 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…They help promote and maintain the health and wellness of an ageing population within the community, in line with the concept of active ageing. In spite of their contribution, nurses and midwives are not often identified as key stakeholders at the health policy table. With the clock ticking down to 2015, governments, civil society and professional associations must work together with educational institutions, NGOs and a range of international and bilateral organizations to remedy the situation so that the input of nurses and midwives is more actively sought and acknowledged,” World Health Organization, Nursing & Midwifery Services Strategic Direction, 2010 Older person care is facing a serious crisis. I realise the term crisis carries with it loaded connotations but in this respect it is not an overstatement. The difficulty in recruiting and retaining nurses is one of the major challenges and outstanding concerns facing the nursing home sector. There is real and present threat to existing bed capacity if increasing numbers of nurses are not recruited, with nursing homes having no option but to potentially close beds at a time of increased demand for nursing home care. This will have a direct impact on the nursing home sector and a significant knock on effect across the health service and impact hugely on our already challenged acute hospitals. Multiple challenges and problems are giving rise to the crisis. Key issues arising are as follows: P It is incomprehensible that there are insufficient numbers of places for non-EEA trained nurses who require placement on the National Clinical Adaptation Programme. Three confirmed dates for 2015 are providing adaptation for 195 nurses. As I write, there are no further plans to extend the adaptation programme. A further 272 nurses are on a waiting list for placement on clinical adaptation. Failure to secure adaptation places will lead to real prospect that nursing homes will have to close beds and restrict admissions because of the failure to have nurses clinically adapted and registered with the Nursing and Midwifery Board of Ireland. This is occurring at a time of increased demand for nursing home beds. P Significant and inordinate delays in nurse registration with the Nursing and Midwifery Board of Ireland (NMBI) are preventing private and voluntary nursing homes from recruiting nurses. P There is complete absence of a workforce plan that recognises the significant growth in requirement for gerontological nursing care, which is increasing rapidly with our ageing population.

01 — NHI NEWS

Presently, serious difficulties in the recruitment and retention of nurses are being exacerbated by the fact that the HSE is itself recruiting and a significant number of nurses are leaving the nursing home sector to work in the HSE. NHI has undertaken a sustained campaign to support our Members in addressing serious issues arising in recruitment of nurses. We will continue to communicate with Members on an ongoing basis providing important updates in respect of developments in this regard. But the issues arising require actions to be undertaken by State Agencies and for the Department of Health to take a lead in this regard. Failure to take urgent action will leave State facing a shortage of nurses to provide care for our older population and a reduction in bed availability. NHI Members have embarked upon a campaign of lobbying of TDs to ensure they are informed of the crisis and of actions required to address by the State to address and plan for what is occurring. Five key asks have accompanied the campaign: P REDUCE NMBI WAITING TIMES: As a statutory body, NMBI must address the current delays in registration of nurses. Its present failure to do so is preventing the recruitment of nurse candidates. P INCREASE PLACES ON HSE CLINICAL ADAPATATION PROGRAMME: The HSE Clinical Adaptation Programme must be increased immediately to address the fact that almost 300 nurses are on a waiting list for a place on the Clinical Adaptation Programme. The HSE Clinical Adaptation Programme must be extended beyond August 2015 to enable trained nurses awaiting placement to take places on programme. A Nursing Homes Ireland submission to the HSE (presented January 2015) outlines the stark reality of the imperative requirement in this respect and a copy is available upon request. Also, there is an urgent requirement for the approval of nursing homes as clinical adaptation sites. Selected private and voluntary nursing homes, linked to an academic teaching hospital (hospital groups), with appropriate clinical governance need to be facilitated and supported to become approved clinical learning sites for the adaptation programme. Selected nursing homes supported, facilitated and approved as adaptation sites can play a lead role in ensuring non EEA trained nurses have timely access to adaptation by increasing the availability of clinical adaptation sites and addressing specific recruitment issues. P URGENT REQUIREMENT FOR WORKFORCE PLAN: Government/Department of Health must undertake immediate engagement with stakeholders to deliver a credible workforce plan for the entire health service (public, private and voluntary) that will place the substantial growth in requirement for gerontological care at the centre of it. The plan must be proactive in addressing issues arising surrounding the recruitment and retention of nurses for the private and voluntary nursing home sector. Failure to do so will present a serious crisis in healthcare and leave our health services not capable of meeting our older population’s clinical care needs. P INCREASE IN NURSING COLLEGE PLACES: The rapid growth in our ‘older-old’ population will present extensive increase in requirement for gerontological nursing care. We must plan now and key consideration in this regard must be requirement to increase the number of places for undergraduate nurses to help ensure an availability of nurses to meet the needs of older population’s clinical care requirements.

CONTENTS READ ALL ABOUT US Google welcomes surfing Mary; a special garden remembering friends past is opened in Co Galway; the 1920’s are revisited in Co Tipperary; nursing home residents and students come together for a stage production in Co Waterford; a threshing demonstration is one of a number of recent activities enjoyed in a Co Kilkenny nursing home; residents captured in summer sun wins national award.

NHI UPDATES News from Nursing Homes Ireland, the representative organisation for the private and voluntary nursing home sector. NHI representations to An Taoiseach outlined job potential of sector to meet ageing population’s residential care requirements, the organisation is warning discriminatory application of HIQA’s physical environment standards would be discriminatory, and the significant contribution of NHI Members in addressing A & E crisis is recognised by HSE.

ASSESSING FAIR DEAL An analysis of the Fair Deal scheme highlights the significant reduction in levels of support for nursing home care during year 2014. Against a backdrop of the numbers growing old increasing rapidly, NHI assesses resource allocation to support nursing home care through the Fair Deal budget. The article examines annual spend allocation since the scheme came into effect. It highlights a marked decrease in allocation of State resources to support nursing home care and by consequence fewer persons availing of it.

MY NURSING HOME LIFE An award winning Carer informs of the great sense of community in nursing home care and contrary to many perceptions, the emphasis that is placed upon activity. The individual characteristics of the residents help make everyday thoroughly diverse and fulfilling.

BEST PRACTICE Older people, family care givers and healthcare professionals all participated in a Falls Prevention Awareness Day that was hosted by a Dublin nursing home. Participants learned about falls in Ireland, how to prevent them occurring, what to do if you fall, and had opportunity to speak to a range of healthcare professionals.

DEMENTIA CARE Unless funding models change significantly to incentivise private nursing homes to further provide specialist dementia care, no such choice will be available in the future to those in pursuit of more person-centered psycho-social models of care, the co-author of An Irish National Survey of Dementia in Long-Term Residential Care has stated. The independent report analysing provision of dementia care has highlighted the lead role of private nursing homes in provision of specialist dementia care and staff training to support persons with dementia.

INTERNATIONAL PERSPECTIVE A delegation of Australian nurses visited NHI Member homes. The consensus view of delegates was that both Ireland and Australia are very similar in the provision of residential care but that the regulatory processes in Australia are a little ahead of where Ireland is at present.

DEMENTIA UNDERSTANDING Person-centred dementia care requires us to move more towards the world of the person living with dementia and to achieve alternative perspectives to enable greater cohesion between the present past and future.

NHI DATES FOR YOUR DIARY Key dates for the year ahead

NHI ACKNOWLEDGES SUPPORT OF

Thanks to all supporters of NHI, many of whom are featured in this newsletter. Please note, NHI is not responsible for third party services advertised in this publication. Inclusion in this newsletter does not endorse, recommend or imply any approval of the suppliers listed in this publication.

P FAIR PRICE FOR CARE: An independent study published by the Dementia Services Information and Development Centre in January 2015 states:“Our findings would lead us to conclude that the complex and high dependency needs of PWD [Persons with Dementia] in SCUs [Specialist Care Units] now need to be more realistically reflected in fairer resource allocation, in recognition of the skill mix of staff employed in SCUs, their training needs and the level of care expected to be delivered to residents with dementia. 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 PWD including those with behaviours that challenge.” The funding and financing of nursing home care under the Nursing Home Support Scheme (Fair Deal) must address the issue of actual cost of care and ensure it meets health and social care requirements of persons requiring long-term residential care. Requirement for a funding model that recognises true cost of care delivery is also recommended by the Oireachtas Health Committee”. This is not a uniquely Irish crisis with many other countries, including England, experiencing similar challenges in respect of nurse recruitment and retention. We in Ireland must be focussed on addressing it with the urgency it demands. By 2021 the population aged 85+ those most dependent upon nursing home care – will increase by 46%. Failure to ensure we have nurses available to ensure older population’s clinical care requirements are met will have catastrophic consequences for healthcare delivery and wider society. This crisis requires the Department of Health to be proactive in planning for our older population’s healthcare requirements. It will defy logic and have serious repercussions for our health services if the Government continues to focus solely on nurse recruitment for acute hospital sector without realising the urgent requirement to support and plan for nursing posts that need to be fulfilled in community care. The recent A & E crisis has highlighted the central role of nursing homes in supporting timely discharge of patients from acute hospitals and in ensuring people can access care in their community. NHI’s series of actions and measures in this respect will support our sector in meeting significant challenges surrounding recruitment. But the warnings five years previously by the World Health Organization persist. Nurses must be identified as key stakeholders at the health policy table and gerontological nursing must be to the fore in this regard. WHO advocates Government engagement with stakeholders to bring together appropriate policy framework. Issues arising are not just long-term but must also be addressed with short-term immediacy. Consequences of inaction are drastic.

Tadhg Daly, NHI CEO

NHI NEWS — 02

READ ALL ABOUT US! What activities are taking place in your home? How are residents fullling their lives? What celebrations are taking place? Read all about us! oﬀers NHI Nursing Homes the opportunity to publicise the wide-ranging activities that are taking place in homes across the country. It provides an excellent opportunity to publicise nursing home life in the positive light it should be seen in and members are encouraged to make us aware of what is going on. You can send any articles or pictures of interest to michael@nhi.ie.

Special Garden remembers persons past

Co. Galway nursing home has opened a very special garden to remember residents who have passed away. Central Park Nursing Home in Conberne held a memorial garden day to officially open the garden that is full of colour and vibrancy, containing beautiful plants, flowers, water features and a small pond. The Enchanted Butterfly Memorial Garden also features a crafted stone monument with plaque that serves as a reminder for the wonderful memories and moments that were shared with residents who have since passed away. Residents of Central Park were also recent visitors to the

03 — NHI NEWS

Knock Shrine. They visited the Knock Museum and visited an old thatched cottage that replicates times past. “Since a few of our residents suffer from dementia, it was very important to them to be able to recall the memories from days gone by and to recognize the way of life that perhaps themselves or of their parents that lived in the way,” Megan Maguire, Assistant Manager at Central Park Nursing Home explains. “It was extremely therapeutic from a sociable aspect and all residents were in good cheer, enjoying the sunshine and outdoors. The beautiful gardens and floral arrangements were pleasing to the eyes inviting many photograph opportunities.”

1920’s revisited in Tipp There was a touch of the 1920’s in a Co Tipperary Nursing Home on 30th January. Millbrae Lodge hosted a 1920’s celebration amongst residents, staff and visitors that incorporated fancy dress and lots of fun P

Lilly O Callaghan, Bridget O’Connor, Anna Kennedy, Roisin Quinn and Aine O’Neill participating in the celebrations.

Lilly O Callaghan pictured with Roisin Quinn enjoying the Millbrae Lodge celebrations.

Tess Mc Mahon and Agnes Collopy are all smiles

Doggy treat

Old English Sheepdogs were visitors to Killure Bridge Nursing Home in Co Waterford. The dogs from Irish Therapy Dogs visited the nursing home and greeted residents, staff and pupils of Fenor National School. P

NHI NEWS — 04

READ ALL ABOUT US

School and nursing home stage production

Busy days in Kilkenny nursing home

Transition year students from Abbey Community College in Ferrybank, Co Waterford, are visiting Rockshire Care Centre once a week to assist residents with art and drama workshops as part of an intergenerational programme. The programme recently saw the production of a nativity play that involved young and old coming together to create backdrops and stage the production. “It was amazing to see how the young people developed relationships with older people,” Liz Martin, Director of Nursing at Rockshire Care Centre said P

Lots of activity ongoing in Gowran Abbey Nursing Home and Retirement Village, Co Kilkenny. Monster bingo, visits by local school kids to perform for residents, performances by local musicians and dancers are just some of the entertaining activities that have taken place recently. Residents Michael Treacy and Paddy Reid are pictured at a recent trashing demonstration, where they mixed with locals, sang songs and enjoyed the food and drink on offer. Paddy Reid is pictured with Care Assistant Helen showing off his NHI Resident Achievement Certification of Achievement. Mary Maddock is picture enjoying a walk of the nursing home grounds and Patsy is pictured enjoying the company of Dude the Dog P

05 — NHI NEWS

Google welcomes surfing Mary A Co Kerry nursing home resident who enjoys utilising Facebook, online shopping and technology to write short stories enjoyed a special day out at Google HQ. Mary Milward, a resident of Cúil Dídin in Tralee, was a finalist in the Hobbies on the Net Award category at the Age Action Silver Surfer Awards. Mary even used technology to organise a family reunion that brought family members from Australia and America together for a reunion in the Co Kerry nursing home, with her faithful iPad key to bringing the gathering together. Highlights of Mary’s trip to Dublin for the awards ceremony included meeting with broadcaster George Hook, a visit to Dublin Zoo, shopping on Grafton Street and a first trip on the Luas P

Mary pictured at the Silver Surfer Awards with Minister for Communications Alex White

Residents captured in award winning snap The residents of Ailesbury Nursing Home, Sandymount, Co Dublin, were the focus of an award winning picture. The residents were pictured enjoying the sunshine on a day trip to the rose gardens of

St Anne’s Park, Raheny, last July. Photographer Bryan O’Brien scooped 3rd place in the People and Daily Life category of The Press Photographers Association Annual Awards for the picture.

NHI NEWS — 06

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NHI UPDATES Committed to excellence in care www.nhi.ie

@NursingHomesIre

Representation to An Taoiseach Physical Environment NHI used opportunity of recent announcement re Action Plan for Jobs 2015 to reiterate to An Taoiseach requirement for a fair price for care. NHI stated an appropriate pricing model must acknowledge true cost of nursing home care and would provide the support framework for private and voluntary nursing homes to expand and create thousands of jobs in urban and rural communities. It also stated there is real prospect nursing homes will have to close beds and restrict admissions with the National Clinical Adaptation Programme not conﬁrmed for beyond August and because of considerable challenges for sector in nurse recruitment that require Department of Health intervention.

Standards must be evenly applied NHI has stated to HIQA it is of the view the discriminatory application of Standard 25 Physical Environment would be contrary to Irish and EU competition law, in reiterating its concern regarding the manner in which Standard 25: Physical Environment of the National Quality Standards for Residential Care Settings for Older People is being applied by HIQA in practice. Minister for Health Leo Varadkar and Minister with Responsibility for Social Care Kathleen Lynch also received copy of letter. In letter to the Authority dated 2nd February, NHI states: “In order for the public to have full conﬁdence in the proper administration of the regulatory regime governing residential care settings for older persons, it is essential that the Standards are applied consistently and fairly across all designated centres be they public, private or voluntary. “It is our view that the discriminatory application of Standard 25 by the Authority to public and private/voluntary sector nursing homes amounts to anti-competitive practice, contrary to Irish and EU competition law, including Article 106 of the Treaty of the Functioning of the European Union which governs state aid measures.”

NHI welcomes increased support for Fair Deal to tackle overcrowding Nursing Homes Ireland has welcomed Government commitment to a package of measures worth €74 million to address problems of Delayed Discharges and overcrowding in acute hospitals and A & E departments. The measures emanate from a report published by the Department of Health Emergency Department Taskforce that brought to Department/Government recommendations in respect of addressing overcrowding in our hospitals The measures announced on 2nd April were as follows: An additional €44 million will be allocated to Fair Deal 2015 Budget to provide an additional 1,600 places. The Department has stated the additional funding will reduce waiting time for approved applicants for payment approval from 11 weeks now to 4 weeks for the rest of this year; P The Transitional Care Bed Initiative currently in place to address Emergency Department overcrowding will be replaced by “sustainable, more cost-effective beds under the Fair Deal scheme”. P €30 million is being allocated to cover the cost of additional transitional care beds (temporary contract beds) through to June and additional community, convalescence and district hospital beds on a permanent basis to facilitate more rapid discharge from hospital. P

09 — NHI NEWS

Tadhg Daly, NHI CEO stated: “The plan recognises ensuring timely access to nursing home care enables efficient delivery of healthcare within the acute hospital sector and supports hospitals to focus on the specialist care they deliver. Acute hospitals are inappropriate settings for older people who are clinically fit for discharge and prolonged stays in these settings can have detrimental impact upon their physical and mental wellbeing. Reducing Fair Deal waiting times will provide greater levels of support and certainty to these people and their relatives.” “The commitment of an additional €44 million for this year is welcome but it is important to recognise this will bring the level of funding to support nursing home care on par with what was committed three years previously. The onus is upon Government to plan for this ageing demographic and to prevent a cataclysmic crisis in coming years in healthcare. We welcome the engagement of both Ministers with our sector, which is the significant majority provider of nursing home care. An appropriate policy framework that recognises the true cost of providing complex care to older people who require nursing home care is imperative and a long-standing call by NHI. We reiterated this at a meeting with both Ministers Varadkar and Lynch on the morning of the announcement and are encouraged by our engagement. It is imperative stakeholders are brought around the table through a dedicated forum to plan for the surge in requirements for nursing home care.”

Relive NHI Care Awards 2014 Relive the NHI Care Awards 2014 now on Youtube. Over 400 people assembled at Citywest Hotel, Co Dublin, on Thursday 6th November to recognise the outstanding care provided by NHI Members in communities across Ireland. Search â&#x20AC;&#x2DC;NHI Care Awards 2014â&#x20AC;&#x2122; on Youtube.

A & E crisis NHI engagement with HSE to support it in alleviating the new year A & E crisis â&#x20AC;&#x153;contributed signiďŹ cantlyâ&#x20AC;? to the Executiveâ&#x20AC;&#x2122;s capacity to respond. Pat Healy, National Director of Social Care at the HSE, told the Oireachtas Health Committee 15th January in respect of the crisis: â&#x20AC;&#x153;We have worked closely with Nursing Homes Ireland in that regard and it has to be acknowledged that it has worked well with us on that. We identiďŹ ed 250 beds from a survey we undertook with Nursing Homes Ireland and are targeting those.â&#x20AC;? The survey undertaken by NHI identiďŹ ed 1,261 unoccupied beds in 277 nursing homes that responded to the survey. Tadhg Daly, NHI CEO stated: â&#x20AC;&#x153;It is important to recognise the current crisis is complex and multifaceted. As a society we require an appropriate framework to ensure we are prepared to meet the health and social care requirements of our rapidly ageing population. The under-resourcing of the Fair Deal scheme in 2014 has led to a crisis in older person care. It has led to the distressing situation of an extraordinary number of older persons remaining in

hospital beds unnecessarily and inordinate waiting times for older people to access nursing home care. It is acknowledged that the large numbers of delayed discharges in acute hospitals are a signiďŹ cant contributory factor leading to current crisis. Ministers Varadkar and Lynch themselves have acknowledged serious issues arising because of the impact of underresourcing of Fair Deal.â&#x20AC;? NHI used opportunity to reiterate requirement for a Long-Term Residential Care Forum. â&#x20AC;&#x153;This must address key issues arising such as an appropriate fee structure to support the increasingly complex healthcare requirements of persons requiring such care â&#x20AC;&#x201C; as recommended by the Oireachtas Health Committee â&#x20AC;&#x201C; and workforce planning to ensure appropriate number of suitably qualiďŹ ed and trained gerontological nurses are available,â&#x20AC;? Mr Daly stated. Over two nights in DĂĄil Ă&#x2030;ireann â&#x20AC;&#x201C; 14th and 15thJanuary â&#x20AC;&#x201C; TDâ&#x20AC;&#x2122;s debated the A & E crisis. NHI brought representations to TDâ&#x20AC;&#x2122;s informing of how the under-resourcing of Fair Deal has coincided with increase in numbers delayed discharged in Irish hospitals and of the urgent requirement to plan for our ageing populationâ&#x20AC;&#x2122;s health and social care requirements.

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NHI NEWS â&#x20AC;&#x201D; 10

www.careersinnursinghomes.ie Promoting careers in the Irish Nursing Home sector NHI continues to promote the NHI nurse recruitment careers website nationally and internationally. The dedicated NHI Member recruitment website is currently seeing over 700 unique new web-users visiting it on a monthly basis. This website allows current vacancies to be uploaded as well as promoting individual nursing homes as a great places to work. Remember to visit the website regularly as it becomes an eďŹ&#x20AC;ective recruitment tool for all. The website has been live for six months and it is reaching candidates worldwide. We therefore urge you to upload your vacancies and promote your nursing home as this is one key tool we will use when meeting nurses in forthcoming recruitment drives. For further information and a step by step guide to register your vacancy please contact grĂĄinne@nhi.ie

NEWS UPDATE

THE LATEST HAPPENINGS IN THE CARE SECTO R

Health tender seeks to identify requirements for nursing home provision The Department of Health Tender issued a tender in February titled: Request for the Provision of Analysis of Potential Measures to Encourage the Provision of Nursing Home and Community Nursing Unit Facilities. The tender has sought to identify and assess various options available to Government to encourage the provision – including the upgrading and refurbishment – of long term residential care facilities for older people in areas where they are needed. The tender stated four key questions should be addressed: 1. What are the current and future requirements for facilities for the period 2015 – 2035 by geographic area and what is the likely gap in the absence of additional measures to encourage provision? 2. What are the reasons for the current lack of investment in facilities and what reasons have the most signiﬁcant effect? 3. What are the potential policy options for addressing the problem and how do the different options perform against key criteria? 4. How does a preferred set of options perform under cost beneﬁt analysis? The tender advised consultation with Nursing Homes Ireland should be a requirement to inform the analysis.

Fair Deal review will address delayed discharges: An Taoiseach The review of the Fair Deal scheme will deal with the challenges on how best to effectively manage persons delayed discharged, An Taoiseach Enda Kenny informed the Dáil. An Taoiseach has reportedly stated the scheme “is a generous one” that carefully matches the contribution made by residents with ability to pay and limits the portion of an applicant’s assets. At Leader’s Questions 25th February, Micheál Martin, Fianna Fáil leader, referred to the Prime Time broadcast of 24th February which referred to correspondence former HSE director of acute hospitals Dr Tony O’Connell brought together in September stating the safety situation in Irish hospitals was unacceptable due to high numbers delayed discharged and patient safety was a risk. Deputy Martin referred to “the appalling cuts to the Fair Deal scheme” and asked the Taoiseach accept the Government did not provide adequate funding to support older person care.

Deputy Martin said: “Four years ago, the Taoiseach said he would review the scheme [Fair Deal]. In December 2006, when the Fair Deal scheme was brought in, Deputy Kenny led the attack and said this was the ‘introduction of a new death tax on the elderly’. However, in a letter to me two days ago, he now describes it in this way: “The scheme is a generous one in that it carefully matches the contribution made by the residents with the ability to pay and its limits the portion of an applicant’s assets.” An Taoiseach said: “It is not an acceptable situation to have so many elderly people in these situations and nobody wants to see that. That is why the Fair Deal review will allow for the Minister to present a report to Government on dealing with the challenges and how best to manage the situation effectively for the future.”

Micheál Martin, Fianna Fáil Leader, stated Government had not provided adequate funding to support older person care

15 — NHI NEWS

Fair Deal would not work for home care: Minister At a meeting of the Oireachtas Health Committee meeting 12th February Minister Kathleen Lynch stated Fair Deal scheme would not be directly applicable for home care provision. She said: “The scheme is based on the individuals concerned contributing 80% of their income, but that clearly would not work in a community setting because the individuals would still have to buy their own food and pay their bills. These details need to be hammered out, but we have to consider the issue carefully. The scheme is fair in that it allows people to access care on an equal basis. However, times and needs have changed. We need to consider the issues arising in a broad context, as well as ensuring those who cannot pay are protected. I hope when the review is published that we will be able to get together, sit down and take a serious look at how to deliver this care into the future.”

Complaints procedure is good governance: HIQA Nursing homes investigating individual complaints brought to their attention is in line with principles of good governance and the investigation of such complaints should remain primarily a role for the service provider, HIQA has informed Minister with Responsibility for Social Care Kathleen Lynch. Minister Lynch stated HIQA considers the complaints procedure appropriate in response to a question tabled in Dáil Éireann 3rd March. Deputy Michael Lowry, Independent, asked the Minister to “take steps to amend legislation to allow the Health Information and Quality Authority to investigate individual complaints within residential care and nursing homes”. In reply, Minister Lynch said: “In relation to the investigation of individual complaints, HIQA’s position is that it considers that, in line with principles of good governance, the investigation of such complaints should remain primarily a role for the service provider. However, HIQA takes into account and uses all information received to inform and plan its regulatory activity, and information on individual cases unannounced inspections is intended to ensure that standards are maintained and where issues of non-compliance arise, that these are addressed and rectiﬁed.” She further stated: “My Department, in consultation with both HIQA and the service providers, works on an ongoing basis to improve and update the requirements that apply to nursing home care. As part of its ongoing assessment of services in designated centres, HIQA has committed to maintaining a focus on the adequacy of complaints procedures in place in registered services.”

Fair Deal should be demand led: Health Ministers

Public Nursing Home Costs

Speaking on the steps of Leinster House 16th February, Minister for Health Leo Varadkar stated he wants to see budget cap on Fair Deal removed. He told reporters: “I would like to see the budget cap removed. Essentially nursing home places in Ireland are rationed and there is a waiting list that has come down but is still 11 weeks which is far too high and one of the factors, but by no means the only factor, contributing to overcrowding EDs.” Minister Varadkar said you there will always be a certain number of delayed discharges because of matters such as the choosing of a nursing home or ward of court. Previously speaking on the Marian Finucane Show, RTE Radio One, on 11th January, Minister Varadkar told the presenter: “We’re going to need in my view to lift the budget cap on Fair Deal and get people out of hospital quicker because what we are doing now is crisis management.” Minister with Responsibility for Social Care Kathleen Lynch has stated in the Dáil the Fair Deal scheme should have been demandled when it was introduced. And she has said an additional €30m a year would be required to meet requirement. During a debate 21st January she stated: “We are very conscious that we must be careful about the difﬁculties in the provision of care for older people into the future. We are equally conscious that we do need additional resources. To be honest and straight about it, provision should have

A task group is examining the cost of public nursing home services and staffing levels and skill mix. The work of the group is set to conclude and should lead to publication of public nursing home costs later in the year, Minister Kathleen Lynch informed Dáil Éireann 12th February. Deputy Billy Kelleher, Fianna Fáil Health spokesperson, asked the Minister for Health to provide “a specific timeframe and commitment in respect of when updated cost of care figures for public nursing units will be published”. He also asked “reason there is a lack of transparency in respect of the cost of care under the nursing home support scheme, in respect of public nursing homes”. In response, Minister Lynch stated: “Currently the HSE is undergoing a process of the review of all costs associated with both long stay and short stay care services across the public system. This review is informed by the work of service improvement teams who have been examining the service type, costs associated with its provision, and the element of quality and safety, as required under the residential care standards. The teams are providing analysis, assessments and recommendations on any improvements that are required. This work is ongoing and leading to actions that are embedded in terms of good practice and value for money. “Under the auspices of Haddington Road and the Joint Oversight Group, there is also a task group in place for the purposes of examining the costs of services that are being provided, particularly linked to staffing levels and skill mix in public services. The task group has representatives from the HSE, the INMO, SIPTU and INAD. This ongoing piece of work is set to conclude in the coming weeks and make recommendations to the Joint Oversight Group with regards to these particular issues. It is hoped that agreement can be reached, and this can be implemented in the course of 2015. “Therefore, in this context the HSE intends to publish its revised costs of care later in the year as the work comes to finality and the staffing and skill mix requirements are being implemented.” NHI continues to bring forward representations to the policy stakeholders and politicians that it is unacceptable the transparency applied to fee provision to private and voluntary nursing homes is not applicable for public units.

been put into the original legislation for this. I believe the fair deal scheme should be demand-led with tight access.” In a separate debate on the same day, she said the “range of needs” of persons requiring nursing home care must be considered in respect of the fee provided to deliver care. Deputy Brendan Ryan, Labour, said it is no coincidence that the increased waiting time in processing of Fair Deal applications has been a contributory factor in the A & E overcrowding crisis and stated Fair Deal should be demand led. Deputy Emmet Stagg, said: “The medical card system, which is far more expensive than the Fair Deal scheme, is entirely demand-led. If a person qualifies for a medical service, he or she receives that service, with no waiting time for access. Nobody says in November that all of the money is gone and that a service cannot be provided. The system should be similar to that for the Fair Deal scheme.” Minister Lynch stated in reply: “On the issue of cost, I am told that if we were to make the scheme resource and demand-led, it would cost an additional €30 million a year. In some years the cost would be higher and in others lower. However, if we do not do this in a planned way and a way we can see what we will be doing six months down the road, the cost will be twice that figure or more. It is about planning and ensuring we know exactly where we will find capacity and how we will meet demand as it arises.”

Minister Varadkar: “ We’re going to need in my view to lift the budget cap on Fair Deal and get people out of hospital quicker.”

Dementia depression more prevalent in community: European study For people with severe dementia, depression is more prevalent for those living in the community as opposed to persons living in care homes, a recently published European study states. The study, Depressive Symptomology in Severe Dementia in a European Sample: Prevalence, Associated Factors and Prescription Rate of Anti-Depressants was published in the journal International Psychogeriatrics. Researchers studied 414 people with dementia along with their carers in England, Estonia, Finland, France, Germany, the Netherlands, Spain and Sweden. The study gathered information on quality of life, activities of daily living such as bathing, feeding and dressing and presence of depressive symptoms using standardised measures. In the groups studied, 37% of the 217 people living in the community showed signs of depression compared with 23% of the 197 in care homes.

NHI NEWS — 16

Fair Deal contributions To August 2014 over €30m had been paid to the Revenue Commissioners from the value of assets of people who have been supported by the Fair Deal scheme.In Dáil Éireann 4th November, Minister with Responsibility for Older People Kathleen Lynch provided a breakdown of amount of asset contribution derived from the persons who have availed of the Fair Deal loan option. She also detailed the number of cases from which the ﬁnance has been derived. These are details as follows: P

2009 – 2011, No of cases 380: €3.8m

2012, No of cases 485: €7.65m

2013, No of cases 583: €9.919m

2014, Jan – Aug478: €9.135m

Total, No of cases 1,926: €30.504m

The average payment equates to €15,838. Under Section 26 of the Nursing Home Support Scheme Act 2009, the collection and recovery of the repayable amount of the nursing home loan (Ancillary State Support) is a function of the Revenue Commissioners and the Commissioners have the authority to act as they deem necessary for the collecting, receiving and accounting of the repayable amount.

HSE transitional care initiative Over a two month period the HSE approved in excess of 1,000 beds under the Transitional Care Beds Initiative, Minister with Responsibility for Social Care Kathleen Lynch informed Dáil Éireann. Speaking on 5th March in reply to a question tabled by Deputy Billy Kelleher, she said: “The provision of Transitional Care Beds (TCBs) to patients who have ﬁnished their acute care episodes and require on-going residential care services. To this end the HSE has approved in excess of 1,000 places across the country since 6 January 2015.”

Senior Citizen Guidebook The sixth edition of the Family and Senior Citizen Guidebook has been published. NHI has again partnered with the publishers Home Instead Senior Care to advise re nursing home care within the book. Around 40,000 copies of the book are distributed nationally to GPs, community nurses, information centres and to nursing homes.

This includes information regarding: P

Allowances and Entitlements

Finance

Legal Information

Community Support

Care Options

Call 1890 989 755 to order a free copy of the 2015 Family Carer and Senior Citizen Guidebook.

A NEW VENUE! NHI Annual Conference & Care Awards 2015 Thursday, 12th November 2015 Double Tree by Hilton, Burlington Road, Dublin 4

Further details to follow! 17 — NHI NEWS

ASSESSING FAIR DEAL

Analysis highlights extent of Fair Deal reductions as requirement for nursing home care grows The Department of Health projects 7,600 nursing home beds will be required to meet ageing population’s long-term residential care requirements by year 2021 and CSO is forecasting the population aged 85+ - those most dependent upon the specialist care provided by nursing homes – will increase by 46% to same year. Michael McGlynn, NHI Communications & Research Officer, assesses resource allocation to support nursing home care through the Fair Deal budget, looking at annual spend allocation since the scheme came into effect. It highlights a marked decrease in allocation of State resources to support nursing home care and by consequence fewer persons availing of it. Fair Deal and the requirement for nursing home care has been generating considerable headlines in recent months. Ministers in the Department of Health Leo Varadkar and Kathleen Lynch have publicly pronounced requirement for the scheme to be demand-led to ensure it can meet the growing requirement for nursing home care. The HSE Service Plan 2015 provided for an additional €10 million in funding – year-on-year-basis – to fund the scheme and has projected an additional 300 persons will be supported by Fair Deal by end of 2015 by comparison with year 2014 (to put into context, numbers projected to be supported by Fair Deal in 2014 service plan was 939 fewer by comparison with 2013 target). €948.8m has been allocated for Fair Deal for year 2015 and it is projected 22,361 persons will be supported by the scheme by year end. The following takes a more detailed look at Fair Deal budget allocation, actual spend and numbers supported by the scheme, based upon analysis of HSE and Department of Health figures. When looking at the resourcing of Fair Deal and support levels, it is important to consider the wider context. In Dáil Éireann 21st January, Minister Lynch stated the population aged 80 years+, “which has the greatest need in terms of utilisation of health services is growing by some 4% annually”. Approximately one in five persons aged 85+ require nursing home care and the CSO has projected that cohort of population will grow by 46% to year 2021*. The Department of Health briefing papers to Minister for Health Leo Varadkar upon his appointment warned 7,600 nursing home beds will be required to meet older population healthcare requirements to year 2021. An analysis follows.

P However, there was a signiﬁcant shortfall in actual numbers

2010/2011

2014

P In Dáil Éireann 25th February this year, Minister Lynch

P The allocated spend for Fair Deal in 2014 in HSE Service

outlined budget allocation for Fair Deal scheme years 2010 The 2015 allocated – 2014. Spend for year 2010 was €979m.T spend by comparison with allocation for 2010 represents a decrease in spend of €30m euro. Budget allocation for 2011 was €963m. T he 2015 allocation represents €14m decrease by comparison with allocation four years previously. 2012

supported by Fair Deal. 22,871 persons were in Fair Deal payment and also ‘approved but not in payment’ at year end 2012 (HSE Performance Report December 2012). Comparing number to be supported by year end 2015 (22,361 persons), 510 fewer persons will be supported. P Looking at the spend in 2012 by comparison with planned

spend for 2015, if we are to take a ballpark ﬁgure that spend for nursing home care in a private nursing home is circa €52,000 per annum (€1,000 per week – actual average is €885). T his year’s spend would present a reduction of approx. 880 persons being supported by the scheme when you consider it with that for 2012. 2013 P Allocated spend for Fair Deal 2013 was €997.4m and this

was revised to €974.2m in the Revised Estimates. Spend allocation for year 2015 is €25.4m less. P The HSE Service Plan 2013 targeted 22,761 persons to be

supported by Fair Deal year end. T he 2015 target is for 400 fewer persons to be supported. 22,065 persons were in Fair Deal payment year end 2012. P At year-end 2013, 23,775 persons were Fair Deal supported and

also ‘approved but not in payment’. If HSE 2015 target is met 1,414 fewer persons will be Fair Deal approved by comparison with the numbers at end of year 24 months previously. 23,007 persons were in Fair Deal payment year end 2013.

Plan and within Revised Estimates Budget was €938m. 2015’s allocated spend represents a €10m increase. P HSE Service Plan targeted support for 22,061 persons

(actual numbers supported yet to be published) and 2015 target is to support 300 additional persons. 22, 360 persons were in Fair Deal payment year end 2014. *CSO: Population & Labour Force Projections 2011 – 2046.

P In 2012, the HSE Service Plan allocated €1.046 million

spend for the Fair Deal scheme. By comparison with the spend allocated for 2015 - €948.8m, this represents a €97.2m planned spend reduction this year. However, the actual 2012 spend was revised to €994.7m in the Revised Estimates Budget. So the comparison with 2015 shows a €45.9m reduction for year 2015. P The 2012 Service Plan projected 23,611 persons would be

supported by Fair Deal by year end 2012. The number projected for support by year end 2015 is a decrease of 1,250 persons by comparison.

T able 1: Numbers Num mbers in F air Deal payment paym ment 2014 23,200 23,000 23,000 22,800 22,600 22,400 22,200 22,000

22,959 2 2,959 22,781 2 2,781 22,553 2 2,553 22,380 2 2,380

22,360 2 2,360 22,254 2 2,254

22,162 2 2,162 2 22,162 2,162 22,038 2 2,038

21,961 2 1,961 2 21,926 1,926

21,800 ,8 21,600 21,400

T able 2. Numbers in Fair Deal payment year ends

19 — NHI NEWS

22,016 2 2,016

Private & Voluntary Nursing Home C are At year end 2014, 16,166 persons were supported by Fair Deal in private and voluntary nursing homes. Over the year 2014, the number supported by the scheme in such homes reduced by 103 persons (December 2013: 16,269).

T able 2. Numb ers in F air Deal payment paymen t year ends Numbers

T able 6. Numbers supported by F air Deal in Private & Voluntary Nursing Homes 2014 16,300

16,247

16,200

23,200

16,100

23,000

16,166

16,157 16,029

16,000

22,800

15,932 15,870

15,900

22,600

15,823

22,400

15,788 15,770 15,768

15,700

23,007

22,200

Public Nursing Home C are

15,600

22,000

number of Fair Deal persons in public nursing homes decreased by 114 over the annual period ! 5,052 The15,500 persons at beginning of year; 4,938 at end of year.

22,360

21,800

15,868

15,850

15,800

22,065

In December 2014 there were 5,290 HSE public beds designated to the Nursing Home Support Scheme ! 2% below target nationally due to HIQA compliance issues.

21,600 21,400 No in payme payment nt

2012: 22,065

2013: 23,007

2014: 20 014: 22,360

DML, DNE and the West were below target at&-1.5%, -7.6%,Nursing and -1.2% respectively. The South Regionally T able 7. Numbers supported by F air Deal in Private Voluntary Homes Y ear E nds was just above the target at 0.1%. Table Deal in public nursing homes 2014 T able 7.9.Numbers Numberssupported supportedby byFair F air Deal in public nursing homes 2014 5,100 5,050

T able 3. O verall bbreakdown ! F air Deal yyear end 2014

5,000 NHSS Public Beds Be (22%)

404 771 81 4,938

4,950

4,900

NHSS Private & (72.3%) Voluntary (72.3%)

4,850

Subvention (1 (1.8%) .8%)

4,750

5,065 5,031 4,979 4,951

4,938 4,916

4,898

4,901 4,865 4,834

4,849

4,869

4,800

4,700

16,166

Con Contract t (3.4%) ( %)

Savers (Section tion 39 3 units) (0.4%)

T able 10: Numbers supported in public Nursing Homes 2014 month-by-month

Fair Deal 2014: 163 fewer persons supported per month T able 4. Personss supported by F air Deall in Public & Private & Voluntary V Hom es Y ear E nd Nursing Homes 2014

4,938

NHSS Public Beds (23 4%) (23.4%)

16,166

NHSS Private & Voluntary (76.6%)

T able 5: New persons supported by the F air Deal scheme 9,000 8,350 8,023 8,000 7,007 7,000 6,286 6,000 5,000 4,000 3,000 2,000 1,000 0

No of new persons supported by F air Deal 2011: 7,007 *(Note H S E Perfor mance Report December 2011 informed of new persons supported in private nursing homes only) ! 2012: 8,023 ! 2013: 8,350 ! 2014: 6,286 !

During year 2014, the Fair Deal scheme supported 1,964 fewer new persons by comparison with preceding year – equating to an average 163 fewer persons per month. The HSE performance report for December 2014 informs 6,386 new persons were supported by the scheme in 2014. During 2013 8,250 new persons were supported by the scheme, so the numbers for year past were 1,964 fewer. At year end 22,360 persons were in Fair Deal payment. This represented a reduction of 647 persons by comparison with 2013 numbers – 647 fewer. At the end of the year, 719 persons had finished their acute care and were awaiting appropriate placement or support. 80% of such persons – 573 – were awaiting long-term nursing care. Looking at the overall breakdown of numbers supported by the scheme (including subvention, contract and ‘saver’ residents), 72.3% of Fair Deal residents are in private and voluntary nursing homes and 22% in public homes. Excluding the subvention, contract and ‘saver’ residents (Performance does not assign to a particular type of unit), 76.6% are in private and voluntary nursing homes and 23.4% in public beds. (See tables 3+4) At year-end 2014, 16,166 persons were supported by Fair Deal in private and voluntary nursing homes. This was 103 persons fewer by comparison with the start of the year (December 2013: 16,269). September was the month when fewest numbers during the year were supported by the scheme in such homes, when 15,770 on Fair Deal were living in private and voluntary nursing homes. (See table 6) At year-end, 114 fewer persons were supported by Fair Deal in public nursing homes – 5,052 persons at beginning of year; 4,938 year end. As per private and voluntary nursing homes, fewest number of persons were supported by the scheme in September – 4,834 persons. (See table 7) The Performance Reports informs of additional 300 approvals during December to alleviate overcrowding in acute hospitals.

NHI NEWS — 20

ASSESSING FAIR DEAL

Escalation in Fair Deal crisis 2014 Numbers awaiting F air Deal

The rise in numbers awaiting Fair Deal payment during year 2014 and also the waiting period to secure funding was outlined in Dáil Éireann. Deputy Denis Naughten, Independent, asked the number of persons that were approved for the scheme but were awaiting payment approval at the end of each monthly period in 2014. He also sought the average waiting period for payment approval at the end of the prospective months. The reply provided by Minister with Responsibility for Social Care Kathleen outlines steady increase in the waiting list and waiting period on month-by-month basis to the end of October. At end of January 629 persons were awaiting Fair Deal payment approval and the average waiting period was four weeks. At end of October 2,135 were awaiting payment and average waiting period was 15 weeks. By year end it had been reduced to 1,411 persons awaiting payment and waiting period to 11.7 weeks.

Table 2014 T able 8. 12.Numbers Numbersawaiting awaiting Fair F airDeal Dealin 2014 *Note, figures for Tables 9 & 10 arising from PQ tabled in Dáil Éireann 17th February 2015. F igures are for end of respective month. 2,500 2,135 2,040 2,000

1,898

1,842 1,688 1,465

1,500

1,411

1,265 1,043 913

1,000 756 629 500

0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14

Waiting period Deal Table T able9.13. W aiting periodfor forFair Fair Dealpayment paymentapproval approval (weeks) (weeks) 16

15 14

14 11.5

11.7

10 8 8

5.5

4 4 2 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14

Fair Deal a core issue for healthcare delivery On 12th March NHI issued a statement reemphasising requirement for Fair Deal resourcing to be demand-led. A report in Irish Times stated a key element being considered in plan to tackle hospital overcrowding was the removal of the Fair Deal funding cap. NHI statement stated: “It is critical persons requiring the dedicated health and social care provided by nursing homes can access it in a timely manner. This is a core issue for healthcare delivery and NHI welcomes any measure to support this objective. Fundamentally, it requires the appropriate resourcing of the Fair Deal scheme long-term on a basis that recognises the increasing numbers in our older old population, who are the most dependent upon the continuous care provided by nursing homes. As Minister’s Vardakar and Lynch have stated, the Fair Deal scheme must become demand-led and we are encouraged by report the Government is giving this serious consideration. The imperative requirement for fairer resource allocation must also be heeded, as recommended in recent weeks by the Dementia Services Information and Development Centre. In its report An Irish National Survey of Dementia in LongTerm Residential Care, it recommended a new

21 — NHI NEWS

funding model to support private sector to meet the complex and high dependency requirements of persons requiring long-term residential care. “As evident in an NHI analysis of the performance of Fair Deal last year, the increase in numbers awaiting Fair Deal payment approval has coincided with a spike in the number of people in our hospital wards who are ready for discharge. Failure to ensure timely access to nursing home care has had widespread detrimental impact for the wider health service. It has led to people unnecessarily lying on hospital trolleys and wards and this has impacted upon wider health service delivery. Nursing Homes Ireland continues to engage with the HSE to support it in addressing hospital overcrowding issues and ensuring older persons within our hospitals can access healthcare appropriate to their requirements. We are willing to engage with all parties but are surprised resistance remains to our participation on the Emergency Taskforce. “We reiterate it is imperative this Government plans now to ensure we are prepared long-term to provide the support and services for the diﬀering healthcare requirements of our older population.”

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BEST PRACTICE

Nursing home leads in creating falls awareness in local community Older people, family care givers and healthcare professionals all participated in a Falls Prevention Awareness Day that was hosted by TLC Santry. Participants learned about falls in Ireland, how to prevent them occurring what to do if you fall, and had opportunity to speak to a range of healthcare professionals. The event won the NHI Care Awards 2014 Community Initiative Award. Shane Hennessy, chartered physiotherapist at TLC Santry, outlines what occurred on the day and the background to it. he falls prevention team in TLC Santry is a multi-disciplinary group whose main focus is on preventing falls and injuries within the centre whilst promoting person independence. The team at local level consists of the Director of Nursing, Clinical Nurse Manager, Physiotherapist, Staff Nurse and a Senior Healthcare Assistant. Regularly we have input from other professionals, including the GP and Pharmacist, if there is an indication for such intervention. The team meet once a month and a significant part of such meetings are in-depth analysis of falls that took place the previous month. This allows us to identify any patterns or trends which are occurring and to put an action plan in place. An example of this would be when we identified a high percentage of falls that were occurring on a corridor during a busy four hour period in the morning. These were occurring on a floor with a high percentage of residents with dementia. We put in place a 30 minute staff rotation rota to supervise closely the corridor during that period and ensure there were no trip hazards, residents had the appropriate footwear, were using their walking aids safely and were offered assistance as needed. This reduced the falls rate in our corridors the following month by almost 40%. A lot of people believe - many of whom are in healthcare, that falls are an inevitable part of the ageing process but at TLC we disagree with this. In general falls are multi-factorial and caused by a combination of issues. Many of the most common risk factors are modifiable. For example loss of muscle strength in the lower

25 â&#x20AC;&#x201D; NHI NEWS

limbs is extremely prevalent among frequent fallers and some literature suggest they are four times more likely to fall. However, this can be successfully improved with an active lifestyle, promoting exercise or a specific strength training programme. Environmental factors are amongst the leading causes of falls in bedrooms. By consistently ensuring simple things are in place such as removing trip hazards, and ensuring appropriate lighting and adequate aids and support rails are in place, then falls can be greatly reduced. Awareness Day A TLC falls prevention awareness day was organised in Santry in June 2014. The main aim of the day was to invite older people from our local community into TLC to learn about falls and benefit from our successful falls prevention structure. We advertised in local GP practices, pharmacies, churches, community centres, placed ads in the local newspaper and appeared on local radio also. We also provided free transport on the day. This led to a great turnout that included attendance from the older people, family care givers and healthcare professionals. The day featured a power point presentation where those in attendance learned about falls in Ireland, how to prevent them occurring and what to do if you fall. Guests then had the opportunity to speak to a range of healthcare professionals, including a qualified nurse, pharmacist and physiotherapist. An exercise workshop taught

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Top: The promo for the awareness day in 2014

some simple home exercises to improve muscle strength and balance. A falls prevention booklet was developed for all to take home and this included information from the presentation, an environmental checklist and useful contact information. There was also an opportunity for the guests to meet our own residents and chat about their own experiences over a cup of tea and cake. Replicating Falls Day The feedback from the event was extremely positive, with many people saying they learned a lot of new information related to themselves and suggesting they were planning on making some changes as soon as they got home. Following on from the event we held a follow-up exercise class in TLC Santry and there is a provisional plan to run the event across all other TLC centres in the coming year. If other nursing homes were considering doing a similar event my advice would be to ensure you plan ahead, carry out

Top: Shane delivering his presentation at the awareness day

significant promotional and advertising of it as it can be difficult to convince older people outside their comfort zone, and finally to make the day as practical as possible with group interaction and workshops. This reenforces the take home message even further.

Right: An exercise workshop taught some simple home exercises to improve muscle strength and balance.

Best Practice is a feature in NHI News that focusses on best and innovative practices in nursing homes. Nursing Homes are invited to make us aware of practices the wider public should be aware of and can contact michael@nhi.ie if interested in contributing an article P NHI NEWS â&#x20AC;&#x201D; 26

DEMENTIA CARE

Specialist dementia care must be recognised in funding model: DSIDC Unless funding models change significantly to incentivise private nursing homes to further provide specialist dementia care, no such choice will be available in the future to those in pursuit of more person-centered psycho-social models of care, Professor Suzanne Cahill, co-author of An Irish National Survey of Dementia in Long-Term Residential Care has stated. Professor Cahill was coauthor of An Irish National Survey of Dementia in Long-Term Residential Care, a report published by the Dementia Services Information and Development Centre. The report highlighted the lead role of private nursing homes in provision of specialist dementia care and staff training to support persons with dementia. The first national survey to map demographic trends in the provision of specialist long-term care for people with dementia in Ireland has highlighted private and voluntary nursing homes are the majority provider for specialist dementia care. This is despite the fact that private providers are expected to comply with specific dementia-related criteria without receiving any payments from the NTPF to help defray costs, the report states. The report published by the Dementia Services Information and Development Centre (DSIDC), which was launched 29th January, is recommending more funding needs to be allocated to private nursing homes in recognition of the specialist services needed to support persons with dementia and NTPF payments need to be commensurate with level of care. Nursing Homes Ireland Members supported the research by responding to survey questionnaire to inform An Irish National Survey of Dementia in Long Term Residential Care. Of total 602 public, private and voluntary nursing homes, 78% responded to the survey – two thirds being privately operated and 13% categorised as not for profit. Key findings within the report included: P 11% of nursing homes surveyed (54) have dedicated

dementia care units. P The private sector provides the main bulk of specialist

dementia residential care (63%), followed by the HSE (30%) and voluntary not-for-proﬁt (7%). P Private providers are more likely to offer residents with

dementia their own individual bedroom (67%) compared with HSE operated units where ﬁgure is 12%. P A total of 1,034 - representing 2% of all people with

dementia in Ireland or 4.5% of all those with dementia in long stay care - were living in the 54 nursing homes identiﬁed with specialist dementia care units. P “Admission criteria used by HSE operated SCUs [Specialist

Care Units] were in some instances more restrictive than those operated by the private sector”. P HSE operated units are more likely to require that all new

admissions of people with dementia be independently mobile. “Of particular concern is the ﬁnding that over two thirds of HSE respondents (69%) stipulated an admission criterion of ‘being independently mobile’. This compares to 18% of privately operated SCUs. The application of this admission criterion is not consistent with the accepted orientation of public nursing homes and SCUs towards persons of high and maximum dependency.” P Certain areas have good provision of specialist dementia

care while other areas have either limited or no provision.

27 — NHI NEWS

- Sligo, Wicklow, Carlow, Kilkenny Westmeath and Offaly have no specialist provision. - Privately operated units are more likely to be located in rural areas - HSE and Voluntary operated units are generally found in towns or cities P Waiting time for admission was far longer in Leinster

where there are signiﬁcantly fewer specialist care units. P Specialist dementia training of staff varies by provider type

with more privately operated specialist care units reporting that all nursing staff and health care attendants receive specialist training. Within HSE operated facilities only one third of nursing staff and health care attendants have been specially trained. P “While the design of private SCUs largely complied with

accepted best practice, this was not the case for SCUs in the public and voluntary sector.” P “Our ﬁndings show that private SCUs are more ideally

designed to cater for the complex and unique needs of PWD [Persons with Dementia] compared with HSE and voluntary SCUs.” The report states: “Previous research has demonstrated the higher dependency needs of residents in public long-stay residential facilities which necessitates a more highly skilled staff mix and in particular a higher ratio of nursing staff. It has been argued that the higher dependency needs of these residents accounts at least, in part, for the significantly higher average weekly payment rates made to the public sector in respect of residents compared to payments made to support residents in private facilities (BDO 2014). More recently it has been shown that the overall dependency level of residents in all long-stay facilities has increased (BDO 2014). The Department of Health Long-Stay Activity Statistics for 2012 revealed that a significant proportion (63.7%) of those cared for in private facilities now also have high or maximum dependency levels (Department of Health, 2014). This may well be due to the fact that the private sector, as confirmed by this survey’s findings, appears to be the main provider of specialist dementia care and is delivering at times complex care to people with very high dependency needs.” A report conclusion reads as follows: “A key finding from this survey is the fact that the private sector is the main provider of specialist long-term care to persons with dementia, whilst the public sector is more likely to be the main provider of residential respite care. This finding is curious given the high dependency needs of PWD, and the comparatively smaller payments private providers receive from the National

Treatment Purchase fund (NTPF) for such residents. Our findings would lead us to conclude that the complex and high dependency needs of PWD in SCUs now need to be more realistically reflected in fairer resource allocation, in recognition of the skill mix of staff employed in SCUs, their training needs and the level of care expected to be delivered to residents with dementia. 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 PWD including those with behaviours that challenge.” The report stated average weekly payments of €888 negotiated by NTPF with private and voluntary nursing homes is contrasted with €1,404 for public nursing homes. Professor Cahill recommended a wide range of long-term care options designed to comply with best practice architectural principles and staffed by competent and skilled personnel should be available. She added: “Unless funding models change significantly to incentivise private providers, no such choice will be available in the future to those in pursuit of more personcentred psycho-social models of care.”

Professor Rose Anne Kenny, Head of Medical Gerontology at Trinity College stated within report: “Consistent with global demographic trends, Ireland’s population is ageing at a rapid rate, this is particularly so for the older age groups. It is estimated that the proportion of people over 80 will increase by 60% over the next two decades. The prevalence and incidence of dementia rises exponentially with age and dramatically so in those over 80 years. Dementia is one of the biggest challenges facing global health care and health economies.” Dr Caroline O’Nolan, co-author of the report and School of Applied Social Science, UCD, stated: “This survey provides an important baseline for further Irish research on specialist care units for people with dementia. It highlights examples of innovative and creative person-centred practice as well as departures from best practice. The survey raises concerns regarding the current pattern of provision of specialist care units and suggests the need for a more structured and planned approach to service provision.”

NHI: Report highlights urgent necessity for appropriate funding model Tadhg Daly, NHI CEO, who spoke at the report launch, stated: “We live in a society with people living longer and persons living beyond 85 years of age will increase by almost 50% in the coming years. This is something to be celebrated but the substantial associated challenges must be addressed. This report is very timely and yet another ‘eyeopener’ for Government and policy stakeholders. It highlights private nursing homes are the lead providers of specialist dementia residential care, despite failure of State funding model to defray associated costs. Despite receiving “smaller payments”, 68% of private nursing homes provided dementia residents with their own bedrooms by comparison with just 12% of HSE units. We wholeheartedly welcome the research ﬁndings that the complex and high dependency needs of persons with dementia need to be realistically reﬂected in better resource allocation. NHI has consistently advocated to Governments the critical requirement for a fair

price for care to ensure nursing homes are appropriately supported in meeting the differing levels of complexity and dependency for persons requiring nursing home care. The recommendation for a payment model that is commensurate with levels of care, staff training and skill mix, and type of non-pharmacological interventions is in keeping with Oireachtas Health Committee recommendation for evidence-based payments for nursing homes that incorporate real cost of care. This report highlights the willingness of our sector to meet the significant challenge of meeting the long-term care requirements of persons with dementia but the urgent necessity for appropriate policy and planning is outstanding. NHI reiterates a Department of Health-led Forum on Long Term Residential Care can ensure stakeholders inform and support Government to help ensure we are primed to meet the growing multifaceted healthcare requirements of our older population.”

Pictured at the report launch in Trinity College are, from left: Dr Chie Wei Fan, Consultant Geriatrician, Mater Hospital; Gerry Martin, CEO, Alzheimer Society of Ireland; Professor Davis Coakley, Centre For Medical Gerontology, Trinity College Dublin; Professor Virpi Timonen, Social Work & Social Policy, Trinity College Dublin; Tadhg Daly, NHI CEO; Prof Suzanne Cahill, DSIDC & Trinity College Dublin.

NHI NEWS — 28

MY NURSING HOME LIFE

‘Supporting our older generation to live independent, active lives & showing appreciation for their sacriﬁces’ Kieran Carbery previously worked shifts in a factory but took the decision to pursue a career in supporting people who need it most. He now takes great pride in supporting the residents of Rockshire Care Centre in Co Waterford to feel at home and safe in a community environment that is focussed on excellent care and activity. Kieran was winner of the NHI Care Awards 2014 Carer of the Year Award. He provides us with an insight into his role as carer in a nursing home.

Can you provide some background as to how you arrived in the role as carer? Were there influences that led to you pursuing a career as a carer? I suppose watching my late mother caring for my uncle had a significant influence upon me. He suffered a stroke at a time, many years ago, when there was little or no help or support for stroke victims. Her innovative and compassionate approach to his care was inspiring. I’m relatively new, in a sense, to the official care assistant role. My previous careers were mainly in shift work settings of factories. Even in this occupation I found myself in a training role - assisting colleagues to further their abilities and careers. While this was satisfying, I felt I could do more - get more involved and support others when they need it most. So I went back to education, got my healthcare qualification and pursued a career which I feel passionate about. During my training an invaluable experience was presented through work placement with South East Simon, which supported me in learning to deal with many different situations. I like to get involved in my local community, for example engaging with local radio station, sports clubs etc. I’m more of a people person, so in a sense I think the caring element of me was always there in some form.

What ‘attracted’ you towards working in care of the older person? I believe that our older generation gave our country a solid foundation when times were hard. I feel that by being a carer it somehow shows appreciation for the sacrifices they made. I want to make a positive impact on people’s lives, where I can, and try to deliver that with dignity, respect and a good dose of humour thrown-in. I try to facilitate the residents to be as independent and active as possible. The residents deserve to enjoy their retirement years with a feeling of comfort and security.

Had you a perception of care of the older person prior to taking up the role? Honestly my perception was one where end-of-life care would be my main role. Generally I think most people’s first thoughts of a nursing home is that it is a place where residents spend the most part, if not all, of their day confined to bed. I genuinely did not expect the residents to be as active and engaged as they are – the residents individual characteristics make everyday enjoyably diverse and challenging.

So perception and reality has differed? Yes, absolutely! With immense support from our Director of Nursing Liz Martin and the dedicated staff here at Rockshire, I see our residents as a ‘community’ in their own right. They know what they want, when they want it and we do our utmost to deliver as best we can. The staff - as a whole - are very active in supporting residents and their families.

On a day-to-day basis, what does your role entail? The morning begins with a staff hand-over meeting at 7.45am. We then assist residents with breakfast and getting ready for the day ahead. This is done in a very relaxed manner. This is a crucial time for the staff to check in with residents on their wellbeing, ask how they’re feeling and take opportunity to note any changes in their behaviour and any health issues. From midday we begin to assist residents with lunch. Afternoons and mornings are filled with activities. Both the staff and local students get involved in our intergenerational program, under the direction of our activities coordinator Sandra. Some residents like to go for walks which we facilitate weather permitting. It’s great to get out in the fresh air - even

29 — NHI NEWS

for just a short walk - while others like to read and just chat. The chats are quite entertaining and even educational – it’s great to get a first had account of our own local history. In the evening it’s on to supper time. We serve refreshments and assist residents who want to retire to their rooms. 8pm is going home time.

What do you enjoy about the role you fulfil? What brings the greatest satisfaction? I enjoy putting a smile on residents’ faces. I also take great pride in helping the residents to feel at home and safe in their new environment. I treat everyone as an individual and by listening to them I can ascertain their own likes and needs. This helps me monitor the residents’ health and happiness and it’s an achievement to get the balance right. We work closely with resident families and I feel extremely happy that they are appreciative of our care of their loved ones.

What are challenges associated with the role? New challenges come with each new resident. Carer and resident have to get to know each other and learn about needs and create a comfortable, friendly atmosphere. I need to be fully aware if someone becomes withdrawn, confused or unwell. It’s challenging trying to communicate with individuals who have dementia related problems. No two people are the same, and are therefore affected in different ways. I’m constantly striving to gain a better understanding of Dementia

and this is a challenge I’m enjoying.

Finally Kieran, what advice would you offer to anyone who is considering pursuing the career of carer in a nursing home? I’d offer a number of important pointers.

j j j j j j

Be yourself. Treat everybody the way you would like to be treated yourself - with dignity, respect and compassion in a nonjudgemental way. Get to know the person you’re caring for; they can teach you a lot. They show you how to be a good carer. The resident’s psychological, physical and emotional health is equally important. It is an honour to be trusted and left into the resident’s lives. Enjoy and take pride in the valuable service a carer provides.

My Nursing Home Life aﬀords persons working within a nursing home setting the opportunity to discuss their role and advise the wider public of what it entails and employment within such a setting.

NHI NEWS — 30

END OF LIFE CARE AWARD

Hospice Foundation sponsors new NHI Award

he NHI Care Awards 2015 will see the introduction of a new award category: the Excellence in End of Life Care in Nursing Homes award. The Irish Hospice Foundation are proud to be sponsoring this new award, which is open to all NHI registered nursing homes. The award is being established to celebrate innovative practices in end-of-life care that are happening in Irish nursing homes. Excellent end-of-life care is person centred, ﬂexible and is built around the needs of the individual, with the resident always at the heart of every decision. It is a holistic approach to care that responds to the person’s physical, social, spiritual and psychological strengths and needs, and also considers the needs of the person’s family and friends. Each year in Ireland, approximately 7,500 people die in nursing home settings and every staff member plays a crucial role in ensuring that every resident receives compassionate end-of-life care and their family get the support they need. Nursing homes are sensitively developing quality initiatives that support the resident, their family and friends and staff to ensure that compassion and dignity is a constant for all at the endof-life and in bereavement. One such initiative is the “Journey of Change” Programme that is available via the

31 — NHI NEWS

Irish Hospice Foundation. This initiative enables nursing homes to engage in quality improvement at three different levels to support them to provide the best care possible to residents at the end of their lives. We know that this area of work requires kind and considered leadership so that the quality initiatives introduced have the required and lasting impact on culture of end of life care provided in the nursing home. NHI and the Irish Hospice Foundation want to acknowledge and recognise the innovation that is happening. Candidates for this new award should be selected on the basis that they have achieved signiﬁcant success in introducing quality improvements in end-of-life care. The innovation should demonstrate the positive difference this improvement has made to the resident, their friends and family and staff. Further details in respect of the award category will be provided to NHI Members when the application/nomination process for NHI Care Awards 2015 opens. The NHI Care Awards 2015 will take place Thursday 12th November at the Double Tree Hilton Hotel, Ballsbridge, Dublin.

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INTERNATIONAL PERSPECTIVE

Oz Tour Visits Irish Nursing Homes

Gowran Abbey Australian Nurses Tour The Australian tour pictured at Gowran Abbey Nursing Home, Co Kilkenny. Also pictured are Gowran Abbey and South East nursing home representatives.

egistered nurses from Australia undertook a study tour in Ireland in September and visited five NHI Member homes. The 13 delegates who are predominantly registered nurses working in senior management positions in Australia visited nursing homes in counties Dublin, Kilkenny, Tipperary and Wexford. The first engagement on the tour was with Tadhg Daly, NHI CEO, who provided the group with an overview of the nursing home sector in Ireland, the role of Nursing Homes Ireland, and the challenges facing the sector in provision of care now and into the future. “The response from the five sites visited was overwhelmingly welcoming with on-site staff more than happy to discuss what they were doing as well as being interested in how they compare to our own experiences,” Pam Bridges, President of Nurses in Management Aged Care (Australia) states. “The consensus view of delegates was that both Ireland and Australia are very similar but that the regulatory processes in Australia are a little ahead of where Ireland is at present.” Since July last year Australia's fees and charges for long term care have changed to incorporate a more 'user pays model', Ms Bridges explains. Australia has always had a system whereby residents in care contribute 85% of their pension to care costs. This remains unchanged but it also has ‘Means Tested Fees’ where a person's assets assessment is used to determine what level of additional fees are required to be paid. The government pays a care subsidy which is determined by a comprehensive assessment - Aged Care Funding Instrument (ACFI) - of assessed care needs in the domains of activities of daily living (ADL); behaviours and complex nursing. Each of the domains has a low, medium and high level and the funding for each level is added to provide the final care subsidy paid per day. There are 64 variations of fees.

33 — NHI NEWS

ACTIVITIES DAILy LIVING DOMAIN LOW

$31.42

MEDIUM

$68.42

HIGH

$94.79 BEHAVIOR DOMAIN

LOW

$7.1 8

MEDIUM

$14.88

HIGH

$31.03 BEHAVIOR DOMAIN

LOW

$14.14

MEDIUM

$40.27

HIGH

$58.15

Additionally the Australian Government has introduced a system whereby anyone who has the capacity to pay must contribute to their care by paying a Refundable Accommodation Deposit (RAD) or a Deferred Accommodation Deposit (DAP) or a combination of both. “This is currently causing a degree of angst as service providers try to manoeuvre the changes and negotiate with potential residents and their families,” Ms Bridges explains. Each service has to register their charges which appear on a central website maintained by the Australian Government. Aged Care in Australia is regulated by both the Department of Social Services (funding) and The Australian Aged Care Quality Agency (standards). Facilities are subject to three-day audits every

3 years, as well as at least one announced and one unannounced visit per year. In the event of complaints, a ‘Review’ audit can be triggered at any time and substantial sanctions applied for non-compliance. “There are a plethora of regulations and legislation that apply to the aged care sector in Australia including ﬁre safety, drugs and poisons, food safety, work health and safety, the list goes on and on,” Ms Bridges states. “The biggest challenge is supporting managers in their quest to comply with all requirements as well as client expectations, which understandably have increased now that more charges apply.” She adds: “The most interesting point of difference the study group found was that it appears Irish staff do not get paid holiday or

sick leave pay - something that we would not be able to achieve in Australia due to our industrial relations laws. Whilst it seems that most staff-work in areas local to their homes, we were surprised that there were not more issues around this. In Australia the acuity and complexity of residents coming into care is putting great strain on the skills mix of stafﬁng required.” She concluded by thanking the participating nursing homes and those who supported their tour. “On behalf of our study tour I would like to thank everyone we met for their generosity of information sharing and hospitality.” Charges are available to view at www.myagedcare.gov.au

Who are NIMAC? NIMAC is a not-for-profit membership encompasses registered and enrolled nurses, care managers, people providing services through consultancy or recruitment agencies, or those working in quality roles. It is an organisation set up to offer its members a professional network and support system. Previous overseas study tours taken in 2011 and 2012 encompassed the Netherlands and Singapore, and Philadelphia and Los Angeles. The tours are aimed at networking with international peers and comparing the provision of quality aged care services in different countries. Nursing homes in the UK were also visited as part of the 2014 study tour.

The ﬁve nursing homes visited by NIMAC during the Irish-leg of their tour were as follows: P

Greenhill Nursing Home, Co Tipperary

Gowran Abbey Nursing Home, Co Kilkenny

Highﬁeld Healthcare, Co Dublin

Kerlogue Nursing Home, Co Wexford

Kiltipper Woods Care Centre, Co Dublin

NHI NEWS — 34

DEMENTIA UNDERSTANDING

Time Travel and Dementia Person-centred dementia care requires us to move more towards the world of the person living with dementia and to achieve alternative perspectives to enable greater cohesion between the present past and future, Jan Dewing, Professor Centre for Care Research Bergen University College & Stord-Haugesund University College, Norway; University of Wollongong, NSW Australia writes. Professor Jan Dewing: In effect we need to become skilled in knowing how the person with dementia time travels

â&#x20AC;&#x153;I'm living under water. Everything seems slow and far away. I know there's a world up there, a sunlit quick world where time runs like dry sand through an hourglass, but down here, where I am, air and sound and time and feeling are thick and dense,â&#x20AC;? Audrey Niffenegger, The Time Traveler's Wife We all live in the present. One thing that makes the present so rich is the way the past projects into the present and how we continually engage with the past. We see people and places; we hear voices and we smell and feel things, often intensely â&#x20AC;&#x201C; welcome, but at times most unwelcome; recollections get through too. Moments of time are all linked together and found in one another. There is no past present and future in nicely boundaried packages. The past is on the horizon of the present moment, according to Merleau-Ponty, the French philosopher. Drawing on a few of Merleau-Pontys ideas, including the notion of mythical time, I want us to explore how we can better understand the experiences of people living with a dementia. I argue that a shift in perspective is essential if we (as people with an intact cognitive view of the world) are to be more welcoming of those of us who move between the cognitive world and the world of memory based imagination. Indeed person-centred dementia care requires

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us to move more towards the world of the person living with dementia. In effect we need to become skilled in knowing how the person with dementia time travels. The purpose of achieving alternative perspectives is to enable the person with dementia to experience a greater cohesion between the present past and future. Where there is a complete cohesion nothing stands out as unusual or different and time travel is simply a wonderful part of being alive. Where differences do stand out then the person with dementia experiences a disconnect and being alive in what is our 'alien' world becomes problematic. Many health and social care practitioners are caught in a double bind about truth telling and lies when it comes to some aspects of time-travel related dementia care. Alternative perspectives will enable us to be more open to the person with dementia and to 'assess' their needs differently and most of all to be more open and ďŹ&#x201A;exible about what interventions we can offer and what we feel comfortable doing. Professor Jan Dewing is keynote speaker at a dementia conference titled Living well with Dementia â&#x20AC;&#x201C; A Person-Centred Approach, which will take place in the Radisson Blu Hotel Cork on Thursday 23rd April. For further information visit: www.stlukeshome.ie/listcourse/dementia-conference/

SPIRITUAL LISTENING with

C I Ă&#x161; N AS Rom an C at holic hym ns and songs t hat trigge r m em o rie s fo r o lder people are now availab le in t he form o f a CD or DVD t hat is available t o p u rc hase fro m CĂunas Reso urce s â&#x20AC;&#x201C; S o nas APC. They were brou ght toge t he r by S is ter Mary Threadgo ld in res pon se to repe ated re que sts from S ona s prac titio ne rs in nu rsing hom es who saw a great ne ed fo r s pir itual hym ns. The cost of t he DVD is â&#x201A;Ź15 and it is sam e pri ce fo r dou b le C D. An inst ruc tional boo klet is also availa ble a nd t he full set costs â&#x201A;Ź30.

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35 â&#x20AC;&#x201D; NHI NEWS

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What an NHI member currently signed up to the offer thinks I signed up to the Irish Independent/Sunday Independent offer and I find it reliable, convenient and great value

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INM together with Nursing Homes Ireland are now offering Nursing Homes nationwide the opportunity to have your daily newspapers The following titles are availible: delivered to your residents DAYS OF PRICE NORMAL RRSP WEEK every day with no 0.95 €2.00 Irish Independent Mon-Fri delivery charge. Irish Independent Saturday €0.95 €2.30 (INCL VAT)

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Supply & Billing: The Nursing Home will be supplied and billed weekly by direct debit by Newspread, our nominated local wholesaler. Once you have signed up, you will be issued with a Newspread account number. You will receive a weekly statement and the direct debit will taken the week after you receive the statement. To Sign Up Call (01) 7055806 or email nursinghomes@independent.ie. and you will be sent out a new account form plus a direct debit form to complete. Simply return these forms to: Nursing Home Offer, Circulation Department, Independent Newspapers, 27-32 Talbot st, Dublin 1

DATES FOR YOUR DIARY NHI Upcoming events of interest April

9 April

15 April

20 April

29 June

22-28 November

12 August & December

37 — NHI NEWS

NHI Webinar - HIQA Dementia Thematic Inspections: Thursday 9th April NHI, in conjunction with Fresenius Kabi, will host the webinar on Thursday 9th April 2015 at 3pm. The presentation is titled ‘HIQA Dementia Thematic Inspections – A practice development approach to inform self-assessment’. It will be delivered by Michelle Hardiman, Development Education & Research Facilitator, Galway Clinic. NHI Members Seminar & Annual General Meeting: Wednesday 15th April Taking place at the Maryborough Hotel, Cork, speakers will deliver a series of presentations aimed at nursing home owners at the Members Seminar before motions are debated at NHI AGM 2015. Promoting Equality in Intercultural Workplaces – project introduction: Monday 20th April In collaboration with Nursing Homes Ireland, Age Action is running a project on the theme of Promoting Equality in Intercultural Work Places. The project will be introduced to nursing homes at NHI offices on Monday 20th April. Places are limited and to reserve yours contact Ann Moroney, Age Action, at 01 4756989 or intercultural@ageaction.ie. NHI Education Day: Wednesday 29th April NHI returns to the Clarion Hotel, Liffey Valley, Co Dublin, for its next education day for year 2015.The title of the education day is: ‘Audit and Research Workshop: Developing Quality Improvement Tools for the Private and Voluntary Nursing Home Sector’. Further details will be circulated to Members in Advance. Nursing Homes Week 2015: Monday 22nd June – Sunday 28th June The third national celebration of the positivity of nursing home life will see wide-ranging celebratory events and activities taking place to bring nursing home residents, their relatives and friends, staff and wider communities together. NHI Annual Conference & Care Awards 2015: Thursday 12th November The NHI Annual Conference & Care Awards 2015 are on the move! This year both events will take place at the Double Tree by Hilton Hotel, Burlington Road, Dublin. The Conference will again bring together an excellent line-up of speakers and we then move into celebratory mode as the Care Awards recognise outstanding care delivery in NHI Member homes. NHI Education Days 2015 Further NHI education days are planned for Tuesday 25th August and Tuesday 1st December. Members will be advised of focus of the days and further details in advance.

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