Private and Voluntary Nursing Homes January 2016
437
5 272 287
private and voluntary nursing homes in Ireland
23,000
3 216 249
12 536 571
2 110 129
The average fee provided for public nursing home care is 58% more than that payable to private / voluntary counterparts
7 397 422
10 525 557
persons are supported by nursing home care
58%
5 267 304 donegal
75
%
approx percentage of persons ‘delayeddischarged’ in acute hospitals awaiting nursing home care
76
%
16 724 744
10 528 597
12 525 553
sligo mayo
cavan
galway
wicklow
laois clare
carlow kilkenny
limerick
tipperary
wexford
waterford
kerry cork
13 723 766 25 1,128 1,221
48 2,526 2,667
Number of Nursing Homes
directly employed by private and voluntary nursing homes
contribution of sector annually to economy through direct taxation
GENERAL ELECTION 2016
21 1,404 1,478
kildare
18 724 769
€190m
5 250 268
dublin
offaly
4 204 221
25,000
19 828 862
91 5,665 5,875
meath
westmeath
7 351 362
Securing a Sustainable Future
louth
roscommon longford
37 1,557 1,632
11 662 673
of Ireland’s nursing home care is provided by private and voluntary nursing homes
leitrim
17 850 867
monaghan
26 941 1,111
Number of Beds
9 476 537
11 526 559
Number Employed
Nursing Homes Ireland Unit A5, Centrepoint Business Park, Oak Road, Dublin 12 t +353 1 429 2570 e info@nhi.ie
f +353 1 429 1845 w www.nhi.ie
+46%
growth of this demographic profile by year 2021
1 in 5 persons aged 85+ require the specialist, dedicated care provided by nursing homes
4% of older persons require nursing home care
Cost of care in acute hospitals is up to eight times fees payable to private and voluntary nursing homes
x8
What should your party manifesto / Programme for Government contain? 1. Commitment to a funding model that recognises the reality of costs incurred to provide nursing home care is imperative.
What would this entail? Fees payable for nursing home care must reflect the reality of costs incurred, for example, capital investment, staffing, regulatory compliance, training, energy and commercial rates. A sustainable nursing home sector is dependent on providers receiving an adequate return on capital employed. Levels of dependency and complexity of care requirements must be encompassed within the payment model to support persons requiring nursing home care.
2. Commitment to introduction of an independent appeals process under the Fair Deal scheme. Nursing home providers who are dissatisfied with the fee proposed by the NTPF must be afforded the opportunity for fair right of independent appeal. 3. Commitment to implementation of a 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. 4. Commitment by Government / Department of Health to take lead in bringing stakeholders around the table through a ‘Forum on Long-Term Care’ to consider and advise re the appropriate planning and policy required to ensure we sustain current provision and meet substantial growth in requirement for this specialist care. The National Economic and Social Council (NESC) has recommended establishment of such forum.
NURSING HOME CARE
How many are employed within private and voluntary nursing homes?
What issues are arising with fees payable for nursing home care?
AN OVERVIEW
Approx. 25,000 people are directly employed by private and voluntary nursing homes, contributing over €190m annually in direct taxation.
DKM Economic Consultants, on behalf of Department of Health, Potential Measures to Encourage the Provision of Nursing Home and Community Nursing Unit Facilities (December 2015):
Approx. 4% of older people live in a nursing home and are supported by the co-payment Fair Deal scheme. 437 private and voluntary nursing homes provide specialist health and social care for 23,000 people. 76% of long-term residential care is provided by the private and voluntary nursing home sector. Average length of stay in a nursing home is 1.9 years, reflective of the increased dependency levels of residents and their complexity of care needs.
Supporting healthcare delivery Having high quality nursing home care available to those who need it is an essential part of a well-functioning health service. Circa 75% of persons clinically fit for discharge in our acute hospitals are awaiting long-term nursing care (HSE Performance Reports). The reduction in waiting time for persons to access nursing home care in 2015, through additional resourcing of Fair Deal, created an additional 265 hospital beds every day to be used by patients, a capacity increase equivalent to a medium-sized hospital, source Minister for Health Leo Varadkar, Dáil Éireann, 12th November 2015.
What is the cost of nursing home care? The average fee provided to public nursing homes is 58% more than that payable to private and voluntary nursing homes (source: Department of Health Review of the Fair Deal Scheme). The current NHSS (Fair Deal) funding model is threatening the sustainability of current provision and stifling the ability of nursing homes providers to meet the growth in requirement for nursing home care. Average weekly cost of acute hospital care is up to eight times the fee payable to private and voluntary nursing homes.
• The lack of reference to efficient cost levels and return on efficient capital in the Fair Deal negotiations represents a disconnect from the reality that the State expects the private sector to potentially provide 80% of nursing home capacity going forward. It is unsustainable in terms both of rational market operation and enabling new investment in areas of the country where payment rates are lower. • The pricing model is acting as a barrier to investment, has been developed in an ad hoc way, lacks logic and is not fit for purpose. • The lack of reference to the level of dependency of residents within the pricing model is discouraging the development of more specialised facilities, where more expensive care is required, and creates an incentive to actively discourage acceptance of high-dependency residents by nursing homes. • The very significant variation in price paid for care from the private and voluntary nursing home sector is unprecedented within State procurement. Dementia Services Information and Development Centre, An Irish National Survey of Dementia in Long-Term Residential Care: “Payments made through the NTPF need to be commensurate with level of care, staff training and skill mix and type of nonpharmacological interventions expected to be delivered.” Oireachtas Health Committee, Report on End-of-Life & Palliative Care in Ireland (July 2014): “In reviewing the current Fair Deal scheme an evidence-based cost-of-care model could be used in assessing the real cost of residential nursing home care in Ireland.” With an appropriate funding model, future requirements for nursing home care can be met by the current experienced providers operating in communities across Ireland.