Nursing homes:Securing a

SustainableFuture

Opening the door to happiness,kindness & activity focussed living

Inspirational care requires a planned approach

Nursing: Emphasis on professional development within rewarding roles

12 page guide to the private & voluntary nursing home sector

in association with

Securing a SustainableSustainable

Future

CRED

ITS

02 Celebrating Excellence in Care

1Over 440 private and voluntary nursing homes in communities across Ireland are providing specialist, dedicated healthcare and a home from home for over 22,000 people.

2Approximately 24,000 people are directly employed by the private and voluntary nursing home sector, directly contributing over 190m annually to the Exchequer through taxation paid.

380 per cent of long-term residential care is provided by private and voluntary nursing homes.4Long-term-care is simply a means to ensure that older people with a signi cant loss of capacity can still experience healthy ageing, stated the World Health Organisation in the World Report on Ageing and Health, September 2015. The integration of healthcare and long-term care services will be crucial to maintaining the functional ability and dignity of older people.

5Nursing home fees are circa 1,000 per week compared to an average weekly cost of over 6,000 in the acute hospital sector.

6One-in- ve persons aged 85 and over require the continuous, specialist care provided by nursing homes. The CSO (Central Statistics Offi ce) is predicting this demographic will increase by 46 per cent up to the year 2021.

7The Department of Health Review of the Fair Deal Scheme states private and voluntary nursing homes provide care for fees that are an overall average 58 per cent below those being paid to HSE nursing homes.

8HSE Performance Reports reveal that approximately 80 per cent of persons clinically t for discharge in our acute hospitals are awaiting long-term nursing care.

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8 facts you should know about nursing home care

Welcome to Nursing Homes: Securing a Sustainable Future, a Nursing Homes Ireland/Irish Independent supplement, that

informs regarding nursing home care.This 12-page publication outlines the

very signifi cant challenges facing the private and voluntary nursing home sector in care provision. With our population rapidly ageing, and the requirement for the specialist care provided by nursing homes growing in tandem, the State must bring stakeholders together to ensure we appropriately plan for this considerable growth in healthcare. From a social and health perspective, we must address the signifi cant challenges facing Ireland in providing nursing home care. Addressing these obstacles with a suitable strategy will ensure the health and social care nursing homes specialise in providing is available to the increasing numbers requiring it. This will create thousands of high-skilled jobs in our urban and rural communities.

Nursing Homes: Securing a Sustainable Future provides an insight into life within these dedicated health and social care home-from-home settings from the people at the heart of nursing home care: nursing home residents.

Read also of the experiences of nurses who are providing this person-focused care and how imperative it is we plan now for our increasing gerontological care requirements. More than 370 NHI members are

committed to achieving best practice in care provision. The high standards delivered in NHI member homes are celebrated on an annual basis at the NHI Care Awards. Read about our 2015 celebrations and winners in this supplement. This publication will provide you, the

reader, with an insight into the speciality that is nursing home care. It also provides strong food for thought for persons with an interest in how we, as a society, fulfi l the challenges facing us in meeting the health and social care needs of our aging population.

Tadhg Daly, NHI CEO

For more information, visit www.nhi.ie,www.nhicareawards.ie or

www.careersinnursinghomes.ie

Planningfor the future

www.nhi.ie www.nhicareawards.ie

03OPENING A WELCOMING DOOR TO HAPPINESS,KINDNESS AND ACTIVITY-FOCUSED LIVINGThe residents of fi ve nursing homes tell us about living lives of happiness, comfort, enjoyment, peace and safety within these activity-focused high-standard settings

04 & 05MEETING RESIDENTIAL CARE REQUIREMENTSTadhg Daly, NHI CEO, warns of the consequences of not bringing together a strategy to ensure we meet residential care requirements

06 & 07FULFILLING RESPONSIBILITIES WITHINREWARDING NURSING ENVIRONMENTNurses in nursing homes outline the responsibilities and varied skills required to fulfi l their roles within dedicated healthcare settings, which place strong emphasis upon continuous professional development

08PLANNING FOR A CARING FUTURENursing home care is intrinsic for healthcare delivery. It is imperative the State recognises our older population will require gerontology nurses to meet present and future clinical care requirements for our older population

09 & 10NHI NEWS The latest updates on the private and voluntary nursing home sector

11 & 12NURSING HOMES IRELAND CARE AWARDS 2015The winners of the sixth NHI Care Awards, which celebrated the roles of nurses, carers, activity co-ordinators, chefs and ancillary workers within nursing home communities

The front cover features pictures from, (l r), Moorehall Lodge Ardee, Co Louth; Ferndene Nursing Home, Blackrock; Marymount Care Centre, Co Dublin; Orwell House, Co Dublin and Sonas Nursing Home, Co Westmeath

Contents

Opening a welcoming door to happiness, kindness and activity-focused livingThe residents of fi ve nursing homes provide an insight into what their life entails. They tell us about living lives of

happiness, comfort, enjoyment, peace and safety within these activity-focused high-standard settings

03Celebrating Excellence in Care

My independence was everything to me. I had led an idyllic life in Cyprus up until Christmas 2013 swimming every day, walking and sailing, playing bridge. I was completely immersed in the Cyprian lifestyle. I suff ered a stroke and to learn I could no longer maintain a free and independent life was a shock. The realisation that I could not return to live alone in Cyprus was horrendous. But the welcome and kindness extended to me here at Craddock House Nursing Home was astonishing. For an independent person like me, their support medically and emotionally made the transition all the easier.

because the residents know they can call on staff day or night if necessary.It is a very peaceful place to be - no strain or anxiety. The whole atmosphere speaks of comfort, warmth, safety and exibility. The staff are very kind and committed. They provide us with a great service that is deeply appreciated by the residents. Sister Camillus OReilly, Millbury Nursing Home, Co Meath

MAIN PHOTOWith residents, staff and visitors forming special bonds, nursing homes are real community settings. Pictured are the staff , residents and visitors to Oak View Nursing Home, Co Cavan at a recent celebration

At Brindley Manor, I have made many good friends. There is great company here and Id also count the staff as my friends. There are also plenty of activities to enjoy. A shopping trip to Derry and an annual holiday were two of the most recent highlights, while other trips are also organised by the nursing home. I would highly recommend nursing home care if you are feeling down or not very well. The food is delicious and all the chores are done for me. Living here, I am not frightened. The staff are here to

When old father time sends you a message that you can no longer live alone, you reluctantly agree to live in a nursing home. You imagine you will be one of the old people sitting around, and hope you are lucky enough to nd a place where things are diff erent to your imagination. After six years living here, I personally nd time is not boring and it ies with the plentiful activities. Here we have wonderful staff nurses, carers and a great Director of Nursing. We have two or three Masses a week which is

Whilst I needed practical and medical support, I was encouraged to pursue my previous hobbies. I swim every week and twice weekly I head out to play bridge. There are so many activities to do here. Now I feel comfortable and safe but with a degree of independence. I have made many good friends here and enjoy a healthy social life.Marjorie Sheppard, Resident, Craddock House Nursing Home, Co Kildare

I am very happy at Millbury Nursing Home and I hope by sharing my experience, it might help someone who has diffi culty with nursing homes in whatever way. A

great sense of security prevails in the nursing home which is most important. Fears and anxieties are eliminated

call on and it is better security wise as there is always somebody here. It has been a good decision for me and has worked out very well.Betty Vance, Resident,Brindley Manor, Co Donegal

great and we have extended exercises every day organised by Marie, our activities co-ordinator, along with many other entertaining activities. We also have outdoor entertainment. In the summer we can enjoy the beautiful garden when the owers are in bloom. We also go on trips to various places of interest, on group outings to the theatre and concert hall. I regard Leeson Park as my home now and its staff as my family and friends.Josephine Walsh, Resident, Leeson Park, Co Dublin

I am 96 years old and celebrated 76 years of consecrated life in August. I was a very independent lady but unfortunately I had a very bad fall, which resulted in me having to make the decision to avail of nursing home care. This was a very daunting experience but the care I receive on a daily basis is second to none. For me, its like a home from home. The staff nurses are very compassionate. I feel so safe and secure when the healthcare assistants, who are extremely supportive, assist me with showering and daily activities. The standard of cleanliness is excellent and the choice of menus is varied each day. Our activities co-ordinator is so

accommodating to my spiritual needs and on a ne day I am brought out for a walk to admire the gardens and views. Once a week our resident chef hosts a cookery demo. This gives me further opportunity to meet the other residents, to have a chat and a cup of tea, and sample what he has baked on the day. I believe that older people are not aware of the high standards in nursing homes nowadays. The mention of a nursing home frightens them. I am more than happy that I have found such a wonderful home to live out the remainder of my years.Sister Emma Moyles, Flannerys Nursing Home, Co Galway

Let us not seek to fi x the blame for the past. Let us accept our own responsibility for the future - John F Kennedy.

Its a maxim that the art of politics is about managing the present and dealing with issues arising for constituents: delivering their requirements, avoiding controversy, generating the necessary goodwill that will secure

re-election. It might be considered a generalisation but much of the reality of politics is about surviving the present and leaving future policy and planning in the hands of those forthcoming.JFK also stated: There are risks and

costs to action. But they are far less than the long range risks of comfortable inaction. The massive growth in our ageing

demographic is well-versed both in political and societal discussions. It does appear on the political horizon. Within discussion surrounding health policy, the ageing demographic and challenges this presents are often cited. The evidence is presented, but are we facing up to the challenges? Are we living within the present and not planning appropriately for the future? Nursing home care fulfi ls an intrinsic

role in healthcare delivery. Presently, more than 22,000 people require the specialist care provided within the dedicated home from home settings that are nursing homes within our communities. It is a small minority of the population and older persons who require this continuous care. Approximately one in 25 people who are classifi ed as older persons those aged 65+ - presently require nursing home care. As outlined by HSE, at present 90 per cent of frail older people in Ireland live at home, with 80 per cent of them living well and independently. It is our older-old population who are

signifi cantly dependent upon nursing home care. Approximately one in fi ve persons aged 85+ reside in a nursing home. These persons have high-dependency healthcare needs. The Dementia Services Information and Development Centre (DSIDC) informs that the prevalence and incidence of dementia rises exponentially with age and dramatically so in those over 80 years. The CSO is projecting for every two persons who were aged 85 or beyond in 2011, there will be a third person living in this age category by 2021. It is fantastic that people are living longer and our older

population must always be embraced and celebrated. However, we cannot overlook the enormous challenges this will present for health services in the medium term. Requirement for the specialist round-

the-clock health, clinical and social care provided by nursing homes will grow exponentially. Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase signifi cantly in the next decade, the Centre for Ageing and Research and Development in Ireland (CARDI) has stated. There will always be a signifi cant requirement for long-term residential care, says the Department of Healths review of the Fair Deal Scheme. The Department and Minister Varadkar are well briefed on the major challenges we face in meeting the requirement for nursing home care. On balance it would appear that a

minimum of an additional 7,600 beds (over 1,000 beds per year) will be required between now and 2021, the Department stated in its briefi ng to the Minister upon his appointment to the health portfolio in July 2014. Such projection is supported by research undertaken by independent agencies such as the ESRI, CARDI and BDO. The Department has estimated that 200m additional spending will be required per annum to meet health needs of an ageing demographic. The Nursing Homes Ireland Annual

Survey 2014/2015 revealed a signifi cant slowdown in provision of new beds in the past fi ve years and decrease in the number of nursing homes. State commitment of 200m to bring

the physical environments of public nursing homes up to HIQA standards will be very inadequate, when you

consider that the HSE stated two years ago that 834m would be required. Minister Varadkar and Minister with

Responsibility for Older Person Care, Kathleen Lynch have recognised the importance of ensuring timely access to nursing home care by reducing waiting period to access funding to four weeks. Speaking in Dil ireann on the 10th November Minister Varadkar said it has enabled 265 new beds to be freed within the acute hospital sector, which is a capacity increase equivalent to a medium-sized hospital.The evidence is bountiful. Back

to the question posed: Are we living within the present and not planning appropriately for the future? Worryingly, with this Government

now moving into its fi nal lap, it has failed to publish a clear and cohesive policy and national strategy for the long-term care of our older population. We need to plan a healthcare model that provides a continuum of care for our older population and enables them to avail of the most appropriate care at the most appropriate stages. In its report, Quality and Standards in

Human Services in Ireland: Residential Care for Older People, published three years ago, the National Economic and Social Council (NESC) recommended the establishment of a problem-solving group to enable services in residential care to be provided at an optimum level for older people. The evidence serves a stark warning that if we fail to plan now, we will be facing a health and social care crisis of signifi cant magnitude in the coming years.Despite the warning coming from the

Department of Health regarding additional bed requirement, there remains a strategic

policy vacuum. NHI continues to push for the establishment of an appropriate forum to bring stakeholders around the table to advise the Government about appropriate planning, policy and strategy to support nursing home care provision. What could such a strategy entail?

There is a critical requirement for the introduction of an evidence-based cost of care funding model that recognises the complexity of care for persons who require long-term residential care. DSIDC and the Oireachtas Health Committee have identifi ed the shortcomings of the scheme in this regard. Payments made through the NTPF need to be commensurate with level of care, staff training and skill mix and type of non-pharmacological interventions expected to be delivered, DSIDCs national survey of dementia care published in January stated. Recognising the lead role the private

sector is fulfi lling in provision of specialist dementia care, the report added: A new funding model is required if the private sector is to be further incentivised, with more funding allocated to private nursing homes in recognition of the specialist services needed to support persons with dementia, including those with behaviours that challenge. In its Report on End of Life & Palliative Care in Ireland, the Oireachtas Health Committee stated: In reviewing the current Fair Deal scheme, an evidence-based cost of care model could be used in assessing the real cost of residential nursing home care in Ireland. Very disappointingly, the Review of

the Fair Deal scheme kicked for touch in this regard. Its recommendation was a review of the pricing model be undertaken by the NTPF within an 18 month period. It is inappropriate that the current commissioners are tasked with such a review and it should be independently undertaken. The importance of ensuring staff are

available to provide the person-focused specialist care befi tting of persons with dementia should also be a key consideration for any strategy. The national and indeed international crisis in nurse recruitment is not confi ned to acute services, with serious issues surrounding the recruitment and retention of nurses threatening bed capacity in nursing homes. Engagement with stakeholders can deliver a workforce plan for the entire health

Even with greater emphasis on careat home and more resources providedto realise it, the demand for residential

care is going to increase signifi cantlyin the next decade

04 Celebrating Excellence in Care

Health service will face repercussions if we fail to grasp evidence and plan now Our ageing demographic and bountiful evidence is pointing to a rapid increase in the growth in requirement for nursing home care. Tadhg Daly, NHI CEO, warns of the consequences

of not bringing together a strategy to ensure we are positioned to meet our residential care requirements

05Celebrating Excellence in Care

Tadhg Daly, NHI CEO: Independent research states importance of evidence-based cost of care payment model to support nursing home care

service public, private and voluntary that would place the substantial growth in requirement for gerontological and dementia care at the centre of it. A shortage of nursing home beds is

presenting severe problems for our acute sector. Hospitals are being affected because an undersupply of nursing homes beds is preventing the discharge of patients who have completed acute hospital care. There is no quick fi x or one defi ned solution. But two outstanding issues arising are inhibiting the ability of the sector to meet the required need at present. These are the appropriate pricing model to encompass the true costs of providing nursing home care and very serious issues

surrounding recruitment of nurses.The Departments review of the Fair

Deal stated: Given projected demographic trends and continuing public expenditure constraints, it appears probable that there will be an expanded role for the private sector in the future nursing home market. The private and voluntary nursing home sector are willing to play their part. 63 per cent of specialist dementia care units are presently provided by the private sector but there is a national shortfall. The Department must take control and bring stakeholders together to plan with immediacy. The trouble at the door of this Government is not going away. It should not be left to others to address.

The sector requires a clear time-defi ned commitment to deliver an evidence-based cost of care payment model that acknowledges the true cost of providing nursing home care. The price negotiated between the NTPF acting on behalf of the State - and individual nursing home operators must take account of the true cost of providing high quality person-centred care. This must include cost of capital and the ability of operators to generate an appropriate return on investment.

Operators who are dissatisfi ed with the rate proposed by the NTPF must be afforded the opportunity for right of appeal to an independent third party. There is clearly a need for an independent appeals mechanism that becomes applicable where the negotiators (NTPF and nursing home) fail to agree a fee for care provision.

The Minister and Department of Health must develop a clear and unambiguous policy that gives certainty to the private and voluntary nursing home sector. This must address requirements to ensure the sustainability of current nursing home provision. There is urgent and imperative requirement to bring stakeholders around the table through a forum that would advise Government in relation to appropriate planning and policy to meet present and growing demand for nursing home care.

KEY ACTIONS REQUIRED

06 Celebrating Excellence in Care

physiotherapists, occupational therapists, doctors, hospitals and regulators, while working closely with my colleagues, the residents and their families. Everyday there is something different happening.There are so many positives that I fi nd

rewarding. I love working closely with new healthcare assistants and watching them grow into the role. I am involved in training staff, which is very enjoyable. I have journeyed with many families

as their loved one reaches the end of their life. This is a very privileged position. Although it is a very sad time for a family, it can be a positive experience to celebrate the achievements of their loved ones life and ensure that journey is as comfortable and pain free as possible.What skills do I utilise? On the nursing

side, treatment preparation, person-centred care planning, end-of-life care and case management are crucial to the role. On the medical side, infection control, syringe drivers, subcutaneous fl uids, peg feeds, infectious diseases, wound management and nutrition are everyday skills needed to fulfi l it. On the management side you need skills in confl ict resolution, policy development, training skills and dealing with regulation. There is considerable paperwork, documentation, and standards to follow and it is crucial to manage this and maintain your high standards of care.I think elderly people deserve to have

young nurses working in nursing homes. You get a vast amount of experience of a wide range of medical conditions of older people. You have huge responsibility, working with residents with complex needs. My advice to graduates? Jobs in

nursing and residential care facilities are expected to grow in Ireland, so you will have a long-term future working in a nursing home. This is a challenging job. You get so much positive feedback. Youll work one-on-one with the same residents and get to know everyones needs. You build personal relationships. Its a job that allows you to experience things spiritually, emotionally and physically. It enables you to connect to others.Youll share laughter, hardships, and

spend quality time with residents. You are not always rushing and busy and dealing only with one aspect of a persons care. You get to practice holistic care - taking time to talk to a resident is just as much part of the care as any medical intervention. If you want to move up in the medical fi eld and increase your skills, most nursing homes will help to pay your education costs. There is huge variety in the job it is never boring.

The reality is in stark contrast to the

perception; Nurses in nursing homes outline

the responsibilities they fulfi l and the

varied skills required to fulfi l their roles within dedicated healthcare

settings that place strong emphasis upon

continuous professional development

Strong emphasis upon professional development

within busy, rewarding nursing environment

Linda OConnor, Registered Nurse in Intellectual Disability, Killure Bridge Nursing Home

Deirdre Tiernan, Assistant Director of Care, Sonas Cloghanboy, Athlone

Linda OConnor, Registered Nurse in Intellectual Disability, Killure Bridge Nursing Home, Co WaterfordThe most fulfi lling part of my role is getting to know each resident in the nursing home. Care of the elderly differs from roles in other areas of the health service as I feel more autonomous in my position. I can have an imperative input into clinical decisions with doctors, dieticians, psychiatrists, and occupational therapists.Continuous professional development is

strongly encouraged in the nursing home. I have been on numerous courses which have developed my knowledge to a high level. These courses include challenging behaviour, elder abuse, medication management, palliative care and dementia care. End-of-life-care is a major part of my role; I have gained considerable experience in this area that I would have not acquired in another area of nursing. There are constantly new residents

coming into the home with many different conditions and diagnoses, so my knowledge and experiences are always expanding.Once I became more confi dent as a

nurse in the nursing home, I was given the role of being nurse in charge on a number of occasions. This carries great responsibility and provides fantastic managerial experience - climbing the ladder into clinical nurse management is a very realistic goal if desired.The perception of nursing in a nursing

home can be outdated. All residents are treated holistically and any medical intervention that will improve their quality of life is provided. By using the most up to date evidence-based best practices, we are constantly striving to improve care while adhering to strict regulations.I would advise any new graduate

or qualifi ed nurse interested in elderly care to ignore perceptions and consider embarking on a new nursing career path where they will gain an excellent, life-changing experience, as well as rewarding employment that combines fl exible rosters, continuous professional and clinical development and work within a team with a positive morale.

Deirdre Tiernan, Assistant Director of Care, Sonas Cloghanboy, AthloneMany perceive nursing homes to be quiet places with very little happening; this could not be further from the truth. Our nursing home is a busy place that is very involved in the community. I work with dieticians,

07Celebrating Excellence in Care

Bernita McDonnell, Staff Nurse, St Attractas Nursing Home, Co Mayo

Working at St. Attractas is truly fulfi lling my expectations of my chosen career as a staff nurse. The ability to work with our residents - forming and building trusting relationships with residents who view the care facility as their home, as well as promoting quality of life to our elderly population - is so rewarding.St. Attractas is a fast-paced,

challenging environment with fantastic learning opportunities. On a daily basis we manage large volumes of medications and complex medical conditions. We are constantly communicating with a wide multi-disciplinary team. I am being continuously encouraged

to upskill and have attended many courses funded by the nursing home. I would highly recommend this work as it is a fantastic experience, especially for graduates. It also offers great support from senior staff nurses.

Philomena Walsh, Registered General Nurse, Innis Ree Lodge, Co Roscommon The greatest satisfaction I get from fulfi lling my role is knowing that residents entrusted in my care feel safe and secure in an environment that is person-centred with staff who are diligent, devoted and dedicated to the personal needs of each and every resident. With upskilling and professional development, staff are enabled to recognise and have a deeper awareness and understanding of residents with dementia and cognitive impairment. By promoting and implementing the skills acquired through training, staff are empowered

to enrich the lives of the residents.Responsibilities entrusted to me in my

daily duties include the administration and documentation of medication, writing reports and keeping all records up to date, liaising with GPs in making appointments and referrals for residents, admission of new residents to include

Nurses specialising in gerontological care fulfi l a very special role within Irish society. These nurses work within dedicated healthcare settings designed to encompass the health and social care requirements of our population requiring long-term residential care.

They provide clinical care and are part of teams that meet the holistic care requirements of people living in nursing homes. The teams incorporate nursing directors/persons in charge, assistant directors of nursing, registered general nurses, carers, chefs and activity coordinators.

These men and women work within highly-regulated professional settings and require key skills, enhanced competencies and considerable expertise to meet particular health and social care requirements of older people, Mary Burke, Chair of NHI Nursing Committee explains. Nurses within residential care settings have

responsibility for administering complex, skilled procedures and have more responsibility than counterparts within acute settings. They work within a sector that places continuous emphasis upon skill development to meet the increasingly complex care requirements of older people.

Gerontological nursing requires the advancement of knowledge, skills, competencies and expertise that are particular to meeting the complex health and social care needs of older people.

NHI is immensely proud of the highly-skilled gerontological nurses working within our sector in communities across Ireland, Mary adds. Many see the role they fulfi l as a vocation. These people are making an immeasurable difference to the lives of the older people in their care. They are empowering the older people and enabling them to live life to their potential.

Applying speci c skills and competencies drawn from the art & science of nursingTo care for those who once cared for us is one of the highest honors - The Inspired Caregiver

www.careersinnursinghomes.ie- Promoting careers in the Irish nursing home sector

NHIs dedicated recruitment website promotes career opportunities within health settings across Ireland. Graduate to senior management posts are promoted, with excellent, competitive packages being offered. Take a step towards a career that can fulfi l like no other.

assessments on activities of daily living, dietary requirements, and implementing a personalised and individualised care plan. My role allows me the privilege of

making a difference in the lives of my residents. Graduates often decline to work in the nursing home sector as they have preconceived ideas of what

it entails. Nurses that work in nursing homes must be knowledgeable, have excellent observation and assessment skills, believe in their abilities and be able to communicate effectively. Nurses just out of college can gain invaluable experience. Our residents deserve the best and it is my honour to work with them.

A TEAM ENVIRONMENT: Bernita, left, is pictured with colleaguesJames Walsh, Clinical Nurse Manager, and Rebecca King, Staff Nurse

care is primary care being delivered in communities across Ireland. These dedicated health settings meet

the clinical care requirements of persons requiring long-term residential care. There is at present a shortage of nurses

to fi ll posts. This problem pertains not just to Ireland but also to the UK and internationally. Throughout 2015, NHI has been pushing for a resolution of the crisis in delays in registration of overseas nurses to work within Irish health settings. On 9th November 2015, 1,927 candidates to fulfi l nursing posts were awaiting the processing of their applications with the Nursing and Midwifery Board of Ireland, the nurse regulator.

The growth in requirement for gerontological nursing care will only escalate in the coming years. The population most dependent upon nursing home care - persons aged 85 plus - is to grow by 46 per cent to year 2021 according to the Central Statistics Offi ce. The requirement for 7,600 additional beds means thousands of nurses will be needed within nursing homes. Longevity is a public health and societal

achievement. The present considerable pressures upon acute hospitals will multiply if the signifi cant challenges in meeting the care requirements of our ageing population are not confronted. It is imperative that the necessity for

gerontological nurses to be available to

08 Celebrating Excellence in Care

Planning for a Caring Future

Healthcare delivery within the community is a primary objective of our Government. Deterring unnecessary admissions to

acute hospitals is in the interest of the patients within our health service and enables hospitals to focus on delivering the care they specialise in: acute care. In 2013, the All Ireland Gerontological

Nurses Association (AIGNA), in conjunction with Nursing Homes Ireland, published the research report Exploring Nursing Expertise in Residential Care For Older People in Ireland. It highlighted the critical contribution nurses make to the lives of older people in residential care settings. Yet it found these nurses feel both undervalued and constantly under threat. Gerontological nurses are both social

and clinical advocates for older people in residential settings, states Professor Brendan McCormack, former AIGNA President. It is the integration of these two perspectives into their daily work that maintains both the health and the social and personal wellbeing of the older person. It is the job of policy makers and managers alike to ensure that gerontological nursing is viewed as a challenging and healthy career choice with a bright and rewarding future. The nursing home sector does not

exist in isolation. We must plan for the care requirements of our rapidly ageing population. Persons aged 65 plus account for almost 50 per cent of total bed days in Irish hospitals. Approximately 75 per cent of persons awaiting discharge from our hospitals are waiting on long-term nursing care. Nursing home

meet our populations clinical care needs is recognised by the policy stakeholders. One of the most important aspects

arising from this study is the imperative of establishing the value of expertise in nursing in residential care of older people, the research report states. Consequently, nursing colleagues in settings outside nursing, society and policy makers need to appreciate such value and expertise. Gerontological nursing needs greater recognition as a speciality in its own right at all levels of nursing education.The World Health Organization has

stated: Acting both as individuals and as members and coordinators of inter-professional teams, nurses and midwives bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost effectiveness of servicesIn spite of their contribution, nurses and midwives are not often identifi ed as key stakeholders at the health policy table.

THE ARTS: There is strong emphasis upon developing the artistic talents within nursing homes. Pictured are the creative writing group at St Elizabeths Nursing Home, Co Meath. The writing brings the imagination of residents together to create new poetry and stories.

MAIN PHOTOArt is an excellent therapeutic activity that nursing homes and their residents embrace. Residents of Ferndene, Co Dublin, are pictured with their creations before recently hosting exhibition of their works.

Its impossible to underestimate the importance of nurses and midwives to the Irish health service.- Minister for Health Leo Varadkar, April 2015

It was the most famous nurse of them all, Florence Nightingale, who described the art of nursing as the fi nest of fi ne arts. In 2015, the HSE launched an overseas recruitment campaign to attract nurses to the Irish health service. At the beginning of the year, in response to Minister Kathleen Lynchs comments regarding the looming crisis for HSE because of shortage in nurse personnel, Nursing Homes Ireland warned that the very considerable challenges facing the wider health sector in respect of nurse recruitment and retention must not be overlooked.

On balance it would appearthat a minimum of an additional

7,600 beds [long-term residential care] (over 1,000 beds per year)

will be required betweennow and 2021.

- Department of Health Briefi ng to Minister Varadkar upon appointment

to health portfolio, July 2014

A man who does notplan long ahead will

fi nd trouble at his door.Confucius

The Government must lead so we can ensure a sustainable plan for our clinical care requirements is implemented. This must strive to ensure that we have an adequate supply of gerontology nurses to meet the increasingly complex healthcare requirements of an ageing population. Nursing programmes must incorporate more gerontology input so we have graduates positioned to meet ageing demographics clinical care needs. Workforce planning and workforce development are essential factors in the delivery of high quality care. Recruitment and retention, training and qualifi cations, continuous learning and skill development all have to be part of a workforce plan for the nursing home and wider health service to meet current and future needs.

09Celebrating Excellence in Care

Cost of care in public nursing homes 58 per cent greater than private and voluntary counterparts

Despite being the majority providers of specialist dementia care, the average fee payable to private and voluntary nursing homes for

care provision is 58 per cent less than that provided to HSE counterparts. The Department of Health commissioned review of the Nursing Home Support Scheme, commonly known as Fair Deal, states: The average weekly cost of care in a public facility was 1,390 and in a private or voluntary facility was 893 at the end 2014. The headline price differential in the average cost of care between public and private facilities is approximately 58 per cent.The fees paid to HSE nursing homes under the Fair Deal scheme were last published over four years ago, in March 2011. The review, published in July 2015, stated the HSE should be required to publish the fees on an annual basis. By contrast, private and voluntary nursing home fees are published consistently, every few months. Tadhg Daly, NHI CEO said publication of the HSE fees on an annual basis would apply a level of transparency that has been absent from State homes on a long-standing basis. Previous Minister for Health, James Reilly, publicly questioned why a 50 per cent fee differential pertained between public and private facilities and the Comptroller and Auditor General also questioned the cost differentials. The Irish National Survey of Dementia in Long-Term Residential Care, published by the Dementia Services Information and Development Centre in January 2015, stated: Despite the fact that the private sector provides the main bulk of specialist dementia care, current weekly rates agreed with the National Treatment Purchase Fund (NTPF) are not differentiated on the basis of individual residents dependency needs and private providers receive signifi cantly lower average weekly fees per resident compared to public

providers. This policy is inherently unfair and fl awed and needs to be reformed.The issue has been raised in Dil ireann, with Minister for Older People, Kathleen Lynch, previously stating under the auspices of Haddington Road Agreement, costs are being examined in State nursing homes and HSE intends to publish the revised costs before the end of 2015.

The private and voluntary nursing home sector has stepped up to the plate to meet the growth in

requirement for residential care in recent years but the absence of a clear and cohesive national policy and strategy for the sector is stifl ing providers ability to meet the growing requirement for this specialist care, NHI has informed a Department of Health review. DKM Economic Consultants

have been commissioned by the Department to analyse potential

measures to encourage the provision of nursing home and community nursing units. Private and voluntary nursing homes provide more than 22,000 nursing home beds, over 80 per cent of the total provision. The lack of a clear and cohesive

policy and national strategy for the long-term care of our older population, combined with uncertainty around current and future funding arrangements, poses one of the biggest challenges to the long-term sustainability of the

nursing home sector, NHI stated. A sustainable and viable

nursing home sector has a key role to play in addressing the well-documented diffi culties in our acute hospital emergency departments and addressing the challenges of meeting the residential care requirements of our ageing population.The sector requires a clear time-

defi ned commitment to deliver an evidence-based cost of care model that acknowledges the true cost of providing residential nursing home

care. This essential element is currently absent from the framework for negotiations between the NTPF and individual nursing homes. The procedures applied to

negotiations with nursing home providers must be fair, transparent and consistent. The State, as a monopolistic purchaser of nursing home care under the Nursing Home Support Scheme (Fair Deal), has a fundamental role in establishing clear and sustainable policies which can provide greater certainty for funders and providers alike.

Nursing home sector requires clear policy andproper pricing framework to meet requirement

To date they remain unpublished.In its submission to DKM Economic Consultants, who have been tendered by the Department of Health to assess potential measures to encourage provision of nursing homes, NHI stated in reference to private and voluntary fees: The NTPF enjoys a dominant position in its negotiations with nursing home operators on the price

to be paid for nursing home care. In the majority of cases, operators must accept the rate proposed by the NTPF, with little or no room for real negotiation. In determining the price with nursing home operators, the NTPF does not use formal costing models which refl ect the nature of the service provided and the acuity of the residents care requirements.

GREAT MINDS: Residents have fantastic knowledge that they are encouraged to share within the nursing home. Oak View, Esker Lodge, Castlemanor and Sheelin nursing homes, Co Cavan pictured at an inter-county pub quiz.

10 Celebrating Excellence in Care

Quality Living, Quality Care Living in a Nursing HomeWhat exactly does nursing home care entail?NHIs Quality Living, Quality Care Living in a Nursing Home booklet provides the necessary and important advice for anyone considering nursing home care. It informs of the independence of nursing home living, designated care plans for residents, nursing home facilities, activities, and the food served within these homes from home. As well as informing on nursing

home living, the user-friendly booklet also advises of the rights of persons living in nursing homes, complaints procedures, and accessing nursing home care via the Nursing Home Support Scheme (Fair Deal) or through paying privately and availing of tax relief. Residents and staff living within

nursing homes write of nursing home care and living. This valuable booklet has been utilised by nursing homes, within the wider health service and information services, and has seen considerable demand from the general public.

Copies are available by contacting NHI at (01) 4292570 or it can be downloaded at www.nhi.ie via the publications section of the website (visit the Guide to Living in a Nursing Home section)

The Department of Health itself has stated 7,600 additional beds are required to meet nursing home care

requirement to year 2021, states Tadhg Daly, NHI CEO. In what NHI described as political infl uence in the independent regulation process, the Department of Health announced on 4th November a revised policy was being applied to public nursing homes to extend their deadline to meet physical environment requirements a further six years, from 2015 to 2021.Two years ago the HSE projected an

834 million investment was needed to address outstanding works in public nursing homes. What specifi cally is the Government planning around meeting the rapid growth in requirement for nursing home care? Where are the additional 7,600 beds going to come from? What of the outstanding 834 million required to undertake physical environment works in public nursing homes?Mr Daly says the evidence is pointing

to a crisis emerging on a grand scale, with private and voluntary nursing homes being stifl ed in extending care services by the unsuitability of the current pricing model to negotiate fees and the

take-it or leave-it attitude of the NTPF during the fee negotiation process. He pointed to State nursing homes

receiving average fees that are 58 per cent beyond private and voluntary counterparts, as revealed in the Department of Healths commissioned review of the Fair Deal scheme. Mr Daly says the introduction of an

evidence-based cost of care funding model is imperative, and has been recommended by both the Dementia Services Information and Development Centre and Oireachtas Health Committee. There is an appetite amongst our

members to continue stepping up to the mark to meet healthcare requirements of persons requiring the continuous care nursing homes provide, he says. What we are asking for is fairness for our sector. An appropriate, fi t-for-purpose support framework that recognises the complexity of care challenges for persons requiring nursing home care must become an immediate priority. Were already in emergency mode within our acute services - lets not move the nursing home sector onto such a footing. This Government still has the chance to leave a lasting legacy in the care of the older persons. We urge them to embrace this opportunity.

A sector on thecusp of an emergencyNHI has warned that we are on the cusp of an emergency in the provision of nursing home care

NATURE: Supporting residents to enjoy the open air and nature is intrinsic to nursing home care. Residents of Harvey Healthcare in Churchview meandering through the Botanic Gardens.

SILVER SURFERS: Nursing Homes facilitate and support residents to use modern communications means to bring connection, knowledge and entertainment.

NURSING HOMES IRELAND CARE AWARDS

2015www.nhicareawards.ie

Nursing Home Director of Nursing/Person in Charge Award Sponsored by Homecare Medical Supplies

WINNERCarol McLoughlin of Moorehall Lodge, Ardee, Co Louth, is pictured third from left receiving the Nursing Home Director of Nursing/Person in Charge Award with, L-R; Tadhg Daly, NHI CEO; Mike Cosgrove, Homecare Medical Supplies; Grinne Seoige, Event MC; Simon McGuinness, Homecare Medical Supplies.

FINALISTSMaura OSullivanSt. Gobnaits NursingHome, Ballyagran,Co Limerick

Rizalyn SilacanFerndene Nursing HomeBlackrock, Co Dublin

Nursing Home Registered Nurse of the Year Award Sponsored by First Choice Purchasing

WINNERLaura Sheridan of Maypark House Nursing Home, Maypark Lane, Co Waterford is pictured third from left receiving the Nursing Home Registered Nurse of the Year Award from, L-R; Colm Lucey and Eoghan Donnellan, First Choice Purchasing; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSEimear CarneyTLC Centre,Maynooth, Co Kildare

Jackie EdwardsMoorehall LodgeArdee, Co Louth

Nursing Home Carer of the Year Award Sponsored by AIB

WINNERVeronica Birchall, TLC Centre, Maynooth, Co Kildare, is pictured third from left receiving the Nursing Home Carer of the Year Award, L-R; Cathal OConnor and Anne Bannon, AIB; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSMarta Nowakowska BartosikFerndene Nursing Home,Blackrock, Co Dublin

Lynn KeyesEsker LodgeCathedral Road, Co Cavan

Nursing Home Social & Recreational Programme Award Sponsored by Miele

WINNERKathleen Hanrahan, Clarenbridge Nursing Home, Craughwell, Co Galway, is pictured second from left receiving the Nursing Home Social & Recreational Programme Award from; L-R; Martina Jennings, Miele Professional; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSMaria BradySt. Elizabeths Nursing Home,Athboy, Co Meath

Ann CrowleySt. Lukes Home,Mahon, Co Cork

11NHI Care Awards 2015Over 500 people from the nursing home and wider health and older person sectors gathered at the Double Tree by Hilton Hotel on 12th November. They assembled to celebrate the superb care being provided by NHI Members in nursing homes across the country. The sixth NHI Care Awards recognised the diversity of nursing home care, celebrating the roles of nurses, carers, activity co-ordinators, chefs

and ancillary workers within nursing home communities. Nursing homes were also recognised for their roles within their local communities and for excellent practice in dementia and end-of-life care. Pat Durcan was recognised for his outstanding contribution to the sector and Henry Delaney of Powdermill Nursing Home, Co Cork, was honoured with the 2015 Resident Achievement Award.

Nursing Home Catering and Nutrition Award Sponsored by Fresenius Kabi

WINNERLaurentia Vaughan of the Catering & Hospitality Team of Knightsbridge Nursing Home, Trim, Co Meath, is pictured, third from left, receiving the Nursing Home Catering & Nutrition Award on behalf of the catering & hospitality team from, L-R; Diana Dihmis and Shiofra OMalley, Fresenius Kabi; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSPascal DesmetBrindley HealthcareConvoy, Co Donegal

Marie GaynorSonas Nursing Home CloghanboyAthlone, Co Westmeath

Celebrating Excellence

in Care

NURSING HOMES IRELAND CARE AWARDS

2015www.nhicareawards.ie

Nursing Home Ancillary Worker Award Sponsored by iD Expert

WINNERFergal Dunne of Knightsbridge Nursing Home, Trim, Co Meath, is pictured, second from left, receiving the Nursing Home Ancillary Worker Award from, L-R; Jacinta McCamley, iD Expert; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSMary B McMahonEnnis Nursing HomeEnnis, Co Clare

Ollie StapletonMaypark HouseMaypark Lane,Co Waterford

Nursing Home Community Initiative Award Sponsored by Bank of Ireland

WINNERBreege Conlon & Michelle Watters of Moorehall Lodge, Ardee, Co Louth, are pictured second and third from left receiving the Nursing Home Community Initiative Award from, L-R; Hilary Coates, Bank of Ireland; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTSPhysiotherapy Department TLC CentreMaynooth, Co Kildare

Katie U ChlainAras Chois FharraigeSpiddal, Co Galway

Nursing Home Innovations in Dementia Care Award Sponsored by BDO

WINNEREileen Kenneally, Angela Ryan & Theresa Horgan of the Social Care Team of Oaklodge Nursing Home, Cloyne, Co Cork are pictured receiving the Nursing Home Innovations in Dementia Care Award from, L-R; Brian McEnery, BDO; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO.

FINALISTS Shirley LarkinSonas Nursing Home CloverhillCloverhill, Co Roscommon

Viva Life TeamTLC CentreSantry, Co Dublin

Nursing Home End of Life Care Award Sponsored by The Irish Hospice Foundation

NHI LifetimeAchievement Award

Nursing Home ResidentAchievement Award 2015Sponsored by CPL Healthcare

WINNERSinead Beirne of Annabeg Nursing Home, Ballybrack, Co Dublin is pictured, second from left, receiving the Nursing Home End of Life Care Award from, L-R; Sharon Foley, Irish Hospice Foundation; Grinne Seoige, Event MC; Tadhg Daly, NHI CEO. FINALIST

Dr. Eileen CourtneyHamilton Park Care CentreBalbriggan, Co Dublin

Pat Durcan, former proprietor Dalkey Lodge Nursing Home, receives the NHI Lifetime Achievement Award, from, back-row L-R; Tadhg Daly, NHI CEO; Gillian Durcan; Marie Williams; Grinne Seoige, Event MC.

Henry Delaney, Powdermill Nursing Home, Ballincollig, Co Cork, is pictured, second from right, receiving the Nursing Home Resident Achievement Award from, L-R; Tadhg Daly, NHI CEO; Helen ODwyer, CPL Healthcare; Eleanor Magunnigle, Director of Nursing, Powdermill Nursing Home; Grinne Seoige, Event MC.

12

CHAIRPERSONDr Amanda Phelan, Co-Director, National Centre for the Protection of Older People

JUDGING PANELMr Rodd Bond, Director, The Netwell Centre,Dundalk Institute of TechnologyMs Margot Brennan, Former PRO,Irish Nutrition & Dietetic InstituteMs Sharon Foley, CEO Irish Hospice Foundation

Ms Susan Kent, Deputy Chief Nursing Offi cer for Womens Health & Primary Care Services Department of HealthMr Eamon Timmins, Chief Executive Offi cer,Age Action Ireland

We also wish to acknowledge the very kind assistance of Mary Flanagan, HSE, with the judging process.

Thank you to Calor Gas for sponsorshipof NHI Care Awards welcome reception.

NHI CARE AWARDS 2015 JUDGING PANEL

Celebrating Excellence in Care