Securing a Sustainable

FutureGENERAL ELECTION 2016

1 in 5 persons aged 85+require the specialist,

dedicated care provided by nursing homes

growth of this demographic profile

by year 2021

+46%

private and voluntary nursing homes in Ireland

persons are supported by nursing home care

437

of Irelands nursing home care is provided

by private and voluntary nursing homes

76%

23,000

25,000directly employed by private and voluntary nursing homes

190mcontribution of sector annually to economy through direct taxation

The average fee provided for public nursing home care is 58% more than that payable to private / voluntary counterparts

Cost of care in acute hospitals is up to eight times fees payable to private and voluntary nursing homes

58%

approx percentage of persons delayed-discharged in acute

hospitals awaiting nursing home care

75%

x8

dublin

wicklow

wexfordkilkenny

carlow

kildare

meath

westmeath

offaly

laois

roscommon

donegal

louth

monaghan

cavanleitrim

longford

waterford

tipperary

corkkerry

limerick

clare

galway

mayo

sligo

dublin

wicklow

wexfordkilkenny

carlow

kildare

meath

westmeath

offaly

laois

roscommon

donegal

louth

monaghan

cavanleitrim

longford

waterford

tipperary

corkkerry

limerick

clare

galway

mayo

sligo

7397422

5267304

10528597

17850867

915,6655,875

211,4041,478

19828862

5250268

13723766

11526559

5272287

10525557

16724744

12525553

371,5571,632

7351362

11662673

4204221

18724769

251,1281,221

Number of Nursing Homes Number of Beds Number Employed

3216249

482,5262,667

12536571

269411,111

2110129

9476537

Private and Voluntary Nursing Homes January 2016

Nursing Homes Ireland Unit A5, Centrepoint Business Park, Oak Road, Dublin 12

t +353 1 429 2570 f +353 1 429 1845 e info@nhi.ie w www.nhi.ie

of older persons require nursing

home care

4%

How many are employed within private and voluntary nursing homes?

Approx. 25,000 people are directly employed by private and voluntary nursing homes, contributing over 190m annually in direct taxation.

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, Dil ireann, 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.

AN OVERVIEW

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.

What issues are arising with fees payable for nursing home care?

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):

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 non-pharmacological 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.

NURSING HOME CAREWhat 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.