State Abusing Dominant Position in Nursing Home Sector


HSE pays itself up to 60% more than it forces the private and voluntary sector to accept for nursing home care


A fee of €4,082.00 per week in one HSE home

Private and Voluntary Nursing Homes are forced by the State to provide care for half the amount that the HSE pays for its own homes, new figures reveal.  Nursing Homes Ireland today said it has taken five years to prise this data out of the HSE.  NHI said it is no surprise it has taken the State so long to publish as it has been operating a system that discriminates against the private and voluntary sector. 

Publication today has laid bare the true cost of nursing home care and the implications of the failure to address this glaring inequity must be addressed by Government, NHI warns.  Failure to do so threatens the sustainability of the private and voluntary nursing home sector and the vital services provided.


NHI has called on the State to immediately engage with the private and voluntary nursing home sector to provide for the true costs incurred of meeting the high dependency care needs of residents in private and voluntary nursing homes.  NHI demands an equitable system be established for the financing of nursing home care under the Fair Deal, whether HSE, private or voluntary.


The long-withheld HSE data, which is accompanied by a litany of HSE-justified vindications for the higher costs, shows it pays its own nursing homes on average 53 per cent more than is paid to private and voluntary operators under the Fair Deal scheme and that State costs have jumped by an average 13 per cent since 2011.  Incredulously the HSE pays one of its own nursing homes €4,082 a week. 


“The State is discriminating in a scandalous way against private and voluntary providers,” said Tadhg Daly, NHI CEO.  “The State is operating a two-tier funding system and has fought for five years not to disclose these figures.  It is unacceptable that private and voluntary providers are forced to provide care for fees way below those paid to the HSE counterparts.  It is a case of one law for HSE operated nursing homes and a completely different one for the private and voluntary providers who are squeezed into accepting fees that are not reflective of the true cost of providing care.  Reform of the National Treatment Purchase Fund’s fee setting system for private and voluntary operators has to come now on foot of these outrageous inequities in the State scheme. The cost pressures are unrelenting and not being recognised in Fair Deal fees in the private and voluntary sector while the HSE just raids the budget, pays itself and increases its own fees by an average of 13% with no ‘negotiation’ or accountability applied.


“There is no justifying such enormous anomalies. HSE fees are devoid of accountability and transparency. There is no negotiation or requirement to justify the fees they pay themselves. Private and voluntary nursing homes are under intense, unjustifiable pressure because of the State pinning them against the wall when it comes to the negotiation of fees. No independent appeals mechanism is available if a private and voluntary nursing home deems a fee unacceptable. The State continues to abuse its dominant position within the sector, adopting a ‘take it or leave it’ approach during the fee negotiation process under the Fair Deal.”


“So while the HSE increases its own fees by on average 13 per cent on already inflated figures, it forces the private and voluntary sector to accept unsustainable fees. The public figures published today highlight a rotten inequality in respect of fees payable for care provision within Ireland’s nursing home sector.  The State is operating an upstairs/downstairs system of payments.  Private and voluntary nursing homes are the majority providers of nursing home care but are expected to do it at half the fees provided to State nursing homes. The sustainability of private and voluntary nursing homes is threatened by fees that are not recognising true costs incurred. Equality in fees payable must become an immediate priority within the Fair Deal. The buck has been passed in this regard by successive Ministers over a number of years and it now must be prioritised. Today’s publication must hasten the review of the Fair Deal pricing mechanism and bring into effect a fair pricing model that provides fees to private and voluntary providers that are reflective of the true costs of providing the high dependency care that nursing homes are delivering in our communities. Arising from today’s publication, we are calling for immediate increases in private and voluntary nursing home fees under the Fair Deal and engagement with the Department of Health and HSE surrounding this critical issue. “  


Editor’s Notes


For a number of years, NHI advanced the requirement for a fair price for care that recognises the true costs of providing nursing home care. A body of independent evidence and the Review of the Fair Deal scheme have highlighted significant shortcomings surrounding the fees payable to private and voluntary nursing home providers.


Furthermore, independent research has highlighted private nursing homes are the majority providers of specialist dementia care and HSE operated nursing homes are more restrictive in admitting persons with higher dependency care needs, being more inclined to refuse admission to those not independently mobile*. The average length of stay in all nursing homes is under two years, reflecting the high dependency care provided within these specialist care settings. Further independent evidence, commissioned by the Department of Health, has highlighted resident dependency levels not being acknowledged in fees payable to private and voluntary nursing homes and are not fair.** 


*Dementia Services Information and Development Centre, An Irish National Survey of Dementia in Long-Term Residential Care.


**DKM Economic Analysis: Potential Measures to Encourage Provision of Nursing Home & Community Nursing Unit Facilities – Department of Health, December 2015


Tadhg Daly, NHI CEO is available for further comment. Contact Michael McGlynn, NHI Communications & Research Executive at 087 9082970 or 01 4699806.


Irish Independent: Cost of care in public nursing homes same as six nights at Ritz, 6th October 2016

Irish Examiner: Fury at discrepancy in public nursing home costs, 6th October 2016

Irish Times: Minister defends discrepancy in nursing home costs, 6th October 2016

Breaking News: HSE run nursing homes '€700 a week more expensive more expensive than private facilities', 6th October

Public nursing home bed costs €700 more than private sector, Irish Times, 5th October 2016

Gulf in nursing home costs puts HSE on the spot, Irish Times, 051016

We're losing our staff to better paid HSE jobs, Irish Times, 051016




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