Nursing Homes Ireland calls on PAC to investigate Cost of Care in HSE Nursing Homes


Serious questions arising regard level of spending by the State on its own nursing homes – payments of up to 7 times the level given to private sector

Nursing Homes Ireland is to ask the Public Accounts Committee again to examine State spending on HSE nursing homes. After consistently refusing to disclose the cost of care in its homes over a five-year period, the HSE eventually last week produced some of the true costs of State spend.  In some instances, the HSE is paying its nursing homes up to seven-times more than fees being paid to private and voluntary counterparts raising issues of competition and displacement of staff using State aid.


In the figures, the average national cost of care was revealed to be 53% beyond the average national fee payable to private and voluntary nursing homes. Spend to provide care for circa 5,000 residents in HSE nursing homes is approx €366m per annum the figures reveal, whereas equivalent spend to support 17,000 in private and voluntary nursing homes is €602m.


Costs unveiled included €4,082 (Abbeyleix District Hospital), €2,584 (St Brigid’s Shaen), €2,089 (Cherry Orchard),  €2,022 (Ofalia House), €1,808 (St Joseph’s).  Within counties across Ireland, there are gaping discrepancies in the cost of care between HSE run nursing homes and the private and voluntary nursing homes.


An NHI analysis reveals huge differences in what is payable to HSE nursing homes as opposed to private and voluntary counterparts in counties across Ireland. Within County Laois, the average cost of a week’s care in the three HSE operated nursing homes is €2,720, as opposed to €910 in four private and voluntary nursing homes – a 199% cost differential. Within neighbouring Westmeath the differential is 135% - with two HSE operated nursing homes averaging €1,899 per week as opposed to average €808 for the 12 private voluntary providers. The difference in Longford is 108%, in Offaly 107%, in Limerick 83%.   


Tadhg Daly, NHI CEO said: ““For more than five years, successive Ministers and the Department of Health and HSE refused to divulge its costs. The now published costs highlight a glaring chasm and discriminatory practice between what the State will spend for care in its own nursing homes and what it will pay private and voluntary counterparts. It is incumbent upon the PAC to look at this critical element of health spend and to ask questions. The PAC would bring required accountability and transparency to bear on the HSE and the Department of Health. HIQA recently called for greater accountability to be applied to procurers of health services. The issue of public nursing home costs provide a prime example of accountability being absent and being allowed to go under the radar.  


“The enormous discrepancies in what the HSE is paying its nursing homes and what private and voluntary nursing homes are coerced into accepting is astonishing. How can it be justified that HSE nursing homes can be paid up to seven times the amount that  a private and voluntary nursing home will be paid. Where is the accountability? It took five years of concerted pressure for the HSE to finally divulge the costs of care in its nursing homes.  The HSE refused to answer parliamentary questions looking for the information year after year.”


“There is no requirement for the HSE to negotiate payments for each of its nursing homes. Yet private and voluntary nursing homes are being coerced into accepting fees that do not reflect the true costs of providing nursing home care. How can the national average 53% fee differential be justified? Independent research and analysis of nursing home care has outlined private providers are leading in providing dementia care and the present funding model is simply unsustainable.”


NHI wants the PAC to consider wider spend on HSE nursing homes, including the €385m investment in works for such nursing homes that was announced by the Department of Health in January, and whether such spend offers the taxpayer value for money. Unlike the HSE, private and voluntary nursing home fees must be utilised to cover capital costs, rates and other State charges incurred by their nursing homes so the HSE figures do not even reflect the full costs for the taxpayer.


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




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