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Oireachtas Report highlights fundamental issues that require redress to support nursing home care

Friday July 31, 2020

31ST July 2020: Nursing Homes Ireland notes publication of an interim report by the Oireachtas Special Committee on Covid-19 Response.  We are pleased the report acknowledges the enormous efforts of staff in nursing homes throughout COVID19 in providing intensive support, as well as noting that the geographic distribution of COVID-19 cases in nursing homes nationally was broadly consistent with that of the general population.

Tadhg Daly, NHI CEO states: “The report correctly finds the public health authorities were slow to respond to the threat posed by Covid-19 in nursing homes and engagement undertaken with our sector was not substantial or fully collaborative in nature. We note the recommendation that steps should have been taken to collaboratively involve all relevant stakeholders in the nursing home sector at the planning stage of the Covid-19 crisis, given the acknowledged higher level of risk to older people and nursing home population. It is absolutely vital the Committee’s recommendations for a comprehensive system of testing and tracing among nursing home staff continues along with appropriate stockpiling of PPE and other essential supplies.”

“We welcome the decision of the Committee to have further discussions with HIQA in September.  Our sector continues to ask why nursing homes were not a bigger priority in the preparations for the pandemic, why guidance was so slow to come and the purpose of the regulator’s latest report when it would have been better to come during the height of the crisis.  We hope the Committee will also get to the bottom of HIQA’s role on NPHET, which failed to focus on nursing homes at the outset.  It will be important too that the report of the independent expert group on the pandemic which is looking at nursing homes will be considered by the Committee too.”

“We believe the Oireachtas Committee should also recall the Department of Health and make it accountable for why it continues to hide critical reports regarding how nursing home care is supported. The review of the Fair Deal scheme, fundamental to funding the provision of nursing home care, remains outstanding three-and-a-half years after it was stipulated for completion. It tasked the NTPF with assessing the suitability of the scheme in meeting the care needs of residents. Coupled with this buried review is a Department of Health Value for Money assessment regarding HSE nursing homes and an examination of Fair Deal undertaken by the Comptroller and Auditor General.

“The Committee needs to set a roadmap for Government to support a long-term sustainable model of care for older people in Ireland.  Compounding the challenges presenting for Government will be the reduction of capacity in HSE nursing homes given their imminent requirement to comply with physical environment regulations. The impact this will have for the broader nursing home sector and for wider social care services requires a considered analysis. This loss of capacity is coupled with the closure of smaller private and voluntary nursing homes due to the failings of Fair Deal to acknowledge reality of costs incurred.“

“It is shocking that the Department of Health has informed the Committee the requirement for HSE nursing homes to meet HIQA’s revised deadline for required capital works will not be met. The report states: ‘The persistent delay in refurbishing community hospitals and community nursing homes will mean that it is likely that these facilities will continue to have challenges with infection control.’  This will likely lead to continued non-compliance with infection prevention within HSE nursing homes.”

NHI welcomes the recommendation that care for older people be integrated into the Sláintecare strategy. Mr Daly states: “The high-intensity, specialised and person-intensive clinical, health and social care provided by nursing homes will grow in requirement. As presented to the Committee, it is about ensuring an appropriate continuum is in place to meet the care needs of older people as per their requirements. Nursing homes are vital within our health services and will continue to fulfil an essential role in meeting the care needs of older people.”

“A national conversation is long overdue with regard to the intensive, specialised care provided by nursing homes. For many years, NHI has been highlighting to Government and the Oireachtas issues with regard to access to healthcare services in the community, fundamental failings with the Fair Deal scheme, the necessity to plan and resource a workforce to meet the specialised care needs of our older population. We welcome the recommendation for enhanced integration of nursing homes into the healthcare system.”

With regard to access to specialist care services operated by the State, Mr Daly states: “NHI has previously highlighted gross inconsistencies and discrimination being applied for residents in private and voluntary nursing homes in retaining access to specialist medical and healthcare services. As per our recommendation to the Committee, there is requirement for greater access to community healthcare services such as those provided by gerontologists, GPs, primary care specialists. As far back as 2013, an unpublished HSE audit highlighted the discriminatory nature in access to these vital care services for residents in private and voluntary nursing homes.”

The Committee notes a key factor in the enhanced response was the improved communication and working relationship between the HSE, HIQA, Department of Health and the private nursing home sector. “We are pleased the Committee notes the improved communication and working relationship between the HSE, Department of Health and the private nursing home sector as COVID19 developed.  This relationship must remain and be formally enhanced as we move forward,” Mr Daly states.

With regard to the funding model, he states: “This report adds impetus to the urgent requirement to address the failings of the Fair Deal scheme and bring into effect an appropriate and fit-for-purpose model to meet the specialised care needs of people requiring nursing home care. In the face of evidence informing it is not fit for purpose, Governments have failed to address substantive shortcomings of the scheme, which is ultimately responsible for funding nursing homes.  State homes have availed of fees twice those payable to private and voluntary operators operating beside them.”

The report also focuses on staffing requirements. “Government must now lead in assessing the challenges that present in terms of ensuring the staffing skill-mix and complement is available to meet the health and social care needs of residents in nursing homes who have high-intensity, complex care needs,” Mr Daly states. “Our long-standing call for Government to implement a workforce plan to address present and growing requirements in this regard takes on greater importance in the context of COVID19.”

Tadhg Daly is available for further comment. Interviews will be facilitated by Michael McGlynn, NHI Communications and Research Executive who can be contacted at 01 4699806 or 087 9082970.