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NEWS NHI News published by: Nursing Homes Ireland, Unit A5, Centrepoint Business Park, Oak Road, Dublin 12. Tel: 01 4292570 | Fax: 01 4291845 | E-mail: info@nhi.ie Visit us online: www.nhi.ie

S U M M E R

2 0 1 5

FAIR DEAL REVIEW

NURSE REGISTRATION

NON-ACTION CAUSES DISAPPOINTMENT

HEALTH COMMITTEE SEEK ANSWERS RE EXTRAORDINARY DELAYS


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COMMENT

Fair Deal review’s prolonged wait finally serves up disappointment

Tadhg Daly, Chief Executive Officer, Nursing Homes Ireland

“Let our advance worrying become advance thinking and planning,” Winston Churchill February 2015. Minister with Responsibility for Older Persons Kathleen Lynch TD and HSE Director General Tony O’Brien are before the Oireachtas Health Committee for the quarterly meeting between the Department of Health and HSE regarding health issues arising. Minister Lynch informs the Committee: “The review of the Fair Deal scheme is almost complete. The one thing it will tell us is that the fair deal scheme is unsustainable in its present form…there will have to be changes.” Recognising the crisis that would emerge within health sector arising from inadequacies of funding earmarked for the scheme to meet requirement in 2015, the Government subsequently allocated in April an additional €44million this year to fund an additional 1,600 nursing home places. This arose from recommendations of the Department’s Emergency Department Taskforce and was welcome, though it is important to recognise it brought the level of funding on par with what was committed to support access to nursing home care three years previously. Mr O’Brien states before the committee the scheme is perfectly set up to become demand-led but the problem arising is “there is lots of demand but insufficient resources, and this is a direct result of demographic change within society”. He goes on to outline the intrinsic role the scheme fulfils in wider healthcare delivery and the importance of appropriately resourcing it: “It could be said that the funding mechanisms and the arrangements for the Fair Deal scheme, as welcome as they are in terms of the benefit it brings to those who can gain access, has become the achilles heel of the acute hospital system. There is a direct correlation between the increase in waiting time and the increase in numbers on the waiting list for the scheme, the numbers of delayed discharges in hospitals and the numbers recorded as waiting for admission on hospital trolleys each day.” When the scheme commenced in 2009 the Department of Health committed it would be reviewed after three 01 — NHI NEWS

years. When present Government assumed office in March 2011, its programme for Government contained a commitment Fair Deal’s “system of financing nursing home care will be reviewed with a view to developing a secure and equitable system of financing for community and long-term care”. This Government has gone on to drag its heels in this regard. When crisis hit Fair Deal in Summer 2011 and the scheme was temporarily suspended due to resourcing issues, then Minister for Health James Reilly stated review would be undertaken in 2012. In February 2013 Minister Lynch informed Dáil it was envisaged review would be completed that year. In 2014 we moved away from a definitive timeline, with Minister informing Dáil the “exercise is broader than was first envisaged and the various issues arising are now being systematically considered with a view to completion and publication as early as possible”. Three years beyond when it was originally envisaged, the review was published in July. Following on from the prolonged wait, the published review has proved very disappointing. With Government heading into final straight of its five year term, very disappointingly the review has ‘kicked for touch’. This Government – commissioned review has absolved Government of requirement to ‘grasp the nettle’ and address the sustainability issues threatening the functioning of the scheme that Minister Lynch and Mr O’Brien have warned of. Announcing its publication, the Department stated: “The future financing of the Scheme is considered in the Review. The Government has decided to make no changes in this area.” This is despite the grave warnings brought before the Health Committee at start of year. The announced establishment of a “Working Group” to oversee implementation of report recommendations is a classic Government tactic of stalling changes or actions that address the fundamental issue of sustainability. Independent stakeholders will not participate on the working group; it is State bodies being brought around the table. A number of previously published independent analyses of the nursing home sector have pointed to the requirement for an evidence-based cost-of-care funding model that recognises the differing complexity of care requirements of persons requiring the continuous, specialist care provided by nursing homes. Again disappointingly, the issue of an appropriate funding model has been put on the long-finger, with this review recommending a further review of the present funding model to be conducted within an 18 month period and submitted to Department of Health. This again enables Government ‘kick for touch’ on a critical issue and it will now be put on the table of its successor. Furthermore, it is astonishing the review has recommended the current commissioners of care – the NTPF - undertake the review into the pricing model.


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CONTENTS NEWS UPDATE News from Nursing Homes Ireland, the representative organisation for the private and voluntary nursing home sector. In this issue NHI states we must not allow the conversation re older person care to become polarised, with the requirement for the focus to be upon providing people with the right care suited to their health and social care requirements. NHI launches a substantial piece of research designed to support Members in the use of restraint and bed rails. In nurse recruitment matters, the HSE has committed to continue nurse adaptation programmes for final quarter of 2015. READ ALL ABOUT US! The residents of St Elizabeth’s Nursing Home in Co Meath are compiling a book of short stories and poems. Daffodil Day 2015 sees residents and staff of nursing homes raise funds for the Irish Cancer Society and the Irish Hospice Foundation has benefitted from fundraising endeavours at a Dublin nursing home. Creativity was recently evident in a Co Tipp nursing home and in a neighbouring home the Alzheimer Society of Ireland was the beneficiary of a tea party that raised €1,500+. All in this edition’s Read All About Us. FAIR DEAL SCHEME REVIEW The long-awaited review of the Fair Deal scheme was published July. Key points within the Department of Health commissioned review are outlined. NHI has expressed disappointment the review has put on the long-finger the requirement for an enhanced funding model to support nursing home care and stated concern further prolonging actions required will present crisis for nursing home care and wider health services. NURSE RECRUITMENT Over a prolonged period NHI has lobbied key stakeholders regarding extraordinary delays being experienced by nurses registering for employment in Ireland. NHI Members have lobbied their local TDs to inform of the crisis emanating because of the delays and at NHI’s Oireachtas Open Day in June, Members of the Oireachtas Health Committee – along with TDs from across the political spectrum – met with NHI representatives to be informed of how critical an issue it is. The Health Committee subsequently invited NMBI to appear before it to explain the causes behind the delays and seek assurances issues would be addressed. NHI ANNUAL SURVEY NHI’s Annual Survey 2014/2015 presents key statistical data re the private and voluntary nursing home sector and outlines challenges facing the sector in the provision of care. Despite increasing requirement for nursing home care, the number of such nursing homes in Ireland has decreased by nearly 4% over past five years. NURSING HOMES WEEK 2015 Wonderful celebrations were hosted by nursing homes across the country to celebrate Nursing Homes Week 2015. This edition of NHI News features a fantastic spread of pictures and details of celebratory events that took place across the country.

NHI ACKNOWLEDGES SUPPORT OF

The prolonging of required actions are against a backdrop of review predicting requirement for 9,000 additional Fair Deal places within nine years. I am reminded of John F Kennedy warning: “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction.” Modern advances in living standards and health and social care mean people are living longer and our older population is increasing in numbers dramatically. This is to be celebrated but with it comes responsibility. Governments must face up to the considerable challenges of planning for the health and social care service requirements that are imminently escalating. It is very disappointing that this long-awaited, important review of a critical component of older person care will serve to expedite important actions that are necessary to place on a sustainable footing the Fair Deal scheme and the required enhancement of its payment model to reflect true cost of older persons residential care requirements. The forthcoming election provides an opportunity for all parties and candidates to outline their proposals to provide a coherent framework for nursing home care planning, funding, regulation and service delivery based on inclusive dialogue with providers and stakeholder groups. We’re presented with a prospective crisis in older person care and for wider health services that can be foreseen and addressed in time. Courage and political will is required to grasp the matters arising with the conviction necessary to ensure a fit-for-purpose framework is implemented to support the residential care requirements of our older population.

Tadhg Daly, NHI CEO

Thanks to all supporters of NHI, many of whom are featured in this newsletter. Please note, NHI is not responsible for third party services advertised in this publication. Inclusion in this newsletter does not endorse, recommend or imply any approval of the suppliers listed in this publication.

NHI NEWS — 02


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NHI UPDATES Committed to excellence in care www.nhi.ie

@NursingHomesIre

NHI research re use of restraint & bed rails

It’s the people that make the difference NHI ran a three-week national advertising campaign in June to promote nursing home care and employment within NHI Member homes. . NHI - It’s the people that make the difference ran across national radio – RTE Radio One, Newstalk, 4FM - and featured two nursing home residents and their carers: Emma, Sarah, Alan and Tony. Pre- and post-campaign measurement highlighted the campaign created significant growth in awareness of NHI and of the invaluable healthcare support that nursing homes provide in Irish communities. It focussed on the attention to detail afforded to residents in nursing home care. The compassionate, person-focussed care within nursing homes delivers extremely high levels of employment satisfaction. Building relationships, bonds and friendships with the people in nursing home care provides immense job satisfaction. The campaign informed NHI Member homes offer a great place to both live and work. Listen again to the advertisements by visiting www.nhi.ie > NHI Events > NHI: It’s the people that make the difference. Job opportunities in NHI Member homes can be viewed at www.careersinnursinghomes.ie

NHI has launched a substantial piece of research designed to support Members in the use of restraint and bed rails. A Review of the Literature on Restraint and the use of Bedrails was undertaken by Dr Kevin Moore, Lecturer in Nursing, Academic Lead, Continuing Professional Development Provision, and an Associate Member of the Institute of Nursing Research in the School of Nursing, University of Ulster. The publication was launched at NHI Education Day: Audit & Research Workshop: Developing Quality Improvement Tools for the Private and Voluntary Nursing Home Sector. “This review will help guide and inform practitioners accordingly by organising in a coherent manner the current published literature on bed rails,” the publication states. “Consequently practitioners will be enabled within the scope of their professional practice to deliver appropriate evidence-based standards of care and to ensure that they are compliant with appropriate legislation, best practice evidence and policy guidance whilst doing so." NHI Members can download the review by visiting the Members section of the NHI Website and visiting Education/Training Days>Education / Training Days 2015 > Audit & Research Workshop 2015.

NHI informs Department analysis of measures required to encourage new nursing home beds Key barriers facing the private and voluntary nursing homes sector in providing additional capacity to meet long-term residential care requirements of ageing demographic have been outlined by NHI for a Department of Health commissioned analysis of required actions to meet demand. NHI has informed DKM Economic Consultants, who are undertaking the Department’s Analysis of Potential Measures to Encourage the Provision of Nursing Home and Community Nursing Unit Facilities, lack of a clear and cohesive policy and national strategy poses one of the biggest challenges to the long-term sustainability of the nursing home sector. This is combined with uncertainty around current and future funding arrangements. An analysis of the demographics confirm that there will be significant pressure in the area of residential care but also on the wider health and social care system for older people, NHI stated in its submission. Key barriers to additional capacity outlined within the submission include: P Absence of a Fair Price for Care and acknowledgement of cost of care

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Monopoly purchaser under the Fair Deal P Arbitrary and unfair process of ‘negotiation’ of rates under the Fair Deal P Absence of a sophisticated commissioning model P Absence of a clear cohesive national strategy (a road map for the future). Government need to create an environment, through public policy, to create conducive environment for existing operators P Ad hoc decisions by government and HSE – in 2014 reducing Fair Deal budget at a time of increased demand P Uncertainty around funding arrangements, delay in Fair Deal review P Access to bank funding and requirement for operators to bring 30% equity P Multi annual funding required for Fair Deal to address and prevent waiting lists Visit the Members section of the NHI website – www.nhi.ie – and view the submission within the ‘NHI Submissions’ section. P


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Demographics indicate future crisis NHI warning to State re Physical in caring for our rapidly ageing population unless we plan properly Environment Compliance Nursing Homes Ireland (NHI) has said the reality of care for older persons in Ireland is that it is all under-resourced. Speaking during Nursing Homes Week 2015, Tadhg Daly, NHI CEO, said that the rate of increase in Ireland’s ageing population meant that a range of policies and services need to be developed urgently to address the challenges this presents. He said: “We must not allow the conversation to become polarised about nursing home care versus home care and vice versa. Suggestions in the media indicating that the number of people receiving nursing home care in Ireland is high relative to other European countries are extremely wide of the mark.” An assessment of OECD statistics re long-term care utilisation in European countries shows Ireland has a low proportion of its older population residing in long-term residential care. Ireland ranked 9 of 15 countries in respect of such utilisation, with 3.6% of its ‘older population’ – persons aged 65+ - living in long-term care. Switzerland has highest proportion with 6.1% and was followed by Netherlands (5.6%), Luxemburg (5.5%), Sweden and Norway (4.9% each), and Finland at (4.7%). Germany and Denmark each have 4% of older people living in long-term residential care. “As our population ages, and it is doing so at a rapidly increasing rate according to demographic figures, the focus should be on providing people with the right care suited to their requirements,” Mr Daly said. “People have a preference to live at home for as long as possible but when people are assessed as requiring nursing home care, the key is ensuring that they access nursing home care in a timely fashion, with nursing homes providing holistic, life-enhancing health and social care of the highest calibre by thousands of dedicated staff across the country.” “The reality is, once people are assessed by independent medical and healthcare professionals as requiring nursing home care as part of the Fair Deal Scheme, it is vital they get access to this care in a timely manner.”

Extension of the remit of the Office of the Ombudsman The remit of the Office of the Ombudsman will be extended to cover the private and voluntary nursing home sector from 24th August. A series of information sessions for nursing home providers and liaison officers nominated by nursing homes will be hosted by the Ombudsman during the month of September. In respect of remit of the Office of the Ombudsman, it is important to note: P The Ombudsman is not a regulator; P

Complainants must first have exhausted the internal nursing homes’ complaints process as required by the Care and Welfare Regulations and provide documentary evidence to the Ombudsman before a complaint will be accepted for consideration;

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Complaints about clinical judgements are also expressly excluded under the statutory instrument;

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Only complaints which relate to matters post the commencement order (24th August 2015) will be accepted. Retrospective complaints will be refused;

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The remit of the Ombudsman extends to all private and voluntary nursing homes that may be in receipt of State funding (whether this funding is paid directly or indirectly to the nursing home) such as Fair Deal, Contract/ DDI Beds, etc. It is important to note that complaints may be made by any resident (or their representative) in the nursing home regardless of whether that resident is in receipt of State funding or not.

In order for the public to have full confidence in the proper administration of the regulatory regime for nursing homes, standards – with particular reference to HIQA’s physical environment standards – must be applied fairly and consistently across all designated centres – public, private and voluntary, NHI has stated in correspondence to the Authority. In report published 12th July, the Sunday Business Post stated HIQA was in advanced discussions with the HSE over the future of public nursing homes that did not meet a July 1 deadline to comply with physical environment standards. An Freedom of Information reply provided to NHI by HIQA was quoted within report, stating 21 public nursing homes had been re-registered and a further 90 were “in progress” of being registered. The report quoted Tadhg Daly, NHI CEO: “Private providers have stepped up to the plate and invested heavily. Any dilution [of standards] would be unconscionable.” The report quoted an NHI letter to HIQA, sent 2nd February this year, stating: “In order for the public to have full confidence in the proper administration of the regulatory regime governing residential care settings for older persons, it is essential that the standards are applied consistently and fairly across all designated centres – be they public, private or voluntary. It is our view that the discriminatory application of Standard 25 [Physical Environment] by the Authority to public and private/voluntary sector nursing homes amounts to an anticompetitive practice, contrary to Irish and EU competition law, including Article 106 of the Treaty on the Functioning of the European Union which governs state aid measures.” The report quoted HIQA as stating: “The authority’s approach to this matter is to ensure consistency and proportionality and that each centre application for renewal of registration is deliberated upon on a case-by-case basis.” In article headlined HIQA adopts get tough stance on nursing homes, the Irish Times reported 4th August the Authority is becoming increasing frustrated at inaction within the health service regarding requirement for HSE nursing homes to meet physical environment standards. The article stated HIQA is adopting a "get tough" policy re physical environment standards and July deadline that has now passed. It stated HIQA had issued two proposals to refuse registration to two HSE nursing homes in the past month and it had proposed ten further centres be prohibited from admitting new residents. Upgrading or rebuilding public nursing homes will cost about €500 million, the article adds.

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NHI UPDATES

Clinical Adaptation Programmes 2015-2016: NHI have had regular meetings with the HSE and the Department of Health on the continuation of the clinical adaptation programme for non-EEA trained nurses and we are delighted to advise that the current model will continue without change for the remainder of 2015, providing 2 further clinical adaptation programmes. The HSE will continue the programmes under the current regime with scheduled programmes in September 2015 and November 2015 providing adaptation placement for 62 (provisional) candidates. 5 further programmes have been provisionally provided to the sites currently offering the programme (from April ‘16 – Nov ’16). Following NHI lobbying and representation the HSE has submitted a funding request to the Department of Health for the continuation of the additional programmes in 2016. The addition of the 7 (2 extra in 2015 and 5 in 2016) programmes will provide a further 277 places for NHI Member nurses only and we see this as a demonstration by the HSE and Department of Health of their commitment to work closely with NHI to address the issue of overseas recruitment.

RCSI Assessment for Overseas Nurses (alternative to the clinical adaptation programme): An RCSI (Royal College of Surgeons in Ireland) initiative to enable registration for overseas nurses through a two-part assessment programme could be ratified by NMBI Board in coming weeks for roll-out in latter part of 2015. The assessment will be a two-part model comprising of (1) knowledge assessment and (2) objective structured clinical exam. Both would take place at the RCSI and it is confident of commencement of the programme in latter part of 2015 - November or December. It is hoped the NMBI Board will ratify the initiative at its September meeting. The RCSI has advised priority will be given to nurses awaiting adaptation places. This will enable nurses gain registration in a more timely manner, with extraordinary delays being experienced at present (as reported within this edition of NHI News). NHI is of the view this is a very welcome initiative. It is encouraging its Members who have nurses overseas awaiting adaptation to engage with these nurses to encourage them to apply for NMBI registration ASAP so they can have a decision letter once the RCSI assessment exam is rolled out.

Recruitment Options – Nursing Agencies: NHI are working closely with our recruitment partners on our Members’ behalf to recruit nurses already booked by members from The Philippines, The EU and India. These recruitment campaigns are ongoing and we look forward to the first intake of these nurses by the end of 2015. Please contact NHI if you have not already booked a nurse through one of these options.

A NEW VENUE! NHI Annual Conference & Care Awards 2015 Thursday, 12th November 2015 Double Tree by Hilton, Burlington Road, Dublin 4

Further details to follow! 07 — NHI NEWS


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ENTER A L N UT RIT ION

More Energy1

More Flavours1 More Protein1

The dessert with.....

Ref 1: Fresenius Kabi Internal Data 2015. Date of prep: March 2015 / EN/creme/001.15

.....so much more1


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READ ALL ABOUT US! What activities are taking place in your home? How are residents fullling their lives? What celebrations are taking place? Read all about us! offers NHI Nursing Homes the opportunity to publicise the wide-ranging activities that are taking place in homes across the country. It provides an excellent opportunity to publicise nursing home life in the positive light it should be seen in and members are encouraged to make us aware of what is going on. You can send any articles or pictures of interest to michael@nhi.ie.

Creative writing in Co. Meath t Elizabeth’s Nursing Home in Co Meath started a creative writing group for their residents over a year ago. The group meet once a week and start their session with word-games and brain exercises to get the creative juices flowing. After this comes the writing of a poem or a short story about a topic the residents decide on themselves. Maria Brady, Activity Coordinator at the Athboy Nursing Home states: “The writing is collective and creativity and imagination is improving continuously. Everybody gets to put in their views and opinions. The group is great fun for all involved and we are currently compiling a book containing these short stories and poems.” P

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The Creative Writing Group. Picture are, back, from left, Maria Brady, Activity co-ordinator, Joan Byrne, Deputy Person in Charge. Front, from left, Sarah Halton, Liam Houston, Teresa Flavin, Mary Tevlin, Oliver Halton and Nancy Halligan.


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Generosity of nursing Bloomsday homes raise funds for celebrations at Cancer Society Ashford House Daffodil Day 2015 saw the residents & staff of Larchfield Park Nursing Home raise almost €1,000 for the Irish Cancer Society. Residents and staff of Millbury Nursing Home in Co Meath also participated in Daffodil Day 2015. Great fun was had by all, with staff baking buns, breads, cakes and cookies that were enjoyed with a cups of tea that were shared amongst residents and visitors. The home also hosted music and over €700 was raised for the Cancer Society from the morning.loves to hear it.” P

Residents and staff at Ashford House Nursing Home in Dun Laoghaire, Co Dublin, come together on an annual basis to celebrate Bloomsday and 2015 was no different. This year’s celebrations took place Sunday 14th June and included readings, live music and a champagne breakfast P

Icy treats at Churchview

Annabeg supports Hospice

Residents and staff of Churchview Nursing Home, Dublin, enjoyed tasty ice-cream treats recently P

€1,000 was raised for the Irish Hospice Foundation recently by all at Annabeg Nursing Home. With works being undertaken in Annabeg, the builders joined in the fundraising endeavours P

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READ ALL ABOUT US

St Martha’s support Alzheimer Society

Creativity in Willowbrook

Over €1,500 was raised for the Alzheimer Society of Ireland by St Martha’s Nursing Home, Cahir, Co Tipperary, when residents, staff and visitors participated in a tea party. Staff and residents are pictured presenting a cheque to Ms Catherine Bartlett of the Alzheimer Society P

The residents of Willowbrook Lodge, Co Tipperary, celebrated their creativity to coincide with the Bealtaine Festival by creating a selection of felt items including toys and small handbags. With the assistance of staff, they also designed invitation cards for the Strawberry Fair that the nursing home hosted during Nursing Homes Week 2015 P

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13 — NHI NEWS


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Risk Management Training Wednesday 23rd September 2015 Hodson Bay Hotel, Athlone. The training, specifically devised for Long Term Care, will cover the following topics: x Risk Management Training o Introduction to Risk Management o Principals of Risk Management o Legislation/Standards guidance o Risk Management Framework x Registers for Risk management x Developing a Risk Register x Individual Risk Management

Cost: ΦϯϬϬ per person. Attendees will receive a Certificate on Completion of the course. For more information please contact 093 36126 or email mairead.campbell@healthcareinformed.com


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FAIR DEAL SCHEME REVIEW

Key points within Review of the Nursing Home Support Scheme, A Fair Deal extracts FAI R DEA L RE QUIREMENT

j Within the overall long-stay population, it is anticipated 23,965 people will be in receipt of support under the Nursing Home Support Scheme by end 2015. This is estimated to grow to 33,070 by 2024. PUBLIC SECTOR CAPA CI Ty j If Government policy is for the public sector to continue to provide circa 20% of all nursing home capacity, this will require public nursing home beds to increase by approximately 1,200 beds by 2024, with an associated capital cost for the provision of these beds [note, this excludes prospective closure of public nursing home beds due to HIQA Physical Environment Standard compliance]. PRIVATE SECTOR CAPACITy j 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. However, Nursing Homes Ireland has indicated that, while there is an appetite to invest in delivering extra capacity including short stay/intermediate type care, there may be merit in stimulating the sector via a series of measures including: m Guarantees of future NHSS funding m Advance price agreements m Extensions to the length of contracts m Tax incentives to encourage targeted development. j The fact that lenders now require developers to provide upfront capital of approximately 30% of the total development costs is a limiting factor. There may not be sufficient ready capital available from existing nursing home operators to co-finance the levels of additional capacity needed over the coming years, resulting in private development only by larger operators. Lenders have expressed concern about this as it concentrates their lending risk more than they would wish. ME ASURES TO EN COURAGE PROVISI ON OF FU TURE NURSING HOME CAPA CI Ty WITHIN PRI VA TE SE CTOR j The Ireland Strategic Investment Fund has identified the nursing home sector as one that could provide a rate of return and an outcome that is compatible with the Fund’s mandate. The Fund would offer loan finance on fully commercial terms (this is not preferential funding) but it could still be a available stimulus to increasing private investment activity. j Detailed consideration should be given to potential new models of collaboration between the public and private sectors. Such new models might provide for a private operator to finance, build and operate a facility. j While sheltered housing appears to offer significant benefits over the longer term, it is currently under developed in Ireland. In developing this sector, it is important that scarce health sector funds remain effectively focussed on healthcare requirements. For example, the creation of an intermediate care model which falls between care at home and long-term residential care is as likely to attract people who may otherwise remain at home, though socially isolated, as it would those in long-term residential care. Those who would shift up from home care may, in many cases, have social housing issues rather than healthcare issues. PRICE SETTI NG IN PRI VA TE NURSING HOMES j Prices paid historically and prices prevailing within a given geographic area are relevant to the price setting process as is the need to achieve maximum value for taxpayers’ funds. P R I C E O F C AR E j The average weekly cost of care in a public facility was €1,390 and

17 — NHI NEWS

in a private or voluntary facility was €893 at end 2014…The headline price differential in the average cost of care between public and private facilities is approximately 58%. j A complete revamp of the pricing system, to one based on dependency categorisations could lead to upward pressure on pricing, and could give rise to considerable complexity in trying to adjust as residents move between dependency categories. j In the medium (within 18 months) the NTPF should review the present pricing system and submit proposals to the Minister for Health with view to: m Ensuring that there is adequate residential capacity for those residents who require higher level or more complex care; m Ensuring value and economy, with the lowest possible administrative cost for clients and the State and administrative burden for providers; m Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible. j The review of the pricing system may require professional and independent costing and other technical and relevant expertise. PUBLIC NURSING HOME PRI CE S j Pending the introduction of any new pricing model the HSE should be required to publish the cost of care on an annual basis. j Costs for public facilities appear to be in excess of what applies in private facilities. j The cost of public long-term residential care should be based on a pricing model that is objectively and consistently formulated, and which takes account and accurately quantifies unavoidable price distortions. j As a result, a Value for Money and Policy (VFM) review will be carried out by the Department of Health which will focus on the extent to which the existing cost differential can be attributed to inherent differences between public and private sector cost structures (eg pay levels), and should identify and analyse the reasons for existing differentials. VOLUNTA Ry NURSING HOME PRICING j The consultants identified a number of options to secure the position of these facilities, but considered that the solution is likely to differ for each facility. Options proposed include: m An increase to the current rate payable to them under the NHSS m A proposed reduction in operating costs; m A change from long-term residential care provision to alternative service models or to a mix of services, such as long-term residential care and respite care. FUTURE FINA NCING OF FAIR DEA L j Reduce Asset Disregard: Currently the first €36,000 of a person’s assets (or €72,000 for a couple), including savings are not taken into account during the financial assessment. By abolishing this disregard altogether, additional contributions of up to €50 per week per couple would be payable by those with assets or savings. By reducing it to €20,000 (or €40,000 for a couple) additional contributions or €23 per week could be payable, yielding an additional €13.1 million in a full year. j Increase the asset contribution: It is estimated that an increase in the rate of contributions based on case and other relevant assets could yield the following additional full year revenues: m 7.5% to 9.5% - €6.6m m 7.5% to 11.5% - €13.4m


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m 7.5% to 13.5% - €19.9m m 7.5% to 15.59% - €26.7m j Increase the asset contribution based on the principal private residence: Currently 36% of nursing home residents have reached the three year cap. If the PPR is subsequently sold, the proceeds of the sale are assessed as cash assets as long as the person remains in longterm residential care. This anomaly has created a perverse incentive not to sell homes, leading to properties being left vacant. Removing or extending the 3 year cap would remove the current disincentive to sell vacant homes. It would, however, lead to the fuller dissipation of the value of PPR (ie for inheritance and other purposes) in over one-third of cases. j Farms and small businesses: Further consideration will be given to the application of the asset-based contribution to family farms or other family businesses where relevant asset generates a household’s income, and where the asset would in the normal course pass on to the next generation as a primary income source. j Increase the income contribution: It is generally acknowledged that a contribution of 80% of income is fair, if the only source of income is the State (non-contributory) pension. However, for those with higher incomes increasing the rate to eg 85% for other income sources could be considered, subject to safeguards providing residents with a minimum amount of income. PRINCIPAL PRIVATE RESIDENT (PPR) OWNERSHIP j Currently approximately 56.4% of applicants to the scheme have been assessed as owning a principal private residence (PPR). The review states HSE believes that reasons for the low rate of PPR ownership declared under the scheme may include: m People are paying privately and waiting 3 years before applying for NHSS; m 5% of clients were admitted more than 3 years before applying for financial support under the scheme and consequently, such clients did not need to submit details of their PPR; m Farmers are transferring their farm and PPR to their adult child and retaining a ‘right of residence’ in the PPR for the remainder of their lives; m Applicants having transferred their PPR to a family member wait until the five year term is up before applying for the scheme; m Applicants have sold their PPR and are renting a smaller more manageable PPR; m Where a couple’s PPR is valued at €72,000 or less and there are no cash assets, the value of PPR is disregarded as per the legislation. j “The fact remains that declared levels of home ownership by NHSS applicants warrant further consideration.” j The consultants considered that there was no standard practice across local NHSOs when reviewing and validating financial declarations. CHA RGES FOR NON-FAIR DEA L SE RVICES j To deal with the issue of additional charges, it is recommended that nursing homes should have a published fee schedule showing all the costs associated with being a resident. j Consideration should be given to including in the Deed of Agreement with facilities details of what additional charges are proposed, of the opt-out arrangements that exist for residents, and confirmation that residents will not be charged for extra services that they cannot participate in because of their dependency level or lack of capacity. RE SIDENT CONTRIBUTION j Resident contributions amounted to approximately €293 million in 2014. j At end 2014 the average weekly contribution from residents in a public unit was €285 and in a private unit was €294.

j The Average cash assets of scheme participants during year 2014 was €49,590.

j Average value per participant of other relevant assets (including principal private residence and other property) was €88,941.

j Just over 9% of applicants opted to defer the portion of their contribution.

j The average declared income for applicants assessed on a single basis was €281 per week.

j The average declared income for applicants assessed jointly (as part of a couple) was €562 per week. SOURCE OF FAIR DEAL APPLICATIONS yE AR 2014 j 43% from people in acute hospitals j 40% from people in the community j 9% from people in private nursing homes j 1% - people from mental health & disability sectors AVERAGE LE NGTH OF STA y j When the scheme first commenced the average length of stay was approximately 4 years and at end 2014 had reduced to 1.9 years in private and in public facilities for those who had entered long-term residential care since the scheme commenced. j At end 2014, taking account of ‘saver’ cases (1.4.11), the overall average length of stay for private nursing homes was 2.9 years and 3.9 years for public nursing homes. The overall average length of stay was 2.93 years (35 months) SOCIA L CARE IN I RE LAND j At present 90% of frail older people in Ireland live at home with 80% living well and independently (HSE National Clinical Care Programme). j Approximately 4% of older people in Ireland are supported by the State in long-term residential care j Nationally, approximately 8% of the population over 65 years are in receipt of some type of home help services. j An integrated approach to service developments, including all relevant stakeholders, will provide a more comprehensive model of care for older people and will facilitate co-ordinated and integrated planning for the provision and delivery of services across home and community care, transitional care, acute hospital care and long-term residential care. j If community based services are to be developed and strengthened, consideration should be given to rationalising and centralising budget provisions for these services. j It should be recognised that those living in the community have different costs associated with daily living and it would, therefore, not be appropriate to apply a rate of contribution based on current NHSS arrangements to those who are living at home. ACCESS TO THERAPEUTIC SERVICES j In some areas where demands exceeds what can be provided, there appears to be a de-prioritisation of nursing home residents and in these circumstances the only option remaining is to pay for such therapies privately. National policy foresees equal access to primary care services, regardless of the place of residence, which means that a person in long-term residential care setting should receive the same level of services as they would if they remained in their own home, and it is important that this policy is implemented consistently by the relevant HSE personnel. GP SE RVICES j There is strong case for requiring nursing homes to offer access to a “house” doctor in each facility. Acquired brain injury j In the absence of a price setting mechanism based on dependency, it may continue to be necessary for HSE to make top-up payments in circumstances where very specialist care is required.

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FAIR DEAL SCHEME REVIEW

NHI disappointment in review that ‘kicks for touch’ HI has expressed disappointment the long-awaited review of the Nursing Home Support Scheme (Fair Deal) has put on the long-finger the requirement for an enhanced funding model to support nursing home care. The review was published by the Department of Health 20th July and emanating from its publication, the Government has decided to establish an internal working group, composed of representatives of a number of Departments, the HSE and the National Treatment Purchase Fund, to oversee implementation of review’s recommendations. The Review was carried out by the Department in collaboration with the HSE, with input from Deloitte and Touche as external consultants. This article outlines the NHI response to matters emanating from the review.

N

PRICING MOD E L NHI welcomed publication of the “long over-due” review of the scheme but expressed disappointment that in respect of the pricing model used to determine fees payable to private nursing homes, it is effectively recommending a further review and fails to bring forward required actions to support providers in care delivery. Tadhg Daly, NHI CEO stated: “We welcome the review’s recognition of the challenges facing private and voluntary providers in respect of pricing and the recommendation to increase the transparency of the pricing mechanism so that providers can make as informed decisions as possible. “A number of previously published independent analyses of the nursing home sector have pointed to requirement for an evidence-based cost-of-care funding model to recognise true costs of providing nursing home care. Disappointingly, the issue of an appropriate funding model has been put on the longfinger, recommending a review of the present system within an 18 month timeframe. This is effectively recommending a further review emanating from a review. Further prolonging actions required will likely present crisis for older person care and for wider health services. Furthermore, NHI believes this should be undertaken independently and not by NTPF as recommended within the review. The NTPF are the current commissioners of nursing home care.” PUBLIC NURSING HOME COSTS Despite repeated representations by NHI, the State has refused to update the fees it pays to HSE-operated nursing homes. Private and voluntary nursing home fees are published on a consistent basis, but the most recently published fee for HSE counterparts date back to March 2011. In May, NHI accused the State of a cover up in this regard, with Tadhg Daly stating: “There has been a very deliberate policy of supressing the costs for fear of the chasm between public and private and voluntary nursing home providers being realised. The reality is private and voluntary nursing homes are being forced to provide care for rates that are at least half those provided to their public counterparts.” The review stated average weekly cost of care in a public home was €1,390 at end of 2014, by comparison with €893 in a private and voluntary home and recommended public costs be published on an annual basis. “Given it is over four years since the cost of care for public nursing homes was last published, the review’s call for such costs to be published on an annual basis will, if applied, apply a level of transparency regarding cost of nursing home care that has been absent from State homes on long-standing basis,” Mr

19 — NHI NEWS

Daly said. “A 58% price differential between public and private/voluntary providers is outlined, with review stating costs for public are in “excess” of what applies in private counterparts. ACCESS TO THERAPIES The issue of the discriminatory nature of access to nursing home therapies was brought forward during the consultation process by NHI. The organisation has previously said a "postcode lottery" exists, whereby access can differ significantly for residents in nursing homes within short proximity to each other because of differing HSE authorities. The review stated national policy foresees equal access to primary care services, regardless of place of residence, and this must be implemented consistently by HSE. “It is critical the review recommendation that HSE implement policy in this regard is addressed,” Mr Daly said. BRINGING STAKEHOLDERS TOGETHER Given the range of alternative services and supports that are available to older people, it is important that more is done to consolidate all of these efforts and initiatives, the review states. “An integrated approach to service developments, involving all relevant stakeholders, will provide a more comprehensive model of care for older people and will facilitate co-ordinated and integrated planning for the provision and delivery of services across home and community care, transitional care, acute hospital care and long-term residential care,” it recommends. Mr Daly said the review “reinforces the absolute requirement for the Department of Health to bring all stakeholders together to ensure an integrated approach in care delivery for older persons”. He added: “In general the Nursing Home Support Scheme has met its key objectives of providing security and certainty to members of society requiring longterm residential care. The scheme is a key component of the Irish health system and meets the needs of those people requiring long-term care and their families. This long-overdue review is welcome and outlines critical challenges facing Ireland in providing nursing home care. “In tandem with long-standing evidence, it recognises the considerable growth in requirement for nursing home care in coming years, stating there will be requirement for additional 9,000 persons to be supported by the Fair Deal Scheme. The challenge reinforces the absolute requirement for the Department of Health to bring all stakeholders together to ensure an integrated approach in care delivery for older persons. “This report sets out challenges in respect of requirement, pricing and funding for wider healthcare delivery for our older population. This is against a backdrop of rapidly ageing population, with review highlighting population aged 80+ will increase by 37% to year 2021. As review states, NHI has affirmed appetite exists amongst private providers to meet the significant challenges in providing the additional capacity required to meet our older population’s long and short-stay residential care requirements – but require an appropriate framework to do so. “This report cannot be left lie idle. Kicking the can down the road will see a drastic scenario of older people not accessing nursing home care and languishing in hospitals. This review must provide further stimulus for us to face up to the enormous challenge facing us in meeting the care requirements of our rapidly increasing ageing population.”


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NURSE RECRUITMENT

Nurse Registration delays brought before Oireachtas Health Committee Over a prolonged period NHI has lobbied key stakeholders regarding extraordinary delays being experienced by nurses registering for employment in Ireland. NHI has held a series of meetings with the statutory authorities to inform of the very serious implications of the delays, with nursing homes identifying suitable nurses to fulfil posts but being unable to fill positions arising from considerable delays in NMBI’s registration process. NHI Members have lobbied their local TDs to inform of the implications in this regard, with bed capacity under threat if staffing requirements cannot be fulfilled. At NHI’s Oireachtas Open Day on 24th June, Oireachtas Health Committee Members – along with TDs from across political spectrum met with NHI representatives and the crisis presenting in registration was laid bare. The Health Committee subsequently invited NMBI to explain the causes behind the delays.

dditional resources have been allocated by the Department of Health to assist NMBI in clearing a backlog of 2,000+ nurse registration applications, the CEO of the Board has informed the Oireachtas Health Committee. “The Department of Health has recently authorised additional resources to assist us in respect of the overseas registration delay backlog,” Dr Maura Pidgeon informed the Committee on 16th July, after NMBI had been asked to explain the delays in registration process. The Board acknowledged it is taking months to respond to applicants who have submitted incomplete documentation. It did not commit to timeframe as to when present backlog of 2,016 applications awaiting processing would be cleared – 698 of them beyond a year – but outlined measures being undertaken to address crisis including staff replacement, identification of an internal manager to oversee clearing the backlog, and development of an online resource to support application process.

A

EXTENT OF PROBLEM Dr Pidgeon outlined to the Committee the extent of the problem, with 2,016 applications being processed, “70% of which cannot progress due to incomplete documentation having been received”, and 698 of the applications (35%) having been in the system for more than 12 months. “Reflecting the lift in the economy, some 974 applications were received between January and June of this year, which compares to 302 applications received in the same period last year,” she stated. “Notable contributory factors to the delay include staffing levels and funding at NMBI, with revenue being significantly less than expected for 2015, due to a lower than expected annual retention fee for the year. This funding crisis has created uncertainty and insecurity among staff in the organisation with the subsequent increase in staff turnover for the first half of this year. Eleven staff have left between January and June 2015. This has added to the challenges of processing applications.” Her colleague, Ms Ursula Byrne, Deputy Chief Executive and Acting Director of Regulation at the NMBI, said in respect of the 698 applications in system one year plus that it is the policy of the Board if it has not received all the required documents by end of calendar year the file is closed. “However, closing files requires resources and we took a decision to prioritise trying to progress those files that are still active and ongoing, rather than diverting resources to closing others,” she added. Dr Pidgeon stated the Board has “engaged in a collaborative process with key stakeholders so that we can improve the process while maintaining the integrity of registration”. “Those involved in the process include representatives from the HSE, Nursing Homes Ireland, independent private hospitals, directors of nursing and midwifery, human resource experts, systems and analysts and NMBI registration staff.”

21 — NHI NEWS

Deputy Jerry Buttimer, Chair of the Committee, explained the meeting arose because of the ‘knock-on-effect’ delays in the registration of nurses and midwives are having upon delivery of essential health care services. Deputy Caoimhghín O’Caoláin, Sinn Féin Health Spokesperson, referred to pre-discussion briefing from NMBI that stated nine vacancies would be filled on an interim basis, but it had experienced an “exodus of 11 staff”. He said: “I would expect the positions to be on a full-time basis”. “The Nursing and Midwifery Board of Ireland appears to be late in responding to identified need,” he added. Deputy Seamus Healy expressed concern the presentation painted a picture of “difficulties almost amounting to crisis level within the organisation”. Dr Pidgeon replied: “Essentially, we have a number of full-time staff working on a short-term basis - that is, for a period of six months.” She said of the 11 staff who left, three left for promotion and opportunities elsewhere and other staff were on short-term contracts. Ms Byrne said there are 15 steps in the process of authenticating registration applications and if concerns arise applicants are asked to provide clarification. Deputy Buttimer asked how quickly NMBI communicates with applicants who have submitted incomplete documentation. “In previous times, that would have been a maximum number of weeks,” Ms Byrne said. “At present, in some instances, it is running to a number of months.” STAFFING Dr Pidgeon added: “This is one of the areas that is clearly a target for additional resources. It is simply the sheer volume of applications coming in and the ability to do even the initial identification of a shortage of documents. This is one of the areas that the working group, which includes our partners and colleagues from the employers and their agents, is drilling into in terms of working together to address this issue. In addition to targeting the backlog that has built up, another requirement is to work with employers if they wish to identify somebody and help applicants in the application process while they are overseas. It is complex. We have provided additional and more simplified information in that respect, but the issue is to work with them in identifying that before the forms even come in. They are two elements of trying to deal with the backlog over time.” She said 11 of 51 staff had left in the first six months of the year and the issue of recruiting further staff would be dealt with by the end of July. “We have to get approval from the Department of Health to replace permanent staff, so they have been approved, plus one,” she added. She further added the staff would be replaced on a short-term contract for a period of six months. “The reasons for that are, first, that we have to finalise the funding of the organisation – creating permanent positions in the absence of firm funding arrangements into the future would not be very prudent. The second reason for short term-contracts is that we wish to address the current crisis in terms


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of the backlog and fixing and enhancing our processes. On that basis, we will evaluate the progress being made because with enhanced systems and with more online capacity as we get towards the end of the year, there may not be the need for the same numbers of staff. It will be evaluated over that period of time.” WEBSITE & CALL CENTRE Dr Pidgeon said a new website that will improve the application process will be developed before year end. “We have also reviewed, and had been reviewing, our internal registration processes in regard to simplifying the process and providing greater clarity of instruction and guidance to applicants,” she told Committee. “That was in tandem with the development and restructuring of our website to have greater online capacity. That will come on stream by the end of the year. There will be a completely new website. It is not just about a fancy page. It is about the restructuring and the development of core applications to enable us to do our business online as a modern organisation.” She said a call centre to deal with the volume of calls and email inquiries relating to registration and restoration would be expanding and an internal manager to lead in clearing the backlog of applications “and develop a robust and sustainable process to prevent further backlogs of this nature” had been identified. ‘TARGET DATE’ Deputy Mary Mitchell-O’Connor said she has visited nursing homes that have informed they will be required to close beds if nurses cannot be secured. “HIQA instructed one nursing home to stop taking in

residents until it is able to fill its nursing vacancies,” she said. “I am particularly worried about nursing homes…I absolutely understand the staffing issues but if we must close down nursing homes and hospitals are backed up with acute beds being kept by patients we have a serious problem.” Deputy Healy asked is there a target date for when it will be back to a “manageable situation”. “It is quite difficult to identify a target date as to when it will be business as usual and we have a normal sustainable process,” Dr Pidgeon replied. “We will have additional staff by the end of the month. Our new website will be available in October which will provide online facilities. Over the course of the coming months we will work with our partners to have a more manageable process in place.” Deputy Buttimer pressed for a date when backlog would be cleared. “Not until I have the staff to assess the situation,” Dr Pidgeon said. “We hope that by the end of month or by August we will have a clearer picture as to the progress being made and we can advise the committee when we have a definite picture.” Later in the debate, Dr Pidgeon said: “We do fully appreciate and acknowledge the difficulties that have been experienced from the perspective of nursing homes and private and public hospitals. This is why we have been listening and have engaged in open information sessions and workshops to deal with the timeframes around the cycle and the adaptation programmes. The restructuring of our website will provide for some online capacity in the initial stages this year. The procurement of an information management system for registration will allow for infinitely more online capacity and the development of a smoother system for registration of all calibres.”

KEY FINDINGS Senator Colm Burke raised the issue of nurse adaptation places with the NMBI. He said: “I also wish to raise the issue of adaptation courses. I understand from Nursing Homes Ireland that more than 300 people have to take adapatation courses. Is there an adequate number of adaptation courses available and, if not, what mechanism is being put in place to ensure there will be an adequate number of them?” He continued: “This question of the availability of adaptation courses is an important factor in addressing the broader issue. My understanding is that the HSE is not providing an adequate number of courses and Nursing Homes Ireland has had to enter into discussions with other organisations about putting courses in place. That needs to be clarified. We can complain all we like about delays in registration but if the adaptation courses are not in place, we are not really achieving anything.” “At present there are 241 places and an additional two adaptation courses will be available in August through the HSE’s structure which will provide for an additional 140 places,” Dr Pidgeon said. Ms Byrne said: The HSE has indicated to us in the last two days that it is putting on more courses in the coming months. As I mentioned earlier, a number of private hospitals have applied to be approved as sites for adaptation programmes and their applications are currently under assessment. We expect decisions to be reached and issued very shortly.” dementia.

NHI BRIEFING TO OIREACHTAS COMMITTEE Prior to NMBI appearance before Oireachtas Health Committee, NHI and its Members had ongoing engagement with TDs and Senators to outline the crisis facing the nursing home sector because of extraordinary delays with the nurse registration process. An NHI briefing to Committee Members prior to NMBI appearance stated there is “immense frustration” amongst candidates and their prospective employers because applications are being submitted but responses are not forthcoming. The briefing stated it is presenting crisis for the sector and bringing enormous pressures upon providers. NHI said nurse candidates are being denied opportunity to meet the clinical care requirements of persons requiring long-term residential care in a timely manner. “This is no idle warning. There is real and present threat to bed capacity if increasing numbers are not recruited, with nursing homes facing bed closures,” NHI further added.

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www.careersinnursinghomes.ie Promoting careers in the Irish Nursing Home sector NHI continues to promote the NHI nurse recruitment careers website nationally and internationally. The dedicated NHI Member recruitment website is currently seeing over 2,000 unique new web-users visiting it on a monthly basis. This website allows current vacancies to be uploaded as well as promoting individual nursing homes as a great places to work. Remember to visit the website regularly as it becomes an eective recruitment tool for all. The website is reaching candidates worldwide. We therefore urge you to upload your vacancies and promote your nursing home as this is one key tool we will use when meeting nurses in forthcoming recruitment drives. For further information and a step by step guide to register your vacancy please contact gråinne@nhi.ie


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NHI ANNUAL SURVEY

NHI Annual survey highlights reduction in nursing homes & increase in staffing costs On Tuesday 30th June NHI published its Annual Survey that collated statistical data for private and voluntary nursing home sector for year 2014. It outlines the challenges facing the sector in provision of care and further emphasises requirement for a clear and cohesive national long-term care strategy to enable sector create required capacity.

D

Author of the report Brian espite increasing McEnery, Partner & Head of requirement for Healthcare, BDO, said: “BDO is nursing home care, delighted to undertake what we the number of nursing view as an important piece of homes in Ireland has decreased research in the nursing home by nearly 4% over the past five industry. We believe it is vitally years, NHI’s Annual Private important that operators in the Nursing Home Survey 2014/2015 industry can make strategic has revealed. decisions based on informed Commissioned by NHI and data. We hope that this survey undertaken by BDO, the survey will give operators the knowledge found between years 2010 – when they require to make these survey last undertaken – and 2014 decisions. It’s clear from the there had been a significant results of the survey that many slowdown in the number of nursing homes are operating in additional beds being provided by an environment in which their the sector. cost base is increasing while at the It showed the appetite exists same time they are struggling to amongst providers to develop achieve an appropriate additional bed numbers in the Pictured at the launch of the NHI Annual Survey are, from left, remuneration rate to fund these coming years to meet the increase Brian McEnery, Partner & Head of Healthcare, BDO; Tadhg Daly, NHI costs. This is a trend that appears in requirement for long-term CEO; Kathleen Lynch TD, Minister with Responsibility for Older likely to continue at least into the residential care. Co-sponsored by Persons; Michael Lauhoff, Head of Growth at Bank of Ireland Business near term, however, it is essential Homecare Medical Supplies and Banking; Hilary Coates, Head of Health, Bank of Ireland; Michael that this is addressed as without Bank of Ireland, the survey was Cosgrove, Director, Homecare Medical Supplies. adequate funding the industry launched by Minister of State at will not be capable of attracting the Department of Health the necessary investment to provide the new bed capacity required to Kathleen Lynch TD at Bank of Ireland Business Banking Centre at accommodate the increasing older person population in Ireland.” Mespil Road, Dublin, on Tuesday 30th June. Welcoming publication of the Survey, Minister Lynch said: Tadhg Daly, NHI CEO stated the lack of a clear and cohesive “The data contained in this report illustrates the very important role national long-term care strategy is posing a huge challenge to the the private and voluntary nursing home sector fulfils in meeting the sustainability of the nursing home sector. “2014 was another health and social care requirements of our ageing population. As challenging year for the private and voluntary nursing home sector illustrated by the survey, the sector is a significant employer within in Ireland with costs continuing to increase, in particular labour the health sector and in both urban and rural communities. This costs,” he stated. “The increase in operating costs and increased sector is vital within the continuum of care available for our older dependency levels of residents, together with the failure of the NTPF population and of key importance to healthcare delivery in Ireland.” as monopoly purchaser to provide a Fair Deal rate appropriate to the The survey, commissioned by NHI, was undertaken by BDO in early cost base, threatens the sustainability of current provision.” 2015 when a detailed questionnaire was sent to every registered “The worrying drop in the number of homes since 2010 risks private and voluntary nursing home in the country. becoming a trend unless the State does more to underpin the sector’s Commenting on the report, Michael Lauhoff, Head of Growth future viability. While this survey gives a clear indication of the desire at Bank of Ireland Business Banking, said: “We have had a dedicated on the part of private and voluntary homes to expand their services healthcare team for many years who have a depth of understanding to meet the care requirements of our ageing population, ongoing of the financial requirements and challenges of this critical sector. uncertainty around the financing of long-term care under the Fair The team was further strengthened by the appointment of Hilary Deal scheme and serious issues surrounding the recruitment of Coates late last year, who has extensive experience in the health nurses threaten the sustainability of current provision. We need to sector, having joined the team from HIQA. Our commitment to better develop a range of policies and services to address the support the future investment requirements of the sector is challenges all this presents. NHI reiterates its long-standing call for underpinned by our lending approvals in excess of €135 million over the Department of Health to take the lead in bringing stakeholders the last 18 months and our allocation of a further €100 million to around the table through a Forum that would advise Government support the continued development and expansion of the nursing regarding appropriate planning and policy to meet the growing home sector throughout the country.” demand for nursing home care.”

25 — NHI NEWS


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Peter McGuinness, Director, Homecare Medical Supplies, also a cosponsor, said: “Homecare Medical Supplies are delighted to be supporting the launch of the NHI Annual Survey Report 2014 & 2015. This survey further informs and allows the healthcare sector to better manage the delivery of high quality care, enhancing quality of life and better health outcomes. Homecare Medical Supplies will continue to partner with NHI, its members and the healthcare sector towards continuously improving the care we offer to our community.”

Copies of the report are available via the Members section of the NHI website, www.nhi.ie or can be purchased from NHI head offi ficce by contacting it at (01) 4292570.

Minister Lynch discusses NHI Annual Private Nursing Home Survey 2014/2015 findings with Tadhg Daly, NHI CEO, and Hilary Coates, Head of Health, Bank of Ireland.

KEY FINDINGS P

The survey found that there are 437 private and voluntary homes providing a total of 22,342 beds in Ireland. The previous survey undertaken in 2009 showed 447 private and voluntary nursing homes providing 20,590 beds.

P

Nationally there is now one private nursing home bed for every 20.23 persons aged 65 and over in the Republic of Ireland.

P

National average occupancy is 90.58% in 2014. This represented an increase of 4.18% since 2009.

P

The average weekly rate nationally prevailing under the Nursing Home Support Scheme (Fair Deal) for accommodation in private and voluntary nursing homes was €896. This compared with an average fee of €850 in 2009. The latest published HSE fees for cost of care date back to 2011, stating average Fair Deal weekly rate at €1,245.

P

Average turnover per bed for most recent financial year was €44,451.

P

Staff costs account for 61% of turnover in respondents homes.

P

The national average staff cost per registered bed was found to be €27,130, an 18% increase since 2009.

P

42% of respondents stated they plan to create additional beds within a year.

P

9% of nursing homes had 25 or fewer beds; 26% 25 – 39 beds; 35% 40 – 59 beds; 30% 60+ beds.

P

59% of rooms were single en-suite; 11% single; 16% double en-suite; 7% double; 7% multiple.

P

79% of residents were Fair Deal; 12% private payers; 6% contract; 3% subvention/other.

P

Average annual food cost per resident in 2014 was €2,487, an increase of 13.4% since 2009.

The survey also found that over 65% of residents cared for in respondents’ homes were in the high or max dependency categories, compared to 54% in 2009. P Approximately 45% of residents were reported to have been clinically diagnosed with dementia.

P

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A New Era in Risk Management The path to a comprehensive model of risk management within residential homes has not been the easiest of ventures. Risk management was, for many, a laboured process aligned more with health and safety requirements rather than a strategic tool underpinning all aspects of care and service delivery. dŚĞ ŵĂŶƚƌĂ ŽĨ ͞&ŝƌƐƚ ĚŽ ŶŽ ŚĂƌŵ͟ was the guiding principle in the initial residential care legislation where risk management was concerned, however, away from the requirements of the regulation, the reality of organisational and resident needs was starting to demand more from the risk management process. Risk Registers were evolving to encompass corporate risk management, resident care and service provision as well as the standard health and safety risks, however, the drive to utilise the model for positive individual outcomes remained somewhat removed from the risk management methodology. Over the last year, a new focus has emerged for risk management, guided by the Health Information and Quality AuthŽƌŝƚLJ͛Ɛ Guidance for Designated Centres: Risk Management (2014) and international best practice, this time with a focus on individual risk management. A model has now emerged of what individualised risk management for residents should look like, that being using evidence based information to make balanced judgements between resident goals and wishes and unnecessary risk. Comprehensive risk management now requires the residential home to investigate specific individual risks, for example, risks relating to: x Potential new activities for a resident, x Personal medical concerns, x Unique resident difficulties. In response to these risks, proactive and reactive responses are required to ensure that resident quality of life is prioritised within the provision of individualised care. Involvement by the resident from the outset, with full consideration of their wishes, is also viewed as central to the success of an effective risk management model. Risk is an inherent part of our everyday lives ʹ it can never be completely eliminated but the residential homes are incumbent to manage risk appropriately from all angles within the organisation. As the risk management process has developed, the guiding principle in relation to residents has progressed from position of preventing negative occurrences towards supporting resident positive advancement, which will assist the residential home in having a clear understanding of the strategies required to ensure resident quality of life in an ever changing environment. Health Care Informed (HCI) have developed a risk management model and tool kit for designated centres that meets national requirements and international best practice to support the provision of safe and effective care with a central focus on improving resident quality of life.


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NHI News Summer 2015  
NHI News Summer 2015  

It's a colorful spread - the Summer 2015 edition of NHI News! Nursing Homes Ireland's newsletter features a spread of colourful, fun images...

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