A 68-BED community hospital for older people built at a cost of €16.4 million is still lying idle in Dingle, Co Kerry, while the independent Health Information and Quality Authority (Hiqa) completes a registration process.
That process, obligatory under 2007 legislation for residential facilities for older people, has been under way for some time but was largely unanticipated by the Health Service Executive (HSE).
More than 40 older patients are being forced to remain in what donors of the hospital site describe as "Dickensian conditions" in the 19th-century St Elizabeth's hospital. It is where Irish author Peig Sayers died. Open wards prevail.
There is one shower facility on each of two floors. Fire certification poses challenges and infection control is difficult because of a lack of single wards.
Other west Kerry patients bide their time in long-stay facilities 40 miles away in Killarney because there are no other residential care facilities in their area.
The full extent of Hiqa's concerns are not clear. But it has concerns about room size, en suite facilities and handrails - including rails in the new facility's gardens.
Earlier this summer, the transfer by the HSE of the 43 elderly people at St Elizabeth's, many of them bed-ridden, was called off within days of the scheduled date.
Relatives had packed up belongings; staff had worked overtime getting used to the new facilities; administrative material and religious objects had been moved. No alternative date has been given.
In reply to Dingle councillor Brendan Griffin (FG), the HSE has outlined how the new hospital had been in the planning process for a decade. The design team was appointed in 2001 by the Department of Health.
"The new building was briefed, designed, contracted and completed (December 2008) at a time when the standards (published in April 2009) and the regulations (enacted July 2009) were not in place," the HSE said. It said it was aware of draft standards but these had not been finalised and delaying might have put the contract for lands and hospital at risk.
"The HSE's clear understanding was that this facility was designed, developed and fully built prior to the introduction of the standards, and that it would be dealt with separately in any future registration process."
Putting in place the new building standards will require building alterations, additional costs and a reduction in beds, the HSE said. It has now received a notice of proposal from Hiqa and has 28 days to reply.
The condition of the old hospital remains a concern, the HSE stressed. It wants to transfer the patients to "a position of safety in a new building which has fire certification and which can deal with infection control issues".
It has also emerged, in the course of exchanges between Cllr Griffin and HSE personnel at a recent health forum, that the HSE only commissioned Hiqa to carry out the registration process in February 2010.
Dingle councillor Séamus Cosai Fitzgerald (FG) said this weekend he had visited the new nursing unit. "It's finished. It's out of this world . . . The general public couldn't see anything wrong. The old hospital is visibly deteriorating," he said.
Hiqa has said the process it was obliged to carry out was "ongoing". So far in 2010, some €144,000 has been spent on lighting, heating and other costs for the unit.
Maura and Shane O'Connor, donors of the five-acre site at the entrance to Dingle town, have expressed their disbelief.
Mr O'Connor said the old building was "Dickensian" and the patients and their families were "devastated" at the delay.