The State is bargain-hunting for nursing home care, and driving down standards in the process, writes Paul Costello
As the representative body for private nursing homes, the Irish Nursing Homes Organisation is extremely concerned that proper standards of care apply in the sector. It wants quality assurance to be independently verified, to the satisfaction of patients and their families. To help achieve these objectives we have recently agreed a policy to guarantee minimum standards of care.
It is regrettable that the majority of nursing homes in Ireland are not members of any representative body. Peer pressure within an industry is an important means of raising standards. The INHO has been contributing to the work of the Health Services Accreditation Board in formulating a residential care accreditation scheme. This scheme of determining excellence in the provision of care will be available to all nursing homes from early 2006.
A key point, however, is that whatever standards and regulation are applied to the private nursing home sector should also apply to the public sector. Many of the problems of the private sector stem from a monopolistic purchaser of care (the State) which is also the sector regulator. The State wants to purchase care from the private sector at significantly less than what it costs the State to provide care itself.
The State is now bargain-hunting for care and this needs to change because it is driving down the standard of care. Particular evidence of this approach by the State was shown in the recent tendering process for the procurement of beds in the private sector
The guiding policies to which the INHO is now committed include:
demanding excellence in care through standards, training and education;
supporting members by providing information and advice; and
influencing public policy and debate surrounding care of the elderly.
We believe there should be an independent regulator and inspectorate for nursing homes, both private and public.
We also believe there should be an independent purchaser of care for the elderly. Our members are happy to compete with the public sector so long as the public sector uses appropriate (non-subsidised) costing.
This will reveal that the cost of providing a public bed is typically three times what the State is willing to provide a nursing home resident in enhanced subvention.
The INHO is undertaking research of international protocols to determine what the minimum levels of care should be. In the meantime, we believe that the levels recommended by the former Western Health Board should apply. They stipulate a minimum of one nursing/care assistant for seven residents from 8am to 2pm; one nursing/care assistant to eight residents from 2pm to 8pm, and one nursing/care assistant to 15 residents from 8pm to 8am.
There should also be an independent qualified building inspectorate for both private and public facilities which would focus on risk assessment for elderly residents.
Of course, staff training is another crucial issue as minimum staffing levels is not a guarantee of excellence in care. The INHO recommends mandatory training for care staff in both public and private facilities, covering such matters as safety and health at work, hygiene, nutrition and palliative care.
The INHO is particularly concerned that many care assistants have no formal training and consequently don't even know what best practice is.
We are also studying how nursing homes should be monitored from the perspective of resident well-being, with periodic review of residents by a geriatrician.
There has been some controversy about the capital allowances available for building nursing homes. While we are not against the improvement of the bed stock in Ireland, the INHO recognises that some developers build nursing homes for tax-saving purposes. We are willing to recommend the withdrawal of capital allowances on the proviso that the benefit to the Exchequer is ring-fenced and used to fund training and improved standards in the private sector.
We would also like to see the true cost of nursing care determined by independent professional financial and economic advisers (co-funded by the public and private sector). There are proven international models of calculating the true cost of care and the practice of looking for the cheapest has to stop. The introduction of minimum standards, together with a fair independent costing method, will help transform the sector from being a commodity to being a caring service.
To summarise: the INHO supports nursing homes that operate to a high standard of care and aspire to best practice in care of the elderly. It wants to raise the bar across the sector (public and private). To do this the sector needs to be taken seriously and consulted by the State authorities
We strongly believe the Department of Health and Children should use the proposed standards legislation in the autumn to require all private nursing homes to be a member of an approved representative body. All operators should feel peer pressure, both for themselves and their staff.
Paul Costello is chairman of the Irish Nursing Homes Organisation