There are a number of anomalies to be sorted out in the nursing-home sector - not least the fact that the State seeks higher standards in nursing homes, while at the same time bargain-hunting for cheap beds, writes Paul Costello.
The latest report of poor nursing standards and physical conditions in some nursing homes in Ireland is a matter of very serious concern.
It leaves all families with relatives in nursing homes concerned, and it is also very upsetting for the many nursing-home operators who do the job well and are offering first-class care. Unfortunately, there is a sense of all nursing homes being "tarred with the same brush", and this is most unfair.
From the standpoint of the Irish Nursing Homes Organisation (INHO), these latest developments again underline the urgent need for agreed minimum standards of care in all nursing homes, public as well as private, and the establishment of an independent inspectorate.
The presence of the MRSA bug does not necessarily reflect the standard of care and hygiene in the affected home.
Patients coming from a hospital to a nursing home can have this bug without a diagnosis to that effect. The HSE has produced guidelines on how to manage the problem, and the INHO has issued these to all its members.
We fully support the guidelines and want all our members to take them on board and implement them.
As the largest national representative body for the private nursing-homes sector, we want to see proper, independently-verified standards of care, so that patients and their families can have full confidence and reassurance.
So how do we establish public confidence in the nursing-home sector?
Well, there are a number of anomalies which do need addressing. Under the law, private nursing homes are required to be inspected every six months and the HSE is currently seeking to establish standardised, State-wide inspections.
However, there are no inspections of State-owned nursing homes. This is not a level playing pitch for care standards, and yet the media focuses mostly on private homes.
The INHO maintains that all nursing homes, public and private, should be subjected to the same minimum standards of inspection, and that the inspectorate should be independent of the HSE.
There are about 28,000 nursing home beds in the State; the private sector provides about 17,000 of these, and the other 11,000 are provided by the State.
We make this point because the State, through the HSE, is also the largest purchaser of beds in the private sector.
And the harsh reality is that the State wants to purchase care from the private sector at significantly less than what it costs the State to provide care itself.
We believe the HSE cannot have it both ways: looking for higher standards throughout the nursing-home sector, and bargain-hunting for beds at the same time, with the inevitable consequence of driving down care standards.
Earlier this year, the State purchased a block of beds in private nursing homes through a tendering process, and now the HSE is about to seek a further 250 nursing home beds in the Eastern Region.
I hope that the State purchaser won't simply settle for the lowest- price provider, but will also base the decision to purchase on proper care standards.
To ensure those standards, we need a suitable benchmarking system. For the past six months, the INHO has been working with the Health Services Accreditation Board on a pilot project to introduce a special residential care accreditation scheme for nursing homes, and it is hoped this standard will be available by next January.
We are actively seeking the support of the Department of Health and other stakeholders for the introduction of minimum standards, and rewards for those nursing homes seeking to deliver a standard above the minimum.
We are currently undertaking research to benchmark minimum levels of care and costing its provision. We expect to be in a position to outline progress on this at our annual conference next month.
Nursing homes need minimum staff-to-resident ratios, including qualified nurses and care assistants.
The standard of care depends largely on the number of staff and how well they are trained.
The INHO recommends mandatory training for care staff in both public and private facilities, covering such matters as health and safety, hygiene and manual handling, nutrition and feeding, and also palliative care. 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 wellbeing, with periodic review of residents by a geriatrician.
This might also involve establishing consumer panels.
There should also be an independent qualified building inspectorate for both private and public facilities, which would focus on risk assessment for elderly residents.
The true cost of proper nursing-home care must also be determined. We have commissioned independent professional financial advisers to undertake this exercise.
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, can transform the sector from being a commodity to being a caring service.
The INHO supports nursing homes that operate to a high standard of care and aspire to best practice in care of the elderly.
We want to raise the bar across the sector, both public and private.
Our residents and their families deserve nothing less. And when our aims are achieved, public confidence will be restored.
Paul Costello is chair of the Irish Nursing Homes Organisation