Sir, – In your editorial “Irish Times view on nursing home ownership: people need more options” (January 10th), it was stated that the biggest drawback of the trend toward bigger, privately operated facilities is that the model does not work in rural settings. You quoted a recent report from the Economic and Social Research Institute (ESRI) which revealed that almost one in five small residential homes (with less than 30 beds) closed between 2020 and 2022, while on the other hand the provision of long -term residential care by large privately owned for-profit operators accounts for 74 per cent of the 31,723 nursing home beds in the State, with the balance made up of voluntary and public providers. The same ESRI report states that the market is now dominated by 15 large operators who control 38 per cent of beds with all but one of them being financed by private equity, with increasing evidence from the US (Gupta et al, 2021), England (Patwardhan et al, 2022) and other countries that the introduction of private equity has changed the landscape of health and social care, and often results in poorer outcomes for residents.
Yes. People need more options and especially in the West and rural counties like Mayo, where the percentage population of older people are highest and where there are already insufficient long-term care beds available. And yes, there is another option available. The St Brendan’s Community Village Project Mulranny, Co Mayo, has stood the test of time and works very well for the people we serve. We provide a service that is broader than a nursing home. It is a continuum of housing care beginning with people living in their own home with supports, through to sheltered housing and when needed, moving to high-support care – all within our local community. People get housing and care appropriate to their needs along the continuum in their own locality. This includes respite, convalescent and palliative care and timely use of intravenous antibiotics locally for life-threatening diseases which helps keep people out of hospital, and allows earlier discharge. By supporting people to stay locally, we have saved our village. St Brendan’s village was established 25 years ago and is a registered “not for profit” community-run charity. It is funded through a mix of the Fair Deal scheme, some State funding, donations and fundraising. It comprises 16 low-support sheltered houses and a 25-bed high-support unit and is the biggest employer in the area with 51 staff. However, the long-term viability of this fully integrated community facility is threatened by the same challenges which have already forced the closure of 34 smaller nursing homes since 2020 (with 30 of those outside the Dublin region).
Our nearest HSE facility is nine miles away and cannot meet local need. However, all HSE Mayo facilities receive on average 60 per cent more State funding per resident per week (€668) from the National Treatment Purchase Fund compared to non-HSE facilities such as St Brendan’s – and both are subject to the same admission criteria, standards and HIQA regulations.
If community-based and community-led continuum of care housing services such as ours are to survive, then Government must recognise this model as part of how we meet people’s needs and give equity with HSE facilities. I am aware that a complaint has been accepted by the EU to be heard against the Government about this inequity.
Unless the Government levels the playing field for smaller not-for-profit housing and care providers, the warehousing of older person’s care into expensive, large, private, urban nursing homes will accelerate.
People should be given the choice to stay locally rather than having to travel to live for the rest of their lives at a distant greenfield site where they know no-one.
The Government has established a Commission on Care which will begin its work shortly. I am calling on the commission as part of its upcoming work to recognise the value of our community-based and community-led continuum model and to invest in this approach as part of the future, not just in Mulranny but nationwide.
The State’s approach should facilitate community based social enterprises to go beyond sheltered housing and expand into providing a broad continuum of housing and care for older people within their localities. There is no reason why there cannot be a St Brendan’s village in every community. We are providing the approach which our older people want. – Yours, etc,
Dr JERRY COWLEY,
Chairman,
Mulranny Day Centre Housing CLG,
Mulranny,
Co Mayo.