Nursing homes need better support to cope with growth in ageing population

Today marks the beginning of Nursing Homes Week 2015, a campaign by Nursing Homes Ireland (NHI) featuring countrywide events and activities celebrating the positivity of nursing home care.

But the rate of increase in Ireland’s ageing population, similar to many countries worldwide, means that as a nation we need to develop a range of policies and services to address the challenges this presents.

An analysis of the demographics in Ireland confirms there is going to be increasing pressure in the area of residential care, but also on the wider health and social care system for older people.

The nursing home sector has a vital part to play. It employs approximately 25,000 people who contribute over €190 million annually to the Exchequer through taxation paid; and we forecast up to 10,000 jobs could be created over the next decade to support potential future growth and development.

However, the latest data shows a decrease in the number of nursing homes operating in Ireland, from 447 in 2010 to 437 in 2014. Despite this there has been a 9 per cent increase in private and voluntary nursing home bed numbers – 20,590 to 22,342.

The figures show that additional capacity is being added by existing providers. And approximately 42 per cent of private and voluntary nursing homes indicate that they are prepared to increase the number of beds in their facilities in the coming year.

However, the current arbitrary system for setting rates through the National Treatment Purchase Fund (NTPF) of "local market price" and "county averages" is illogical. If this policy continues, it may stymie current plans and the additional capacity required as well as further development in rural locations based on the current low level of NTPF fees.

The current and future arrangements for the funding and financing of nursing home care must take account of the more acute needs of our ageing population and the actual costs incurred by nursing homes in providing care to people. For example nursing homes that also care for dementia residents require a variable payment plan to match the needs of those residents, as recommended by the Oireachtas Health Committee (July 2014) and the Dementia Services Information and Design Centre (DSIDC – Jan 2015).

The provision of extra beds by existing providers challenges will significantly help future challenges to be met, as the existing operators have the necessary experience and a proven track record in what is a highly regulated market.

But the Department of Health and the Government must address the issue of a "fair price for care" if they wish the private and voluntary nursing home sector to provide those required additional bed numbers . The model of funding must provide a sustainable basis for the delivery of high quality nursing home care and also allow for on-going investment in service development.

Serious issues surrounding the recruitment and retention of nurses are also threatening bed capacity in nursing homes. The HSE Clinical Adaptation Programme must be extended beyond August 2015 to tackle the large number of nurses on the waiting list for placement. The Department of Health must also ensure adequate resourcing of the Nursing and Midwifery Board of Ireland to ensure the board can address the current delays in registration of nurses. In this respect there is an urgency for engagement with stakeholders to deliver a workforce plan for the entire health service (public, private and voluntary) that will place the increasing demand for gerontological nursing at its centre.

NHI reiterates its long-standing call for the Department of Health to take the lead in bringing stakeholders around the table through a forum that would advise Government on planning and policy to meet the growing demand for nursing home care.

Private and voluntary nursing homes are uniquely positioned to tackle the challenges, having the necessary experience, knowledge and proven track record.

Department of Health strategy must ensure that the increasing numbers of our population that require nursing home care are able to access the care they need in a timely and cost effective manner.

Nursing Homes Week 2015 marks a key moment for the increasing number of older people requiring long-term residential care in Ireland. It provides an opportunity for the Department of Health to address the challenges relating to policy and funding in respect of long-term care. But we need the State to plan with us for the decades ahead now, not when the crisis has deepened.

Tadhg Daly is CEO of Nursing Homes Ireland