The Republic could face a shortage of about 62,000 staff to fill healthcare assistant roles over the next 12 years, a new report for the Department of Employment has forecast.
Healthcare assistants (HCAs) provide assistance, support and direct personal care to patients and residents in hospitals, clinics, nursing homes and facilities for older people and generally work in support of nurses or other health professionals.
Since June 2021, workers from outside the European Economic Area can seek an employment permit to work as an HCA, provided they have a job offer with an annual salary of €27,000 or more.
The report by consultants KPMG examined the impact of these arrangements on the labour market.
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The report suggests that HCAs employed under a work permit, particularly in private nursing homes, are earning less than those who do not require such documentation.
“HCAs with employment permits are disproportionately likely to work in private nursing homes. HCA wages are generally low, but private sector wages for HCAs are typically lower than pay in HSE [Health Service Executive] institutions,” it states.
“Annual wages for HCAs are approximately €35,000 in hospitals and around €30,000 in nursing homes. [Salaries for] permit-holding HCAs in private nursing homes are much lower at around €27,000 annually. The current wage floor of €27,000 translates to €13.31 per hour. For comparison, the overall average hourly wage in the Irish economy in quarter one 2022 was €27.41. At a sectoral level, the average weekly wage in the same period was €17.95 in retail trade and €14.90 in food and beverage service activities.”
The report maintains the low-wage floor under current and future expected inflationary pressures “will make the role of HCA more unattractive”.
It says in certain scenarios the State could face a shortage of up to 62,000 staff in healthcare assistant roles by 2036.
“Comparison of the demand and supply models suggests current unmet demand for HCAs in Ireland, with the shortfall expected to worsen over the next decade,” the report says.
Recent modelling from State think tank the Economic and Social Research Institute shows the population aged 80 and over is projected to increase by up to 94 per cent – or 135,000 – from 2015 to 2030.
Its study, published in October, says the demand for long-term and intermediate care resident places is projected to increase by up to 54 per cent by 2030.
The KPMG report says HCA wages are higher in the public sector and permit-holding HCAs tend to start in private nursing homes and then move to hospitals for better pay and conditions.
It notes that Nursing Homes Ireland (NHI), the representative body for employers in the sector, has said the employment permit scheme was “significant and critical” for its members to remain operational.
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“NHI reported that the €27,000 salary floor had effectively set a new salary expectation for all HCAs across the sector, increasing costs for private nursing homes. These higher wages do not appear to have attracted additional local talent. They remarked that the way nursing homes negotiate funding means it is critical that any increase in HCA salary thresholds is well signposted well in advance.”
Trade union Siptu told KPMG the €27,000 salary threshold “was acting as a ceiling rather than a floor and was in fact suppressing wage growth for HCAs in the private sector”.
In the HSE pay scales for healthcare assistants start from €32,473.
In its staffing forecast, the KPMG report concludes: “The shortage of HCAs decreases in scenarios where patients receive less HCA care and increases when more HCA care is needed. In a scenario where patients receive less HCA care and fewer people reside in nursing homes, Ireland would experience an excess of HCAs until 2028 and a shortage afterwards. In contrast, in scenarios where patients receive more hours of HCA care and are more likely to reside in nursing homes, the model predicts the highest shortage, ranging from 22,165 HCAs in 2024 to 62,243 by 2036.”
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