The long-running and politically explosive issue of substandard nursing home accommodation is coming to a head and will be decided one way or another in the coming months.
Either the Government will stump up the large amounts of money needed to bring State-run nursing home care up to 21st century standards, or older nursing home will have to close beds and turn away new residents. Some could close altogether.
The Department of Health and HSE say they have identified the nursing homes most in need of refurbishment or replacement. Many are institutional buildings from the 19th century which provide dorm-style accommodation no longer considered appropriate. Worse, some units are considered fire-traps and repeatedly fall foul of inspectors from the Health Information and Quality Authority (Hiqa).
The department has presented its capital plans to the Department of Public Expenditure, which has requested more information. Remedial works on all the substandard homes would cost €500 million, while dealing with the worst cases might cost about half that.
The Government can’t claim it didn’t know about the problem. Hiqa has been assessing nursing home standards since 2009, a few years after shocking revelations about the mistreatment of older people at Leas Cross.
While existing homes were given until last month to get their house in order, repeated reports highlighted serious shortcomings in individual homes. The department and HSE commissioned reports which set out the extent of the problem but they languished on official desks for years.
Two years ago, Hiqa issued a final warning to operators demanding a timeframe for compliance, but still nothing happened.
Earlier this year, HSE director general Tony O’Brien warned there is insufficient funding to bring accommodation standards in 30 large public nursing homes up to the levels required by Hiqa. Minister of State for Primary Care Kathleen Lynch claimed the watchdog had agreed to extend the deadline for closures by up to three years, provided there was a commitment to a timeframe for the works, but Hiqa quickly denied any blanket guarantee had been given
Now with the passing of the July deadline, the game has changed. Nursing homes have to have their registration renewed every three years. Where a home is found on inspection to be non-compliant, Hiqa has a number of options.
It can issue a notice of proposal to cancel the home’s registration. The operator has 28 days to make representations and any dispute could ultimately end up in the courts.
Alternatively, it can impose conditions on the registration of the nursing home. For example, a home could be told it can accommodate only 75 people instead of 150. This would not impact on existing residents, but as people die they would not be replaced until the limit was reached.
Public nursing homes are an important source of employment in many parts of the country and the workforce is largely unionised. Any proposal to close all or part of a home is likely to prove controversial.
It could also have a disastrous knock-on effect on a health service just recovering from last winter’s trolley crisis, which was largely caused by a shortage of stepdown residential care.
Once the problems of the nursing home sector are dealt with, it will soon be time to tackle similar issues in residential care of the intellectually disabled. Hiqa has only recently started monitoring these homes but similar problems are emerging.
Bringing older homes up to the standard required is likely to cost a further €500 million, it has been estimated.
