NHI News Summer 2015

S U M M E R 2 0 1 5

NEWSNHI News published by: Nursing Homes Ireland,Unit A5, Centrepoint Business Park, Oak Road, Dublin 12.Tel: 01 4292570 | Fax: 01 4291845 | E-mail: [email protected] us online: www.nhi.ie

NURSE REGISTRATIONHEALTH COMMITTEE SEEK ANSWERSRE EXTRAORDINARY DELAYS

FAIR DEAL REVIEWNON-ACTION CAUSESDISAPPOINTMENT

NHI News_Jul 2015:Layout 1 07/08/2015 15:09

Fair Deal review’s prolonged wait finallyserves up disappointment

Tadhg Daly,Chief Executive Officer,Nursing Homes Ireland

COMMENT

01 — NHI NEWS

years. When present Government assumed office in March2011, its programme for Government contained acommitment Fair Deal’s “system of financing nursinghome care will be reviewed with a view to developing asecure and equitable system of financing for communityand long-term care”. This Government has gone on to dragits heels in this regard. When crisis hit Fair Deal inSummer 2011 and the scheme was temporarily suspendeddue to resourcing issues, then Minister for Health JamesReilly stated review would be undertaken in 2012. InFebruary 2013 Minister Lynch informed Dáil it wasenvisaged review would be completed that year. In 2014we moved away from a definitive timeline, with Ministerinforming Dáil the “exercise is broader than was firstenvisaged and the various issues arising are now beingsystematically considered with a view to completion andpublication as early as possible”. Three years beyond whenit was originally envisaged, the review was publishedin July.

Following on from the prolonged wait, the publishedreview has proved very disappointing. With Governmentheading into final straight of its five year term, verydisappointingly the review has ‘kicked for touch’. ThisGovernment – commissioned review has absolvedGovernment of requirement to ‘grasp the nettle’ andaddress the sustainability issues threatening thefunctioning of the scheme that Minister Lynch and MrO’Brien have warned of.

Announcing its publication, the Department stated:“The future financing of the Scheme is considered in theReview. The Government has decided to make nochanges in this area.” This is despite the grave warningsbrought before the Health Committee at start of year. Theannounced establishment of a“Working Group”to overseeimplementation of report recommendations is a classicGovernment tactic of stalling changes or actions thataddress the fundamental issue of sustainability.Independent stakeholders will not participate on theworking group; it is State bodies being brought aroundthe table.

A number of previously published independent analysesof the nursing home sector have pointed to therequirement for an evidence-based cost-of-care fundingmodel that recognises the differing complexity of carerequirements of persons requiring the continuous,specialist care provided by nursing homes. Againdisappointingly, the issue of an appropriate fundingmodel has been put on the long-finger, with this reviewrecommending a further review of the present fundingmodel to be conducted within an 18 month period andsubmitted to Department of Health. This again enablesGovernment ‘kick for touch’ on a critical issue and it willnow be put on the table of its successor. Furthermore, it isastonishing the review has recommended the currentcommissioners of care – the NTPF - undertake the reviewinto the pricing model.

“Let our advance worrying become advancethinking and planning,”Winston Churchill

February 2015. Minister with Responsibility for OlderPersons Kathleen Lynch TD and HSE Director GeneralTony O’Brien are before the Oireachtas Health Committeefor the quarterly meeting between the Department ofHealth and HSE regarding health issues arising.

Minister Lynch informs the Committee: “The review ofthe Fair Deal scheme is almost complete. The one thing itwill tell us is that the fair deal scheme is unsustainable inits present form…there will have to be changes.”Recognising the crisis that would emerge within healthsector arising from inadequacies of funding earmarked forthe scheme to meet requirement in 2015, the Governmentsubsequently allocated in April an additional €44millionthis year to fund an additional 1,600 nursing home places.This arose from recommendations of the Department’sEmergency Department Taskforce and was welcome,though it is important to recognise it brought the levelof funding on par with what was committedto support access to nursing home care three yearspreviously.

Mr O’Brien states before the committee the scheme isperfectly set up to become demand-led but the problemarising is “there is lots of demand but insufficientresources, and this is a direct result of demographicchange within society”. He goes on to outline the intrinsicrole the scheme fulfils in wider healthcare delivery and theimportance of appropriately resourcing it: “It could besaid that the funding mechanisms and the arrangementsfor the Fair Deal scheme, as welcome as they are in termsof the benefit it brings to those who can gain access, hasbecome the achilles heel of the acute hospital system.There is a direct correlation between the increase inwaiting time and the increase in numbers on the waitinglist for the scheme, the numbers of delayed discharges inhospitals and the numbers recorded as waiting foradmission on hospital trolleys each day.”

When the scheme commenced in 2009 the Departmentof Health committed it would be reviewed after three


CONTENTS The prolonging of required actionsare against a backdrop of reviewpredicting requirement for 9,000additional Fair Deal places within nineyears.

I am reminded of John F Kennedywarning: “There are risks and costs toaction. But they are far less than thelong range risks of comfortableinaction.” Modern advances in livingstandards and health and social caremean people are living longer and ourolder population is increasing innumbers dramatically. This is to becelebrated but with it comesresponsibility. Governments must faceup to the considerable challenges ofplanning for the health and social careservice requirements that areimminently escalating. It is verydisappointing that this long-awaited,important review of a criticalcomponent of older person care willserve to expedite important actions thatare necessary to place on a sustainablefooting the Fair Deal scheme and therequired enhancement of its paymentmodel to reflect true cost of olderpersons residential care requirements.

The forthcoming election provides anopportunity for all parties andcandidates to outline their proposals toprovide a coherent framework fornursing home care planning, funding,regulation and service delivery based oninclusive dialogue with providers andstakeholder groups.

We’re presented with a prospectivecrisis in older person care and for widerhealth services that can be foreseen andaddressed in time. Courage and politicalwill is required to grasp the mattersarising with the conviction necessaryto ensure a fit-for-purpose frameworkis implemented to support theresidential care requirements of ourolder population.

Tadhg Daly,NHI CEO

Thanks to all supporters of NHI, many of whom arefeatured in this newsletter. Please note, NHI is notresponsible for third party services advertised in thispublication. Inclusion in this newsletter does not endorse,recommend or imply any approval of the suppliers listedin this publication.

NHI NEWS — 02

NHI ACKNOWLEDGESSUPPORT OF

NEWS UPDATENews from Nursing Homes Ireland, the representative organisation for theprivate and voluntary nursing home sector. In this issue NHI states we must notallow the conversation re older person care to become polarised, with therequirement for the focus to be upon providing people with the right care suitedto their health and social care requirements. NHI launches a substantial piece ofresearch designed to support Members in the use of restraint and bed rails. Innurse recruitment matters, the HSE has committed to continue nurse adaptationprogrammes for final quarter of 2015.

READ ALL ABOUT US!The residents of St Elizabeth’s Nursing Home in Co Meath are compiling a book ofshort stories and poems. Daffodil Day 2015 sees residents and staff of nursinghomes raise funds for the Irish Cancer Society and the Irish Hospice Foundationhas benefitted from fundraising endeavours at a Dublin nursing home. Creativitywas recently evident in a Co Tipp nursing home and in a neighbouring home theAlzheimer Society of Ireland was the beneficiary of a tea party that raised€1,500+. All in this edition’s RReeaadd AAllll AAbboouutt UUss.

FAIR DEAL SCHEME REVIEWThe long-awaited review of the Fair Deal scheme was published July. Keypoints within the Department of Health commissioned review are outlined.NHI has expressed disappointment the review has put on the long-finger therequirement for an enhanced funding model to support nursing home careand stated concern further prolonging actions required will present crisis fornursing home care and wider health services.

NURSE RECRUITMENTOver a prolonged period NHI has lobbied key stakeholders regardingextraordinary delays being experienced by nurses registering for employmentin Ireland. NHI Members have lobbied their local TDs to inform of the crisisemanating because of the delays and at NHI’s Oireachtas Open Day in June,Members of the Oireachtas Health Committee – along with TDs from acrossthe political spectrum – met with NHI representatives to be informed of howcritical an issue it is. The Health Committee subsequently invited NMBI toappear before it to explain the causes behind the delays and seek assurancesissues would be addressed.

NHI ANNUAL SURVEYNHI’s Annual Survey 2014/2015 presents key statistical data re the privateand voluntary nursing home sector and outlines challenges facing the sectorin the provision of care. Despite increasing requirement for nursing homecare, the number of such nursing homes in Ireland has decreased by nearly4% over past five years.

NURSING HOMES WEEK 2015Wonderful celebrations were hosted by nursing homes across the country tocelebrate Nursing Homes Week 2015. This edition of NNHHII NNeewwss features afantastic spread of pictures and details of celebratory events that took placeacross the country.


NHI UPDATESCommitted to excellence in care

05 — NHI NEWS

wwwwww..nnhhii..iiee @@NNuurrssiinnggHHoommeessIIrree

NHI ran a three-week national advertising campaign in June to promotenursing home care and employment within NHI Member homes. . NHI - It’s the people that make the difference ran across national radio – RTE Radio

One, Newstalk, 4FM - and featured two nursing home residents and their carers:Emma, Sarah, Alan and Tony.

Pre- and post-campaign measurement highlighted the campaign createdsignificant growth in awareness of NHIand of the invaluable healthcare supportthat nursing homes provide in Irishcommunities.

It focussed on the attention to detailafforded to residents in nursing homecare. The compassionate, person-focussedcare within nursing homes deliversextremely high levels of employmentsatisfaction. Building relationships, bondsand friendships with the people in nursinghome care provides immense jobsatisfaction. The campaign informed NHIMember homes offer a great place to bothlive and work. Listen again to the advertisements byvisiting www.nhi.ie > NHI Events > NHI: It’sthe people that make the difference. Jobopportunities in NHI Member homes canbe viewed at wwwwww..ccaarreeeerrssiinnnnuurrssiinngghhoommeess..iiee

It’s the people that make the difference

NHI informs Department analysis of measures requiredto encourage new nursing home bedsKey barriers facing the private and voluntary nursing homes sector inproviding additional capacity to meet long-term residential carerequirements of ageing demographic have been outlined by NHI fora Department of Health commissioned analysis of required actions tomeet demand.

NHI has informed DKM Economic Consultants, who areundertaking the Department’s Analysis of Potential Measures toEncourage the Provision of Nursing Home and Community NursingUnit Facilities, lack of a clear and cohesive policy and national strategyposes one of the biggest challenges to the long-term sustainability ofthe nursing home sector. This is combined with uncertainty aroundcurrent and future funding arrangements. An analysis of thedemographics confirm that there will be significant pressure in thearea of residential care but also on the wider health and social caresystem for older people, NHI stated in its submission.

Key barriers to additional capacity outlined within the submissioninclude:

P Absence of a Fair Price for Care and acknowledgement of cost ofcare

P Monopoly purchaser under the Fair Deal

P Arbitrary and unfair process of ‘negotiation’ of rates under theFair Deal

P Absence of a sophisticated commissioning model

P Absence of a clear cohesive national strategy (a road map for thefuture). Government need to create an environment, throughpublic policy, to create conducive environment for existingoperators

P Ad hoc decisions by government and HSE – in 2014 reducing FairDeal budget at a time of increased demand

P Uncertainty around funding arrangements, delay in Fair Dealreview

P Access to bank funding and requirement for operators to bring30% equity

P Multi annual funding required for Fair Deal to address andprevent waiting lists

Visit the Members section of the NHI website – wwwwww..nnhhii..iiee– and viewthe submission within the ‘NHI Submissions’ section.

NHI research re use of

restraint & bed rails

NHI has launched a substantial piece of researchdesigned to support Members in the use of restraintand bed rails. A Review of the Literature on Restraintand the use of Bedrails was undertaken by Dr KevinMoore, Lecturer in Nursing, Academic Lead,Continuing Professional Development Provision,and an Associate Member of the Institute of Nursing Research in the School of Nursing,University of Ulster.

The publication was launched at NHI EducationDay: Audit & Research Workshop: DevelopingQuality Improvement Tools for the Private andVoluntary Nursing Home Sector. “This review willhelp guide and inform practitioners accordingly byorganising in a coherent manner the currentpublished literature on bed rails,” the publicationstates. “Consequently practitioners will be enabledwithin the scope of their professional practice todeliver appropriate evidence-based standards of careand to ensure that they are compliant withappropriate legislation, best practice evidence andpolicy guidance whilst doing so."

NHI Members can download the review by visiting the Members section of the NHI Website and visiting Education/TrainingDays>Education / Training Days 2015 > Audit &Research Workshop 2015.


NHI NEWS — 06

www.nhi.ie @NursingHomesIre

Extension of the remit of theOffice of the OmbudsmanThe remit of the Office of the Ombudsman will be extended to cover the privateand voluntary nursing home sector from 24th August. A series of informationsessions for nursing home providers and liaison officers nominated by nursinghomes will be hosted by the Ombudsman during the month of September.

In respect of remit of the Office of the Ombudsman, it is important to note: P The Ombudsman is not a regulator;

P Complainants must first have exhausted the internal nursing homes’complaints process as required by the Care and Welfare Regulations andprovide documentary evidence to the Ombudsman before a complaint willbe accepted for consideration;

P Complaints about clinical judgements are also expressly excluded underthe statutory instrument;

P Only complaints which relate to matters post the commencement order(24th August 2015) will be accepted. Retrospective complaints will berefused;

P The remit of the Ombudsman extends to all private and voluntary nursinghomes that may be in receipt of State funding (whether this funding ispaid directly or indirectly to the nursing home) such as Fair Deal, Contract/DDI Beds, etc. It is important to note that complaints may be made by anyresident (or their representative) in the nursing home regardless ofwhether that resident is in receipt of State funding or not.

Nursing Homes Ireland (NHI) has said the reality of care for older persons inIreland is that it is all under-resourced. Speaking during Nursing HomesWeek 2015, Tadhg Daly, NHI CEO, said that the rate of increase in Ireland’sageing population meant that a range of policies and services need to bedeveloped urgently to address the challenges this presents.

He said: “We must not allow the conversation to become polarised aboutnursing home care versus home care and vice versa. Suggestions in the mediaindicating that the number of people receiving nursing home care in Irelandis high relative to other European countries are extremely wide of the mark.”An assessment of OECD statistics re long-term care utilisation in Europeancountries shows Ireland has a low proportion of its older population residingin long-term residential care. Ireland ranked 9 of 15 countries in respect ofsuch utilisation, with 3.6% of its ‘older population’ – persons aged 65+ - livingin long-term care. Switzerland has highest proportion with 6.1% and wasfollowed by Netherlands (5.6%), Luxemburg (5.5%), Sweden and Norway (4.9%each), and Finland at (4.7%). Germany and Denmark each have 4% of olderpeople living in long-term residential care.

“As our population ages, and it is doing so at a rapidly increasing rateaccording to demographic figures, the focus should be on providing peoplewith the right care suited to their requirements,” Mr Daly said. “People havea preference to live at home for as long as possible but when people areassessed as requiring nursing home care, the key is ensuring that they accessnursing home care in a timely fashion, with nursing homes providingholistic, life-enhancing health and social care of the highest calibre bythousands of dedicated staff across the country.”

“The reality is, once people are assessed by independent medical andhealthcare professionals as requiring nursing home care as part of the FairDeal Scheme, it is vital they get access to this care in a timely manner.”

Demographics indicate future crisisin caring for our rapidly ageingpopulation unless we plan properly

NHI warning to Statere PhysicalEnvironmentComplianceIn order for the public to have full confidence inthe proper administration of the regulatory regimefor nursing homes, standards – with particularreference to HIQA’s physical environmentstandards – must be applied fairly and consistentlyacross all designated centres – public, private andvoluntary, NHI has stated in correspondence to theAuthority.

In report published 12th July, the SundayBusiness Post stated HIQA was in advanceddiscussions with the HSE over the future of publicnursing homes that did not meet a July 1 deadlineto comply with physical environment standards.An Freedom of Information reply provided to NHIby HIQA was quoted within report, stating 21public nursing homes had been re-registered and afurther 90 were “in progress” of being registered.

The report quoted Tadhg Daly, NHI CEO:“Private providers have stepped up to the plate andinvested heavily. Any dilution [of standards] wouldbe unconscionable.” The report quoted an NHIletter to HIQA, sent 2nd February this year, stating:“In order for the public to have full confidence inthe proper administration of the regulatory regimegoverning residential care settings for olderpersons, it is essential that the standards areapplied consistently and fairly across alldesignated centres – be they public, private orvoluntary. It is our view that the discriminatoryapplication of Standard 25 [Physical Environment]by the Authority to public and private/voluntarysector nursing homes amounts to ananticompetitive practice, contrary to Irish and EUcompetition law, including Article 106 of theTreaty on the Functioning of the European Unionwhich governs state aid measures.”

The report quoted HIQA as stating: “Theauthority’s approach to this matter is to ensureconsistency and proportionality and that eachcentre application for renewal of registration isdeliberated upon on a case-by-case basis.”

In article headlined HIQA adopts get tough stanceon nursing homes, the Irish Times reported 4thAugust the Authority is becoming increasingfrustrated at inaction within the health serviceregarding requirement for HSE nursing homes tomeet physical environment standards. The articlestated HIQA is adopting a "get tough" policy rephysical environment standards and July deadlinethat has now passed. It stated HIQA had issued twoproposals to refuse registration to two HSEnursing homes in the past month and it hadproposed ten further centres be prohibited fromadmitting new residents. Upgrading or rebuildingpublic nursing homes will cost about €500million, the article adds.


07 — NHI NEWS

NHI UPDATES

A NEW VENUE!NHI Annual Conference &

Care Awards 2015Thursday, 12th November 2015

Double Tree by Hilton,Burlington Road,

Dublin 4

Further details to follow!

NHI have had regular meetings with the HSE and the Department of Health on the continuation of the clinical adaptation programmefor non-EEA trained nurses and we are delighted to advise that the current model will continue without change for the remainder of2015, providing 2 further clinical adaptation programmes. The HSE will continue the programmes under the current regime withscheduled programmes in September 2015 and November 2015 providing adaptation placement for 62 (provisional) candidates.5 further programmes have been provisionally provided to the sites currently offering the programme (from April ‘16 – Nov ’16).Following NHI lobbying and representation the HSE has submitted a funding request to the Department of Health for the continuationof the additional programmes in 2016.The addition of the 7 (2 extra in 2015 and 5 in 2016) programmes will provide a further 277 places for NHI Member nurses only and wesee this as a demonstration by the HSE and Department of Health of their commitment to work closely with NHI to address the issueof overseas recruitment.

RCSI Assessment for Overseas Nurses (alternative to the clinical adaptation programme): An RCSI (Royal College of Surgeons in Ireland) initiative to enable registration for overseas nurses through a two-part assessmentprogramme could be ratified by NMBI Board in coming weeks for roll-out in latter part of 2015. The assessment will be a two-part modelcomprising of (1) knowledge assessment and (2) objective structured clinical exam. Both would take place at the RCSI and it is confidentof commencement of the programme in latter part of 2015 - November or December. It is hoped the NMBI Board will ratify the initiativeat its September meeting. The RCSI has advised priority will be given to nurses awaiting adaptation places. This will enable nurses gainregistration in a more timely manner, with extraordinary delays being experienced at present (as reported within this edition of NHINews). NHI is of the view this is a very welcome initiative. It is encouraging its Members who have nurses overseas awaiting adaptationto engage with these nurses to encourage them to apply for NMBI registration ASAP so they can have a decision letter once the RCSIassessment exam is rolled out.

Clinical Adaptation Programmes 2015-2016:

Recruitment Options – Nursing Agencies: NHI are working closely with our recruitment partners on our Members’ behalf to recruit nurses already booked by members from ThePhilippines, The EU and India. These recruitment campaigns are ongoing and we look forward to the first intake of these nurses by the end of2015. Please contact NHI if you have not already booked a nurse through one of these options.


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READ ALL ABOUT US!What activities are taking place in your home? How are residents fullling their lives? Whatcelebrations are taking place? Read all about us! offers NHI Nursing Homes the opportunity to publicise thewide-ranging activities that are taking place in homes across the country. It provides an excellent opportunityto publicise nursing home life in the positive light it should be seen in and members are encouraged to make usaware of what is going on. You can send any articles or pictures of interest to [email protected].

St Elizabeth’s Nursing Home in Co Meath starteda creative writing group for their residents overa year ago. The group meet once a week and start

their session with word-games and brain exercises toget the creative juices flowing. After this comes thewriting of a poem or a short story about a topic theresidents decide on themselves. Maria Brady, ActivityCoordinator at the Athboy Nursing Home states: “Thewriting is collective and creativity and imagination isimproving continuously. Everybody gets to put intheir views and opinions. The group is great fun for allinvolved and we are currently compiling a bookcontaining these short stories and poems.” P

Creative writing inCo. Meath

11 — NHI NEWS

The Creative Writing Group. Picture are, back, from left, MariaBrady, Activity co-ordinator, Joan Byrne, Deputy Person in Charge.Front, from left, Sarah Halton, Liam Houston, Teresa Flavin, MaryTevlin, Oliver Halton and Nancy Halligan.


NHI NEWS — 12

Generosity of nursinghomes raise funds forCancer SocietyDaffodil Day 2015 saw the residents & staff of Larchfield ParkNursing Home raise almost €1,000 for the Irish Cancer Society.Residents and staff of Millbury Nursing Home in Co Meath alsoparticipated in Daffodil Day 2015. Great fun was had by all, withstaff baking buns, breads, cakes and cookies that were enjoyedwith a cups of tea that were shared amongst residents andvisitors. The home also hosted music and over €700 was raisedfor the Cancer Society from the morning.loves to hear it.” P

Residents and staff of Churchview Nursing Home, Dublin,enjoyed tasty ice-cream treats recently P

Icy treats atChurchview

Residents and staff at Ashford House Nursing Home in DunLaoghaire, Co Dublin, come together on an annual basis tocelebrate Bloomsday and 2015 was no different. This year’scelebrations took place Sunday 14th June and included readings,live music and a champagne breakfast P

Bloomsdaycelebrations atAshford House

€1,000 was raised for the Irish Hospice Foundation recently byall at Annabeg Nursing Home. With works being undertaken inAnnabeg, the builders joined in the fundraising endeavours P

Annabeg supports Hospice


13 — NHI NEWS

READ ALL ABOUT US

St Martha’s supportAlzheimer SocietyOver €1,500 was raised for the Alzheimer Society of Ireland bySt Martha’s Nursing Home, Cahir, Co Tipperary, when residents,staff and visitors participated in a tea party. Staff and residentsare pictured presenting a cheque to Ms Catherine Bartlett ofthe Alzheimer Society P

The residents of Willowbrook Lodge, Co Tipperary, celebrated theircreativity to coincide with the Bealtaine Festival by creating aselection of felt items including toys and small handbags. With theassistance of staff, they also designed invitation cards for theStrawberry Fair that the nursing home hosted during NursingHomes Week 2015 P

Creativity inWillowbrook

Risk Management Training

Wednesday 23rd September 2015 Hodson Bay Hotel, Athlone. The training, specifically devised for Long Term Care, will cover the following topics:

Risk Management Training o Introduction to Risk Management o Principals of Risk Management o Legislation/Standards guidance o Risk Management Framework

Registers for Risk management Developing a Risk Register Individual Risk Management

Cost: per person. Attendees will receive a Certificate on Completion of the course.

For more information please contact 093 36126 or email [email protected]

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Risk Management Training

Wednesday 23rd September 2015 Hodson Bay Hotel, Athlone. The training, specifically devised for Long Term Care, will cover the following topics:

Risk Management Training o Introduction to Risk Management o Principals of Risk Management o Legislation/Standards guidance o Risk Management Framework

Registers for Risk management Developing a Risk Register Individual Risk Management

Cost: per person. Attendees will receive a Certificate on Completion of the course.

For more information please contact 093 36126 or email [email protected]


Key points within Review of the Nursing Home SupportScheme, A Fair Deal extracts

FFAAIIRR DDEEAALL RREEQQUUIIRREEMMEENNTTj Within the overall long-stay population, it is anticipated 23,965

people will be in receipt of support under the Nursing HomeSupport Scheme by end 2015. This is estimated to grow to 33,070by 2024.

PPUUBBLLIICC SSEECCTTOORR CCAAPPAACCIITTyyj If Government policy is for the public sector to continue to

provide circa 20% of all nursing home capacity, this will requirepublic nursing home beds to increase by approximately 1,200beds by 2024, with an associated capital cost for the provision ofthese beds [note, this excludes prospective closure of publicnursing home beds due to HIQA Physical Environment Standardcompliance].

PPRRIIVVAATTEE SSEECCTTOORR CCAAPPAACCIITTyyj Given projected demographic trends and continuing public

expenditure constraints, it appears probable that there will be anexpanded role for the private sector in the future nursing homemarket. However, Nursing Homes Ireland has indicated that, whilethere is an appetite to invest in delivering extra capacity includingshort stay/intermediate type care, there may be merit in stimulatingthe sector via a series of measures including:

m Guarantees of future NHSS funding

m Advance price agreements

m Extensions to the length of contracts

m Tax incentives to encourage targeted development.

j The fact that lenders now require developers to provide upfrontcapital of approximately 30% of the total development costs is alimiting factor. There may not be sufficient ready capital availablefrom existing nursing home operators to co-finance the levels ofadditional capacity needed over the coming years, resulting inprivate development only by larger operators. Lenders haveexpressed concern about this as it concentrates their lending riskmore than they would wish.

MMEEAASSUURREESS TTOO EENNCCOOUURRAAGGEE PPRROOVVIISSIIOONN OOFF FFUUTTUURREE NNUURRSSIINNGGHHOOMMEE CCAAPPAACCIITTyy WWIITTHHIINN PPRRIIVVAATTEE SSEECCTTOORRj The Ireland Strategic Investment Fund has identified the nursing

home sector as one that could provide a rate of return and anoutcome that is compatible with the Fund’s mandate. The Fundwould offer loan finance on fully commercial terms (this is notpreferential funding) but it could still be a available stimulus toincreasing private investment activity.

j Detailed consideration should be given to potential new modelsof collaboration between the public and private sectors. Such newmodels might provide for a private operator to finance, build andoperate a facility.

j While sheltered housing appears to offer significant benefits overthe longer term, it is currently under developed in Ireland. Indeveloping this sector, it is important that scarce health sectorfunds remain effectively focussed on healthcare requirements.For example, the creation of an intermediate care model whichfalls between care at home and long-term residential care is aslikely to attract people who may otherwise remain at home,though socially isolated, as it would those in long-termresidential care. Those who would shift up from home care may,in many cases, have social housing issues rather than healthcareissues.

PPRRIICCEE SSEETTTTIINNGG IINN PPRRIIVVAATTEE NNUURRSSIINNGG HHOOMMEESSj Prices paid historically and prices prevailing within a given

geographic area are relevant to the price setting process as is theneed to achieve maximum value for taxpayers’ funds.

PPRRIICCEE OOFF CCAARREEj The average weekly cost of care in a public facility was €1,390 and

in a private or voluntary facility was €893 at end 2014…Theheadline price differential in the average cost of care betweenpublic and private facilities is approximately 58%.

j A complete revamp of the pricing system, to one based ondependency categorisations could lead to upward pressure onpricing, and could give rise to considerable complexity in tryingto adjust as residents move between dependency categories.

j In the medium (within 18 months) the NTPF should review thepresent pricing system and submit proposals to the Minister forHealth with view to:

m Ensuring that there is adequate residential capacity forthose residents who require higher level or more complexcare;

m Ensuring value and economy, with the lowest possibleadministrative cost for clients and the State andadministrative burden for providers;

m Increasing the transparency of the pricing mechanism sothat existing and potential investors can make as informeddecisions as possible.

j The review of the pricing system may require professional andindependent costing and other technical and relevant expertise.

PPUUBBLLIICC NNUURRSSIINNGG HHOOMMEE PPRRIICCEESSj Pending the introduction of any new pricing model the HSE

should be required to publish the cost of care on an annual basis.

j Costs for public facilities appear to be in excess of what appliesin private facilities.

j The cost of public long-term residential care should be based ona pricing model that is objectively and consistently formulated,and which takes account and accurately quantifies unavoidableprice distortions.

j As a result, a Value for Money and Policy (VFM) review will becarried out by the Department of Health which will focus on theextent to which the existing cost differential can be attributed toinherent differences between public and private sector coststructures (eg pay levels), and should identify and analyse thereasons for existing differentials.

VVOOLLUUNNTTAARRyy NNUURRSSIINNGG HHOOMMEE PPRRIICCIINNGGj The consultants identified a number of options to secure the

position of these facilities, but considered that the solution islikely to differ for each facility. Options proposed include:

m An increase to the current rate payable to them under theNHSS

m A proposed reduction in operating costs;

m A change from long-term residential care provision toalternative service models or to a mix of services, such aslong-term residential care and respite care.

FFUUTTUURREE FFIINNAANNCCIINNGG OOFF FFAAIIRR DDEEAALLj RReedduuccee AAsssseett DDiissrreeggaarrdd:: Currently the first €36,000 of a person’s

assets (or €72,000 for a couple), including savings are not takeninto account during the financial assessment. By abolishing thisdisregard altogether, additional contributions of up to €50 perweek per couple would be payable by those with assets or savings.By reducing it to €20,000 (or €40,000 for a couple) additionalcontributions or €23 per week could be payable, yielding anadditional €13.1 million in a full year.

j IInnccrreeaassee tthhee aasssseett ccoonnttrriibbuuttiioonn:: It is estimated that an increasein the rate of contributions based on case and other relevantassets could yield the following additional full year revenues:

m 7.5% to 9.5% - €6.6m

m 7.5% to 11.5% - €13.4m

FAIR DEAL SCHEME REVIEW

17 — NHI NEWS


NHI NEWS — 18

m 7.5% to 13.5% - €19.9m

m 7.5% to 15.59% - €26.7m

j IInnccrreeaassee tthhee aasssseett ccoonnttrriibbuuttiioonn bbaasseedd oonn tthhee pprriinncciippaall pprriivvaatteerreessiiddeennccee:: Currently 36% of nursing home residents have reachedthe three year cap. If the PPR is subsequently sold, the proceeds of thesale are assessed as cash assets as long as the person remains in long-term residential care. This anomaly has created a perverse incentivenot to sell homes, leading to properties being left vacant. Removingor extending the 3 year cap would remove the current disincentiveto sell vacant homes. It would, however, lead to the fuller dissipationof the value of PPR (ie for inheritance and other purposes) in overone-third of cases.

j FFaarrmmss aanndd ssmmaallll bbuussiinneesssseess:: Further consideration will be givento the application of the asset-based contribution to family farms orother family businesses where relevant asset generates a household’sincome, and where the asset would in the normal course pass on tothe next generation as a primary income source.

j IInnccrreeaassee tthhee iinnccoommee ccoonnttrriibbuuttiioonn:: It is generally acknowledgedthat a contribution of 80% of income is fair, if the only source ofincome is the State (non-contributory) pension. However, forthose with higher incomes increasing the rate to eg 85% for otherincome sources could be considered, subject to safeguardsproviding residents with a minimum amount of income.

PPRRIINNCCIIPPAALL PPRRIIVVAATTEE RREESSIIDDEENNTT ((PPPPRR)) OOWWNNEERRSSHHIIPPj Currently approximately 56.4% of applicants to the scheme have

been assessed as owning a principal private residence (PPR). Thereview states HSE believes that reasons for the low rate of PPRownership declared under the scheme may include:

m People are paying privately and waiting 3 years beforeapplying for NHSS;

m 5% of clients were admitted more than 3 years beforeapplying for financial support under the scheme andconsequently, such clients did not need to submit detailsof their PPR;

m Farmers are transferring their farm and PPR to their adultchild and retaining a ‘right of residence’ in the PPR for theremainder of their lives;

m Applicants having transferred their PPR to a familymember wait until the five year term is up before applyingfor the scheme;

m Applicants have sold their PPR and are renting a smallermore manageable PPR;

m Where a couple’s PPR is valued at €72,000 or less and thereare no cash assets, the value of PPR is disregarded as per thelegislation.

j “The fact remains that declared levels of home ownership byNHSS applicants warrant further consideration.”

j The consultants considered that there was no standard practiceacross local NHSOs when reviewing and validating financialdeclarations.

CCHHAARRGGEESS FFOORR NNOONN--FFAAIIRR DDEEAALL SSEERRVVIICCEESSj To deal with the issue of additional charges, it is recommended

that nursing homes should have a published fee scheduleshowing all the costs associated with being a resident.

j Consideration should be given to including in the Deed ofAgreement with facilities details of what additional charges areproposed, of the opt-out arrangements that exist for residents,and confirmation that residents will not be charged for extraservices that they cannot participate in because of theirdependency level or lack of capacity.

RREESSIIDDEENNTT CCOONNTTRRIIBBUUTTIIOONNj Resident contributions amounted to approximately €293

million in 2014.

j At end 2014 the average weekly contribution from residents in apublic unit was €285 and in a private unit was €294.

j The Average cash assets of scheme participants during year 2014was €49,590.

j Average value per participant of other relevant assets (includingprincipal private residence and other property) was €88,941.

j Just over 9% of applicants opted to defer the portion of theircontribution.

j The average declared income for applicants assessed on a singlebasis was €281 per week.

j The average declared income for applicants assessed jointly (aspart of a couple) was €562 per week.

SSOOUURRCCEE OOFF FFAAIIRR DDEEAALL AAPPPPLLIICCAATTIIOONNSS yyEEAARR 22001144j 43% from people in acute hospitals

j 40% from people in the community

j 9% from people in private nursing homes

j 1% - people from mental health & disability sectors

AAVVEERRAAGGEE LLEENNGGTTHH OOFF SSTTAAyyj When the scheme first commenced the average length of stay

was approximately 4 years and at end 2014 had reduced to 1.9years in private and in public facilities for those who had enteredlong-term residential care since the scheme commenced.

j At end 2014, taking account of ‘saver’ cases (1.4.11), the overallaverage length of stay for private nursing homes was 2.9 yearsand 3.9 years for public nursing homes. The overall averagelength of stay was 2.93 years (35 months)

SSOOCCIIAALL CCAARREE IINN IIRREELLAANNDDj At present 90% of frail older people in Ireland live at home with

80% living well and independently (HSE National Clinical CareProgramme).

j Approximately 4% of older people in Ireland are supported bythe State in long-term residential care

j Nationally, approximately 8% of the population over 65 years arein receipt of some type of home help services.

j An integrated approach to service developments, including allrelevant stakeholders, will provide a more comprehensive modelof care for older people and will facilitate co-ordinated andintegrated planning for the provision and delivery of servicesacross home and community care, transitional care, acutehospital care and long-term residential care.

j If community based services are to be developed andstrengthened, consideration should be given to rationalising andcentralising budget provisions for these services.

j It should be recognised that those living in the community havedifferent costs associated with daily living and it would,therefore, not be appropriate to apply a rate of contributionbased on current NHSS arrangements to those who are living athome.

AACCCCEESSSS TTOO TTHHEERRAAPPEEUUTTIICC SSEERRVVIICCEESSj In some areas where demands exceeds what can be provided,

there appears to be a de-prioritisation of nursing home residentsand in these circumstances the only option remaining is to payfor such therapies privately. National policy foresees equal accessto primary care services, regardless of the place of residence,which means that a person in long-term residential care settingshould receive the same level of services as they would if theyremained in their own home, and it is important that this policyis implemented consistently by the relevant HSE personnel.

GGPP SSEERRVVIICCEESSj There is strong case for requiring nursing homes to offer access

to a “house” doctor in each facility.

AAccqquuiirreedd bbrraaiinn iinnjjuurryyj In the absence of a price setting mechanism based on

dependency, it may continue to be necessary for HSE to maketop-up payments in circumstances where very specialist care is required.


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» Clinical Indicators Report

» De�ning your requirements

» Onsite audit of current records

» Process mapping of Care Planning

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» Resident Transfer Letter

» Hand Over Report - shows progress notes, task

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» Monitoring - overview facility allows you

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NHI disappointment in review that ‘kicks for touch’

NHI has expressed disappointment the long-awaitedreview of the Nursing Home Support Scheme (FairDeal) has put on the long-finger the requirement for anenhanced funding model to support nursing home care.

The review was published by the Department of Health 20th Julyand emanating from its publication, the Government hasdecided to establish an internal working group, composed ofrepresentatives of a number of Departments, the HSE and theNational Treatment Purchase Fund, to oversee implementationof review’s recommendations. The Review was carried out by theDepartment in collaboration with the HSE, with input fromDeloitte and Touche as external consultants. This article outlinesthe NHI response to matters emanating from the review.

PPRRIICCIINNGG MMOODDEELLNHI welcomed publication of the “long over-due” review of

the scheme but expressed disappointment that in respect of thepricing model used to determine fees payable to private nursinghomes, it is effectively recommending a further review and failsto bring forward required actions to support providers in caredelivery.

Tadhg Daly, NHI CEO stated: “We welcome the review’srecognition of the challenges facing private and voluntaryproviders in respect of pricing and the recommendation toincrease the transparency of the pricing mechanism so thatproviders can make as informed decisions as possible.

“A number of previously published independent analyses ofthe nursing home sector have pointed to requirement for anevidence-based cost-of-care funding model to recognise truecosts of providing nursing home care. Disappointingly, the issueof an appropriate funding model has been put on the long-finger, recommending a review of the present system within an18 month timeframe. This is effectively recommending a furtherreview emanating from a review. Further prolonging actionsrequired will likely present crisis for older person care and forwider health services. Furthermore, NHI believes this should beundertaken independently and not by NTPF as recommendedwithin the review. The NTPF are the current commissioners ofnursing home care.”

PPUUBBLLIICC NNUURRSSIINNGG HHOOMMEE CCOOSSTTSSDespite repeated representations by NHI, the State has

refused to update the fees it pays to HSE-operated nursinghomes. Private and voluntary nursing home fees are publishedon a consistent basis, but the most recently published fee for HSEcounterparts date back to March 2011. In May, NHI accused theState of a cover up in this regard, with Tadhg Daly stating: “Therehas been a very deliberate policy of supressing the costs for fearof the chasm between public and private and voluntary nursinghome providers being realised. The reality is private andvoluntary nursing homes are being forced to provide care forrates that are at least half those provided to their publiccounterparts.”

The review stated average weekly cost of care in a publichome was €1,390 at end of 2014, by comparison with €893 in aprivate and voluntary home and recommended public costs bepublished on an annual basis.

“Given it is over four years since the cost of care for publicnursing homes was last published, the review’s call for suchcosts to be published on an annual basis will, if applied, apply alevel of transparency regarding cost of nursing home care thathas been absent from State homes on long-standing basis,” Mr

Daly said. “A 58% price differential between public andprivate/voluntary providers is outlined, with review statingcosts for public are in “excess” of what applies in privatecounterparts.

AACCCCEESSSS TTOO TTHHEERRAAPPIIEESSThe issue of the discriminatory nature of access to nursing

home therapies was brought forward during the consultationprocess by NHI. The organisation has previously said a "postcodelottery" exists, whereby access can differ significantly forresidents in nursing homes within short proximity to each otherbecause of differing HSE authorities. The review stated nationalpolicy foresees equal access to primary care services, regardlessof place of residence, and this must be implemented consistentlyby HSE. “It is critical the review recommendation that HSEimplement policy in this regard is addressed,” Mr Daly said.

BBRRIINNGGIINNGG SSTTAAKKEEHHOOLLDDEERRSS TTOOGGEETTHHEERRGiven the range of alternative services and supports that are

available to older people, it is important that more is done toconsolidate all of these efforts and initiatives, the review states.“An integrated approach to service developments, involving allrelevant stakeholders, will provide a more comprehensivemodel of care for older people and will facilitate co-ordinatedand integrated planning for the provision and delivery ofservices across home and community care, transitional care,acute hospital care and long-term residential care,” itrecommends.

Mr Daly said the review “reinforces the absoluterequirement for the Department of Health to bring allstakeholders together to ensure an integrated approach in caredelivery for older persons”. He added: “In general the NursingHome Support Scheme has met its key objectives of providingsecurity and certainty to members of society requiring long-term residential care. The scheme is a key component of the Irishhealth system and meets the needs of those people requiringlong-term care and their families. This long-overdue review iswelcome and outlines critical challenges facing Ireland inproviding nursing home care.

“In tandem with long-standing evidence, it recognises theconsiderable growth in requirement for nursing home care incoming years, stating there will be requirement for additional9,000 persons to be supported by the Fair Deal Scheme. Thechallenge reinforces the absolute requirement for theDepartment of Health to bring all stakeholders together toensure an integrated approach in care delivery for older persons.

“This report sets out challenges in respect of requirement,pricing and funding for wider healthcare delivery for our olderpopulation. This is against a backdrop of rapidly ageingpopulation, with review highlighting population aged 80+ willincrease by 37% to year 2021. As review states, NHI has affirmedappetite exists amongst private providers to meet the significantchallenges in providing the additional capacity required to meetour older population’s long and short-stay residential carerequirements – but require an appropriate framework to do so.“This report cannot be left lie idle. Kicking the can down the roadwill see a drastic scenario of older people not accessing nursinghome care and languishing in hospitals. This review mustprovide further stimulus for us to face up to the enormouschallenge facing us in meeting the care requirements of ourrapidly increasing ageing population.”

FAIR DEAL SCHEME REVIEW

19 — NHI NEWS


The Complete Solution » Complete set up of VCare Complete

» Ongoing Care Plan updates,

support and training days

» Care Planning training, utilising VCare Complete

“The functionality of VCare Complete is superb, it provides a comprehensive suite of care and daily living assessments,

evidence based care plans and interventions and allows us to record and monitor tasks in a timely manner”.

- Tom Cummins, Proprietor, Cherrygrove Nursing Home.

For more information on VCare Complete or to request a demo, contact Health Care Informed, High Street, Headford, Co. Galway

Tel: +353 (0)93 36126 Email: [email protected]

Features» Customisation - through process mapping,

the system is customised to meet your needs

» Regular Updates - Care plans,

assessments and policies

» Triggers - you are alerted when an assessment

score falls outside expected norms

» Event Reporting - record and manage events

such as incidents, allergic reactions etc.

» Clinical Indicators Report

» De�ning your requirements

» Onsite audit of current records

» Process mapping of Care Planning

» Regular updates within the software to

ensure the best possible care for residents

» Resident Transfer Letter

» Hand Over Report - shows progress notes, task

completion and due for completion in a 24hr period

» Monitoring - overview facility allows you

to quickly view any overdue activities

» Graphs - measurements and assessments are

instantly graphed once recorded

» Evidence Based Care Plans - a comprehensive

set of evidence based care plans templates are

provided as part of the VCare Complete package.

Electronic Care Planning and Resident Record Solution.VCare Complete... A Complete Care Planning Solution

Our Record.

Their Care.Your Plan.

uO

TheourYYour

Reru

CirThe Pour


Additional resources have been allocated by the Department ofHealth to assist NMBI in clearing a backlog of 2,000+ nurseregistration applications, the CEO of the Board has informed

the Oireachtas Health Committee. “The Department of Health hasrecently authorised additional resources to assist us in respect of theoverseas registration delay backlog,” Dr Maura Pidgeon informed theCommittee on 16th July, after NMBI had been asked to explain thedelays in registration process.

The Board acknowledged it is taking months to respond toapplicants who have submitted incomplete documentation. It did notcommit to timeframe as to when present backlog of 2,016applications awaiting processing would be cleared – 698 of thembeyond a year – but outlined measures being undertaken to addresscrisis including staff replacement, identification of an internalmanager to oversee clearing the backlog, and development of anonline resource to support application process.

EEXXTTEENNTT OOFF PPRROOBBLLEEMMDr Pidgeon outlined to the Committee the extent of the problem, with2,016 applications being processed, “70% of which cannot progress dueto incomplete documentation having been received”, and 698 of theapplications (35%) having been in the system for more than 12 months.

“Reflecting the lift in the economy, some 974 applications werereceived between January and June of this year, which compares to302 applications received in the same period last year,” she stated.“Notable contributory factors to the delay include staffing levels andfunding at NMBI, with revenue being significantly less than expectedfor 2015, due to a lower than expected annual retention fee for theyear. This funding crisis has created uncertainty and insecurityamong staff in the organisation with the subsequent increase in staff turnover for the first half of this year. Eleven staff have leftbetween January and June 2015. This has added to the challenges ofprocessing applications.”

Her colleague, Ms Ursula Byrne, Deputy Chief Executive andActing Director of Regulation at the NMBI, said in respect of the 698applications in system one year plus that it is the policy of the Boardif it has not received all the required documents by end of calendaryear the file is closed. “However, closing files requires resources andwe took a decision to prioritise trying to progress those files that arestill active and ongoing, rather than diverting resources to closingothers,” she added.

Dr Pidgeon stated the Board has “engaged in a collaborative processwith key stakeholders so that we can improve the process whilemaintaining the integrity of registration”. “Those involved in theprocess include representatives from the HSE, Nursing HomesIreland, independent private hospitals, directors of nursing andmidwifery, human resource experts, systems and analysts and NMBIregistration staff.”

Deputy Jerry Buttimer, Chair of the Committee, explained themeeting arose because of the ‘knock-on-effect’ delays in theregistration of nurses and midwives are having upon delivery ofessential health care services. Deputy Caoimhghín O’Caoláin, SinnFéin Health Spokesperson, referred to pre-discussion briefing fromNMBI that stated nine vacancies would be filled on an interim basis,but it had experienced an “exodus of 11 staff”. He said: “I would expectthe positions to be on a full-time basis”. “The Nursing and MidwiferyBoard of Ireland appears to be late in responding to identified need,”he added. Deputy Seamus Healy expressed concern the presentationpainted a picture of “difficulties almost amounting to crisis levelwithin the organisation”.

Dr Pidgeon replied: “Essentially, we have a number of full-timestaff working on a short-term basis - that is, for a period of six months.”She said of the 11 staff who left, three left for promotion andopportunities elsewhere and other staff were on short-term contracts.

Ms Byrne said there are 15 steps in the process of authenticatingregistration applications and if concerns arise applicants are asked toprovide clarification. Deputy Buttimer asked how quickly NMBIcommunicates with applicants who have submitted incompletedocumentation. “In previous times, that would have been amaximum number of weeks,” Ms Byrne said. “At present, in someinstances, it is running to a number of months.”

SSTTAAFFFFIINNGGDr Pidgeon added: “This is one of the areas that is clearly a target foradditional resources. It is simply the sheer volume of applicationscoming in and the ability to do even the initial identification of ashortage of documents. This is one of the areas that the working group,which includes our partners and colleagues from the employers andtheir agents, is drilling into in terms of working together to addressthis issue. In addition to targeting the backlog that has built up, anotherrequirement is to work with employers if they wish to identifysomebody and help applicants in the application process while theyare overseas. It is complex. We have provided additional and moresimplified information in that respect, but the issue is to work withthem in identifying that before the forms even come in. They are twoelements of trying to deal with the backlog over time.”

She said 11 of 51 staff had left in the first six months of the yearand the issue of recruiting further staff would be dealt with by the endof July. “We have to get approval from the Department of Health toreplace permanent staff, so they have been approved, plus one,” sheadded. She further added the staff would be replaced on a short-termcontract for a period of six months. “The reasons for that are, first, thatwe have to finalise the funding of the organisation – creatingpermanent positions in the absence of firm funding arrangementsinto the future would not be very prudent. The second reason for shortterm-contracts is that we wish to address the current crisis in terms

NURSE RECRUITMENT

21 — NHI NEWS

Nurse Registration delays brought beforeOireachtas Health Committee Over a prolonged period NHI has lobbied key stakeholders regarding extraordinary delays being experienced by nursesregistering for employment in Ireland. NHI has held a series of meetings with the statutory authorities to inform of the veryserious implications of the delays, with nursing homes identifying suitable nurses to fulfil posts but being unable to fillpositions arising from considerable delays in NMBI’s registration process. NHI Members have lobbied their local TDs toinform of the implications in this regard, with bed capacity under threat if staffing requirements cannot be fulfilled. At NHI’sOireachtas Open Day on 24th June, Oireachtas Health Committee Members – along with TDs from across political spectrum -met with NHI representatives and the crisis presenting in registration was laid bare. The Health Committee subsequentlyinvited NMBI to explain the causes behind the delays.


NHI NEWS — 22

of the backlog and fixing and enhancing our processes. On that basis,we will evaluate the progress being made because with enhancedsystems and with more online capacity as we get towards the end ofthe year, there may not be the need for the same numbers of staff. Itwill be evaluated over that period of time.”

WWEEBBSSIITTEE && CCAALLLL CCEENNTTRREEDr Pidgeon said a new website that will improve the applicationprocess will be developed before year end. “We have also reviewed,and had been reviewing, our internal registration processes in regardto simplifying the process and providing greater clarity of instructionand guidance to applicants,” she told Committee. “That was intandem with the development and restructuring of our website tohave greater online capacity. That will come on stream by the end ofthe year. There will be a completely new website. It is not just abouta fancy page. It is about the restructuring and the development ofcore applications to enable us to do our business online as a modernorganisation.” She said a call centre to deal with the volume of callsand email inquiries relating to registration and restoration would beexpanding and an internal manager to lead in clearing the backlog ofapplications “and develop a robust and sustainable process to preventfurther backlogs of this nature” had been identified.

‘‘TTAARRGGEETT DDAATTEE’’Deputy Mary Mitchell-O’Connor said she has visited nursing homesthat have informed they will be required to close beds if nurses cannotbe secured. “HIQA instructed one nursing home to stop taking in

residents until it is able to fill its nursing vacancies,” she said. “I amparticularly worried about nursing homes…I absolutely understandthe staffing issues but if we must close down nursing homes andhospitals are backed up with acute beds being kept by patients wehave a serious problem.”

Deputy Healy asked is there a target date for when it will be backto a “manageable situation”. “It is quite difficult to identify a targetdate as to when it will be business as usual and we have a normalsustainable process,” Dr Pidgeon replied. “We will have additionalstaff by the end of the month. Our new website will be available inOctober which will provide online facilities. Over the course of thecoming months we will work with our partners to have a moremanageable process in place.” Deputy Buttimer pressed for a datewhen backlog would be cleared. “Not until I have the staff to assessthe situation,” Dr Pidgeon said. “We hope that by the end of month orby August we will have a clearer picture as to the progress being madeand we can advise the committee when we have a definite picture.”

Later in the debate, Dr Pidgeon said: “We do fully appreciate andacknowledge the difficulties that have been experienced from theperspective of nursing homes and private and public hospitals. Thisis why we have been listening and have engaged in open informationsessions and workshops to deal with the timeframes around the cycleand the adaptation programmes. The restructuring of our websitewill provide for some online capacity in the initial stages this year.The procurement of an information management system forregistration will allow for infinitely more online capacity and thedevelopment of a smoother system for registration of all calibres.”

KEY FINDINGS

Senator Colm Burke raised the issue of nurse adaptationplaces with the NMBI. He said: “I also wish to raise the issue ofadaptation courses. I understand from Nursing Homes Irelandthat more than 300 people have to take adapatation courses.Is there an adequate number of adaptation courses availableand, if not, what mechanism is being put in place to ensurethere will be an adequate number of them?” He continued:“This question of the availability of adaptation courses is animportant factor in addressing the broader issue. Myunderstanding is that the HSE is not providing an adequatenumber of courses and Nursing Homes Ireland has had toenter into discussions with other organisations about puttingcourses in place. That needs to be clarified. We can complainall we like about delays in registration but if the adaptationcourses are not in place, we are not really achieving anything.”

“At present there are 241 places and an additional twoadaptation courses will be available in August through theHSE’s structure which will provide for an additional 140places,” Dr Pidgeon said. Ms Byrne said: The HSE hasindicated to us in the last two days that it is putting on morecourses in the coming months. As I mentioned earlier, anumber of private hospitals have applied to be approved assites for adaptation programmes and their applications arecurrently under assessment. We expect decisions to bereached and issued very shortly.” dementia.

NHI BRIEFING TO OIREACHTAS COMMITTEE

Prior to NMBI appearance beforeOireachtas Health Committee, NHI andits Members had ongoing engagementwith TDs and Senators to outline thecrisis facing the nursing home sectorbecause of extraordinary delays with thenurse registration process. An NHIbriefing to Committee Members prior toNMBI appearance stated there is“immense frustration” amongstcandidates and their prospectiveemployers because applications arebeing submitted but responses are notforthcoming. The briefing stated it ispresenting crisis for the sector andbringing enormous pressures uponproviders. NHI said nurse candidates arebeing denied opportunity to meet theclinical care requirements of personsrequiring long-term residential care in atimely manner. “This is no idle warning.There is real and present threat to bedcapacity if increasing numbers are notrecruited, with nursing homes facing bedclosures,” NHI further added.


www.careersinnursinghomes.iePromoting careers in the Irish Nursing Home sector

NHI continues to promote the NHI nurse recruitment careerswebsite nationally and internationally. The dedicated NHIMember recruitment website is currently seeing over 2,000 uniquenew web-users visiting it on a monthly basis.

This website allows current vacancies to be uploaded as well aspromoting individual nursing homes as a great places to work.Remember to visit the website regularly as it becomes an effectiverecruitment tool for all.

The website is reaching candidates worldwide. We therefore urgeyou to upload your vacancies and promote your nursing home asthis is one key tool we will use when meeting nurses in forthcomingrecruitment drives.

For further information and a step by step guide to register yourvacancy please contact grá[email protected]


NHI Annual survey highlights reduction in nursinghomes & increase in staffing costsOn Tuesday 30th June NHI published its Annual Survey that collated statistical data for private and voluntarynursing home sector for year 2014. It outlines the challenges facing the sector in provision of care and furtheremphasises requirement for a clear and cohesive national long-term care strategy to enable sector createrequired capacity.

Despite increasingrequirement fornursing home care, the number of nursing

homes in Ireland has decreased by nearly 4% over the past fiveyears, NHI’s Annual PrivateNursing Home Survey 2014/2015has revealed.

Commissioned by NHI andundertaken by BDO, the surveyfound between years 2010 – whensurvey last undertaken – and 2014there had been a significantslowdown in the number ofadditional beds being provided bythe sector.

It showed the appetite existsamongst providers to developadditional bed numbers in thecoming years to meet the increasein requirement for long-termresidential care. Co-sponsored byHomecare Medical Supplies andBank of Ireland, the survey waslaunched by Minister of State atthe Department of HealthKathleen Lynch TD at Bank of Ireland Business Banking Centre atMespil Road, Dublin, on Tuesday 30th June.

Tadhg Daly, NHI CEO stated the lack of a clear and cohesivenational long-term care strategy is posing a huge challenge to thesustainability of the nursing home sector. “2014 was anotherchallenging year for the private and voluntary nursing home sectorin Ireland with costs continuing to increase, in particular labourcosts,” he stated. “The increase in operating costs and increaseddependency levels of residents, together with the failure of the NTPFas monopoly purchaser to provide a Fair Deal rate appropriate to thecost base, threatens the sustainability of current provision.”

“The worrying drop in the number of homes since 2010 risksbecoming a trend unless the State does more to underpin the sector’sfuture viability. While this survey gives a clear indication of the desireon the part of private and voluntary homes to expand their servicesto meet the care requirements of our ageing population, ongoinguncertainty around the financing of long-term care under the FairDeal scheme and serious issues surrounding the recruitment ofnurses threaten the sustainability of current provision. We need tobetter develop a range of policies and services to address thechallenges all this presents. NHI reiterates its long-standing call forthe Department of Health to take the lead in bringing stakeholdersaround the table through a Forum that would advise Governmentregarding appropriate planning and policy to meet the growingdemand for nursing home care.”

Author of the report BrianMcEnery, Partner & Head ofHealthcare, BDO, said: “BDO isdelighted to undertake what weview as an important piece ofresearch in the nursing homeindustry. We believe it is vitallyimportant that operators in theindustry can make strategicdecisions based on informeddata. We hope that this surveywill give operators the knowledgethey require to make thesedecisions. It’s clear from theresults of the survey that manynursing homes are operating inan environment in which theircost base is increasing while at thesame time they are struggling toachieve an appropriateremuneration rate to fund thesecosts. This is a trend that appearslikely to continue at least into thenear term, however, it is essentialthat this is addressed as withoutadequate funding the industrywill not be capable of attracting

the necessary investment to provide the new bed capacity required toaccommodate the increasing older person population in Ireland.”

Welcoming publication of the Survey, Minister Lynch said:“The data contained in this report illustrates the very important rolethe private and voluntary nursing home sector fulfils in meeting thehealth and social care requirements of our ageing population. Asillustrated by the survey, the sector is a significant employer withinthe health sector and in both urban and rural communities. Thissector is vital within the continuum of care available for our olderpopulation and of key importance to healthcare delivery in Ireland.” The survey, commissioned by NHI, was undertaken by BDO in early2015 when a detailed questionnaire was sent to every registeredprivate and voluntary nursing home in the country.

Commenting on the report, Michael Lauhoff, Head of Growthat Bank of Ireland Business Banking, said: “We have had a dedicatedhealthcare team for many years who have a depth of understandingof the financial requirements and challenges of this critical sector.The team was further strengthened by the appointment of HilaryCoates late last year, who has extensive experience in the healthsector, having joined the team from HIQA. Our commitment tosupport the future investment requirements of the sector isunderpinned by our lending approvals in excess of €135 million overthe last 18 months and our allocation of a further €100 million tosupport the continued development and expansion of the nursinghome sector throughout the country.”

NHI ANNUAL SURVEY

25 — NHI NEWS

Pictured at the launch of the NHI Annual Survey are, from left,Brian McEnery, Partner & Head of Healthcare, BDO; Tadhg Daly, NHICEO; Kathleen Lynch TD, Minister with Responsibility for OlderPersons; Michael Lauhoff, Head of Growth at Bank of Ireland BusinessBanking; Hilary Coates, Head of Health, Bank of Ireland; MichaelCosgrove, Director, Homecare Medical Supplies.


Peter McGuinness, Director,Homecare Medical Supplies, also a co-sponsor, said: “Homecare MedicalSupplies are delighted to be supporting thelaunch of the NHI Annual Survey Report2014 & 2015. This survey further informsand allows the healthcare sector to bettermanage the delivery of high quality care,enhancing quality of life and better healthoutcomes. Homecare Medical Supplieswill continue to partner with NHI, itsmembers and the healthcare sectortowards continuously improving the carewe offer to our community.”

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NHI NEWS — 26

KEY FINDINGS

P The survey found that there are 437 private and voluntary homes providing a total of 22,342beds in Ireland. The previous survey undertaken in 2009 showed 447 private and voluntarynursing homes providing 20,590 beds.

P Nationally there is now one private nursing home bed for every 20.23 persons aged 65 andover in the Republic of Ireland.

P National average occupancy is 90.58% in 2014. This represented an increase of 4.18% since2009.

P The average weekly rate nationally prevailing under the Nursing Home Support Scheme (FairDeal) for accommodation in private and voluntary nursing homes was €896. This comparedwith an average fee of €850 in 2009. The latest published HSE fees for cost of care date backto 2011, stating average Fair Deal weekly rate at €1,245.

P Average turnover per bed for most recent financial year was €44,451.

P Staff costs account for 61% of turnover in respondents homes.

P The national average staff cost per registered bed was found to be €27,130, an 18% increasesince 2009.

P 42% of respondents stated they plan to create additional beds within a year.

P 9% of nursing homes had 25 or fewer beds; 26% 25 – 39 beds; 35% 40 – 59 beds; 30% 60+beds.

P 59% of rooms were single en-suite; 11% single; 16% double en-suite; 7% double; 7% multiple.

P 79% of residents were Fair Deal; 12% private payers; 6% contract; 3% subvention/other.

P Average annual food cost per resident in 2014 was €2,487, an increase of 13.4% since 2009.

P The survey also found that over 65% of residents cared for in respondents’ homes were in thehigh or max dependency categories, compared to 54% in 2009.

P Approximately 45% of residents were reported to have been clinically diagnosed withdementia.

Minister Lynch discusses NHI AnnualPrivate Nursing Home Survey 2014/2015

findings with Tadhg Daly, NHI CEO,and Hilary Coates, Head of Health,

Bank of Ireland.


A New Era in Risk Management The path to a comprehensive model of risk management within residential homes has not been the easiest of ventures. Risk management was, for many, a laboured process aligned more with health and safety requirements rather than a strategic tool underpinning all aspects of care and service delivery.

was the guiding principle in the initial residential care legislation where risk management was concerned, however, away from the requirements of the regulation, the reality of organisational and resident needs was starting to demand more from the risk management process. Risk Registers were evolving to encompass corporate risk management, resident care and service provision as well as the standard health and safety risks, however, the drive to utilise the model for positive individual outcomes remained somewhat removed from the risk management methodology.

Over the last year, a new focus has emerged for risk management, guided by the Health Information and Quality Auth Guidance for Designated Centres: Risk Management (2014) and international best practice, this time with a focus on individual risk management. A model has now emerged of what individualised risk management for residents should look like, that being using evidence based information to make balanced judgements between resident goals and wishes and unnecessary risk. Comprehensive risk management now requires the residential home to investigate specific individual risks, for example, risks relating to:

Potential new activities for a resident, Personal medical concerns, Unique resident difficulties.

In response to these risks, proactive and reactive responses are required to ensure that resident quality of life is prioritised within the provision of individualised care. Involvement by the resident from the outset, with full consideration of their wishes, is also viewed as central to the success of an effective risk management model. Risk is an inherent part of our everyday lives it can never be completely eliminated but the residential homes are incumbent to manage risk appropriately from all angles within the organisation. As the risk management process has developed, the guiding principle in relation to residents has progressed from position of preventing negative occurrences towards supporting resident positive advancement, which will assist the residential home in having a clear understanding of the strategies required to ensure resident quality of life in an ever changing environment.

Health Care Informed (HCI) have developed a risk management model and tool kit for designated centres that meets national requirements and international best practice to support the provision of safe and effective care with a central focus on improving resident quality of life.


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NHI News Summer 2015

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Transcript of NHI News Summer 2015