Tadhg Daly, Chief Executive of Nursing Homes Ireland from The National Homecare Ireland Conference...

Supporting the

Continuum of Care Care Requirements of our

Ageing Population Tadhg Daly – CEO Nursing Homes Ireland

28th March 2014

PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE

About NHI

• Representative organisation for private and voluntary nursing home sector

• 442 Private and Voluntary nursing homes registered • Provide care and a ‘home from home’ to 21,866

residents (Feb 2013)

• NHI Membership: 352 member homes/18,133 beds• NHI provide lobbying, representation, support and

guidance• Training and Education, Research• Education days, Annual Conference, Annual Care

Awards, Publications


About NHI


Our Vision, Our CommitmentNursing Homes Ireland is committed to providing leadership, supporting members and promoting excellence.Committed to working in partnership with our members and other stakeholders to achieve best practice in the care of the older person.

About NHI


Members Commitment • Maintain and enhance the quality of life of residents • Preserve the autonomy of residents, guaranteeing free

expression of opinion and freedom of choice • Maintain a safe physical and emotional environment • Ensure that the privacy and dignity of residents is

respected • Be an employer of choice and provide continuous

professional development and training


Not an exhaustive list

Partnership with Stakeholders

Nursing Home Sector

• Independent Registration & Inspection (July 2009 – HIQA)

• Nursing Home Support Scheme Act - Fair Deal (October 2009)

2 significant and largely positive developments embraced by the nursing home sector but not without

challenges



• Residential care independently regulated - HIQA• Arguably most highly regulated in health sector • Robust regulation – required to be consistent and

proportionate

“ Most recent inspection experience across the sector highlights a productive cooperation of providers with the regulator in both delivering quality outcomes and in improving standards of care continuously over time.” – HIQA

Designated Centres for Older People, An Analysis of Inspection Findings During the First 15 months of Inspection, HIQA

Nursing Home Sector


Changing role of nursing homes

• Increased Dependency levels• Increased specialisation • Dementia Care • Age profile • Reduced length of stay• Complex care needs


Community Care

• Day Care• Respite Care • Rehabilitation • Convalescent Care • Short stay / Intermediate • Independent livingDiscretionary with access and availability unclear and inconsistent – varies from region to region.Impacted by demand for LTC


NHSS “Fair Deal”, provides financial support to people who need long-term nursing home care, to make nursing home care “Affordable, Accessible and Anxiety Free”.

Assessed as requiring residential care – high/maximum dependency

Common Summary Assessment Record (CSAR): • ability to carry out the activities of daily living• The medical, health and personal social services being provided• The family and community support available• Persons wishes and preferences

Resident Choice - once approved for Fair Deal the resident chooses where they wish to live be it public, private or voluntary nursing home.

Fair Deal


• Legislative basis – NHSS Act 2009 • Fair Deal – financial support for Long Term Residential Care• Fair Deal scheme replaced subvention • A significant milestone for persons requiring nursing home care• Clear, uniform system of support for long term care• Demand – average of 867 applications per month in 2013

• 23,775 people Fair Deal approved year end 2013 (23,007 in payment) • Source HSE Performance Report December 2013

• Cost of Care “We have to ask why 50% additional costs pertain in public long-term institutions and facilities for the care of the elderly which do not apply in the private sector, and have to examine and address that,” Dr James Reilly, Minister for Health, Joint Committee on Health and Children, November 24th 2011

Department of Health issue Request for Tender (July 2013)

Objective of Review from Request for Tender(RFT)

The overall objective of the Review is to examine the future sustainability of the Nursing Homes Support Scheme, taking account of Government policy, relevant demographic growth trends and the current and projected fiscal situation and to make costed recommendations as to how the Scheme should operate in the short (to 2016) to medium (2023) term, to ensure that it best supports government policy, and how residential and community provision will be balanced as part of an overall approach.

Fair Deal Review


Ageing Population – Something to be celebrated


DEMOGRAPHICS – KEY NUMBERS - KEY CHALLENGES

Age 2011 2021 % Growth(2011-2021)

2031 2041 2046 % Growth(2011-2046)

65-69 172.1 225.6 31% 281.2 333.2 354.6 106%

70-74 130.1 191.6 47% 238.3 291.1 318.7 145%

75-79 101.4 139.5 38% 192.1 245.6 269.3 166%

80-84 69.8 90.1 29% 143.9 187.4 213.8 206%

85+ 58.2 85.0 46% 135.5 219.0 262.9 352%

Total 65+ 531.69 731.9 38% 991.0 1,276.3 1,419.3 167%

% of Pop 11.6% 14.9% 18.7% 22.4% 24%

4.5% 23,920 32,930 44,590 57,430 63,870

Nursing Homes Ireland

• Across all 65+ cohort, population to grow from • 2011 - 11.6% population• 2046 – 24% population

• 65+ population to grow• 2011-2021 + 38%• 2011-2046 + 167%

• 85+ to grow • 2011-2021 +46%• 2011-2046 +352%

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2026 2031 2036 2041 20460

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

Aged Population Growth & Split by Age

65-69 70-74 75-79 80-84 85+

Source:CSO Census of Population 2006 + 2011 & Population and Labour Force Projections 2016-2046


Demographics - An Ageing Population

HSE outline that the €23million allocated from Fair Deal is a “first step in aligning the model of care towards home and community support services”

This amount of €23million is broken down as follows: • €10m of the funding to support acute hospitals service pressures by commissioning to provide additional intensive Home Care Packages (forecast approximately 190 HCP’s at any time, benefitting approximately 250 people in a full year)

• €3m of the funding to commission additional intermediate care and community support beds to provide a greater range of options to avoid admission to acute hospitals (approximately 25 intermediate / transitional care beds with 650 people benefiting together with 20 beds to provide for more complex cases benefiting 130 people)

• €10m to address funding shortfalls in the provision of public short stay beds with a funding and commissioning type payment mode for ‘short stay beds’ based on the ‘money follows the patient’ approach already applied to NHSS – A Fair Deal.

HSE Service Plan 2014


“Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significant in the next decade,”

CARDI, Future Demand for Long Term Care in Ireland, 2012

“ We welcome the HSE’s plans to concentrate on developing community based services and supports to enable more older people remain living at home, but we are extremely concerned that the switch in some of the funding from nursing home supports to community supports which the HSE is planning will be insufficient to meet the needs of the sickest of older people who will be affected,”

Eamon Timmins, Age Action Ireland, December 2013


Continuum of Care

Continuum of Care


• National Positive Ageing Strategy – National Goal 2. “Support people as they age to maintain, improve or manage their physical and mental health and wellbeing.”It focuses on promoting the development and delivery of a high continuum of high quality care services and supports that are responsive to the changing needs and preferences of people as they age and at end of life.

• Requirement to have appropriate care at the appropriate time – people needing support should have access to a range of quality services, so that their care and support can be tailored to their individual needs, preferences and circumstances

• Such care should be available through a developed continuum of care to include homecare, day care, independent living, nursing home care (short and long stay), and other community-based services

• Not about Homecare V Residential • Development of a true continuum of care• Independent regulation (registration and inspection) of homecare must be a priority

“Our focus now, more than ever, must be to look beyond traditional models of service delivery if we are to deliver local services for local communities,”

Pat Healy, newly appointed HSE Director Social Care


Continuum of Care

• Single Assessment Tool - interRAISingle Assessment Tool (SAT) will commence in 2014 with a minimum of 50% of all new entries to the Nursing Homes Support Scheme, Home Care Package and Home Help Schemes assessed by the SAT in the last quarter of 2014, with full implementation of SAT by the end of 2015.

• Role of nursing home sector in complimentary services (homecare/ day care/ meals and wheels)

• Nursing homes a hub of community services? Primary Care• Independent living – care communities • Implications, if any, of UHI and Healthcare Commissioning

Agency?


NHI recommends that a new scheme mirroring Fair Deal with dedicated funding should be introduced on a statutory basis for community care. This scheme could mirror the principles of Fair Deal and Money Follows the Patient:• A uniform assessment (SAT)• Equitable access to those assessed as requiring such

care• Dedicated ring-fenced funding• A co-payment model that makes such care affordable

and accessible


Fair Deal Review

The future?

NHI concerned at lack of planning

“Present and future generations will regard with dismay the failure of successive Ministers and senior officials in the Department of Health and the HSE to remedy a deficit, widely recognised for many decades, in nursing home places, particularly in urban areas,” – Professor Des O’Neill, Centre for Ageing, Neuroscience and the Humanities, TCD, Irish Times, March 2014


BDO Report:Health’s Ageing Crisis; Time For Action

BDO Report – need to plan – in all our interests

• Ageing Demographic• Demand for residential care

exceeding supply• Development of ‘continuum of care’• Cohesive national strategy • Implications of inaction


Future Policy?

• NHI campaign for Dept of Health led “Forum on Long-Term Residential Care”• Bring together all of the relevant stakeholders involved in the provision of long-

term residential care for older people– Department of Health– HSE– NHI– HIQA– NTPF– Representatives of Older People

• “Too many reports, too much talk, not enough action”Quality & Standards in Human Services in Ireland: Residential Care for Older People,National Economic and Social Council (NESC), July 2012, recommendation: “A problem-solving group of those influencing provision of long term care (e.g. providers, the Department of Health, and HIQA) may be useful to examine and address the challenges of providing sufficient quality long term care in an equitable and sustainable way.”


Unit A5, Centrepoint Business ParkOak Road Dublin 12

(01) 429 2570www.nhi.ie [email protected]

www.nhicareawards.ie


http://www.nhi.ie/

mailto:[email protected]

http://www.nhicareawards.ie/

Tadhg Daly, Chief Executive of Nursing Homes Ireland from The National Homecare Ireland Conference...

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