Nursing Home Care: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes that:

- the majority of long-term residential nursing home care is delivered by the private and voluntary sectors;

- since 2020, there have been 31 private and voluntary nursing home closures which have resulted in a loss of 915 beds;

- increasingly, nursing homes are considering leaving the Fair Deal Scheme and contend it is not providing sustainable funding;

- a significant number of nursing homes reported an operating loss in 2022, and are raising concerns about the viability of the sector;

- nursing home capacity, where under-utilised for long-term care, can be used for "step-down" transitional care;

- according to the PwC report, commissioned by Nursing Homes Ireland, entitled "Challenges for Nursing Homes in the Provision of Older Persons Care - Private and Voluntary Nursing Home Sector", the nursing home operational cost for care per resident has increased by 36 per cent, and new bed development costs have increased by more than 45 per cent per bed since 2017;

- as the population grows and ages, with the number of people aged over 85 set to double in the next two decades, and as more care is delivered in the home, the health profile of nursing home residents will tend to be older and more complex; and

- nursing homes face significant difficulties in recruiting and retaining experienced staff;

recognises that:

- immediate action is needed in the short-term to halt further nursing home closures;

- a medium- and long-term plan is needed to ensure the sustainability of the sector and develop public capacity; and

- the promised Commission on Care has yet to be established, despite being central to developing a sustainable plan to ensure a viable residential care sector for those who need it, and reorientate care into the home for those who prefer it; and

calls on the Government to:

- deliver and fund a collective pay agreement for workers in the nursing home and home care sectors, to ensure a living wage and proper remuneration;

- review public funding arrangements for long-term nursing home care, to provide better pay and conditions for workers, quality of care for residents, and maintain viability in the sector;

- reform the pricing mechanism to enable the Fair Deal Scheme rates to be based on resource allocation that is reflective of a resident's individual care needs;

- directly fund hospitals to contractually purchase bed space for fixed periods in local nursing homes where capacity is available; and

- establish the Commission on Care.

I welcome to the Visitors Gallery members of Nursing Homes Ireland, including the CEO, Tadhg Daly, and many of his members, Shane Scanlan from The Alliance – A Support Network for Nursing Homes, staff members of nursing homes from across the State and, crucially, family members of relatives in nursing homes who, unfortunately, are facing the threat of closure because of the lack of sustainability and lack of viability of the sector. Our motion was tabled to send a very strong message and very strong signal to the Government that action is needed and that inaction is not something that can be accepted or is acceptable. Residents of nursing homes, their families and providers need urgent action from the Minister of State with responsibility for older people, Deputy Butler, but also the Minister for Health, Deputy Donnelly.

Since 2020, 34 private and voluntary nursing homes have closed their doors with a loss of more than 1,002 beds. The loss of 1,002 beds is bad enough but the Minister has to accept that the loss for people who lived in those homes, the people who cared for them and the people who own and manage them is also enormous. I can tell the Minister that the stress of closure and the threat of closure for both residents in nursing homes and their families is intolerable. We need to send a very clear message to the sector that we want to support it, we will support it and there will be sustainability in the sector. We would all accept, as do those who run nursing homes and provide nursing home care, that we also need to make sure we have adequate home care supports. In the first instance, we have to ensure people are cared for in the home. We still have not seen the statutory home care scheme that was promised or the commission on care that was to be established as part of the programme for Government. Of course, there is a lot to do in the home care sector and we need more investment in that area.

There are people who will need to be in nursing homes. Some of my family members were in nursing homes. My grandparents were in private nursing homes and they received the very best of care. They were in nursing homes because they had dementia and other illnesses which meant they simply could not be cared for in the home.

What we are hearing all of the time from home care providers and from nursing home providers is that there is lack of capacity. The nursing home providers whom I have met over recent years have told me that we have been building up to this crisis over that time, yet we have seen no action from the Government. I do not know how many times the Minister has visited private nursing homes or voluntary nursing homes. I do not know how many meetings he has had with Nursing Homes Ireland and the representative groups. I do not know how many residents he has met in recent years. I can tell him all of the people, providers, residents, staff and family members I have met are crying out for help. They are telling the Minister that the service is unsustainable. It is not just the service providers who are saying this. A report from PwC was published recently that clearly set out the challenges in this sector. Time and again, there were HIQA reports that identified problems in the sector. We have known for some time that we have to review the fair deal scheme, we know we have to review the pricing mechanism and we know that reports are telling us that costs have gone up by 30%, including energy costs, food costs and staffing costs. All of that has to be paid for and all of that is putting a huge financial strain on those private and voluntary nursing home providers, but they are not getting support from the Government. I have to relay to the Minister that they are telling me they are not being supported and they do not hear anything from the Minister.

I want to finish my contribution by reading into the record one story of a family who contacted me. It reads:

My mother's name is Joan. She is 90 years of age. Joan has advanced dementia or Alzheimer's. She married in 1962 and reared five children with my dad. She has worked hard in the home all her life, caring for her family. She previously cared for her father when he was widowed.

Joan's daughter told me:

She cared for her mother who died from cancer when she was young. She cared for my sister and father at home before they died. Now there is time for her to receive care. The care she is receiving is phenomenal. The staff work extremely hard. They know Joan's personality now. They know her likes and dislikes, how to get around her, her interests and her habits. My eyes have been opened to the tremendous work the carers and the staff do. They are inspirational. I am angry having to write this down about my mother because of an action by Government and I am begging you to act to ensure that her nursing home is not closed.

The responsibility does lie with the two Ministers I am looking over at. They have to act. They should not go into the summer recess without taking any decision here or we will see more homes close. That would be intolerable. The political leadership has to come from the Minister of State, Deputy Butler, and the Minister, Deputy Donnelly.

Deputy Patricia Ryan

As Sinn Féin’s spokesperson for older people, I am proud to commend the motion to the House. Unfortunately, due to the Government’s inaction, the motion is urgently needed to address an issue that poses a threat to the dignity and well-being of our elderly, namely the alarming surge in nursing home closures across the State. Since 2020 we have seen the closure of 34 private and voluntary nursing homes, translating into a loss of more than 1,000 beds. That represents not only numbers but individual lives being displaced and families being plunged into deep uncertainty and distress. It is crucial that we do not forget that these are not merely statistics but real people and lives being impacted. Our elders, the ones who have built and shaped our nation, now find themselves and their safety net being gradually eroded.

I want to mention Eily Ahern. Eily is a mother, a wife, a seamstress who survived war and the death of close relatives. She loves to dance and sing despite her advanced dementia. She has been a resident in Beaumont nursing home since 2019 but she may now have to leave her home. Is the Minister or anyone in the Government going to explain to her why this is the case? Who will tell her this? This will be left to her family to do and it breaks my heart that the Minister can sit there and let that happen. Everyone is increasingly concerned about the fair deal scheme. Once hailed by the Government as the cornerstone of residential care, it is now under threat. Many nursing homes are contemplating abandoning the scheme altogether. They say it is no longer providing sustainable funding for them. The uncertainty is compounded by the stark revelation that a significant number of nursing homes reported operating losses in 2022. That casts a shadow over the future viability of the sector. This is especially true of smaller nursing homes that are family-run businesses which are struggling to make ends meet. The PwC report commissioned by Nursing Homes Ireland paints a stark picture of escalating costs with operational costs per resident and now bed development costs increasing by 36% and over 45% respectively since 2017. Nor must we forget these challenges occur against a backdrop of a rapidly ageing population. The health profile of nursing home residents is set to become increasingly complex as we expect the number of people over the age of 85 years to double over the next two decades. As we increase care provision in the home we must consider the profound implications this will have on our nursing-home sector. We need action now to avert further crises in future.

However, an issue that is facing our older folk now is that of staff shortages. Nursing homes face significant difficulty in recruiting and retaining experienced staff. HIQA has echoed this concern in its 2022 annual report. Staffing shortages have a direct impact on the number of available beds and the quality of care given in homes. HIQA's December 2021 report noted the decrease in available beds in 17 counties and a persistent trend of smaller nursing homes closing. All this is happening while the commission on care essential for a sustainable plan for residential care is yet to be established. Why is it not established? We need to heed these cautionary statements and for the Government to act to deliver a collective pay agreement for workers and review public funding arrangements for long-term nursing care.

Our elderly citizens deserve to spend their later years with dignity and without fear of displacement in their homes, which are suitably funded, properly staffed and competently managed. Sinn Féin will continue to advocate for the rights of our older people. We are committed to ensuring this issue does not slip through into oblivion but is given the attention and the action that it urgently requires. Families voices must be heard. I urge the Government to support our motion.

Deputy Donnchadh Ó Laoghaire

I apologise that I must leave as soon as I have made my contribution to rejoin a meeting with a group from my constituency so I will not hear the Minister’s response.

The Minister will be very aware of the issues in relation to Beaumont nursing home. The motion is about the sector generally. It is facing potentially an existential crisis. The Minister of State, Deputy Butler, will be very aware of my concerns on this. Some of my colleagues have given examples of some of the people who live in these homes. It is worth remembering that nursing homes are not sterile places where people simply sleep and eat. These are places where life happens. They are places where people live. I am sure people can think of all types of examples from their own lives. I think of bringing my son in to meet his great-grandmother, her very first great-grandchild. I think of my cousin on the other side going in in her wedding dress on the morning of her wedding. These are places where, yes, loss happens and hardship happens but also great happiness, great joy and great love as well as great care. That is what these homes provide. The model we have selected may not be the ideal model in many ways but it is the model we have and we have to make it work for the residents and their relatives and loved ones. I have talked about care and I am thinking of some of the people I have met over the last week. I met Eoghan Horgan, the husband of Madeleine Horgan, who was a designer who worked in fashion and sales and she instilled a good work ethic. She taught her employees the importance of loyalty and hard work. In 2013, she was diagnosed with early-stage dementia and the family made the hard decision to bring her to Beaumont Nursing Home. I spoke to Eoghan. He is a man of great dignity but also great resolve. He is an absolute gentlemen but he is very determined not to allow what is happening to happen and to ensure there is a solution. I share his determination. I met John Murphy earlier today for the second time. His father Patrick Murphy worked in CIÉ from 1949. He is in his 99th year. He worked for decades for a semi-State company. As a taxpayer he paid his dues and as a family man he raised his family. Surely he and his family do not deserve this uncertainty. We need a solution. We need full engagement from the Government and a solution not only in Beaumont but across the sector to reassure people and bring an end to this stress and trauma that residents, staff and relatives are suffering.

Deputy Seán Crowe

Long-term residential nursing home care is yet another aspect of the health service that we have surrendered to the private sector and it is ordinary people who are suffering the consequences. Increasingly, nursing homes are considering leaving the fair deal scheme and we are losing more and more bed capacity as nursing homes close. Some 31 have closed since 2020 with the loss of almost 1,000 beds. There are now real concerns about the viability of the sector. The same has happened with dental care. The dental treatment service scheme has been a disaster and many medical card holders cannot access a dentist. This is the result of successive Governments' policy of stripping away the health service to the point where people believe that you have to have private insurance to be guaranteed timely access to health-related services. We need to view the health service as a machine of many parts; if one part slows down then the whole machine clogs up and slows down. Step-down beds and community supports are a vital cog in that machine. It costs €1,029 a day for an acute bed in our hospitals. That is over €7,000 a week. A nursing-home bed averages about €1,400 a week yet everyday hospitals across this State find themselves with patients who should be getting care in different settings. Delays in discharging patients from hospital also create bottlenecks in our emergency departments. We should directly fund hospitals to purchase bed space contractually for fixed periods in local nursing homes where capacity is available. Too many people are stuck in hospital beds when more appropriate care can be delivered elsewhere.

Too many homes are relying on agency staff, which drives up costs and makes margins so tight that homes close.

Sinn Féin in government would deliver and fund a collective pay agreement for workers in the nursing home and home care sectors to ensure a living wage. We would establish the commission on care, which would modernise the care sector and better align care, including family carers, care in the home, nursing home and residential care, and palliative care.

If we do not act now, we create a huge problem now and for the future. Ireland has an ageing population. That is a good thing, but we need to use our resources better.

Deputy Paul Donnelly

At this moment we face into a serious problem as regards nursing homes and care homes. There are closures happening all over the State. Thirty-four have closed with a loss of more than 1,000 beds, and there have been four closures in Dublin with a loss of 169 places. This is not a time for empty words. It is not a time to simply nod this motion through and then slink off for the summer recess and hope it goes away in September. We know it will not go away. A significant number of nursing homes are reporting huge operating losses, and that has raised concerns about the viability of the sector.

Five weeks ago a very close relative of mine passed away in a nursing home and we had the honour of being there with her in the last three or four days. I cannot commend enough the entire staff, from the cleaning staff right the way through to the nurses and the care workers. They were absolutely incredible.

We have all received emails from distressed families of residents whose homes are at risk of closing, like this one:

When my mom got sick I made her a promise that I would look after her and do what I could to make her comfortable and be there for her no matter what, like she did for me. I intend to keep that promise.

When the time came to make the decision of putting my mom in residential care she wanted to be as close to us as possible and that's when we chose Beaumont. Upon seeing Beaumont we knew that was the home for her.

The staff are fantastic, she loves them, she has made friends and has a routine, she's happy and content and settled there. Ministers, Taoiseach and Tánaiste, I ask you please to intervene in the funding of the fair deal scheme as it needs further funding to remain sustainable.

I recently met with migrant nurses' representatives and they told us of the huge difficulties they have trying to work in this State and in this sector. The barriers being placed in their way by this State are nothing short of bizarre given the dire need for qualified and skilled nurses and care workers. I appeal to the Minister and the Minister of State to address that as a matter of urgency. I know we had them in the Houses recently expressing their concerns.

Our motion is clear. It is time for action and time to support the nursing and care home sector and its workers because the most vulnerable in our society rely on us to do that work.

Deputy Thomas Gould

I have met with families from Beaumont nursing home in Cork city. I have heard their heartbreaking stories. I know the Minister of State, Deputy Butler, has promised alternative beds. Residents I have heard from do not want other beds; they want to remain in Beaumont. That is where they themselves chose to be. Beaumont is their home. It is not just a bed; it is where they have established daily routines and made friends and where they have their favourite table and chair to sit down and to chat at. That is the lived reality. I ask the Minister to cast his mind back three years ago, when the HSE tried to close Mount Carmel nursing home in Cork. We led a campaign then, and I remember talking to the people affected when the HSE tried to close the home. They were terrified. These are people who are in a nursing home, who are happy, whose families are supporting them and who have staff who care about them. It is like an extended family. I remember at the time people from Farranree being told to go to Youghal and other people being told to go to Kinsale. These people are now at a certain stage of their lives and the Government is inflicting pain on them with the stress, the nervousness and the fear factor.

Where is the compassion, the dignity and the respect for these people? I implore the Minister and the Minister of State now, before the summer recess comes, to take the action. They are intelligent people; I know they are. They can hear the stories. They have spoken to people in Beaumont. I have talked to people from Montenotte. They feel their nursing home is next. Everyone out there - the people in the nursing homes, their families, the staff and the owners - now feel their nursing home is next. Will the Minister and the Minister of State give them an answer tonight? Or will this be another one of these motions whereby we in Sinn Féin put forward solutions and the Minister goes up to his or her office and puts them up on the shelf there and leaves them there? If Sinn Féin are in government, we will take them down from the shelf and make them policy.

Minister for Health (Deputy Stephen Donnelly)

I welcome this opportunity to address the House and thank the Deputies for tabling what is a largely sensible motion, bar one piece in it which does not make sense to me at all and which I will come to at the end. Broadly, however, I think the motion has been tabled in good faith and it is a very sensible motion. On that basis we will not oppose the motion. It is an important opportunity to debate these issues.

As Minister for Health and a citizen of our Republic, I am deeply appreciative of the care services provided right across this country - in every one of our constituencies, in every county, in every town. I recognise the extraordinary work, the compassion, the dedication and the professionalism of those working in our nursing homes every single day, every single night, taking care of some very vulnerable residents, some of whom colleagues have given examples of and have read out testimony from. I also acknowledge the dedication and the leadership of the Minister of State, Deputy Butler, which I know is broadly acknowledged around the House. I have the great honour and privilege of working with the Minister of State and have done for the past three years in office. I have never seen a Minister more dedicated, more passionate or more resolved to ensure older care in this country is fit for purpose, fit for our Republic and something we want to see get better and better.

Colleagues, I hope, will acknowledge that there has been an unprecedented level of investment in older care, in the nursing home sector and in health generally in the lifetime of this Government. To be clear, last year €1.4 billion of public money was used to support nearly 23,000 women and men under the fair deal scheme. This year the figure will be approximately €1.5 billion. It is a vast amount of money - public money - going to support these places, and quite rightly. The Government, during its lifetime and through Covid, as well as providing that €1.5 billion, has provided very substantial additional funds, and quite rightly. In excess of €150 million was provided through the Covid-19 temporary assistance payment scheme, TAPS. An additional €10 million was provided through the temporary inflation payment scheme. On top of that, as colleagues will be aware, the State is covering the costs of personal protective equipment, PPE, and oxygen to private nursing homes. It may surprise colleagues to hear that the cost of that to date is €75 million. Therefore, on top of the €1.5 billion under the fair deal, hundreds of millions of euro are being provided directly to nursing homes in financial aid from the State. The investment is very clear, tangible evidence of this Government's commitment.

I will update colleagues on some of the other measures going on and on which the Minister of State, Deputy Butler, is leading. The patient advocacy service was extended to private nursing homes last November. Revised regulations have been in place since December. Those regulations enhance and streamline the complaints process which came into effect in March of this year. The results of the first nursing home care experience survey were published last November, and I know colleagues will have looked to that. In conjunction with the HSE, recruitment has commenced for new dedicated infection prevention and control and safeguarding specialists for our nursing homes. On top of that, new training and development opportunities are being rolled out for staff working in nursing homes with a new palliative and end-of-life programme. That was launched last year. I know we all agree on the huge value that palliative care and end-of-life services are providing in nursing homes and in other services throughout the country.

Let us come to the National Treatment Purchase Fund, which goes to the core of the motion we are debating. As regards the funding of nursing homes, it is important to note that all private and voluntary nursing homes must agree a maximum price they can charge to a fair deal resident. They do that with the National Treatment Purchase Fund, which is the designated State agency.

These prices are agreed with the National Treatment Purchase Fund, NTPF, following negotiations and are based on cost criteria such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. The NTPF carries out this role independently under the 2009 Act. It has statutory independence. Deputy Gould referenced what Sinn Féin would do in government, and he is right to say so, but he should be aware that Sinn Féin would be statute-barred from interfering in any individual negotiation. For reasons we all understand, the NTPF has statutory independence in those negotiations.

Any nursing home that has had a scheduled renegotiation of its deed of agreement this year with the NTPF has seen a significant uplift. Nursing home providers I have spoken to directly have stated that, when they got the uplift, they reached a much more sustainable financial position. They stated that, before the uplift, the cost of living had exceeded their cash flow and that, once they got the uplift, which amounted to 6% or 7% in most cases, it made their organisations and businesses financially viable. To date this year, more than 120 nursing homes have renegotiated their contracts with the NTPF. As colleagues will be aware, that is happening on a rolling basis.

There is an additional and welcome reform. Under it, nursing homes can now accept 12-month contracts rather than three-year ones. This speaks specifically to their reasonable concerns about the inflationary environment in which we are.

I wish to discuss nursing home closures. While I accept the good faith of colleagues across the floor, one could be forgiven for thinking that, based on the contributions we have heard so far, the total number of nursing home beds in the country was reducing. It might come as a surprise to people who are watching the debate to know that the total number of nursing home beds in the country increased last year and has increased again this year. To date this year, there have been an extra 185 beds. We expect that number to keep increasing.

Deputies have rightly pointed to nursing homes that are closing. I have great sympathy for certain cases, for example, a mom and pop operation that has been in the family for years and is totally dedicated to the care of its residents but that, due to inflationary pressures, what has happened with Covid, the jobs market and many other reasons, has found itself unable to continue its services. There are other nursing homes that are very well capitalised and whose ultimate corporate objective under law is to maximise shareholder return. There are nursing homes that are not complying with the HIQA standards. We would all agree that every nursing home must comply with those standards. I accept fully that there are nursing homes that are closing and that, in some cases, they are services in the community that we would dearly love to see being sustained.

Deputy Gould referenced a particular nursing home. Like him, I feel for its residents. However, may I respectfully suggest that he direct at least some of his outrage towards the private company that told the residents that they might have to leave within 30 days? It is a well-capitalised private company that has nursing homes around the country. It is not some mom and pop operation that found itself unable to do anything other than give those residents short notice. By all means, the Deputy should direct some of his ire and criticism at the Government - that is part of his job - but I suggest that we all focus on the nursing home provider that has caused its residents a great deal of concern. My understanding is that the residents were told they might have to vacate in a brief period. Let us remember that as well.

A pricing review is under way. My Department has facilitated a review of the pricing mechanism for long-term residential care. Recommendations have been received and implementation of those is under way.

As colleagues have rightly pointed out, a core focus for the Government is addressing workforce issues. There are nursing homes that are struggling to hire the healthcare assistants, nurses and other staff they need. An interdepartmental group was put together in March of last year and has made 16 sensible recommendations covering the issues that the Deputies have raised. Implementation of those is under way. Alongside this work, a process of engagement to examine the pay of workers in the community and voluntary sector - section 39 organisations - is under way. The commission on care has been referenced by colleagues opposite. We plan to have that established this autumn. It will be essential.

We are all agreed on the need for our Republic to provide appropriate and fit-for-purpose care. The one area where I was taken aback by the motion was where it suggested that the State deliver and fund a national pay agreement. I imagine that would cost well in excess of €1 billion. I do not imagine that Deputy Cullinane is suggesting that the State underwrite the wage.

Deputy David Cullinane

The Minister did not read the motion at all. Would a living wage cost €1 billion?

Deputy Stephen Donnelly

The motion-----

Deputy David Cullinane

Read it.

Deputy Stephen Donnelly

-----states clearly: "deliver and fund a collective pay agreement".

Deputy David Cullinane

No, that is not what it says. The Minister did not read it.

Deputy Stephen Donnelly

I did. With respect, I have just read it out.

Deputy David Cullinane

Read the whole sentence.

Deputy Martin Browne

Read it all.

Deputy Stephen Donnelly

We are not opposing the motion.

Deputy Patricia Ryan

The Minister has not read it all.

Deputy David Cullinane

No. Do not be inaccurate, Minister.

Deputy Stephen Donnelly

A great deal of progress is being made. While the Deputies should of course criticise the Government and hold us to account, as that is part of their job, let us not lose sight of the fact that there are highly sophisticated, well-capitalised, for-profit organisations involved in this that also deserve a certain level of scrutiny from us all.

Deputy David Cullinane

The Minister's head is in the sand.

An Cathaoirleach Gníomhach (Deputy Seán Canney)

Next are Deputies Martin Kenny, Martin Browne, Buckley and Ellis, who are sharing time.

Deputy Martin Kenny

This motion is about trying to help a sector that we all know is in deep trouble. At the gates of Leinster House last week, I met many managers and owners of nursing homes. They did not come here because there were minor problems. They came here because there were serious issues, which have resulted in many smaller nursing homes being unable to survive on the payments known as the fair deal scheme. I am not sure what is fair about it. It is not very fair if it does not provide for people.

Constituents and families are contacting us about people they have in nursing homes who need specialist pieces of equipment, for example, waterbeds, special chairs and the like. They have to pay for that equipment themselves in addition to what they already pay because there is no provision to take care of it.

There are major issues with nursing homes across the country. The Minister mentioned the small number of closures among smaller nursing homes, including small family businesses. That may be the case, but it still means we are losing beds and places of care that people need. This is the issue. As more places are lost, it puts more pressure on the hospital system, which we will be discussing with the Minister in the Chamber next week or the week after because there are such large waiting lists in accident and emergency departments and people cannot get out of hospital beds, given that there are no nursing home beds for them to go to. One thing not working has an impact on everything else. We need to recognise that one of the key aspects of our health service has to be the provision of adequate nursing home beds across the country. That is not the case currently, and we need to address that.

It has been said that, if we were starting again, we might not opt for this exact system, but we have to make it work. We have to be able to deliver for everyone who needs a bed and a place to live. Most of us will end up in a nursing home some day as we approach the end of our lives. There are 600,000 pensioners in Ireland. In 25 years’ time, it is said that there will be more than 1 million pensioners in Ireland. As that number grows, the care needs of those people will grow as well. We will have to provide for those adequately. The State has a responsibility to step up to the mark in response.

Saying that it is somehow the large nursing homes’ responsibility to carry the weight does not let the Minister off the hook. He has to provide for people. Who we are speaking on behalf of are not nursing home providers as such, but the patients and their families, who will be under stress until these issues are resolved. The Minister needs to step up to the mark and resolve them.

Deputy Martin Browne

I hope the Minister replays his multiple mom and pop statements later. Has he listened to any of the people in the Public Gallery who are telling him that they are losing beds and their sector is in trouble?

I welcome the chance to speak on this issue because it has been clear for some time that, as the population has aged, the cost of doing business has increased and the funding model has continued, the sector is facing challenges that need to be addressed urgently.

Back in April, representatives of a number of smaller nursing homes, including a significant number in my county of Tipperary, got together and briefed members of this House on the situation they find themselves in. Smaller nursing homes are suffering. As those nursing home representatives said to us a couple of months ago, it disregards the rights of people needing private nursing home care not to have access to an appropriate cost-of-care model. This can deny them access to a facility in their locality or general area.

In 2021, HIQA pointed out that the single fee payable by the nursing home support scheme does not provide funding based solely on the care needs of the older person. That was in the value-for-money review of nursing home care costs. There is no interpretation needed here because it is as clear as day.

I will read from correspondence I received recently from the family of a man who is 94 and a half years old. He is described as a "kind, gentle, softly spoken man and dad". He has been in Beaumont Residential Care for the past four months purely because his physical care needs increased. He was an extremely hard working, conscientious engineer in his day and had responsibility for some of the largest factory plants in Munster. When the day came that he needed nursing home care, his first preference was Beaumont Residential Care because over previous years he had visited people there. He liked the feel and the setting of the home and his friends were happy there so it was a no-brainer when it came time to choose a nursing home. It is incomprehensible to him that at this stage of his life there is a viable threat to his home. He does not want to move. Why should he? This is an appalling situation visited on him and many others through no fault of their own. It is inhumane for elderly people to have the threat of no bed and for the situation to have been allowed to get to this impasse. The writer asks that someone listens to the family members speaking on behalf of residents and gives them peace of mind. The Government is not opposing this motion, but for Christ's sake, for once it must act.

Deputy Pat Buckley

I welcome the visitors who are in the Public Gallery. I, too, want to read from correspondence I received recently from the son of Patrick Murphy, who is in his 99th year. Patrick worked for CIÉ for 40 years from 1949 to 1989. His job was as a ganger on the permanent railway between Cobh and Cork. He walked the line in both directions every two weeks with a heavy hammer and a large spanner to ensure that all the keys were in place and to tighten the bolts. His wife Mary died suddenly in 1979 but Patrick continued living on his own in the same house for almost 60 years before going to Beaumont Residential Care in October 2020 at the age of 96 as he could no longer live alone. It took him about six months to settle in but now he loves the room he is in and the caring staff who look after him every day. Having to leave Beaumont "would literally kill him". The writer finishes by saying that now, in the twilight of his life he may have to leave the place he loves because of "the failure of Government policy" in its duty of care to our most vulnerable people, our elderly. These are not my words but those of the son of Mr. Patrick Murphy.

I listened to the Minister's speech earlier. He finished by saying that this is not about pitting the private sector against the public sector, especially in an emergency and in the context of care for the elderly. The Minister spoke about an additional 185 beds and others spoke about 900 beds lost but these are not beds; these are actual human beings with families.

The Minister mentioned the NTPF but we have to change things. We are legislators and we can change things. This is all about doing the right thing. A company that is getting €657 less per week per resident cannot compete on the same level. There are lots of small things that we might be able to change too, like commercial rates in the private sector, to give them a break. People on all sides are giving the best level of care possible in this country, which is what they are supposed to do. The Minister is not opposing our motion but he must accept that there is a trend here. The Minister of State, Deputy Butler, is well aware of the situation with regard to services at Owenacurra. We are seeing the same trend in mental health and respite services. They are going as well and we are heading for another tsunami. If we do not address the matter now, we are all going to be in deep trouble.

Deputy Dessie Ellis

One of the most difficult decisions that families have to make is how to take care of their parents as they get older and it becomes clear that they can no longer take care of themselves. Difficult choices have to be made to ensure that elderly parents receive the type of care they deserve and that their adult children can no longer provide, especially in the long term. People want the best for their elderly parents and want to put them in an environment where they will thrive and enjoy a good quality of life.

Placing an elderly parent in a nursing home is often the first choice for a number of reasons. In general, nursing homes offer a secure environment with specialist 24-7 care for residents, with on-site nurses and trained care assistants. They offer elderly residents a variety of activities and entertainment to keep them active and engaged and a social community that they would not otherwise have if they remained at home. We can imagine the trauma and stress elderly people would feel if they were faced with the prospect of leaving what has become their home. This is unfortunately the reality for many elderly people as the crisis in nursing homes escalates with unprecedented numbers of private and public nursing homes closing across the country. Take the example of Maureen who is 81 years of age. She is over two years in Beaumont Residential Care in County Cork. She suffers from dementia and Alzheimer's disease. She has a husband and six children. As a result of her condition and the fact that her family was unable to deal with her worsening health, she ended up in Beaumont Residential Care. This was a very difficult decision but was made in the best interests of Maureen and her family. Closing down the centre after all that Maureen and her family have gone through is unthinkable and will have an untold effect.

The fair deal scheme has provided the opportunity for many elderly people to find a place in a nursing home who would not otherwise be able to afford this sort of care. However, there is now a funding crisis in the fair deal scheme and this has resulted in groups such as CareChoice withdrawing Beaumont Residential Care from the scheme. The current NTPF rate of support for fair deal scheme participants per resident per week at Beaumont is just not sustainable. This is causing great distress for the families of the residents who fear losing their homes as a consequence of this crisis. This needs to be looked at urgently and reforms brought in to ensure proper funding for the fair deal scheme. This crisis has to be resolved. Consideration needs to be given to the residents and the underpaid staff if we are to have a functioning, fit-for-purpose nursing home sector.

Deputy Sean Sherlock

I support the motion. I am glad we are debating this matter tonight. I read the Minister's speech and listened to him speaking earlier. He spoke about the NTPF and said that any nursing home that "has had a scheduled renegotiation of its deed of agreement this year with the NTPF has seen a significant uplift" and that the uplift has been in the region of 6% to 7% above the baseline price for the weekly rate charged per resident. To date, over 120 nursing homes have renegotiated their contracts with the NTPF. Many nursing homes are telling us that the uplift is not keeping pace with inflation and that therefore they are still operating at a real time loss in terms of their overheads and costs that accrue to nursing homes arising from their day-to-day operations. The statement by the Minister needs further interpretation based on my experience of talking to the so-called mom and pop shops. That is an American aphorism that is used. It normally refers, with all due respect to the Minister, to somebody who has a café employing two or three people but I am talking about entities that are businesses, intergenerational family-run businesses employing anywhere from 30 up to 100 people, or 150 people in one case. They are not mom and pop type operations. We need to be careful about the language we use so that it is not patronising or diminishing anyone in any way. I know the Minister is not seeking to do that.

We have to speak for people like Angela Liston, for instance, from the Youghal and District Nursing Home, who wrote to me to say "we are currently barely keeping our heads above water" due to the ongoing crisis in the funding of nursing home care under the fair deal scheme. Her nursing home is currently receiving €1,040 per week per resident whereas the local HSE community nursing home is €1,697 per week per resident. That disparity between a public and a private nursing home is something that we need to interrogate further.

What I do not have on this side of the House is transparency with regard to the model that determines the cost or amount that is allocated per resident per week. We will be told there is a higher rate of dependency among those in the public system. I have not seen evidence of that or research on it. The people, including Angela, in the Public Gallery want some form of equalisation. They cannot wait for the review or scheduled renegotiation to be able to get that 6% or 7%. They want to know whether there will be equalisation across the system to bring people who are on the lower scale up. As her public representative, I need to know how the review of pricing will get to that point.

My fear is that the intergenerational businesses will decide to sell on to the larger corporate entities, which have economies of scale and can mobilise people. The Minister referred to that. The intergenerational businesses will sell up and get out of the business and, before he knows it, the Minister will be dealing with three or four entities that are owned by fund managers and they will have the Government and the NTPF over a barrel. I ask the Minister to please allay my fear when he replies. Protections should be given to people such as Angela. I refer to Angela, but the same is true for hundreds of businesses throughout the country.

I am taken with the concept that allows for the principle of force majeure to be built into the system such that a nursing home would be given its price per resident on day one of the agreed negotiation. When external shocks or negative externalities, such as a massive increase in inflation or increases in energy costs, occur, a built-in force majeure mechanism would allow people such as Angela to go back to the NTPF and tell it their business cannot wash its face because of the massive impact of things such as inflation. A mechanism to allow for leeway or headroom in that regard would be welcomed by the nursing homes to which I have spoken. If the State introduces an additional bank holiday, national wage agreement or statutory sick pay scheme, for example, that will need to be factored in. In light of the level of dependency on long-term residential care entities, there needs to be a mechanism to allow for additional funding for nursing homes within a certain category and size to cover overheads arising from legislation passed by this House. I take the point made by the Minister in respect of the large corporate entities that have economies of scale. A mechanism could be found in the pricing mechanism to give alleviation to people like Angela. That is the fundamental point I wish to impart this evening.

The Minister of State, Deputy Butler, is well aware of the demographic pressures the country is facing. Central Statistics Office, CSO, figures indicate that, six or seven years from now, there will be 1 million people over the age of 65. Unless we tackle this issue now, we will face a cliff edge in the context of care for older people. I know the Minister of State is acutely aware of that and seeking to plan for that future. It is clear, however, that transparency regarding how a price or amount in respect of an individual, whether in the public or private system, is arrived at would help. If one goes through the HSE list of nursing homes under the nursing home support scheme and looks at centres in Carlow, Galway, Cork and Donegal, one will see the differences are massive. They are not just based on geography. There are massive differences within counties as well. For instance, my community hospital receives €1,859 but the Breffni Care Centre - I am not familiar with it and have picked it at random - in County Cavan receives €1,999. I do not understand the differentials and how they are arrived at. To go back to Angela's case, she needs to know why there is a difference of €657 between her business and the local nursing home. Nobody has been able to explain that through research. The logic that applies in rhetoric and in the public domain is that there is a higher level of dependency in community nursing homes but, as a layperson, my first-hand experience is that there are high levels of dependency across the private realm as well.

I want businesses such as the Youghal and District Nursing Home, run by Angela Liston, to be able to survive. I do not want smaller nursing homes to disappear from communities. If they disappear and nursing home care is corporatised, we will be going down the wrong road. Through the introduction of small and incremental changes, businesses such as the one run by Angela could be allowed to survive and thrive and continue with the ethical and local model of care she has provided for all her professional life.

Deputy Róisín Shortall

I move amendment No. 1:

To insert the following after "the Commission on Care":

"further calls on the Government to:

— act on Recommendation 2 of the Final Report of the Oireachtas Special Committee on Covid-19 Response, by carrying out a review into the impact of nursing home privatisation; and

— urgently bring forward legislation to provide for a statutory right to home care.".

I welcome this debate. It is long past time that we had a debate on the care of older people. It will be a short debate and we need to have a much more extensive one. I stress that to the Minister and the Minister of State, Deputy Butler, who are both present. Such a debate should not only involve people providing services and Members of these Houses; it should also fundamentally entail hearing from older people and their advocates with regard to what they are seeking. I would like a proper debate to take place with organisations such as Sage Advocacy, Age Action and the Irish Senior Citizens Parliament. They have a lot to say on behalf of their members and older people regarding what older people want. We need to stop talking about what we think older people want and, instead, listen to what they want and design services that are in their best interests.

There is no denying that many nursing homes are in serious financial difficulty. In the past three years, 31 private and voluntary nursing homes closed. As a result, 915 beds were lost. For many years, there have been calls for reform of the fair deal pricing mechanism. It is clear that is now needed, given inflationary pressures. The aim of any such reform, however, must be to improve facilities, make them patient-centred, ensure the workers are paid a living wage and address the challenges faced by small nursing homes, rather than the big chains.

The financial difficulties facing small nursing homes and those facing large operators should not be conflated. The latter is still viewed as a lucrative investment opportunity, especially for overseas operators and investors.

I note the comments made by the Minister in that regard.

In recent years, we have seen a significant consolidation of nursing homes, with 15 operators now controlling almost 40% of private nursing homes and almost 50% of all nursing-home beds. Only seven of the top 15 are Irish-owned. Four are French-owned while the rest are owned by German, Spanish, Dutch and Chinese operators. A Global Commercial Real Estate Services, CBRE, report into the Irish nursing home market found there were 18 nursing home deals last year worth €440 million. This was the second strongest year after 2021, when there were 25 deals worth approximately €600 million. Although activity is expected to drop to 14 deals this year, the CBRE director told the Business Post that she expects continued investor interest in this sector. It is clear from these figures that large nursing homes are still a very attractive investment opportunity despite inflation. That is why any reform of the fair deal scheme must not fall into the trap of incentivising or encouraging the larger nursing home model. The problems with accommodating older people in these large congregated settings were laid bare during Covid-19 and we were told that lessons would be learned. On 14 May 2020, the Taoiseach said that we needed to consider alternatives, for example, more and better home care. He went on to say that we needed to consider a move away from large, modern, newly-built, 150 to 200-bed, single-room nursing homes towards smaller units, as we have done in the disability sector.

However, the Taoiseach was not alone in this sentiment. A month earlier, the then Minister for Health, Deputy Harris, said in response to issues which I raised:

At the outset I just want to say that we will need to have a very serious conversation about the way we care for older people at the end of this pandemic. The Deputy is 100% correct that the current model is not fit for purpose.

Yet here we are, three years on with a further 16 medium to large nursing homes under construction, including a 146-bed in Clondalkin and a 151-bed in Portmarnock. I ask the Minister what has happened to alternative models of elder care. Why has this Government continued with an arm's-length approach? How are we still in a situation where elder care is viewed as a business opportunity best left to the private market? The Special Committee on Covid-19 Response recommended a review into the impact of nursing home privatisation but there has been no movement at all on that. That report was published in October 2020, almost three years ago. In February, I raised this issue at the Joint Committee on Health with the Secretary General of the Department of Health regarding that committee's report and the report of the expert group. He was not aware of the recommendations. Has anything at all happened in the Department of Health in terms of learning lessons from the appalling experience during the pandemic? Is anybody in the Department listening to what is being recommended in terms of new models of care? Clearly, all of the talk of doing things differently post pandemic was just that; it was just talk.

If we are to fundamentally change the way we care for older people and support them in their own self-care, then we need to resource and expand alternatives to nursing homes such as home care in particular. In 2018, a statutory right to home care was first promised by Government, with 2021 identified for the delivery date. Here we are five years later and there is still no statutory scheme or even regulations. What is the hold-up? I raise this matter with the Minister on a regular basis and there never seems to be any progress.

Another aspect of elder care policy which has been entirely sidelined by successive Governments is proper accommodation and sheltered housing for older people. We know most older people wish to stay in their own community. However, there often comes a point when their homes are no longer suitable for their needs. In these instances, people should have the choice to downsize but there is rarely an alternative option in most communities. However, to address this, we do not need to reinvent the wheel. There are two existing local authority schemes which have been underutilised since the economic crash and should be scaled back up. The first of these is for older people who are local authority tenants who want to surrender larger accommodation and move into purpose-built older people's accommodation that is accessible, properly insulated and that is in a group setting but allows them to maintain a high level of independence themselves. Another scheme which was used very successfully was the financial contribution scheme where an older person could sell back their home to a local authority and in exchange be able to rent one of the new purpose-built, high-quality senior citizen units. Both of these schemes were extremely successful. We used them extensively in the north west area of Dublin and they could have been filled many times over.

It is also worth looking at the model the Iveagh Trust has, for example. It has really good quality group sheltered housing schemes and employs nurses to come in and to check on the needs of residents on a regular basis. That is an ideal kind of set-up. We need local authorities and the HSE working together to provide that kind of range of choice for people. We know that staying in their own homes with supports is what older people want. We know that this is how we get the best health outcomes. We have the fastest ageing population in Europe and we need to prepare for that. However, we need to prepare for it in a way that addresses what older people want to do and what is in their best interests. We should know what that is at this stage.

Deputy Gino Kenny

I will be sharing time with Deputy Barry. I thank Sinn Féin for this very important motion on nursing home and elder care. There are obviously viability issues in the nursing home sector and if we had the same speeches 25 years ago, we would be talking about a different composition of nursing home care. At that time in Ireland, it was 80% owned by the public and 20% owned by the private sector. That is now reversed. Whether that is a good or a bad thing is up for negotiation. I would say it is not a good structure as it is one that is largely based on profit. As Deputy Shortall said, 15 huge companies, that have billions in revenue, own 40% of all nursing home private beds. That is almost a monopoly on nursing home care and it is not a good structure. The fair deal scheme is not fit for purpose and it needs to be completely restructured.

We have a different vista now about how our elders want to be treated in later life. Do people want to go to nursing homes? Most people do not; they want to be cared for at home. Sometimes that is not possible but we should put the infrastructure in place if it is possible for people to stay at home because that is where they are happier and more comfortable. In order to do that, the infrastructure has to be put in place.

I refer to an issue around workers' pay, which is crucial to this issue. When we think about it, people who work in that care profession are very undervalued and underpaid. They do the most amazing job in society. They look after our parents, our friends, and people who we love but sometimes they are not recognised and are paid very poorly. It is a reflection on the society we have that the people who give everything and look after our loved ones are not paid properly.

I will touch on the Special Committee on Covid-19 Response.

The committee made a number of important points on the structure of nursing home care and identified serious weaknesses in that structure. It stated, "The State is over reliant on institutional care for our vulnerable population" and that we should move to a publicly-owned and funded model of care, rather than the system we have. Covid showed a huge amount of weaknesses in nursing home care, especially in the private sector. That is not to speak against the people who work in the private sector and the small owners, as they do an amazing job, but there are seriously worrying trends in how this is going. As others said, the small operators that run as family businesses are going to be squeezed and in a couple of years' time, we will not be talking about 20% private but 90% and the 40% private beds will probably be double, given the way things are going. We need to look at things in a different way. We are not going to do it here, but the trend is not going in the right direction.

Deputy Mick Barry

I will speak to one issue only in the time available to me, namely, the crisis at Beaumont Residential Care in Cork. As has been said, we have 56 people who are residents of Beaumont Residential Care, who are there on the fair deal scheme and who are facing, to put it mildly, an uncertain and precarious situation. Not all of these residents, although many of them, are people who are frail, suffering from ill health and in some cases suffering from Alzheimer's and other forms of dementia.

The first point about this is that under no circumstances whatsoever can we have a situation where a single one of those residents is removed from that place against his or her will or that of his or her relatives, transferred elsewhere against his or her will or that of his or her relatives, or in effect evicted from the place. These things cannot be allowed to happen under any circumstances. Beaumont Residential Care is owned by CareChoice. CareChoice has a chain of 14 nursing homes throughout the State. I think six are in the Cork area. CareChoice is in turn owned by a large French multinational corporation by the name of InfraVia, which invests in various projects throughout the Continent. My understanding of the position is contacts have been made and meetings are to take place between CareChoice and people in positions of power and authority. CareChoice is seeking a higher rate of payment from the National Treatment Purchase Fund and I think talks are to take place immediately or in the short term. Whatever the outcome of those talks, there must not be a single person removed from that place against his or her will or that of his or her relatives or transferred to another place against his or her will or that of his or her relatives. That is the bottom line here and a position I wanted to state strongly.

I will finish with an observation. A number of speakers have made the point that 20 to 25 years ago we had a position where 80%, or four out of five, nursing homes in the State were in public ownership. They were run on a not-for-profit basis. The remaining 20% were run privately for profit. That has completely reversed in the space of those 20 to 25 years and today 20% are in public ownership and run on a not-for-profit basis and 80% are in private hands and run for profit. That has happened after 20 to 25 years of Governments led by Fianna Fáil, Fine Gael and by the two of them together. We have seen a privatisation of our nursing home sector on the basis of that. If we were to reverse that policy in the morning, the crisis we see at Beaumont Residential Care would not be taking place and indeed could not be taking place. The residents and their relatives would make the contribution they make at present and as the State would own the nursing homes, it would be up to it to cover all the other costs in any case. It could not be any other way. That is the direction we need to point towards. It is the change that needs to take place. We need to go back, as speedily as possible and not in ten or five years' time, to a situation where nursing home care and residential centres in this country are not run for profit and the maximisation of that profit, but for the needs of people. That can only be done when the bulk of those homes are in the hands of society and of the State.

I conclude by saying I hope this issue is resolved immediately or shortly, but the bottom line is there must be nobody removed from or transferred from that place against his or her will or that of his or her relatives. Sin é.

Deputy Peadar Tóibín

I thank the campaigners in the Gallery for the work they have done on this over the last number of months. Were it not for the work they have done, this issue would have gone below the radar and we would not have had the attention of the Government on it at all.

The Government is sleepwalking towards a nursing home capacity cliff edge at the moment and that is putting hundreds of older people in real danger of being evicted or ejected from the nursing homes they are in. The nursing home sector has experienced a 36% increase in cost of care since 2017 and one third of nursing homes are losing money. The Economic and Social Research Institute, ESRI, has stated we need 40,000 residential care places by 2030. This is double what we have at the moment. Some 31 nursing homes have closed and 950 beds have been lost in the last three years. Even though we must double the number of nursing home beds in the future, we are significantly in reverse in capacity terms at present. A report published in the last couple of weeks by NHI found 33% of homes surveyed were in operational loss. That must change. If it does not, capacity will go. It is as simple as that. We have a situation where on average €744 more is paid per HSE home, in terms of funding, compared with private nursing homes.

The Cork example is very serious. If Aperee closes its beds there will be 200 gone and if CareChoice shuts there will be 500 gone. That would mean 700 beds missing in the Cork area. Where will those residents go? It is the key and most important question we must answer here. How are those families going to afford it? The Minister and Minister of State do not realise how serious this is.

Deputy Mary Butler

Yes we do.

Deputy Peadar Tóibín

I thank the campaign for sharing footage of older people having to leave nursing homes due to the funding crisis. That footage is absolutely heartbreaking. The residents are incredibly emotional. The staff are heartbroken and the older person leaving is at a loss as to what is happening. The level of anger in the community is exceptional. I know of one 99-year-old man who may have to leave his home if this crisis is not fixed.

A woman who is in a secure dementia unit has been told by CareChoice that it can no longer provide the service after NTPF sanctioned just €2.28 a day extra per resident to meet the cost of inflation. This has not happened all of a sudden. I have warned the Minister about this. Aontú raised this issue in the Dáil twice in the past two weeks with the Ministers of State, Deputies Butler and Rabbitte. It seems the Minister is, unfortunately, listening to the NTPF and is not listening to the families. Consequently, we have this situation where residents are in danger of being ejected or forced from their homes. That has to change. If it does not change, we will have a crisis of epic proportions happening to the people who least deserve it.

Deputy Seán Canney

I commend Sinn Féin on bringing forward this motion. I welcome to the Public Gallery the representatives of nursing homes, including Brian McNamara from Greenpark Nursing Home in Tuam.

This really and truly is an issue about patient care and making sure older people are taken care of properly. We have a divided service at the moment in that big business is getting involved and it is investing in and creating critical mass for itself. I put it to the Minister of State, Deputy Butler, that if we are not careful, we will end up being servants to these people. We have the finest of family-based nursing units in our communities. I will not call them what some people call them. They are run by families, their friends and their relatives. They are providing much-needed employment in rural areas and in local areas. They provide services and jobs ancillary to their business. That is all very fine, but many of these businesses are now operating at a loss. There is something wrong when it is like that, and especially when there is a difference in price for the public community nursing unit per head, which is a lot higher than for the private, small operator.

Transparency is required, setting out exactly what one is paying the community nursing units and for what. I have heard the Minister of State say from time to time that the community nursing homes provide more care, or different care or additional care. I have seen, at first hand, people with high dependency in private nursing homes getting the finest of treatment, and getting everything they require with no questions asked. I do not believe we should be comparing the service. The service is excellent right across any of them but the problem is the difference in pay. It leaves the people who are running these nursing homes in a position where they are saying they will sell or close down as it is not worth it. People who have invested real money in these nursing homes are finding, after nine or ten years, that they are losing money and nobody seems to be listening. The stress levels at the moment are unbelievable for people in these places.

We come back to transparency. Why is there a difference? If the difference can be demonstrated to be A, B, C or D, so what? We need to have a real and immediate response to the crisis we now have. Two nursing homes closed in the Galway-Roscommon area last year. When I talked to the HSE about what it was doing last year in regard to the winter programme, this was the first thing it talked about. Basically, we are going to have more of that, if we are not alert to the fact there are real problems here. I genuinely ask the Minister of State, Deputy Butler, to talk to these people. Let us get a solution.

Deputy Peter Fitzpatrick

Nursing homes play a pivotal role in providing care in the community for those older persons whose high dependency needs are not suitable for home support services, while also facilitating the provision of short-term care services for older persons discharged from acute hospitals, freeing up bed capacity and enabling them to ultimately return to their own home.

Although nursing home bed capacity has increased over the past decade, the population aged over 65 has grown at a rate three times faster. There is, therefore, a decreasing proportion of nursing home beds available to those over 65. Ireland’s ageing population, longer life expectancy, and increasing prevalence of chronic diseases will place significant pressure on the healthcare system in the coming years, amplifying the importance of nursing homes. On top of this, increased use of home support services means that individuals are staying in their homes for longer and those entering nursing homes are now older and with higher dependency.

In line with the objectives of Sláintecare, nursing homes play a critical role in providing care in the community for older persons. They facilitate the discharge of older persons from acute hospital settings either through long-term residential care or step-down rehabilitation and reablement services, thus freeing up acute bed capacity.

Nursing Homes Ireland commissioned an independent report on the unprecedented crisis the sector is currently going through. Its findings present an uncertain future for the care of our ageing population and the home care sector.

Over the last three years, there has been a marked increase in the number of private and voluntary nursing homes closures, with 31 nursing homes leaving the sector with the loss of 915 beds. These were primarily located in regional and rural areas. The closures have led to some residents being relocated from their local communities, resulting in significant trauma and the loss of regional employment for nursing home workers.

The financial sustainability of the private and voluntary nursing home sector is being threatened by the rising cost of care. I received an email from Mr. Alan Hynes, registered provider of ACH Nursing Home and Healthcare Limited, in Blackrock Abbey Nursing Home, Blackrock, County Louth. Mr. Hynes highlighted, in line with the Nursing Homes Ireland's report, the significant pressures placed on nursing homes as they deal with complex resident profiles and as they incur rapidly rising operational costs driven by infection prevention control requirements, recent inflationary pressures, and industry-wide staffing shortages. There has been a 6.4% year-on-year increase in the cost of a resident’s care in contrast to a 3.1% increase in weekly fair deal rates. The need for reform of the NTPF pricing mechanism for determination of weekly fair deal rates has been highlighted by the inability of the system to respond to recent increases in the cost of care, including staffing, regulatory compliance, and a higher dependency resident profile.

Over the past five years operational costs per resident have increased by 36%. Costs have risen across nearly all categories of operational expenditure. The biggest impact, however, has been in staffing, rent, energy, and food costs. Resourcing challenges and staff turnover have placed further pressure on nursing homes with increased reliance on higher cost agency staff, driving further increases in day-to-day operational expenditure.

Yet, despite the necessity for further nursing home capacity to accommodate the ageing population, new developments in the sector are extremely unlikely to commence over the coming years due to insufficient returns for providers, increased costs and insufficient revenues, coupled with rising interest rates, construction costs and land prices. Immediate short-term action is needed to stave off a further wave of nursing home closures.

Deputy Mattie McGrath

The majority of long-term residential nursing home care on the island is provided by the private and voluntary sector. We all know that. As Ireland's population continues to age, the demand for nursing home care is increasing. Ireland's ageing population is rising faster than any other European country. The changing demographics provide the single biggest challenge to the sector and the services. Despite these challenges, the Government is not listening. Indeed, the CSO pointed this out clearly but the Government is not listening to the CSO either. Tá an dá chluas dúnta. It is crucial to address the challenges facing the nursing home sector to ensure the availability of quality care for older adults.

The report stated that since 2020, there have been at least 31 closures of private and voluntary nursing homes, resulting in the loss of 915 beds for elderly people needing care. In this country, 17 nursing homes closed in 2022 alone. These closures have created concerns around accessibility and availability of nursing home care, and especially for those who require specialised services and support. The viability of operating nursing homes in Ireland is becoming increasingly untenable due to rising costs and the cost of everything associated with the cost of living, the cost of heating, and inflation.

In all sectors across the country, the Government has gotten into bed with big business. The same is happening with nursing homes where the Government wants to support the big companies and funders from China and God knows where else, perhaps Timbuktu. There will be a time when some of the Ministers of State will go off to Timbuktu and maybe stay there. The Minister has gone already, we hope to Timbuktu, because he would not listen to us anyway. We ask the Minister of State, Deputy Butler, to please act on this. These are mainly family-run nursing homes. They have dedicated their lives to personal service, as have their husbands, partners and siblings, over the years.

They love to care. They want to give and want to look after our loved ones. We are all facing death sooner than we may think down the line so please support the family-run and voluntary nursing homes. The discrimination against them and the disparity in pay or remuneration the State gives to the private and family nursing homes compared with the big HSE ones is disgraceful. I hope somebody will take a challenge to that in Europe because it beggars belief to have such discrimination perpetrated by our Government.

Deputy Michael Collins

I welcome Tadhg Daly, chief executive of Nursing Homes Ireland, and other visitors in the Gallery who run family nursing homes the length and breadth of our country. Nursing homes all over the country, including west Cork, have serious concerns about the ongoing crisis in the funding of nursing home care under the fair deal scheme. For what is now a long-standing basis, private and voluntary nursing homes such as those about which I speak have been dealing with severe, sustained financial pressures in the provision of care for residents. Their costs have increased dramatically in the past three years. This has not been matched with an increase in the funding support they receive through the fair deal scheme. Allied with the squeeze on fees payable, it is now proving extremely difficult to recruit staff. This is leading to rapidly increasing wage costs. The increased use of home support services has also resulted in individuals staying in nursing homes for longer, meaning that those entering a nursing home are now older and of higher dependency. Nationwide, this has led to more than 30 nursing homes closing in the past three years along with 915 resident beds. Nursing homes are under exceptional cost pressure. The Government needs to take urgent action to support them and fellow providers who inform me they are in a similar predicament.

Already, in the past three years, more than 900 people have been displaced, causing great upset and trauma for people who are moved from their local communities. If action is not taken soon by the Government, more closures will follow, causing further upset and trauma for old people, and pressures upon our health services will increase significantly. The crisis requires urgent attention.

I pay tribute to nursing homes throughout west Cork, in Skibbereen, Bantry, Drumalee, Clonakilty, Kinsale and Belgooly, which give the best service they can to people. These are vital local healthcare and employment providers. One nursing home in west Cork employs 65 staff. I urge the Government to act as soon as possible.

Deputy Michael Healy-Rae

I thank Deputy Cullinane and his party for bringing this very important motion before the House this evening. I also welcome the people from the sector in the Public Gallery. If I am ever wrong about anything I will always admit it. I thought all along that the real difficulty was with the smaller nursing homes, that they were finding it difficult to survive. However, I realised at the weekend after a number of important meetings with people who run bigger nursing homes that they too are in dire financial difficulty. For any business, whatever it is, to work, it has to bring in enough money to cover its costs, be able to run the show, wash its face and keep going forward. However, nursing homes cannot do that at the moment.

I am not a critical person but what is wrong with this Government is that there is no business person among its members. Not one of them has to pay anybody on a Friday evening. That is what is wrong with this Government. If its members had to go home at the weekend and pay people, they would know what it is to run a business but they do not have a clue. They expect the people running nursing homes, small, medium and large, to be able to run at a loss. They cannot run at a loss. We cannot have a situation in which public facilities are able to get thousands of euro every week while these people are supposed to run on a shoestring, keep their show on the road and deal with HIQA, that out-of-control, horrible monster that goes around the country doing more harm to our fine nursing homes.

Minister of State at the Department of Health (Deputy Mary Butler)

You are not allowed-----

Deputy Michael Healy-Rae

I condemn it for what it is doing. We all want standards but HIQA is an out-of-control monster.

Deputy Mary Butler

That is scandalous.

Deputy Michael Healy-Rae

I will keep calling it out for what it is. The Minister of State can shake her head until tomorrow but I know what I am talking about.

I compliment the nursing homes I have worked with for many years, including St. Joseph's in Killorglin, Tír na nÓg in Kenmare, St. Joseph's nursing home in Kinnear, Our Lady of Lourdes nursing home in Kilcummin, Kilcara House nursing home, Killarney nursing home, the Sonas nursing home in Milltown, Willow Brooke care centre in Castleisland and all the fine nursing homes we have in Kerry. They are all under pressure. I compliment and thank the people who work in them. They are working in very stressful circumstances trying to balance the books every week, keep the doors open and provide a service.

I make one prediction to the Minister of State, and I hope that I am wrong. Not long ago, it would have been outrageous to think that a person with a housing need would have to be housed by the State in a hotel. We are not a million miles away from the day the Government will be housing older people in hotels and paying nurses to mind them inside.

Deputy Danny Healy-Rae

I, too, thank Sinn Féin for bringing forward this timely motion. We have all known for a long time that the nursing homes are in trouble. I acknowledge the presence of all the people in the Gallery, who include managers and staff from small nursing homes and Mr. Tadhg Daly who is in charge of the representative body. I also welcome Timmy Murphy from Brosna who, with his family, runs a number of small nursing homes in Dublin, Kildare and other places. These people are busy and would not be here only that they have a serious problem with funding. As has been said, they have to pay people on a Friday evening and make ends meet. It is very clear, as the Minister of State knows, that the public nursing homes are being funded to a greater extent. They receive almost 50% more and that cannot continue. I condemn the absence of the senior Minister who is not here this evening to hear this. He was here and he ran. He is gone putting labels on bottles or something that will get his name written into the history books.

Since 2020, 31 family nursing homes have closed. Many of them have been running at a loss since 2022. They are concerned about their viability. They face continuous problems recruiting and retaining experienced staff. We all know what happened during Covid-19 when the HSE robbed many small nursing homes of their staff. The fair deal scheme needs to be reviewed to ensure that private nursing homes can address the individual needs of patients who need much more attention and care. Ministers know that these private nursing homes are being paid almost 50% less. That cannot continue. It will be too late when they close. One has already closed in the Kilcummin area.

I thank all the nursing homes in Kerry. Close to me, we have St. Joseph's nursing home in Kenmare, and the Tír na nÓg and Our Lady of Lourdes nursing homes. We have the Willow Brooke home in Castleisland. I thank the staff working in the St. Columbanus home in Killarney and those providing long-stay beds in the community hospital in Kenmare.

Deputy Joan Collins

I thank Sinn Féin for bringing this motion to the floor of the House. I also welcome those in the Gallery who have come to listen to the debate. I hope they will get a resolution to this issue.

It is clear from the PwC report that the current fair deal scheme, commonly known as the "unfair deal scheme", is rapidly becoming unsuitable for our social care needs. Providers are warning of a tidal wave of nursing homes leaving the scheme. What does a tidal wave of nursing homes leaving look like? People are already struggling with a cost-of-living crisis, having to pay more and more on costs to look after the older people in their lives, their parents and grandparents and also people with disabilities. There are fewer beds in hospitals and more visits to emergency departments. That means more pressure on the healthcare system, which is already creaking under the pressure. People who worked all their lives are left out in the cold because the Government is reducing supports for them in their old age, putting less money into the fair deal scheme and making what are effectively cuts to their State pensions because increases have not kept up with inflation.

PwC found that since 2020, State spending on public nursing homes has grown significantly, while funding for the fair deal scheme has declined. This is not just about losing nursing homes and beds. We are creating a two-tier system, whereby nursing homes in the public system receive, on average, 60% more funding per resident per week than those in the fair deal scheme, according to two official reports published before Covid.

This is a massive difference in resources, and what does that mean for the residents and staff in these private and voluntary nursing homes? The report found that 60% of operational expenditures were staffing costs, and there was a clear difference in terms and conditions between equivalent roles in the private and voluntary nursing home sector, and publicly funded HSE organisations. If one has a high turnover, low pay, understaffing and poor working conditions, we know that this is going to have an impact on care for the residents. A 60% average difference in funding is massive. It is a clear double standard, and it is creating a clear two-tiered system for residents and staff in the public sector, and those in the private and voluntary sector.

The State will have a €65 billion budget surplus over the next three years, just in corporation tax alone. I have heard time and time again statements from the Government about how that money cannot be used to build the houses or hospitals we need, because we have an ageing population and we must save for our older people. The Government is speaking out of two sides of its mouth. It wants to save money for our ageing population, but when we are faced with a breakdown in the system which it wants to look after that ageing population, it is not prepared to meet the costs needed.

The Economic and Social Research Institute, ESRI, found that a 10% increase in per capita long-term residential care bed supply could result in 19,000 fewer inpatient bed days per annum. Despite only accounting for 34% of acute cases, older persons represent 55% of hospital bed days. A proper social care system for the elderly would save money in the future, and so would implementing it before this gets even worse. There is a solution. The Government must fund the fair deal scheme properly in the short term to meet its costs and start to put the proper infrastructure in place now so that we can move to a proper, publicly funded social care system. It must guarantee that there is no two-tier system in care, that all staff get proper pay and conditions, and that we have a proper State-funded response to our ageing population, including me in the future. The Government would have the money, the ageing population is what it is supposed to be saving it for, and the Government should start spending it.

I strongly support the amendment put forward by the Social Democrats which proposes to carry out a review into the impact of nursing home privatisation and to introduce legislation to provide for a statutory right to home care.

Deputy Catherine Connolly

I welcome the opportunity provided by Sinn Féin to make a contribution on this. While I support the general thrust of the motion, I have difficulty with some of the calls that are set out in it. I realise that some nursing homes are struggling, without a doubt. There are additional costs, retention and recruitment problems, and a whole myriad of difficulties. I have read the PwC report.

However, I would like to place this in context. I have always deplored what I witnessed first-hand as I sat on a health forum for ten years of my life: the privatisation for profit of our home care service. If this was a start, and this is just a temporary thing - which I am not sure it is - I welcome that as one immediate step, with a view to reversing what the percentages are, because they are absolutely frightening. I look back at the Minister of State's previous comprehensive speech on 16 November 2022. The Minister of State pointed out that at that stage, it was 80%:20%. If we are to take the PwC report, the actual imbalance is even more. It is 84% private and voluntary, with only a tiny percentage of voluntary, mostly for profit, and less than 20% public. That is scandalous. I know the Minister of State agrees with me, and I know she is on record for doing that.

I am here tonight caught, in a sense, because - I say it publicly, and I welcome the people in the Gallery - I abhor a system of care that is based on profit. It has no role in the care of our elderly. That does not mean that there is not a place for small nursing homes. Absolutely, there is always a place for private nursing homes, but the model has to come from the Government, and it must provide the funds and the premises, and reverse this. This was done for an ideology that reduced everything and every type of care to products. It valued the products, but the care was never valued. That is not taking from the wonderful care provided in most of the nursing homes.

The Minister of State said in her last speech, which I appreciate, that the average size of private nursing homes is increasing year on year. She went on to say that the latest figures indicate that the top 15 private providers operate and own five or more nursing homes. These are no small providers. They are operating five or more, and they contribute approximately 40% of nursing home beds. I am quoting the Minister of State's own words here, as she has set it out. It has actually worsened since then.

While I support the call to take some immediate steps regarding the difficulties, I would like that to happen within a framework of reversing this trend. I very much endorse the amendments tabled by the Social Democrats with regard to recommendation 2 of the report of the Oireachtas committee that carried out a review into the impact of nursing home privatisation. They are absolutely essential, and urgently bring forward a statutory right to home care. I welcome that the Minister for Health, Deputy Stephen Donnelly, has set out that the commission on care will be established by the autumn.

What I am particularly worried about is that on the one hand, the Minister of State wants to reverse this trend - I want to work with her - but then on the ground, let us look in Clifden, where there is a promise of a new nursing home. It was to be for 50 beds, and mysteriously this became 40 beds at a time when all of these reports tell us that the population is increasing. Certainly, we are gone back to 40 beds. We have a nursing home in Carraroe. It just got the thumbs-up from HIQA today, and everything about the nursing home in Carraroe was endorsed, except one criterion that was "substantially compliant". That was with regard to care plans. I would have been stronger on that, but it said "substantially compliant". Otherwise, it got the thumbs up. There are seven or eight beds empty in that, within the declared capacity, and the actual capacity is, I believe, much higher. There was no explanation; nothing. HIQA gave it the thumbs up.

I remember years ago I had a petition. I only did two petitions in my life. One was for light rail, and the other was to keep a nursing home open, which was the St. Francis Nursing Home. On the very week that they closed the St. Francis Nursing Home in Galway, despite about 25,000 signatures - they kept the day care part open - there was an announcement from whatever entity the health board was called at that point saying that there was a shortage of public nursing home beds. That is the contradiction in terms that I am watching all of the time.

In my last minute, I will say that we need a completely different model, one that is not based on profit, or based on huge size. If the bigger companies are going for 150 and 200 beds, and the HSE side says, "We only need 40 beds in the brand-new home in Clifden", there is something awfully wrong with this model. Personally, I have no idea. The Minister of State recognises that the model was wrong. I believe it was led by the Progressive Democrats at the time, and the ideology was "private market is best". We know the value of products, but we do not know the value of care. If we are reversing that, I will stand with the Minister of State 100%. Absolutely, if that is what we are doing. However, I do not see a care plan here. I know from the recommendations that we discussed the week before last regarding care generally, that the strongest recommendation in the 13 - I say it was the strongest - was that we should fund more public home care and beds. I would like to see that happening with the plan.

Minister of State at the Department of Health (Deputy Mary Butler)

I welcome the opportunity to address the Houses on the issues raised by the Deputies tabling the motion. I want to acknowledge the contributions from all Deputies across the House this evening.

My only focus and motivation is to ensure that our older population has access to safe, high-quality and regulated long-term residential care services in a timely manner. In order to avail of this care, the majority of people access this support through the nursing home support scheme known as fair deal. Fair deal was designed to protect and support vulnerable older people, and to ensure equal access to nursing home care based on what they could afford. That is what fair deal is all about. This gives certainty to people and their families.

This morning I visited St. Joseph's, Shankill, a dementia-specific facility that is delivering Trojan care under the butterfly model. I then moved on to Leopardstown Park Hospital, and I met more residents there who are under the care of that fantastic hospital. All the residents I met today were there because of fair deal. Government funding for fair deal is to support vulnerable older people at a time in their lives when full-time care is essential.

This is a very difficult decision for people and their families and often takes place at a time of crisis and is a decision that is not to be taken lightly.

Supporting the nursing home sector is a priority for the Government. This year, €1.5 billion will be allocated to support 22,700 residents in nursing home care. To put this in context, this is larger than my entire mental health budget and the entire budget for the South/South West Hospital Group.

While our population is growing and ageing, Ireland has the highest life expectancy in the EU as determined by the World Health Organization. It is important that we can provide safe environments and effective supports that focus on the well-being of older people with increased care needs both in the community and in long-term residential care. The Government has delivered unprecedented levels of investment for the nursing home sector in recent years. This is a sector which is highly fragmented - many have spoken about this tonight - with 80% of nursing home care provided by private providers, including 4% voluntary providers. Within the sector, 15 companies control approximately 60% of all private beds under fair deal. The rest of the private sector is made up of smaller, in some cases, family-run, nursing homes the length and breadth of the country and embedded in our communities. Smaller and voluntary nursing homes may not have access to the same economies of scale as larger homes or groups. Residents in public HSE community hospital and community nursing units represent approximately 20% of fair deal scheme participants and there were 4,500 residents last year.

As referenced earlier by the Minister, we have provided an additional €75 million for PPE and oxygen to private nursing homes since 2021. This still continues and is a significant saving for private nursing homes. We have provided €150 million in payments through the Covid-19 temporary assistance payment scheme, €10 million through the temporary inflationary payment scheme and over €40 million for the nursing home support scheme this year. I fought hard to get that extra money in the budget with the support of the Minister. I checked the Sinn Féin health budget for 2023. It contains nothing for nursing homes or the NTPF. I am asking whether this was an oversight because there was nothing in it for nursing homes - not one cent.

In addition, more than €5 million has been provided from January 2022 to March 2023 alone to private nursing homes to support residents with particularly complex care needs. These are classed as top-up payments. I was delighted to be able to extend the temporary inflationary payment scheme on two occasions and up to the end of June 2023. Each nursing home could claim up to €5,250 per nursing home per month and the average amount per claim is €2,800 per nursing home per month. They could claim €5,250 but the claims are coming in at €2,800.

Investment in the nursing home sector has been a substantial priority for me and the Government but we know it is not just about investment and that meaningful reform is vital for the future of our long-term residential care sector. Both the Minister and I are committed to greater public provision of long-term residential care. A central component of reform is the implementation of the interRAI system. InterRAI will provide a wealth of data on dependency and will enable a care banding approach to funding. The focus is currently on piloting and embedding in home care with phase 2 involving a roll-out to residential care. InterRAI will facilitate effective, efficient, fair and transparent care needs assessment and planning and appropriate service delivery.

A review of the pricing system for long-term residential care facilities was carried out under the oversight of a steering group with representation from various Departments and agencies. The group made four recommendations and implementation is under way. I also acknowledge that a framework for safe nurse staffing and skill mix is under development for long-term residential care for older persons. The core objective of the framework is to better align staffing levels and skill mix with dependency levels in a facility. The nursing home sector has raised many concerns recently relating to cost pressures. There has been much media commentary on this matter. Some context with respect to the closures is important.

Data show that overall, 2022 saw a net addition of 112 registered beds to total national capacity of private beds registered with HIQA. The stock of private nursing home beds has increased by 185 registered beds to date in 2023. The number of private nursing home beds is increasing, as was borne out by the report. It is essential that when nursing homes are intending to close or to cease participating in the nursing home support scheme, residents and their families are consulted with and given appropriate notice in order that new homes can be found and residents can move in a safe, planned way. There is a legal requirement that providers must give at least six months’ notice to HIQA if they intend to close. This provides residents, families and public health authorities with appropriate time to respond effectively.

We know that so far this year, more than 120 private nursing homes have negotiated and signed new deeds of agreement with the NTPF. As these new contracts have seen an average baseline increase in price per bed of between 6% and 7%, the process is working for most nursing homes. Reform of the negotiation process now allows for 12-month contracts to be signed where requested. This allows nursing homes to renegotiate with greater regularity during an inflationary period.

There is no other mechanism for funding from the public purse for nursing home residents outside the nursing home support scheme. Other options to support nursing homes are also being explored such as help with the often costly nature of compliance for nursing homes under necessary HIQA regulations.

I now wish to speak about the commission on care. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older people, the programme for Government commits to the establishment of a commission on care that will "assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens". An initial scoping exercise for the commission on care has been undertaken. It is envisaged that the commission will support a whole-of-government and whole-of-society approach to examining existing policies and strategies that support positive ageing. It will effectively address the gaps that currently exist in the policy landscape. The commission will be established in autumn of this year.

Before I conclude, I wish to recognise the outstanding work of staff members across all of our long-term residential facilities and thank them for it. Our staff deserve to be paid well by their employers. For clarity, the motion calls on the Government to deliver and fund a collective pay agreement for workers in the nursing home and home care sectors. The Government cannot deliver collective agreements in the private sector. Collective agreements are a voluntary matter for employees and their employers or their representatives such as unions or both. The autonomy of those parties is to be respected. Work is ongoing by Government to introduce a new living wage set at 60% of hourly median wages in line with the recommendations of the Low Pay Commission to be introduced over a four-year period and be in place by 2026, at which point it will replace the national minimum wage.

In relation to transitional care funding, there is an approximate €32 million budget in place. Funding is granted to people in acute hospitals who have been medically approved as requiring long-term care and are in the process of a nursing home support scheme application. Last year, 9,500 transitional care funding applications were approved. This year, there have been 5,500 approvals up to June.

In addition, as of June 2023, there are 722 contracted beds currently on stream between the HSE and private and voluntary nursing homes. Of these, 542 of these are nationally managed and 180 are locally managed in nursing homes across the country with a focus on providing short-stay residential beds with additional therapy and support services.

The Government is committed to supporting healthy and positive ageing, as well as ensuring that older people can continue to live independently in their homes and communities for as long as possible. This is the work this Government is currently engaged in and this is the work I will continue.

Deputy Mairéad Farrell

I listened to what the Minister of State had to say. She listed what she has done and provided but she must admit that what is happening at the moment is not working. We all know it is not working. We know that because the families are telling us it is not working. The families are telling us they are terrified about what will become of the nursing homes in which their loved ones live.

Urgent action is needed to halt potential closures and drastically expand the capacity. Since 2020, 34 nursing homes have closed and that has resulted in losses of so many beds. We can all imagine the worry, the stress, the anxiety for the residents of homes and, of course, of their families.

I will recount one of the stories I have heard and it is of the Garvey family and the concerns they have for their mother, Maureen. She has been a resident in Beaumont Residential Care nursing home. She is 90 years of age and has late stage dementia. She cannot speak for herself. She needs help with feeding, dressing and going to the toilet and her family are at their wit’s end with this. They are terrified that her nursing home could close and that they will not be able to find an alternative. It is not only the families who are raising these concerns but it is also the people who are running them and working in those homes. I have spoken to providers who just do not believe that they will even be able to see the end of this year. That would have a knock-on impact in respect of beds and jobs. I am very concerned about those more rural areas also and the knock-on effect that would have and whether nursing homes will be reopened in those areas. I completely understand the concern of families and of people who work in those facilities and who provide that care.

We know that we have an ageing population and that we need to consider longer-term capacity. We are waltzing into a disaster zone on this issue.

I think of our young people who are being forced to emigrate because this Government will not put a roof over their heads but it also cannot do that with our elderly population.

Deputy Rose Conway-Walsh

It disappoints me that the Minister does not understand the context or the seriousness of the problem in the short term. All of the providers who are present, whom I welcome to the Gallery, have been in touch with our party and with the Minister. They are not just making up the crisis that is there. There is a real crisis there at the moment. The Minister stated that the fair deal scheme provides certainties for families and to nursing homes but I remind him that if there are no nursing homes there, then that certainty is gone.

This is similar to the home help provision. If we do not have the providers to provide the care, it is of no use whatsoever. I, along with Deputy Cullinane, spoke with the owners of one family-run intergenerational nursing home. It is not just a business. It has operated for 31 years in County Mayo. It is embedded in the local community and is trusted and valued there. For more than 31 years it has come through recessions, severely hard times, and then Covid-19 on top of all that. Now they are faced with the real possibility of not being able to continue in their business.

The devastation of the closure of the nursing homes was expressed to me by one family in Mayo. They spoke of their mum Bríd, who is 82 years old and has lived with vascular dementia in residential care since 2017. She was a very active woman in her community and was widowed at a young age. She is a mother of three and a grandmother of seven. She is non-verbal now and is cared for in one of the most amazing settings by the most amazing staff. She does not want to be put out of that nursing home nor do her family want that.

We are corporatising the nursing care for our older people. Our older people are not commodities to be shifted around on a chessboard. The question is: what do we want nursing home provision to look like in ten or 20 years? The Ministers talk about reconfiguration. Reconfiguration is no good if all of the nursing homes in Mayo and in the west are closed and are shifted somewhere else. The Ministers need to take control of the situation in the short, medium and the long term. Short-term interventions are also needed. How do we provide care for our elderly people and for those who care for them? This says everything about us as a nation. The Ministers very much have an opportunity here to do the right thing.

Deputy David Cullinane

The Minister's contribution was disingenuous in the first instance. It was disappointing to many providers who are listening, and not just those in the Public Gallery, but many who are depending on the Government to act and to deal with the very real crisis that many of them face. It was also unnecessarily hostile in places given the motion does not criticise the Government at all and was, in fact, an earnest attempt on our part to ask and, indeed, to put pressure, rightly, on the Government to act to ensure sustainability.

The most recent HIQA report in 2022 stated that there was a net reduction in the number of registered beds by 168. I just want to spell out a number of issues for the Government so that there is complete clarity on what I want to see and on how I see this sector growing and developing. If I was starting today, I would build more public capacity. I want a very ambitious public building programme introduced by the Minister of State with responsibility for older people, whose contribution, by the way, was much more conciliatory and focused on the solutions.

If the Minister was to announce 1,500 beds tomorrow, it would take three or four years to build them and even that would not be enough. The reality is that whether I, the Minister or anybody else in this Chamber likes it or not, we are dependent on private and voluntary providers to provide care for people that we love, and 80% of that capacity is in the private and voluntary sector. The vast majority of them provide this very good high-quality care.

References were made to HIQA. For many of these facilities, while the authority can be very challenging, these providers nonetheless understand that it has a job to set very high standards. When we set high standards, which we should, it comes at a cost. Costs are increasing because of regulation but they are also increasing because of increased food, energy and staffing costs. We have to deal with the reality of the here and now.

The Minister was engaged in a straw man argument in talking up the big institutional investors that are buying the smaller and family-run providers. That is happening but he said it did not happen on his watch. He has to ask himself who created the circumstances and the conditions to allow that to happen in the first place. It was not me. This Government, and successive Governments, have questions to answer there but we have to make the sector viable now.

Of course we have to increase public capacity and to do more with home care, but we have to make it viable now because far too many nursing homes are closing. There is no point in the Minister putting his head in the sand and hoping that this problem will go away because it will not. He is hearing first-hand what is being told with regard to the extent of the crisis.

The Ministers quite rightly spoke about the additional funding that was made available for PPE, oxygen, the temporary assistance payment scheme and the temporary inflation payment scheme, all of which I welcomed. It must be borne in mind, however, that this was for the people who are resident in those homes. That is why the money was made available and, of course, it was a support for those who are providing the care as well but it was essentially for the residents.

Our motion calls for a collective pay agreement to ensure a living wage at the very least in that sector. I have made it very clear to private providers that if we are going to increase funding into the sector, and I would want to see increased funding for the NTPF to make the sector viable and to deal with the additional and rising costs; there has to be a quid pro quo in ensuring that there are fair wage levels. This is because one of the problems affecting the sector at the moment is that it cannot recruit and retain staff while competing with the HSE.

I have also proposed a review of the pricing mechanism that is archaic and does not work. It is for another year. We need a modern pricing mechanism that works. That is not what the Minister was talking about earlier when he was saying that we cannot interfere with individual pricing allocations. Nobody is saying that we should do that. We are saying that we must overhaul the overall pricing mechanism. Incidentally, if I was to do that, it would be done to retain those intergenerational family providers who are providing the best of care for older people in this State and to keep them in business. The final point I will make to the Minister-----

Deputy Stephen Donnelly

Deputy Cullinane’s party did not allocate a single euro in its budget.

Deputy David Cullinane

Let us look at next year's budget to see what will be in it because there was absolutely nothing in the Minister's budget.

Deputy Mary Butler

There was €41 million in mine.

Deputy David Cullinane

Had the Government implemented our budget across healthcare, we would be in a much better place than we are now.

Deputy Stephen Donnelly

If we had implemented the Deputy's party's budget we would not have a 6% or 7%-----

Deputy David Cullinane

The people listening to this know that the Minister has absolutely failed this sector, not just last year but over successive Governments which created the crisis that we are in today. He needs to take his head out of the sand, deal with it today, deal with it quickly and deal with urgently. If he does not, more will close and he and the Minister of State, Deputy Butler, will have to deal with the reality and the consequences of that which should not happen. It is in his gift to deal with it and he should deal with it.

Amendment agreed to.

Motion, as amended, agreed to.

Dáil Éireann debate - Tuesday, 27 Jun 2023

Nursing Home Care: Motion [Private Members]

Dáil Éireann debate -
Tuesday, 27 Jun 2023