Dáil Éireann Debate, Thursday - 18 January 2024
318. Deputy Brendan Griffin asked the Minister for Health what progress he has made on ensuring that small private independent nursing homes can remain viable into the future; if he will address the lack of parity in the system in respect of subsidies provided to private and public establishments; if he acknowledges that there is unfairness built into the current system; and if he will make a statement on the matter. [2272/24]
View answerThe Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups.
To that end the Government has provided substantial support to the private and voluntary nursing home sector over the pandemic. Over €151m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS). The provision of free PPE and oxygen to private nursing homes continues, costing approximately €77 million to date. A €10 million scheme (TIPS) was established in 2022 to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. This scheme was extended for a second time to the end of June 2023.
Budget 2023 saw over €40 million in additional funding for the Nursing Homes Support Scheme (NHSS or Fair Deal) which is providing for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.
Anyone who has had a scheduled renegotiation of their Deed of Agreement this year with the National Treatment Purchase Fund (NTPF) has seen a significant uplift (an average baseline increase in price per bed of 6%)
The budget to support 22,800 people to live in nursing homes through Fair Deal is approximately €1.5 billion this year.
An additional €45.6 million has been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with HIQA compliance. The new scheme is designed to target and support structural improvements in nursing homes to assist their meeting HIQA compliance plans in respect of protection against infection and fire precautions. This is active as from 1 January 2024 and can be backdated for eligible works to 1 January 2020.
The Department of Health acknowledges that there are differences in the cost of care between public and private nursing homes. Maximum prices for individual nursing homes are agreed with the National Treatment Purchase Fund (NTPF) following negotiations and based on the NTPF’s cost criteria such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. The NTPF has statutory independence in this process.
Rates for public nursing homes are set based on historic costs and available resources, according to a list of eligible expense categories agreed by the Oireachtas.
The cost for the resident does not change whether they are in a public or a private home.
The Value for Money (VFM) review published in 2021 report clearly showed that this cost differential is driven by a higher level of staffing in public nursing homes, with a higher nursing ratio per resident and a different skill mix to private nursing homes. The HSE is staffed at a level that allows delivery of more complex care where required, according to its responsibility as provider of last resort.
The review made 9 recommendations, including agreement of the safe staffing and skill mix framework, rollout of the InterRAI tool for assessing dependency, and a review and audit of certain public nursing homes. The Department of Health continues to take these forward.
