I propose to take Questions Nos. 783 and 785 to 787, inclusive, together.
The Health Information and Quality Authority (HIQA) is the independent authority established under the Health Act 2007 to drive continuous improvement and to monitor safety and quality in Ireland’s health and personal social care services. Since 2009 all nursing homes have been registered and inspected by HIQA for compliance with regulations and National Quality Standards.
The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 require that registered providers must ensure that the number and skill mix of staff is appropriate having regard to the assessed needs of the residents and the size and layout of the designated centre. The purpose of the regulations is to ensure proper standards apply to all designated centres, irrespective of whether the residents are cognitively impaired, therefore they make no specific reference to dementia or any other condition.
HIQA assesses whether residential services are providing high quality, safe and effective services and supports to all residents, and ensures that any issues or deficits are addressed. HIQA’s programme of both scheduled and unannounced inspections is aimed at ensuring that standards are maintained and where issues of non-compliance arise, that these are addressed and rectified. Over the last number of years HIQA inspectors conducted thematic inspections of nursing homes focused on dementia care and this will continue.
The National Standards for Residential Care for Older People provide a framework for HIQA to assess the quality of service provided in nursing homes. They place a strong focus on quality of life and a person-centred approach to care for all residents including those with dementia.
The Nursing Homes Support Scheme commenced in 2009. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for the in most appropriate settings. Anyone who is assessed as requiring long-term nursing home care can avail of the scheme, regardless of age. The nursing home care provided under the scheme must be appropriate to meet the individual’s care needs.
A fundamental principle enshrined in the legislation underpinning the Scheme is that of patient choice. Once a person receives approval for financial support, they can choose to enter any nursing home that is participating in the scheme in any part of the country, subject to the nursing home having an available bed and being able to cater for the person's particular needs, including their cognitive function. This applies to public, private and voluntary nursing homes alike.
In relation to costs, the price agreed between the National Treatment Purchase Fund and each nursing home participating in the NHSS is averaged to take account of the range of dependency levels of all residents.
There are a number of dementia specific residential care units across the country and most nursing homes will accommodate people living with dementia, however they may not have a secured dementia unit or dedicated dementia beds. While some people will enter long-term care with a formal diagnosis of dementia, others will develop dementia while they are resident in the nursing home.
A survey of nursing homes in Ireland, undertaken by the Dementia Services Information and Development Centre in 2014, reported that there were 54 Dementia Specific Units accommodating 1,034 people with dementia. Figures on the number of people with dementia in long-stay care range from between 40% and 50% (O’Shea et al, 2017) however this information is not collected on a regular basis. Information on the number of people with dementia requiring long-term care is also not centrally collated by the HSE.
