Dáil Éireann Debate, Thursday - 18 January 2024
4. Deputy Róisín Shortall asked the Minister for Health to respond to the recent ERSI report on the changes and challenges facing the Irish long-term residential care sector since Covid-19; his views on the consolidation of nursing home ownership, with 14 operators controlling 40% of all beds, and the increasing monetisation of elder care; and if he will make a statement on the matter. [2279/24]
Amharc ar fhreagraI am raising the issue of the recent ESRI report that made fairly damning findings about what is happening in the area of residential care for older people. We have seen the rapid closure of small, community-based nursing homes and a trend towards much bigger and much more commercial nursing homes, which is certainly not in the interests of older people. What is the Minister of State's response to that?
I thank the Deputy for her question. This is a conversation we have had across this floor several times in recent years. I welcomed the recent ESRI report on long-term residential care in Ireland and developments since the onset of the Covid-19 pandemic. The report articulated an awful lot of what we already knew about the challenges facing the long-term residential care sector. The Government continues to address these to provide short-term stability and then long-term growth to this sector.
The ESRI report highlighted long-term residential care supply and care bed ownership. It stated that the private, for-profit sector was driven my new entries into the market financed by international private equity funds. We have 15 companies that now control 10,700 beds. That is one side. On the other side, we have family-run, community-based, voluntary nursing homes that are predominantly located in rural areas and towns and villages. These homes are struggling. The matter is very concerning because 22 or 25 years ago, 80% of nursing home care was run by the State, with the remaining 20% private. That ratio has flipped completely. I am trying to support nursing homes, especially smaller homes. Last year, for example, over 180 nursing homes renegotiated the deals they have, which has resulted in an increase in funding of between 6% and 7%. They can now negotiate yearly as well, which is much more helpful as regards the fees they are receiving.
Before Christmas, I was delighted to put out to public consultation a design guide for long-term residential care settings for older people. Under this, when a private operator, the State or the voluntary sector applies to build or extend a nursing home, it must have a pre-planning meeting with HIQA in advance of applying for planning permission.
With all due respect to the Minister of State, I asked for her response and she described the report. She said we have often have had conversations across the floor. That is the problem. All we have is talk from her. There has been no action. Residential care is not the first choice of many older people. What we should be doing, of course, is expanding other options. In May 2020, at the height of Covid, the Taoiseach spoke about the work done by the previous Government to develop alternatives such as supported housing and housing with care. He stated:
... the new Government can and should build on and operationalise this work. We also need to consider a move away from large, modern, newly-built, 150 to 200-bed, single-room nursing homes towards smaller units ...
What, if anything, has the Minister of State done to develop alternatives to the large-scale, investment-focused facilities we are seeing springing up, which older people do not want to be in and which are not in their interest given that they want more independence?
The majority of people want to age in place. They want to age in their own homes. Working with my colleagues in Government, I have put in place a triangle of supports consisting of home care, day care and meals on wheels. Today, 56,000 people will receive care in the home to support them to age in place. We have 323 day centres open across the length and breadth of the country, plus an additional 52 dementia-specific day centres. We have made great progress in that regard working with the Alzheimer Society of Ireland. About 50,000 people will receive meals on wheels today. That service is so much more than a nutritious meal brought to their house; it is also a social connection. As I said, I have done the new design guide. It is worth taking a look at it because it recommends that we use a household model whereby the nursing homes that will be built will have a maximum of 84 beds each. Action has been taken.
In 2020, the then Minister for Health also made the point that the current model was not fit for purpose. We had two senior people in the middle of Covid saying we had to move away from the model of big nursing homes. I cannot see that the Minister of State has done anything of substance on that. I point to the fact that she continues to allow a situation where nursing home care is incentivised over home care. The promise made six years ago to introduce a statutory right to home care has not yet materialised. What is the Minister of State doing about that issue? What is she doing about expanding the prospect of supported living, which is what most people want, including building new facilities through local authorities with a health element and a care element involved? I cannot see any new initiative on her part. She continues to incentivise the big, commercial, profit-driven nursing homes, which clearly are not in the interests of older people.
I continue to support the 22,700 people who are in nursing homes under the fair deal scheme. The whole purpose of that scheme is to support older people, regardless of their means, to have access to nursing home care. It is important to also point out that the commission on care has commenced. It is led by Mr. Alan Barrett, the chairman of the ESRI. The commission will look very closely at all the issues the Deputy has raised. It is also important-----
The Minister of State is kicking the can down the road again.
Please allow the Minister of State to conclude.
We need action on this.
We have short memories here. When I came into post in July 2020 the nursing home sector was under immense pressure due to Covid. We all know that Covid bore down very hard on older people. For almost two years, the emphasis and focus were on supporting older people in nursing homes.
