Special Report: Investors poised to make millions from nursing homes
Ireland's ageing population has spawned a new breed of grey market entrepreneurs, writes Maeve Sheehan
We are all getting older and we will be older for longer. In 20 years time, there will be 1.3 million old age pensioners in this country, almost twice the number today. Most of us will soldier on at home, but many of us will need to live out our days in a nursing home - that's if we can get a bed. Grim news perhaps for most of us, but what canny investors hear is 'kerching!'
Ireland's ageing population has presented investors with a lucrative money-making opportunity. It's a simple case of supply and demand: there are not enough nursing home beds to cater for the huge numbers of elderly people who will need long-stay residential care.
Who is going to supply them? Not the State, it seems, which is pouring millions into upgrading its existing fleet of crumbling public nursing homes. Instead, Ireland is depending on commercial operators to provide nursing home beds for the ageing population.
The future demand for beds has spawned a new breed of Irish nursing home entrepreneurs, while overseas investors circle the grey landscape hoping to buy in for a slice of the future profits.
The income is considerable. New figures show that 10 Irish nursing home operators shared fees of €53.2m last year paid by the Health Service Executive under the Government's Fair Deal scheme. That is €13m more than the top 10 nursing home operators collected four years ago.
Their owners range from motoring millionaires to publicans to husband and wife teams who developed small care home businesses into multi-million euro enterprises.
The biggest recipient of Fair Deal funds last year was the Alzheimer's Care Centre in Dublin 9, founded by a longstanding medical family who have a tradition of working in psychiatry and mental health. The high HSE income at the centre is expected because of the level of care that residents with Alzheimer's require.
Investors in the nursing home sector include a former chair of the Economic and Social Research Institute, Joseph Harford, a key figure in the pharmaceutical industry in Ireland and abroad with a string of awards and board positions to his name. He is one of six investors in the high-tech Tara Winthrop nursing home in Swords.
Another investor who has come to nursing homes form a different path is Oisin O'Buachalla, whose daughter Sheena married rugby player Jamie Heaslip. He dominated the car leasing business with his wife Sharon. He got in more than a decade ago, along with two other entrepreneurs, with the purpose-built Marlay Nursing Home in Rathfarnham, which took in €4.9m in Fair Deal fees last year.
Several of the 10 are families that have managed to prosper in a challenging sector and expand their nursing homes to meet the growing demand.
They include Eileen and Anthony Gallagher who opened Ryevale Nursing Home in Leixlip, Kildare, in 1985 with 13 beds - it is now one of the highest paid under the Fair Deal scheme at €5.14m. According to the abridged accounts, the company had shareholders' funds of €9.4m in 2015.
Our investigation has found that many nursing homes don't publish accounts because they are unlimited entities, and not required to. Others have structured shareholdings in the business in companies registered in offshore havens such as the Isle of Man or in Mowlam Healthcare's case, the British Virgin Islands.
Nursing Homes Ireland has long pleaded that the reality behind the figures is different. It says there is little evidence of new nursing homes being built while sales in the sector are few and far between. They must contend with stringent Hiqa regulations, often incurring significant capital outlay to meet standards, and suffer the same staff shortages that affect the rest of the health service.
However, the lobby group's biggest bugbear is the disparity between what the HSE pays public and private nursing homes per patient per week, under the Fair Deal scheme. The fees - which are set by the National Treatment Purchase Fund (NTPF) and are under review - also vary wildly from county to county. Even a government-commissioned report said the pricing model "lacked rationale, consistency and fairness" and was a deterrent to investment.
However, this has not deterred Dublin's biggest professional advisers from promoting nursing homes to their clients as a lucrative investment - advisers such as Arthur Cox and BDO.
Foreign investors are circling, hoping to buy their way into nursing homes by offering money for expansion.
There is even an American millionaire poised to move in. Dan Pena, a businessman and high performance coach who claims to have generated €50bn in his lifetime, is chairman of Seneca, an Irish outfit that is actively looking for nursing homes to buy into.
Now 76pc of all nursing home residents are in privately owned facilities. In 20 years time, the likelihood is that long-stay elderly care in Ireland will be more or less privatised, in the hands of commercial operators.
Should we be concerned?
As long as Hiqa, the regulatory body for nursing homes, is doing its work, Age Action Ireland, the advocacy group for older people, says it has no preference.
However, one issue crops up not frequently but consistently with residents of private nursing homes, and that's the fear of overcharging.
Justin Moran, head of advocacy for Age Action Ireland, outlined two recent complaints. One concerned an elderly woman who contributed 80pc of her pension and 22.5pc of her property to a private nursing home under the Fair Deal scheme. In addition, the home billed her for the following extra costs: €50 a month for incontinence wear; €100 a month for 'in-house doctor' services; a €10 surcharge on the three 'free' chiropody visits per year; and €222 a month for 'social activities'. It adds up to a hefty €4,474 a year in additional costs.
In the second case, a resident in a private nursing home, who is on a medical card and entitled to free GP care, is charged a monthly fee for the 'in-house' doctor.
Age Action has advised both complainants to refer their cases to the Ombudsman, and urges residents in general to seek itemised bills.
Moran said: "Once a nursing home resident's Fair Deal obligations are met they can be left with very little to meet the financial pressures of these demands."