Thursday 26 April 2018

Current Trends and Issues in the Nursing Home Sector

Nursing homes in Ireland
Nursing homes in Ireland

Orna Stokes

Ulster Bank are delighted to host an information briefing for the nursing home sector at its offices in Georges Quay, Dublin on Thursday 26th May.

Tadhg Daly, CEO of Nursing Homes Ireland (“NHI”) will be sharing his insights on current trends & issues in the nursing home sector at the event.  

Places at this breakfast briefing are free to nursing home operators & advisors – please email for information and firm your attendance.

Ahead of this Briefing, Orna Stokes of Ulster Bank spoke with Tadhg Daly to find out more about the challenges and issues faced by private & voluntary nursing homes in Ireland at this time.

What is the size and impact of the nursing home sector in the Republic of Ireland?

Tadhg: The private & voluntary nursing home sector is a vital part of a well-functioning health service. There  are 577 nursing homes, across the Republic  of Ireland, providing c30,000 residential care beds (source Public Bed register April 2012, and NHI Bed Register June 2014).  

The private & voluntary nursing home sector has ‘taken the lead’ in providing this specialist care within our communities, with circa 80% of such care delivered by our sector. 23,000 people are provided with this specialist care in “homes from home” by 430+ private & voluntary nursing homes.

It is a key employer and contributor to the economy, employing circa 25,000 people.   It contributes €190m to the Exchequer annually through direct taxation. In rural locations, the local nursing home may be the largest employer and is a key part of the social fabric of the community.  

While historically nursing homes were “over the wall”, they are now very much a part of the community, with intergenerational activities, such as transition year student engagement and young / old memory sharing programmes ongoing within many nursing homes.

The fourth annual Nursing Homes Week (13th to 19th June, 2016) will include a range of celebrations hosted in nursing homes across the country. These will bring the nursing home residents, their families & friends, staff and wider communities together, with activities this year focused on sharing 1916 memories. Nursing Homes Week promotes the positivity of nursing home care and informs the wider public of what nursing home care entails. 

So the private & voluntary nursing home sector is a very significant service provider, and has real impact in our communities, what does future demand look like?

Tadhg: A relatively small number of our ‘older’ population – persons aged 65+ - require nursing home care. Around one in 20 persons or 4% in this cohort require the continuous care provided by nursing homes.

It is our ‘older old’ population – persons aged 85+ - who are most dependent upon nursing home care. Approximately one in five of such persons will require nursing home care. This number of the population is anticipated by the CSO to grow by 46% by 2021.

The sector is seeing investment through additional capacity being added in particular parts of the country. In tandem with our ‘older old’ population growing significantly, the requirement for nursing home care will increase. A Department of Health commissioned report undertaken by DKM Economic Consultants, published December 2015*, stated 400 – 700 additional beds will likely be required nationally per annum to meet need.  

However the current funding model under the Fair Deal is a disincentive to investment. Present providers with the experience and proven ability to provide this specialist care and meet the high standards it entails must be supported through an enhanced, fit-for-purpose funding model. 

What are the key issues faced by nursing homes in Ireland at this time?

Tadhg: Essentially there are three key challenges for the nursing home sector: funding; increased demand for services and the challenge of ensuring continued availability of quality committed staff.


Fair Deal, the nursing home sector funding model currently in place, is a positive scheme from the point of view of nursing home residents, but does pose significant financial challenges for nursing home providers.

Effectively the State is a monopoly purchaser of nursing home services, and its main focus is on driving down the costs of care.   If this downward focus on care costs continues, NHI fears that it may negatively impact the standards and quality of care that are established within the Irish nursing home sector.  The downward push on care costs poses a real threat to the sustainability of private & voluntary nursing homes in Ireland.

The average fee provided to public nursing homes is 58% higher than the fees paid to private & voluntary nursing homes.   The divergence between the prices paid for care to public and private & voluntary nursing homes is unprecedented within State Procurement.    

The DKM review pf the Fair Deal scheme ** was highly critical of the present funding model to support nursing home care. It cited lack of reference to efficient cost levels and return on efficient capital, stating the present funding model is unsustainable, has been developed in an ad hoc way, lacks logic and is not fit for purpose. It criticised the lack of reference to the dependency levels of residents who require nursing home care.

Furthermore, private and voluntary nursing home providers dissatisfied with the fee being offered by the monopoly purchaser of care – the NTPF – are not afforded fair right of independent appeal.

NHI will be impressing upon new Ministers at the Department of Health Minister Harris and Minister McEntee the imperative requirement for introduction of an independent appeals process under the Fair Deal scheme for nursing home providers who are dissatisfied with the fee proposed for care provision.

Requirement for nursing home care

Nursing home care fulfils a critical and central role in healthcare delivery. This will continue in the years ahead, given substantial growth in our older population and the increasing requirement for the specialist care nursing homes provide.    Circa 75% of people who are clinically fit for discharge within our acute hospitals – commonly referred to as “delayed discharges” – require long-term nursing care.

Keeping a person who doesn’t need to be there, in an acute hospital bed, is not a person-centred approach to care. Future care strategies need to be developed which include a holistic mix of homecare, community care and nursing home care, so that older people who are not in need of acute hospital care, are looked after in more appropriate settings.

Such care strategies would make financial sense – it costs an average of eight times the fees payable to private & voluntary nursing homes, to keep a person in an acute hospital setting.  

Workforce Planning

Our healthcare system needs to adopt effective workforce planning, recruitment and retention policies, so we have sufficient appropriately trained and skilled people to meet the needs of our entire health and social care sector.  Such a system needs to embrace the non-public hospital system and offer attractive career paths for care staff, reflecting their relevant skills & attributes, and their personal sphere of interest.   

Nurse recruitment is a critical issue; there is a shortage of qualified nurses world-wide. We need to plan and develop a strategy for recruiting, training and keeping qualified, committed and caring staff, who can effectively meet the needs of our people in the care system. The growing numbers growing old will lead to escalation in requirement for gerontological nurses to support their clinical care requirements. Registration applications from overseas nurses wishing to fulfil nursing roles in Ireland must be processed in a timely manner.

As Minister Harris takes up his new role, what would you like him to do for the nursing home Sector?

Tadhg: NHI would call on Minister Harris to take on board the recommendations of the DKM report* in terms of a developing a more sophisticated funding /commissioning model and introducing an independent appeals process.

We rarely hear about the “unsung heroes” of nursing home care, but there are many who make real differences to the lives of nursing home clients. Is there anything a “satisfied client”, their family or friends can do to recognise great carers?

Tadhg: Yes, the NHI Care Awards recognise excellence and dedication across the Nursing home sector. There is a range of awards, reflecting the wide encompassing and holistic care that is provided in nursing homes..

Nominating nursing home staff or nursing home initiatives is a great way of saying thanks to someone or a nursing home that goes the extra mile. The nursing home community and the general public can nominate anyone they feel deserving of an award, from 1st June 2016, on   

*DKM Economic Consultants, on behalf of the Department of Health “Potential Measures to Encourage Provision of Nursing home & Community Nursing Unit Facilities”, December 2015”

*Review of the Nursing homes Support Scheme, A Fair Deal,  Deloitte & Toucnsultants 9th May to

**The Review of the Fair Deal scheme report can be downloaded here:

Sponsored by: Ulster Bank

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