Ten years ago, the new Health Information and Quality Authority (Hiqa) assumed responsibility for the independent regulation and inspection of nursing home care.
Regulation was not new to the private and voluntary nursing home sector, but the regulator was inspecting under regulations and national standards underpinned by law. Critically, these also applied to HSE nursing homes, which had never been subject to inspection.
The private and voluntary nursing home sector embraced the new regime, engaged in the development of the new standards and invested heavily in staff and premises to further enhance care provision.
Regulation has made choosing a nursing home easier for residents and their families, with reports available online. These are based on announced and unannounced inspections.
To coincide with the 10th anniversary of this change, Nursing Homes Ireland analysed the 385 inspection reports published by Hiqa for year 2018. We found that 86pc of nursing homes inspected were achieving full or substantial compliance with the regulations covering nursing home life.
Regulations and standards encompass person-centred care, delivery of best outcomes, protection, and promotion of optimum health development and outcomes for those in our care.
The high standards being achieved are a positive reflection on the dedicated staff in our nursing homes. The specialist care is backed by the person-centred care, compassion and support of staff and management.
These standards are reflected in Office of the Ombudsman and Hiqa reports. The Ombudsman has the remit to investigate complaints about nursing home care.
In his annual report for 2018, the Ombudsman said the 61 complaints his office had received "is relatively small when you consider that there are 122 public nursing homes and 458 private nursing homes which cater for around 30,000 residents". Five complaints were upheld, a minute number in the context of 30,000 people living in our nursing homes.
Nursing Homes Ireland and our members recognise people desire to be cared for at home. We are committed to creating a home-from-home for every resident. That ethos is at the core of what staff seek to achieve. Our homes-from-home are created within purpose-built healthcare settings that meet the specialist health and social care needs of 25,000 people on a 24/7 basis.
This has been reflected in the University of Ulster and Nursing Homes Ireland research, the Lived Experience of Nursing Home Residents in the Context of the Nursing Home, as their nursing homes are perceived as "home" by many residents.
"This can be attributed in significant part to compassionate, responsive and dedicated staff who on a daily basis help create a welcoming environment for residents in nursing homes across all parts of the country," the study states.
As we reach this important milestone of 10 years of statutory regulation, I am given to thinking what lies in store for nursing home care over the next 10 years.
Nursing homes fulfil a need for those who require full-time care, 24 hours a day, 365 days a year. They are continuously striving to exceed standards and improve care delivery through introduction of new technologies, care approaches and services.
Our health service must recognise the role fulfilled by these dedicated healthcare settings and their specialist staff can be further enhanced within our communities. They can fulfil an essential role in providing complementary community services such as home care, meals-on-wheels, independent living.
The nursing home should be a hub for people requiring specialist care from nurses, physiotherapists, dieticians and other professionals. Nursing home and home care should operate in tandem. Expanding the specialist role fulfilled by nursing homes is in keeping with Slaintecare objective of the reorientation of care provision from hospitals to the community.
To support providers in improving and enhancing health and social care standards, a funding mechanism must be implemented to recognise the reality of the cost entailed in providing high-dependency, 24/7 care. Publication of this review, which has been handed to the NTPF, is now two years' delayed.
Residents in private and voluntary nursing homes are supported by fees that are a national average of 66pc below those payable to HSE nursing homes. HSE nursing homes, without any level of scrutiny, avail of one-third of the €1bn Fair Deal budget to provide care to 20pc of the residents. This discrimination cannot continue to be tolerated. Hiqa has stated smaller nursing homes have closed, citing the current funding model and provision.
The State has committed over €500m capital investment in its own nursing homes. Such investment will not increase capacity and it is legitimate to ask if this is best use of our health budget.
HSE nursing homes are accommodating residents in buildings that are not compliant with regulatory requirements.
The regulations set a deadline of 2015 for all nursing homes to comply, but at the stroke of a pen in November 2015, Minister Kathleen Lynch extended this to 2021.
As the independent regulator, Hiqa must ensure the regulations are applied and that state nursing homes meet the regulatory requirements 13 years after their introduction.
The fact people are living longer is to be celebrated and will increase our health services' reliance on nursing home services. It is time for the Government to stop thinking in a silo about our sector and the delivery of health services.
The change in thinking must focus on ensuring the nursing homes in our communities, already providing nursing, rehab, respite and further specialist care to thousands on a 24/7 basis, are supported in extending the health and social care services they provide within the locality. The role of a nursing home at the hub of healthcare provision must be enhanced.
Our members look forward to working in partnership with the Department of Health, Hiqa and other stakeholders to advance nursing home care and wider healthcare delivery in the years ahead.
It is incumbent on the Government and politicians across the spectrum to lead in advancing the evolution of nursing home care.
Opportunity presents to ensure they fulfil their potential in meeting diversity of healthcare needs in our communities.
Tadhg Daly is CEO of Nursing Homes Ireland.