Q: What led you into a career in the aged care industry?
I am a people’s person. Before my current role I worked with the Irish Society for the Prevention of Cruelty to Children. I am passionate about care and the care of people who require special care and support to progress in life. Given the challenges of meeting the care requirements of our ageing population I wish to contribute to and lead the debate on how as a society we can continue to develop and fund sustainable high quality person-centred community care across Ireland.
Q: What would you consider to be particular strengths of the Irish nursing home sector?
The caring and committed staff and providers. First and foremost, it is the people within the sector who are providing specialised care in our local communities on a 24/7 basis. People requiring nursing home care in Ireland have very specialised and high-dependency care needs, requiring intensive person-focussed care. People are only availing of nursing home care if they are really dependent upon the care of others on a continuous basis.
The people in our nursing homes work collectively to provide care of an excellent standard. The sector they operate in is subject to strict regulation and the independent regulator has commented upon nursing homes exceeding regulatory requirements to achieve best standards in care. This is testament to the outstanding staff and leaders within our nursing homes who are continuously striving to excel in achieving the best in healthcare. The care within our homes is diverse and is personalised to meet the individual’s health and social care needs. It is about the nurses who are providing excellent standards in clinical care, the carers who support people in their day-to-day living, the catering teams who offer tasty and diverse food choices of nutritional benefit, and the personnel who deliver activities that bring stimulation, comfort and happiness to our residents. The committed staff are essential for a proper functioning health service and of fundamental importance for any society that wishes to treat its older people with proper dignity and respect.
Underpinning the quality care being provided within our nursing homes is a strong regulatory environment. The nursing home sector is the most heavily regulated in Irish health services. Independent regulation has been in effect for ten years and it has presented challenges for the regulator and also nursing homes. However, as acknowledged by recently the regulator, the Standards that have been applied for nursing homes have led to our Members exceeding mandatory requirements and achieving excellent standards in care provision. An analysis we recently undertook of 385 inspection reports published during the year 2018 informed 86% of nursing homes achieved full or substantial compliance with the regulations that stretch across nursing home life. The high compliance levels are evident via analysis of the inspection reports that are publicly published for every individual nursing home, providing members of the public with essential information regarding the high care standards that are being applied within our nursing homes.
From a resident perspective the high standards of care together with a statutory scheme of funding that provides clarity on entitlement to funding for nursing home care (challenging from operator perspective as the State operates as a monopoly purchaser). The Fair Deal is a significant improvement of the previous system of nursing home subvention.
Q: What are some of the biggest challenges facing aged care in Ireland?
An ageing population and in tandem with most countries, the funding of care is arguably the single biggest challenge. From our members perspective the three ‘big ticket’ challenges are funding, workforce and regulation.
Smaller nursing homes have closed their doors because of substantial shortcomings with the funding model to support nursing home care. Nursing homes in Ireland operate under a monopoly purchaser for care, which is effectively the State. A body acts on behalf of the State to negotiate a fee with each individual nursing home. The fee agreed with the nursing home applies for the provision of care for all residents availing of care in that nursing home. Every nursing home operates under the scheme and failure to agree a fee with the State will effectively lead to the closure of the nursing home. Therefore the body acting on behalf of the State holds all the cards and compounding the unfairness of the process, there is no independent appeals mechanism for a provider unable to reach agreement with regard to the fee. Effectively what is applied is a ‘one-size fits all’ fee and is not dependency related.
Compounding the issues presenting with regard to fees payable for provision of care, there is an inherent unfairness in how the fees are applied. Nursing homes operated by the State are not subject to fee negotiation and are paid fees that are a national average 66% above those payable to private and voluntary counterparts. Effectively, within communities there are State nursing homes being paid fees that are twice those payable to the private or voluntary homes located beside them. A review of the pricing scheme recommended a standalone review of the pricing process be undertaken. The State has been tasked with undertaking this review that was recommended in 2015 and is now two years past the deadline that was set by the then Minister for Health for its completion. Effectively the State is stalling this critical review while private and voluntary nursing homes are closing their doors.
Significant challenges in staffing also present not just for nursing home care in Ireland but for our wider health services. There is a constant challenge in the recruitment of nursing staff but this has been superceded by the challenges presented in the recruitment of carers and healthcare assistants. Analysis recently undertaken by Nursing Homes Ireland informs there is a shortage of about 1,300 of such staff across the 440 private and voluntary nursing homes operating in Ireland. Our health and older person Ministers have also informed of challenges presented for the State in providing health services due to shortages of carers and healthcare assistants. Homecare providers have estimated an additional 7,000 care workers will be required by 2021 to meet requirement. Members of Nursing Homes Ireland have pushed to recruit candidates from the EU, however the pool of candidates is limited. Our organisation and others are actively advancing representations to our Department of Business to facilitate the recruitment of candidates from outside the EU to fill such roles.
A further challenge is the ability of nursing homes to access the services of our general practitioners on a consistent basis. There is a limited number of GPs and those operating state they are under-resourced and under extreme pressure. This is resulting in considerable challenges being presented to nursing homes in facilitating regular visits by GPs to nursing home residents. The Government and main GP union recently reached an agreement to reform the GP contract. This entailed provision of additional payments to GPs for the delivery of services to nursing home residents. Disappointingly for nursing homes it did not specifically address obligations upon GPs to provide services to nursing home residents. However, the union has stated future negotiations are required in relation to GP services to nursing home residents.
Q: From what you know of other jurisdictions, are these challenges similar to those faced abroad, or are they unique to Ireland?
Depressingly the challenges are similar in many jurisdictions across the world. We are members of the Five Nations Care Forum, an alliance of independent sector care organisations across England, Northern Ireland, the Republic of Ireland, Scotland and Wales. The Forum has called for remedial action to address the severe underfunding of the social care sector across Ireland and the UK. People are living longer, often with more complex needs, and demand for care is increasing all the time. At the same time, the funding of social care across the five nations remains wholly inadequate. It has resulted in serious constraints on the delivery of social care services to individuals who need state support.
We observe what is arising in the United Kingdom and, as per the Forum, we frequently engage with UK counterparts to discuss common challenges. Similar to Ireland, care providers in the UK are being threatened by under-resourcing by the State for the provision of long-stay residential care. In the UK over 900 care homes providing care to 30,000 people have closed their doors the past decade, recent analysis informs.
Considerable staffing challenges also present for our counterparts across the world as advanced by WHO. An increasing ageing population requires more people to provide that care.
Q: What steps are being taken to overcome these challenges in Ireland?
Nursing Homes Ireland continues to engage and lobby the Irish Government to address the severe inequality in the funding of nursing home care and regarding the failure of the present funding model to recognise the reality of costs incurred to provide high dependency, specialist care. Our lobbying in this regard is long-standing. Arising, the State has commissioned a review of the pricing mechanism to assess its suitability to meet the care needs of residents presenting for nursing home care. As I stated earlier, the review is now two years overdue but the indications from Government are it will be published imminently.
Two separate significant reviews are also being undertaken under the auspices of the State. One is being undertaken by the State agency responsible for independent oversight with regard to public spending. The office is examining how the funding scheme operates. A further review has been commissioned by our Department of Health to assess expenditure (Value for Money Review) within State-operated nursing homes. As previously mentioned, these homes receive fees that are a national average 66% above those payable to private and voluntary counterparts and the fees payable are not subject to negotiation or independent scrutiny. We have inputted to the aforementioned reviews to advance the gross disparity and inequality presented in the funding of nursing home care in Ireland. People availing of nursing home care should be treated equally and with underlying fairness.
Nursing Homes Ireland is advancing to Government the huge challenge being presented in the recruitment of care workers and healthcare assistants ultimately requires redress by expanding the ‘pool’ from which candidates can be recruited. We are presenting a case to the Department of Business to advance requirement for nursing homes and the wider health sector to be allowed recruit candidates from outside the EU on a controlled basis.
The consequences of inaction are enormous and we hope through our lobbying and engagement with all stakeholders in a spirit of cooperation that Ireland takes proactive steps to address the challenges in the interests of current and future residents and Society as a whole.
Q: I understand you were one of the key figures in establishing Nursing Homes Ireland. What was the impetus for setting up a national industry body association?
The proposal to create one strong national organisation to represent all private/voluntary nursing homes (re)emerged in February 2007 during discussions between existing organisations.
Among the identified reasons for unity was the need to create a strong unified voice for the sector; the uncertainty of the situation at that time; the lack of recognition given to the private nursing home sector and an acknowledgement that what worked in the past would not be sufficient to deal with emerging and future issues.
Independent regulation (HIQA) together with a new funding model (Fair Deal) also focussed the minds of providers and the need to have a strong organisation shaping and influencing the future policy direction. Both HIQA and Fair Deal commenced in 2009 so the timing of NHI establishment in 2008 was significant.
Q: What are some of the key changes you have implemented since you’ve been at the helm of Nursing Homes Ireland?
A strong, focused organisation that delivers for members and those in the care of our members. An organisation that has earned the respect of the myriad stakeholders and speaks without fear or favour on the challenges and offers evidenced based solutions.
Our members need the active support of a strong national organisation which can both advocate on their behalf and can supply a range of support services which add real value and which help them to provide sustainable, high-quality care to their residents.
- Providing a strong, unified voice to represent the interests of our members in the media, with government, the political system, state agencies and regulatory bodies and service providers;
- Engaging, on behalf of members, with the media, government, the Oireachtas, state bodies and regulatory bodies, health stakeholders, representative organisations for older persons and service providers;
- Providing professionally researched expert advice to members on all relevant matters, including new regulations, standards, care planning and delivery and workforce issues;
- Delivering a range of value-adding services to members, such as Garda vetting, legal advice, education and training, a group purchasing scheme, regular member communications, and events and networking opportunities.
Q: We are looking forward to having you as a keynote speaker at our New Zealand Aged Care Association conference. What can our delegates expect to learn from you (without giving too much away!)?
As a proud Munster rugby man, I will be giving advice to New Zealanders on reaching the top level in rugby! Only joking. New Zealand and Ireland are countries of a comparative population size. The nursing home sector in Ireland has undergone considerable change in the past decade, with the advent of a new co-payment model and introduction of independent regulation for the sector. The nature of provision of nursing home care has also changed considerably, increased dependency, more complex care, dementia/ Alzheimer care and private providers leading in the provision of high-quality, specialist care. Private nursing homes have stepped forward to meet the growing requirement for nursing home care in Ireland, while the State’s role in provision of such has significantly reduced. New regulatory requirements did present considerable challenges for providers and they operate within an regulatory framework that is subject to intensive independent scrutiny. The regulator has complemented providers for striving beyond regulatory requirements but it has highlighted high levels of non-compliance within State nursing homes. I will speak regarding what the regulatory requirements have entailed, the challenges they presented, and the current landscape ten years after their introduction.
I will speak about how the funding model operates and its shortcomings. My presentation will also inform regarding the care landscape in Ireland – number of beds, average length of stay, increased dependency levels, age profile of residents – and what nursing home care in Ireland entails. I look forward to speaking with providers/ policy makers at the conference and learning from the experiences of aged care in New Zealand.
Q: Have you been to New Zealand before? Is there anything in particular you are keen to observe or learn from New Zealand’s aged care industry?
No, not to New Zealand – regrettably and I am really looking forward to visiting. I have a sister working in healthcare in Melbourne, Australia where I have visited.
I am keen to learn more about the funding, regulation of aged care and developments in respect of the continuum of care. Nursing Homes Ireland consistently advances to the Irish Government requirement to shift the focus of healthcare delivery from our acute hospitals, where possible, back into the community. In fairness to the Irish Government and parties from across the political spectrum, this is being recognised in policy. I want to learn about the New Zealand healthcare system and the role fulfilled by care homes in meeting your population’s healthcare needs. I am keen to bring my observations back to providers in Ireland and believe my experience can help shape Nursing Homes Ireland’s outlook.
I also hope to meet formally with your Health Minister.
Q: Please share a little of your non-work self (if you’re willing!) When you’re not at work, where can you be found?
Family and sport. Spending time with my wife Maura and 2 daughters Bronagh and Muireann. All sport, particularly Gaelic games – Irish hurling and football. Interested in politics and current affairs.