‘Massive’ disparity in Clare nursing home costs

THE cost of accommodating patients in public long-stay residential facilities is almost double private nursing homes, with a €790 gap between the dearest and cheapest beds in Clare, new figures have revealed.

The maximum weekly Fair Deal rate for a bed in St Dominic Savio Nursing Home is €860, according to latest figures obtained by The Clare Champion.

This compares to a weekly fee of €1,650 in Raheen Community Nursing Unit, €1,607 in St Joseph’s Community Hospital, €1,481 in Ennistymon Community Nursing Unit and €1,422 in Regina House Nursing Unit.

The cost of care in publicly-run facilities throughout the country was set in January 2020, but the figures for private and voluntary nursing homes came into force at the end of last month.
The average Fair Deal rate in Clare is in the region of €910 weekly.

Carrigoran House Newmarket-on-Fergus is the dearest of the privately-run facilities in the county, with a weekly rate of €1,010.

Other facilities charge the following – Ennis Nursing Home €995; The Lakes Nursing Home, Killaloe, €980; Cahercalla Community Hospital €945; Ennis Road Care Facility, Meelick, €945; St Theresa’s Nursing Home, Kilrush, €930; Kilrush Nursing Home €930; Cratloe Nursing Home, €920; Riverdale Nursing Home, Ardnacrusha, €907; Athlunkard Nursing Home, €885; St Senan’s Nursing Home, Kilrush, 875.

The maximum prices chargeable by private nursing homes for residents funded under the NHSS are agreed between each nursing home and the National Treatment Purchase Fund (NTPF), which has a legally designated function to negotiate rates with nursing homes under the Nursing Homes Support Scheme Act 2009.

St Dominic Savio Nursing Home operator, Andrew Smith recalled Nursing Homes Ireland (NHI) has been asking the government to justify the difference in the fees charged by private and public nursing homes for more than five years, but the state hasn’t been able to provide a satisfactory answer.

St Dominic Savio is registered to accommodate 28 patients, and it is almost at full capacity with 26 patients.

Mr Smith expressed concern that a report on the issue, which was completed by the NTPF about two years ago, still hasn’t been published by the government.

He confirmed medical card holders have to pay for non-standard dressings in a nursing home, which are normally covered if they are living in their own residence. He admitted it is a “massive battle” to provide the same service to patients in private nursing homes at a significantly lower weekly rate.

He told The Clare Champion their weekly rate is under review with the NTPF and should increase by about €30 weekly in the near future.

He expressed concern about the lack of an independent external appeal process for the Fair Deal rates.

Gerry O’Malley of St Senan’s Nursing Home Kilrush described the disparity between the public and private nursing home care as “massive”, and claimed the current funding system is “unfair”.
Mr O’Malley admitted it is a “struggle” to keep the nursing home open, particularly when the facility isn’t at full occupancy.

“It is a constant struggle for most of the private nursing homes, apart from the very big nursing homes. A few nursing homes closed throughout the country during the pandemic.”
There are currently 30 residents in the home, which is registered to accommodate 43.

Speaking to The Clare Champion, Mr O’Malley explained the NTPF examine the accounts of nursing homes providers in the private sector and estimate what it would cost the facility to provide care at full occupancy.

However, he pointed out very few long stay residential facilities achieved full occupancy during the Covid-19 pandemic.

“When we started out our policy was to have the cheapest cost per bed. When we joined the Fair Deal Scheme we had a very low base, which went against us. If you haven’t any borrowings, it comes against you. We are a charity that never had borrowings. In the public sector, all the costs are added up and divided by the number of beds provided, which determines the Fair Deal rate.

“We provide the same service as any public nursing home. We have totally upgraded what was previously Kilrush District Hospital. We have no old big wards and all our rooms are ensuite.
“There is a vast difference in the money allocated under the Fair Deal, but there is no difference in the care that is given.”

He confirmed the Fair Deal Scheme doesn’t cover laundry, hairdressing, physiotherapy, which is extra. However, while most private nursing homes charge patients an extra fee for laundry, this service is provided free in St Senan’s.

Responding The Clare Champion queries, the Department of Health outlined the Nursing Homes Support Scheme (NHSS), commonly referred to as ‘Fair Deal’, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means, while the State pays the balance of the cost.

The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone, and that people are cared for in the most appropriate settings, whilst ensuring good value for the taxpayer.

The NHSS currently supports about 22,000 people. Around 80% of those are supported in private nursing homes, with the remainder in public HSE-run facilities, both systems are funded through the NHSS). There is a total scheme budget for State funding of €1.044 billion for 2021. Given its scale, both the sustainability of the scheme and timely access to support for applicants can be significantly impacted by cost pressures.

A department spokesman stated prices can differ for a variety of reasons, including local market price, which is one of the four criteria to which the NTPF has regard in negotiations:
The costs reasonably and prudently incurred by the home and evidence of value for money; the price(s) previously charged; the local market price; and budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner are also taken into account.

“The role the NTPF has played in setting the prices for participating private and voluntary nursing homes has been an effective one, delivering value to the taxpayer and affordable access to long-term care for citizens.

“It should be noted that public (HSE) nursing homes are not subject to the negotiation process; the HSE determines the cost of care for public nursing units. Over 460 private nursing homes are registered with HIQA to operate as nursing home providers. Overall bed capacity has increased significantly over recent years.

“The Report of the NHSS Review published in 2015 identified a number of issues for more detailed consideration, including a review of the pricing mechanism used by the NTPF, with a view to:
Ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers; Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and ensuring that there is adequate residential capacity for those residents with more complex needs.

“The NTPF has now completed its report, which makes recommendations as to how the pricing system might be improved. The report has been reviewed by Ministers and will be published in due course,” the spokesman stated.

By Dan Danaher