Public nursing homes twice as costly as private ones

A VALUE for money audit on Clare’s four main public nursing homes needs to be undertaken following the revelation that the average weekly cost of providing care in these residential facilities is almost twice as high compared to local private and voluntary units.

Health Service Executive Forum member Councillor Tom McNamara made the call following the release of official figures confirming a glaring disparity of €700 weekly between the cheapest private voluntary nursing home and the dearest corresponding public facility.
According to figures obtained by The Clare Champion, the average cost of providing a single or shared room under the Nursing Home Support Scheme in Kilrush District Hospital is just €675 compared to €1,376 in St Joseph’s Geriatric Hospital, Ennis.
The average weekly cost up to July last in the three other public facilities was: Ennistymon Community Hospital, €1,251; Raheen Community Hospital, €1,287 and Regina House Kilrush, €1,061.
More up to date figures for private and voluntary nursing homes from December 7 illustrates a startling difference. The most expensive weekly cost was in Carrigoran House Nursing Home at €915, followed by the Lake’s Nursing Home, Killaloe at €874; Ennis Nursing Home, €856; Cahercalla Community Hospital Ennis, €830; Athlunkard Nursing Home, Westbury, €785; Kilrush Nursing Home, Killimer Road, €770; St Dominic Savio Nursing Home, Liscannor, €770; Santa Maria Nursing Home, Cratloe, €770; Riverdale House Nursing Home, Ardnacrusha, €720 and Kilrush District Hospital, €675.
Councillor McNamara’s call coincides with growing concern that Ennistymon Community Hospital, Raheen Community Hospital, Regina House, Kilrush and St Joseph’s Geriatric Hospital could be threatened with closure or substantial cuts following speculation that up to ten public-run community nursing units with 900 beds may face shutdown nationwide in 2012.
The former psychiatric nurse estimates it could cost about €940,000 a year to cover the cost of 14 nurses and a ward orderly, to provide four nurses by day and two by night in a public unit with 25 patients, taking into account night duty, weekend work and annual leave cover. He pointed out this excluded administration costs, which seem to be a high cost factor in the public service and other costs.
Calling for a review of all staffing levels in public nursing homes, he proposed that the employment of more qualified care assistants should be considered to carry out non-nursing duties to safeguard the future of these facilities.
John Hehir from the Kilrush District Hospital, which is a non-profit making facility, questioned the value for money being provided in public nursing homes on the basis of the huge disparity.
Having spent over €200,000 upgrading the former hospital over the last year, Mr Hehir pointed out that all private and public nursing homes had to comply with Health and Information Quality Authority (HIQA) regulations concerning staffing and overall accommodation.
He outlined the facility currently provides care for 30 maximum and 15 medium dependency patients, with three nurses during the day and two at night. He claimed that a new model of care should be introduced in public nursing homes by employing more qualified care assistants for non-medical work.
There are 21 maximum, 16 high and four medium dependent patients in the Lake’s Nursing Home, which has 57 beds and two nurses on duty with other staff day and night. Five people are on a waiting list for the nursing home support scheme.
St Theresa’s Nursing Home is caring for one maximum, five high, seven medium, five low and two independent patients in the facility with three nurses, three care assistants and other staff during the day. A rate of €600 is offered to patients being admitted for the first two weeks during the winter months.
A spokesperson expressed concern about the number of assessment beds in public homes, which have turned into long-stay beds and the need for immediate approval under the scheme before admission, which has resulted in a reduced number of patients for private facilities.
A Clare nursing home provider, who didn’t wish to be named, pointed out public homes have the services of a geriatrician and GP on call, as well as an in-house physiotherapist and occupational therapist in old buildings, which results in higher overheads.
The provider explained patients in private homes are taken to or provided with medical services when needed, as opposed to having routine scheduled attention, which is most costly.
Efforts by The Clare Champion to contact a manager or proprietor in a number of local private nursing homes proved unsuccessful.
Nursing Homes Ireland chief executive Tadhg Daly warned there will be a chronic shortage of nursing home beds for the country’s ageing population unless private nursing homes are paid a fair price for the provision of care.
Claiming current rates are unsustainable in some cases, Mr Daly stressed it isn’t fair to expect private operators to provide care at about €700 weekly, almost half the cost of some public providers.
Stating the provision of care has to be attractive for private operators, he noted that up to 13,000 long-stay beds have been identified by the ESRI to cater the needs of Ireland’s ageing population by 2020.
Nursing Homes Ireland Mid-West representative, Marie Carey blamed the introduction of benchmarking in the ’90s for increasing the entitlements and rates of pay for nurses in public facilities to a level that private operators cannot afford, forcing them to seek nurses from abroad.
Ms Carey pointed out traditionally, public facilities had a higher nursing ratio per patient and also could afford to provide additional services, such as physiotherapy and occupational therapy, which were paid for by the Government.
Opposing any closure of public nursing homes, she stressed it is wrong to move any long-stay residents from any nursing homes who are there for years as this is now their home and argued there is room for public and private facilities once changes are made.
However, she pointed out some public care is being provided in outdated facilities, which weren’t upgraded by the HSE when money was more plentiful.
Under A Fair Deal, which came into operation on October 27, 2009, the National Treatment Purchase Fund (NTPF) sets the weekly price for the cost of care in all facilities, based on the financial support payable by the HSE under the scheme.
The national HSE has cited the employment of a greater number of nursing staff and higher nursing to patient ratio than many private nursing homes as one of the reasons for the higher cost of care.
“These higher staffing ratios are in place because public nursing homes have traditionally provided care to patients with high-dependency levels and care needs, where their needs cannot be met in other care facilities. HSE long-stay residential units have the highest proportion of maximum dependent older people at just over 60%, compared to that of private nursing homes with almost 35%,” the national HSE stated.
A spokesman for the Mid-West HSE hadn’t responded to a number of queries concerning Ennistymon Community Hospital, Raheen Community Hospital, St Joseph’s Community Hospital and Regina House, Kilrush at the time of going to press. Initial direct queries to management in these facilities were redirected to the regional HSE office in Limerick.
Ennistymon Community Hospital is a two-storey building dating back to the 1840s, when it opened as a workhouse. For decades, the building was used as a hospital, until it became a residential centre for older people in 1976.
There are places for 27 residents providing long, short-term and palliative care. Twenty-two residents were living there during a recent inspection. All residents were over 65 years of age, some had dementia and one resident was receiving palliative care.
Raheen Community Hospital has seen its bed compliment cut from 33 in recent times to 25, which includes 15 long-stay, two palliative care and eight respite beds, which are not available in many private nursing homes.