Public-private comparisons not valid

THE cost of caring for the elderly in long-stay public residential facilities in Clare is much higher than private and voluntary units because different services are provided.
Bernard Gloster insists comparisons between public and private or voluntary units aren’t really valid, as they don’t compare “like with like”.
Official figures have shown a disparity of about €700 weekly between the cheapest private voluntary nursing home and the dearest corresponding public facility in Clare.
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 was just €675, compared to €1,376 in St Joseph’s Geriatric Hospital, Ennis last year.
The average weekly cost up to July 2011 in the three other public facilities was Ennistymon Community Hospital, €1,251; Raheen Community Hospital, €1,287 and Regina House, Kilrush, €1,061.
Mr Gloster explained there is usually a greater prevalence of dementia in public nursing homes, which requires higher staffing levels.
In addition to the provision of more nurses in public facilities for rehabilitation therapy, they also provide respite care and can have a day centre for a day hospital attached to it, all of which increases the cost base significantly.
As part of a reorganisation of public elderly care, the HSE have been examining the skill mix of nurses and attendants in facilities, with a view towards maximising resources in the best possible fashion to protect beds in the future.
“By reorganising their duties into patient care and non-patient care, we can achieve other positive benefits. The HSE are going to evaluate a recent exercise like this in Ennistymon Community Hospital to see how it is working out.
“It is a means of getting better value from resources, while providing safe levels of care,” he said.
Commenting on the community nursing units of Regina House, Ennistymon and Raheen with about 30 beds apiece, he said they were mostly built in the 1970s as welfare homes for a more mobile elderly resident, who couldn’t look after themselves and were generally living alone.
These buildings were primarily designed to provide a more welfare social type of service than a medical one. Nowadays, the type of residents in these public facilities are now characterised by a level of disability associated with a number of illnesses, especially after a stroke.
Mr Gloster confirmed the number of public elderly care beds in Clare dropped from 178 beds in November 2009 to 124 last January for a variety of reasons.
These included new HIQA guidelines, which required improvements to buildings to provide better space for individual residents, reduced staffing and the need to reduce dependency on agency employees.
Five elderly care beds were lost last year due to reduced funding and some of these were restored this year.
There has been a lot of criticism from public representatives in Clare about the dramatic reduction in the number of elderly beds in St Joseph’s Geriatric Hospital, Ennis, which have fallen from 256 in 2005 to 142 last January.
Mr Gloster pointed out St Joseph’s is now a much different facility, compared to what it was in 2005 and is no longer just a long-stay residential centre. St Joseph’s now provides rehabilitation, respite and dementia care.
The introduction of HIQA regulations to provide a more adequate living space for people, increased the space between beds, reduced the number of beds per room and made recommendations about day rooms and dining rooms, which all combined to reduce the overall bed complement.
He pointed out the two administrative staff in St Joseph’s play a vital role in terms of governance.
“People would generally have no idea the level of compliance that goes into operating a place like St Joseph’s. All of the patient records have to be managed, all of the facts and figures, all of the statistics that have to be collected for the different lines of accountability.
“That is an accountability that we, as a society, have demanded through the regulation and the legislation of recent years. And because times are hard now, we can’t sort of say ‘well, they’re all pen pushers and that should end’ because if you don’t retain a good level of governance for a service like St Joseph’s, or any part of the health service…what you find is your standards can slip and then it’s only in better times in a couple of years on, that people start to question ‘why did we do that?” he added.