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  • Senator Sharon Keogan

Senator Sharon Keogan — Private Nursing Homes


There is a story about the anthropologist, Margaret Mead, who when answering the question about what she considered to be the first signs of civilisation in a culture, her answer was a femur or thighbone that had been broken and healed. In the animal kingdom, a broken leg signals death as it means the animal cannot walk to find food or drink and cannot escape from predators. No animal survives a broken leg. The existence of a healed femur meant that someone had taken the time to stay with the injured party, had set and bound the wound, carried the person to safety and tended to that individual during his or her recovery. That selflessness and care for others, the sense of community and duty beyond the self, is where civilization starts.


The people being cared for in these nursing homes we are discussing are among the most vulnerable in our society. They deserve the highest level of care we can give. I have spoken with people involved in the private nursing home sector and asked them what the main challenges facing Irish nursing homes are today. Their answers were definite and unanimous. The hike in energy prices is impacting these homes greatly. As one can imagine, a nursing home is not exactly the type of place where a few machines can just be switched off, so many of the tips that work for homeowners cannot be applied there. The €10 million allocated across private nursing homes is, I am afraid, a drop in the bucket when spread across the more than 500 nursing homes we have in the country.


Recruitment is a constant struggle. So many representations have been made to the Department of Justice by industry representatives regarding the stringent restrictions on employing healthcare workers and assistants from abroad. I am told that the threshold of €27,000 for a healthcare assistant, HCA, to be allowed into the country is a massive barrier. HCAs will earn this in Dublin, but not outside it. Could this be examined? Perhaps a lower threshold could be introduced for workers to be employed outside Dublin, à la the Department of Housing, Local Government and Heritage’s first home scheme. However, this points to a wider issue in respect of salaries. According to an independent review conducted by an economist for the NIH, the private nursing home sector requires €65 million in funding to bring its healthcare workers’ salaries into line with the HSE pay scale.


The nursing home sector, like all healthcare sectors, is facing into a tough winter. Bed capacity is the primary concern. The sector lost 474 beds last year due to homes shutting down, mainly smaller ones in rural areas. The service has become financially unviable. While lost bed capacity is often made up for on a national level by large new builds, these are rarely in the same areas as those that close down, which puts pressure on families and other homes. This lack of bed capacity will have a knock-on effect for our hospitals. Often, a hospital patient is approved for a home care package, but there is no capacity to deliver that service, as the HSE similarly lacks HCAs. In order to free up a hospital bed, the HSE will contract a nursing home bed as a step-down until such time as a HCA becomes available to make good on the offer of home care.


It is very much the case that the feeling on the ground is this will be a particularly tough year. The staff retention crisis is not that hard to wrap one's head around. It takes a full year of full-time training to complete the necessary Quality and Qualifications Ireland course in care of the elderly in order to work as a HCA and, in return, most of these workers are earning in the region of €11 to €12 an hour. Is this really how much we value this essential work? At the end of the day, HSE nursing homes are getting a 60% higher fair deal rate than private homes, and so can pay higher wages and pensions. Private homes want to do that too but simply cannot; the maths does not add up. Industry representatives have stated that the fair deal is being unequally managed and is unfit for purpose, and the vital services being provided by private nursing homes cannot continue if the State does not offer the necessary support. A major review is needed and major changes must be the result.

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