State-run nursing homes face closure without investment of hundreds of millions

State-run nursing homes which currently provide long-term accommodation for thousands of older people face closure unless the State invests hundreds of millions to upgrade facilities, a confidential report for the Government has warned.

The report on the future viability of public long-stay residential units says that if the safety watchdog Hiqa enforces new standards scheduled to come into force in 2015, only 10 of more than 100 existing facilities around the country would comply and would be able to continue in operation.

The report says that that the four HSE regions have indicated that there are 109 publicly-run units that would not meet the new Hiqa standards after 2015. It says if these units are removed there would only be 720 residential beds out of an existing complement of 7,449 that complied with the Hiqa standards.

“If capital investment is not made in the non-compliant public units and Hiqa enforces standards post 2015, this will effectively put the public long-stay units out of business as there will only be 10 that can continue to operate.”

Compliant
The report says that 84 existing units – providing 3,555 long-stay and 1,228 short-stay bed – could be made Hiqa compliant with capital investment ranging from €240,000 to €9 million. However it said that in the case of 25 units – currently providing more than 1,220 long-stay and 380 short-stay beds – it would be cheaper to develop new buildings than refurbish existing facilities.

“Refurbishment costs to bring potentially compliant units up to Hiqa standards is approximately €210 million. Replacement costs to rebuild units where it is cheaper to rebuild is approximately €525 million.”

The HSE was given 7 years after the introduction of Hiqa regulations to bring units up to full compliance and that deadline expires in 2015 . However the report says the financial climate has limited the availability of capital investment over the last three years.

The report says that Hiqa is reviewing the standards to apply but that “the practice in other countries would indicate that the bar on the new standards will be raised and will push public units which are currently compliant out of compliancy”. At present, there are around 29,000 long-stay residential beds in with 75 per cent of these in the private sector and 25 per cent in the public system.

Viability
The viability report also maintained that "very aggressive targets" that have been set for the HSE to shed 7,000 more staff by the end of 2014 presented "very real risks to our continued capacity to maintain public long-stay un its.

“Considering out-sourcing of public units to a franchise-type model will be dependent on having units that are fit for purpose.”

The report also says that there is a “significant difference between the average weekly cost of care in the public system of €1,404 per weekand that in the private sector which is running at €885 per week. It says that this will not be sustainable going forward.

“Work around efficiencies with skill mix and rostering will continue to be rolled out. However it will still not be possible to achieve the private sector efficiency for operating long-stay units due to public pay agreements and conditions which cannot compete with the private sector.”

The report says that the viability of public long-stay units is reliant on a number of developments including the Government making a policy decision on the the role of the public sector in residential care and on giving a commitment to protect such services.