Hospital overcrowding: Hundreds of well patients await discharge while 1,000 care home beds empty

Lack of discharge options is a big cause of hospital congestion and the trolley crisis

About 1,000 nursing home beds lie empty across the State, according to a new survey, while hundreds of well patients remain in hospital due to a lack of discharge options.

Private nursing homes have 900-1,100 beds available to receive hospital patients at present, according to estimates from Nursing Homes Ireland (NHI) based on a survey of members in recent days.

The HSE reported 537 well patients who could not be transferred out of hospital – so-called delayed transfers of care – on Sunday morning.

Delayed transfers, a big cause of hospital congestion and the trolley crisis, often arise from delays in organising Fair Deal nursing home places or transitional care in other facilities in the community. NHI urged the HSE to “inject the required urgency” into supporting timely discharges from hospital to free up beds.


After a week of record trolley numbers, overcrowding in hospitals eased at the weekend. There were 258 patients in emergency departments waiting for admission on Sunday morning, according to the HSE’s TrolleyGar count. This was 24 per cent higher than the same day last year but lower than the 391 patients recorded last Friday. TrolleyGar numbers are expected to be around the 400 mark on Monday.

Health sources attributed the improvement to a rise in staff coming in to work in hospitals at the weekend, with attendance up by 30 per cent on normal levels at some locations. HSE chief executive Stephen Mulvany last week appealed to consultants and support staff to work extra hours over the coming weekends in order to ease the pressure on emergency department.

Preliminary HSE figures show that just over 400 patients were discharged on Saturday, up from 278 a week earlier.

“Isn’t it interesting to see the correlation between senior decision makers on site and trolley numbers,” said one senior Government figure.

However, despite the recent signs of improvement, a health source said it was “too soon to even speculate that the worst is over”.

A HSE spokesman said “the extraordinary volume of activity managed in the health service this weekend is due to staff working extra shifts in the interest of patient welfare”.

“Staff will continue to work to ensure that the system continues to treat patients and keep them safe amid unprecedented pressure,” he added.

Fine Gael’s Colm Burke says chronic overcrowding in hospitals could be relieved by providing improved packages to care for patients transitioning to the community. The Cork North-Central TD said the HSE should offer an eight-week transitional care package to incentivise nursing homes and other care providers to accept patients leaving hospitals.

He said the processing of Fair Deal applications for nursing home places should be improved from a wait time of four to six weeks. He said “it shouldn’t be left to the moment of discharge to tell families what they need in order to make” an application for the scheme.

Mr Burke said he had been dealing with a number of cases involving hospital patients with complex needs where discussions about moving them to step-down care have lasted months. In one case, negotiations around a care package for a young man with paralysis have been continuing for more than 12 months. In another, he said, there had been a seven-month “stand-off” between different health facilities over the care of a patient with dementia.

NHI chief executive Tadhg Daly said local hospitals should be given the budget to secure beds quickly and efficiently in nursing homes.

The HSE should have focused more on measures to ensure the rapid discharge of well patients in November so the health system would be prepared for the pressures coming on it now, he said, adding that hospitals could be given more discretion to vary transitional care funding according to needs. “There is uncertainly around the amount being provided, and the length of time that it applies,” he said.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times

Pat Leahy

Pat Leahy

Pat Leahy is Political Editor of The Irish Times