Elderly in rural areas face beds shortage as small nursing homes close

Older people living in rural Ireland will face a shortage of nursing home beds close to home as larger, new facilities open in counties with big populations and greater numbers of existing beds, new research has found.

A paper by the Economic and Social Research Institute (ESRI) has found that almost one in five smaller private nursing homes closed over a two-year period with the country increasingly relying on large centres funded by international private equity firms.

Researchers warned regional inequalities were likely to increase further with planning data showing several other large facilities, all situated in counties with the highest per capita bed supply for long-term residential, are due to open.

The Government is now facing calls from its own backbenchers to do more to support small, local nursing homes, including subsidies and providing skills and expertise training free of charge. Fergus O’Dowd, Fine Gael TD for Louth, said: “We should keep the small nursing homes open, it’s critical for the health of people and to keep communities vibrant and alive.”

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The ESRI report focuses on the changes and challenges facing the residential care sector since the Covid-19 pandemic.

It found that in February 2020-December 2022, almost one in five of all smaller private nursing homes – those with 30 beds or less – closed. These closures were mainly in rural areas, the report found.

In December 2022, there were 31,728 long-term residential care beds in Ireland, a decrease of 336 beds from the beginning of the pandemic.

Since the onset of the pandemic, almost every county has seen a decline in the number of beds. However, Dublin and commuter belt counties saw increases, driven by the opening of large care homes with 150 beds or more by private equity funded owners and operators.

More rural counties such as Laois, Sligo, Donegal, Monaghan, Kerry and Leitrim have the lowest per capita supply of nursing home beds.

There has also been a consolidation of private, for-profit, long-term residential care home operators driven by recent entrants into the Irish market who are mainly financed by international private equity.

About 74 per cent of all beds are now provided in private homes and 14 large private operators now provide about 40 per cent of all beds nationally. Two-thirds of all beds in Meath, Monaghan and Laois are now provided by large private operators.

Senior research officer at the ESRI Dr Brendan Walsh said Ireland was at an “important juncture” in establishing a sustainable long-term care system for older people.

“The Covid-19 pandemic had a terrible impact on long-term residential care [LTRC] residents and workers. But this period also saw large changes in supply, ownership and financing, and the sector faces a number of challenges as it emerges from the pandemic,” he said.

“We now have a LTRC system increasingly reliant on a small number of profit-driven operators. Policies that harmonise financial incentives for nursing home providers with the primary objective of fulfilling residents’ health and social care demands within a more integrated care environment are required.”

Social Democrats health spokeswoman Róisín Shortall said: “We know that it’s not in the best interests of older people to be in large-scale facilities which are primarily operated as investment opportunities.”

She said the present funding system “militates against” the small local model. She said home care had been underfunded, undermining older people who want to stay in their own homes with support.

The Department of Health said Minister for older people Mary Butler was “fully aware of the important role” smaller and voluntary nursing homes play, and pointed out the total number of beds grew in 2023, according to provisional figures, due to the larger size of new nursing homes.

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