Áine Moran says it will be really tough closing the doors of Stella Maris, her family-run nursing home in Athlone, for the final time on Friday in advance of the care home’s closure after 35 years in business.
The 25-bed Co Westmeath home has been in the McNally (Moran’s maiden name) family since 1987 when her parents bought it. People were being cared for in this building long before then; it originally operated as a maternity home in the 1940s and 1950s.
Moran and her sister, Clare McNally, who own and have run the home alongside their mother, grew up around its residents. They talk about them like family or old friends. More recently, residents got to know Moran’s teenage son who spent so much time in the home before Covid-19 hit. In the past, it was home to some residents for more than 20 years; of the 21 who had to find new homes with Stella Maris’s closure, one had been there for 15 years.
“It has been very, very difficult. It is kind of eerie seeing all the rooms empty when they have been so busy for so long,” Moran told The Irish Times.
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Nursing home closures should be a ‘huge wake-up call’ for the Government to act
Stella Maris is the latest in a growing number of family-run nursing homes operating for years in regional towns and villages across the country that are being forced out of the business. These smaller “mom-and-pop” operators are closing due to soaring costs and what many see as unrealistic and increasing expectations of the State’s nursing home regulator, the Health Information and Quality Authority (Hiqa), particularly for old buildings that have served as people’s homes for years but may no longer meet more demanding modern standards and rules of care.
One operator described the regulator as “the dust police” — a reference to overbearing and unrelenting standards that nursing homes are being forced to meet. Hiqa, for its part, says there is no flexibility around care standards set by law enacted by the Oireachtas.
The financial pressures on nursing homes are compounded by a system where their incomes are fixed. The Government has refused to raise the Fair Deal fees — the funding scheme on which nursing homes survive — to cover runaway costs and the added financial pressures due to the requirements of the pandemic. This is despite repeated reviews of the scheme highlighting the fact that the funding model needs to be revisited.
Nursing homes — like most businesses — having to bear the burden of surging energy costs. But as they must remain heated and operational 24 hours a day, seven days a week, it is hard to find cost savings.
All this is landing at a traumatic time for almost 500 private and voluntary nursing homes in the wake of a public health emergency during which almost a third of the State’s 7,758 Covid-19 deaths occurred within their walls.
For Stella Maris, the reasons for its closure are manifold. McNally points to strict and costly regulatory demands to improve its building continuously and the lack of flexibility shown by the regulator on staffing requirements when rising staffing costs generally, and the burden of covering sick days or that extra bank holiday, cannot be absorbed by fixed Fair Deal fees. She says smaller nursing homes do not have the economies of scale that the large chains with multiple nursing homes have and which act as a “buffer” to help protect against these costs. Instead, their financial model makes even managing the regulations a considerable challenge.
All this is posing an existential crisis for nursing homes, particularly the smaller, family-run ones, if the Government doesn’t step in and help.
“We have no desire to finish — even now we don’t — but the only ones that can survive are the big nursing homes with big investors. The worry is where will all the local people go. There doesn’t seem to be much forward thinking on the care of older people,” said McNally.
Officials figure back up a worrying trend. In 2018, there were 217 nursing homes with fewer than 40 beds. By the end of last year, this had fallen to 188, according to Hiqa. So far this year, four homes with fewer than 40 beds have closed.
At the same time, nursing homes are getting bigger. The average number of beds per home and the size of new homes seeking registration are both increasing. The average number of beds has increased in each of the past five years and now stands at almost 55 per nursing home nationally.
Tadhg Daly, chief executive of Nursing Homes Ireland, the representative body for private nursing home owners, says that 400-500 beds (out of about 27,000 private and voluntary nursing home beds nationally) have been lost this year. One nursing home operator estimates that up to 5,000 beds could be lost in the next four years if action is not taken. If that happens, 80 per cent of nursing home beds will be controlled by bigger groups, compared with 40 per cent currently. This will heap pressure on a system at a time when the proportion of older people in the State’s population is growing and demand for nursing home care will remain at about 4 per cent of all over-65s. The loss of beds will in turn lead to longer hospital stays, squeezing an acute hospital system already struggling to cope.
The State subsidises long-term nursing home care for older people through the Fair Deal scheme, known formally as the Nursing Home Support Scheme, at a cost of about €1.4 billion a year based on prices previously agreed with the State’s National Treatment Purchase Fund (NTPF).
Daly believes nursing home closures should be a “huge wake-up call” for the Government to act. Private homes are quick to point out that State-owned nursing homes, run by the Health Service Executive, receive greater financial support. Private nursing homes say they need at least half again on top of the €950 they receive for every resident every week under Fair Deal to make ends meet. The sector had hoped for an inflationary increase in Fair Deal fees but this has not yet materialised. NHI has called for an annual increase of €3,500 per resident — equal to €69 per resident per week — under the scheme.
“To say it is disappointing is an understatement. If corrective action is not taken, our fear is you will have very many more nursing homes closing and not just the smaller ones,” said Daly, speaking in advance of Nursing Homes Week 2022 next week when the sector marks the role nursing homes play in Irish society.
Tim Murphy, chairman of nursing home group Brookhaven, confirms that bigger groups are feeling the pinch too from rising direct and indirect costs, including those coming from regulatory pressure. For example, nursing homes have to comply with stricter infection control measures with water connections in corridors that require retrofitting on already-compliant buildings.
“These demands are coming at a time of severe shortages of contracts and significant building-cost inflation. We are under regulatory pressure to increase activities across all homes. The Fair Deal rate does not cover the cost of these activities,” he said.
In reply to queries, a spokesman for Minister for Older Persons Mary Butler said she and her department were “considering reasonable and evidence-based policy” to support the sector.
“I am acutely aware of the specific challenges faced by the nursing home sector related to price inflation and increased energy costs,” said the Minister.
The greatest impact from closures will be on the residents themselves, their families and their communities. Despite the criticism levelled at it, Hiqa says it is very much aware of the important role that smaller care homes play in local communities offering “person-centred care in a very homely environment” in what it says are “people’s homes”.
“Their closure sometimes means that older people in need of residential care have to travel further in order to receive care. This has knock-on effects for residents, particularly in terms of visitors, social activities and links to their preferred doctor or pharmacy,” a spokesman said.
Daly described the closure of smaller, family-run nursing homes as a “huge loss” to local communities and to residents’ families who may have to travel further for visits.
“In reality, those homes that have closed are not going to be reopened. In two recent closures, they are intergenerational families running them; it is their life’s work,” he said.
“To make that decision to close is heartbreaking on so many accounts, not least for the residents and families.”
At Stella Maris, the sisters hope something can be done for other homes struggling to stay open. “We know we are not going to be the last small home to fall,” said Moran.
McNally said it is “too late” for Stella Maris, but “there is still time for them to save other ones.”
“It will be a crying shame if all of the smaller family ones disappear because they are more than a nursing home in the community. It is local jobs. All you need to do is walk across the road to visit somebody. It is very much valued by local people but it doesn’t seem to go past that.”
