HSE faces questions as gulf in nursing home costs revealed

The publication of new figures on the cost of running public nursing homes will undoubtedly lead to an outcry from private operators who will claim they are receiving far less than the HSE.

It will also put pressure on the HSE to state what it intends to do following the failure of lengthy talks with trade unions on agreeing “consistent staffing levels and skill mix” in public long-stay residential facilities.

For five years, the HSE declined to publish the costs involved in providing care in each of the 112 public long-stay residential centres around the country.

However, a new report to be published in coming days will acknowledge starkly that it costs far more to accommodate a patient in a public centre than in a private nursing home.

The figures show the cost of providing care in a public facility ranges from €884 per week to €2,089. The approved rate for private nursing homes operating under the Government’s “Fair Deal” scheme runs from €685 to €1,325 per week.

For the private operators, the price paid under the scheme is negotiated with the National Treatment Purchase Fund (NTPF). Prices for public facilities are calculated on the basis of the cost of operation rather than on a rate agreed with the NTPF.

Complexity

In the main, the arguments about why it costs more in the public sector involve two factors – the complexity of care needed by residents and pay for staff. One of these is disputed, the other not so.

In the Dáil last June, Minister of State at the Department of Health Helen McEntee said "more complex and highly dependent residents are catered for by the public system, whereby private nursing homes may not have the available skill set and multidisciplinary personnel to cater for such complex needs. "From an acute hospital discharge perspective, the challenge to find suitable placements for those with more complex needs is often resolved in public centres where nurse staffing levels in particular can cater for their needs."

Nursing Homes Ireland, which represents the private and voluntary nursing homes sector, has argued that three quarters of people needing nursing home care are of high or maximum dependency, with 80 per cent of the care provided by the private and voluntary nursing home sector.

Staffing costs

The HSE report is expected to say staff ing costs – which are based on public service rates of pay and conditions – comprise the bulk of the spend on long-term residential care in public facilities. A contributory factor is that public homes also generally have higher nurse staffing ratios.

Ms McEntee told the Dáil a review of costs in public nursing homes had taken longer than anticipated.

“As part of the process to review and bring consistency to pay costs in public facilities, the HSE has been engaged in extensive negotiations with staff organisations to agree consistent staffing levels and mix in public centres,” she said.

The new report is also likely to indicate that during the years of the moratorium on public service recruitment, many HSE long-stay facilities relied on more expensive agency personnel to maintain safe levels of service.

Such arrangements are currently being replaced.

The report will also argue that the layout of many public centres – which tend to be located in older buildings – presents challenges in staffing levels in both bedrooms and shared areas. However, major investment is promised under the Government’s capital plan.

The report will also contend that while about 400 long-stay beds in public facilities had been closed since 2009/10 to comply with new regulations, the cost of care had risen in some cases as fixed costs could not be cut back significantly.