Sir, – I do not own a nursing home. But I was struck by a statistic in the full-page advertisement taken by Nursing Homes Ireland on December 6th. I read that the Fair Deal scheme pays 73 per cent more to HSE nursing homes than it does to privately-owned facilities. This, we are told, equates to an additional €35,000 per resident per annum.
Why? Prof Suzanne Cahill has pointed out that the Fair Deal scheme is anything but fair (Opinion, June 11th, 2021). She wrote that in October 2016 38 per cent of the €940 million Fair Deal budget was absorbed by the 23 per cent who were cared for in public nursing homes.
Martin Wall wrote in similar terms in 2019 (“Fair Deal: How is it funded and how does it work?”, August 26th, 2019). He quoted the spending review conducted by the Department of Public Expenditure in 2017 which found that the average cost of a public bed was more than 50 per cent higher than the cost of a private bed.
Martin Wall was on the case again a year later. He wrote that the Comptroller & Auditor General had concluded that the average charge rate for public nursing homes was €1,564 per week and that this was 62 per cent higher than the agreed maximum price chargeable for private or voluntary homes at €968 per week (“Weekly costs in public nursing homes over 60 per cent higher than private”, News, August 10th, 2020).
READ MORE
Prof Cahill wrote that the HSE has attributed these price disparities to a higher proportion of high-dependency residents in public facilities, greater costs associated with older buildings used in the public sector and better pay and conditions required for staff working in the public system.
The first of these is disputed by the private providers. They say that the private and voluntary sector provides the main bulk of dementia care and in any event that the respective dependency levels of residents is not a factor which is taken into account in setting pricing. All private facilities receive the same price without reference to their residents’ needs.
The second suggested cause echoes a point made in the C&AG’s 2020 report. It referenced the higher costs associated with older buildings which typically were not purpose built for long-term residential care. The essential point here is that public provision is inefficient and is compensated for that reality. Put another way, private providers of custom-built facilities are paid less because their facilities are designed and built specifically as care facilities!
Finally we come to what I suspect is the main driver of the pricing disparity. The aforementioned C&AG report noted the better pay and conditions and the higher staff-to-resident ratios in public nursing homes. This echoes the HSE’s reference to better pay and conditions required for staff working in the public system.
We are not told whether the difference in staff-to-resident ratios is explained by overstaffing in the public sector or understaffing in the private sector. But we can hazard an informed guess. I do not believe that private facilities which are understaffed would be allowed by the regulators to continue in business. It is an even greater stretch to think that the National Treatment and Purchase Fund, whose functions include negotiating pricing agreements with private nursing homes for the Fair Deal Scheme, could justify capping pricing for private facilities at about 60 per cent of the price allowed to public facilities in circumstances where private homes were inadequately staffed. The conclusion must be that private facilities are adequately staffed and that the acknowledged disparity in staffing levels points to overstaffing in the public sector.
Finally we come to “the better pay and conditions required for staff working in the public sector”. One doesn’t hear calls for benchmarking here! When the better pay and conditions available to many in the public sector are highlighted, a fairly typical trade union response is that we should not be advocating a race to the bottom and that any equalisation should be up and not down. But that is off the agenda here because the public sector decides that the pricing available to private nursing homes should be capped at about 60 per cent of that applying to public facilities.
It is difficult to avoid the conclusion that many of the additional charges levied by private nursing homes on their residents are imposed because of the egregious misallocation of Fair Deal funding between public and private facilities. – Yours, etc,
PAT O’BRIEN,
Rathmines,
Dublin 6.
