Government must heed regulators statement re closure of nursing homes

Tuesday August 20, 2019

HIQA Overview report highlights discrimination of residents in access to medical card services

Commenting today, 20th August 2019, on HIQA’s Overview report on regulation of designated centres for older people – 2018, Tadhg Daly, NHI CEO states: “For the second year running, HIQA has stated the present funding model is resulting in the closure of nursing homes. The regulator is informing of a funding environment that is not fit for smaller providers to operate in, yet our Government are standing idly by and allowing dedicated care providers in our local communities to close their doors. Two years have now passed since the deadline for completion of the Fair Deal pricing review, commissioned by then Minister for Health Varadkar. Yet this Government has facilitated protracted delays with regard to this vital body of work and the result is some nursing homes are closing their doors. The warnings from the regulator are seismic and cannot go unheeded – ‘nursing homes closing voluntarily due to concerns over their financial viability’. We call upon the Government to immediately publish the Fair Deal pricing review and prioritise a funding model that recognises the true costs of meeting the care needs of nursing home residents.”

Mr Daly also welcomed the regulator’s highlighting of issues for nursing home residents surrounding access to services covered by the medical card. “NHI has continually raised this issue with Department of Health and have advanced to the Oireachtas Public Accounts Committee the discrimination that operates with regard to nursing home residents accessing a range of allied health services covered by the medical card. This report highlights delays and a lack of priority in accessing such have significant consequences for the wellbeing of residents. It acknowledges providers have taken action to redress this very serious issue and secured services on a per-fee basis to ensure the health and wellbeing of residents in their care. We welcome HIQA statement that nursing home residents should not be any way disadvantaged by virtue of living in a nursing home and services that they could avail of free in charge in the community should be equally available to those living in the nursing home. We welcome the fact that HIQA inform its Chief Inspector has also formally raised this issue with the Department of Health.”

Mr Daly concluded by commending staff in nursing homes. “This report once again highlights compliance rates are very high within the private and voluntary nursing home sector. This is a testament to the compassionate, caring staff and providers within our nursing homes who are committed to providing residents with the very best standards of care.”

NHI statement re CCPC guidelines re contracts for care in nursing homes

Nursing Homes Ireland notes today’s publication by the CCPC. This guidance from the CCPC will further support residents and nursing homes. Under the Health Act 2007, nursing homes must agree upon admission a contract with every resident. On an annual basis over 8,000 people enter 580 public, private and voluntary nursing homes and providers agree individual contracts with each individual.

Contracts within every nursing home – HSE, private and voluntary – are required by regulation and are subject to independent oversight and scrutiny by the independent health regulator HIQA. Nursing homes proactively engage with prospective residents and their families at enquiry stage in an open and transparent manner regarding their contract for care. Our Members are committed to a process of engagement, openness and transparency to provide a thorough understanding of the contract and ensure their decision is informed. Such engagement supports both the nursing home and the resident in establishing and maintaining a good relationship. We engaged with the CCPC to inform development of the guidelines and will consider them with view to briefing our Members with regard to supporting residents during a difficult and often stressful time in transitioning to nursing home care.

As presented by the CCPC and stipulated within the regulations, nursing homes charge for services that are not encompassed within the fees payable under Fair Deal. Charges for services excluded from Fair Deal are, by regulation, stipulated within the contract and the services presented. Residents are supported by personalised care plans that are stipulated within their contracts to encompass their needs, preferences and interests.

ESRI Report: Projections of Demand for Healthcare in Ireland 2015 – 2030

Nursing Homes Ireland notes publication today, 26th October, by the ESRI of the report Projections of Demand for Healthcare in Ireland, 2015 – 2030. The report confirms the critical role of the nursing home sector in respect of meeting the care requirements of our ageing population as part of a proper functioning health service.
Tadhg Daly, NHI CEO commented: “Today’s report provides further evidence and confirmation if it were needed of the requirement to ensure effective, sustainable planning and the associated resourcing to meet the growing requirement for older person healthcare services. The Government itself has recognised the challenges in sustainability of current nursing home provision and has commissioned a ‘Review of the system for setting nursing home prices under the Nursing Homes Support Scheme’.
This pricing review of Fair Deal was scheduled for completion by 1st June 2017, but publication remains outstanding. We again call upon the Department of Health to immediately publish this pricing review.
While much of the focus from today’s report is likely to be upon the growth in capacity within our health services, it is critical to recognise escalating demand will bring substantial increase in requirement for specialist staff across the entire health and social care system. There is urgent requirement for the State to lead in developing a workforce plan to enable us meet our health and social care needs.
As a society we cannot continue to ignore the evidence and it is incumbent on the State to lead in policy, planning and resourcing, in partnership with all stakeholders. We reiterate our call for immediate publication of NTPF’s review of the Fair Deal pricing mechanism.”

NHI Letter to Minister Simon Harris 26 June 2017

Minister Simon Harris TD
Minister for Health
Department of Health,
Hawkins House,
Dublin 2
D02 VW90
26th June 2017

Re; Nursing Home Charges

Dear Minister Harris,

I am taking this opportunity of communicating with you on the matter of nursing home charges under the Nursing Home Support Scheme (Fair Deal).
As you will be aware under the Nursing Home Support Scheme – commonly referred to as Fair Deal – the State offers financial support to people whose care needs confirm, following a care needs assessment, that they need long-term residential care. All nursing homes are required under Regulations to provide services expressly excluded under the Fair Deal and the regulations are explicit re charges for such services to residents supported by the Fair Deal.

Prior to and since inception of the Fair Deal scheme, NHI has consistently highlighted the narrow definition of goods and services under the scheme and that State financial support to residents approved under the Fair Deal do not encompass the reality of the health and social care costs incurred to meet the day-to-day care and living requirements of persons requiring nursing home care.
NHI submitted amendments to the legislation during the passage of the NHSS Bill through the Houses of the Oireachtas however our amendments were defeated.
Such concerns have also been advanced by the Office of the Ombudsman and Health Information and Quality Authority (HIQA).

The definition of long term residential care services under the Fair Deal specifically excludes services that are provided to persons in nursing homes to enhance their health and wellbeing. Excluded in this regard are services that include, for example, social programmes, physiotherapy, occupational therapy and other health and social care services. These services are essential to support living and healthcare requirements of older persons in nursing home care, as recognised within the national standards and Regulations, and are provided in all nursing homes. Because such services are expressly excluded under the Fair Deal, their costs are not included within any such negotiations with the NTPF and therefore nursing homes are required to charge for such services.

EXTRACT FROM THE Deed of Agreement under the Nursing Home Support Scheme
“Long-term Residential Care Services” shall have the meaning assigned to it by the Act and shall, without prejudice to the generality of the foregoing, include:
• Bed and board;
• Nursing and personal care appropriate to the level of care needs of the person;
• Bedding;
• Laundry service; and
• Basic aids and appliances necessary to assist a person with the activities of daily living.

For the avoidance of doubt, Long-term Residential Care Services shall not include: inter alia
• Daily delivery of newspapers;
• Social programmes;
• All therapies;
• Incontinence wear
• Chiropody;
• Dry cleaning;
• Ophthalmic and dental services;
• Transport (including care assistant costs);
• Specialised wheelchairs; and
• Hairdressing and other similar services”

I refer to the statement issued by the NTPF 18th March 2014 in respect of nursing homes charging fees for services provided which stated: “Under the Nursing Home Support Scheme Act 2009, price negotiation for cost of care in approved nursing homes is administered by the NTPF. The NTPF consider the pricing of long term residential care for each private and voluntary nursing home on an individual basis. Rates, for the cost of care to be paid for by the State, are arrived at by negotiation with the proprietor(s) on a one to one basis with each of the providers. The ‘cost of care’ in private nursing homes covers services as outlined in the Nursing Homes Support Scheme Act 2009, and subsequent regulations. Such costs include bed and board, and nursing and care services as defined. Private Nursing Homes may impose additional charges for incidentals/extras such as social programmes, transport, newspapers, hairdressing etc. as these costs are not included in the cost of care. Under the Nursing Home Support Scheme, it is the client who chooses the nursing home in which they wish to avail of residential care services.”
The Office of the Ombudsman and HIQA have previously raised concerns regarding the exclusion of care and activity-related services within the fee that is set between nursing homes and the NTPF for provision of care.

In its report ‘Who Cares? An Investigation into the Right to Nursing Home Care in Ireland’, the Office of the Ombudsman states: “The exclusion from the care package of therapies and social programmes appeared to be at odds with what (in the words of the Department) “is commonly understood as long-term nursing home care”.

Furthermore, it appeared that the care packages provided for in the NTPF agreements are not consistent with the obligations placed on private nursing homes under the Health (Nursing Homes) Act 1990 (as amended) and the Health Act 2007 (including regulations made under the latter Act) (14). The Ombudsman was concerned that, in many individual cases, the NTPF agreed care packages were not adequate to meet the actual care needs of that individual and that, in this event, the agreements made by the NTPF were falling short of the level of care apparently envisaged under the NHSS Act. However, a careful reading of the NHSS Act suggests that the narrow care packages agreed by the NTPF may not necessarily be at odds with the provisions of the Act.”

The HIQA report ‘Designated Centres for Older People: An analysis of inspection findings during the first 15 months of inspections’, published February 2012, highlighted the most common breaches of the regulations underpinning nursing home care. In this respect it stated: “Inadequate access to all care services, i.e. physiotherapy, chiropody, occupational therapy, or any other services as required by the resident. This reflects a wider funding and access issue in the sector and is an issue in particular for some private centres who are not able to access HSE services such as those listed above as they fall outside of the Fair Deal Scheme. Therefore, the options in these circumstances are either that the resident pays privately or the provider pays. Otherwise the resident does not receive the service.”

In 2013 the HSE Quality and Safety Audit ‘Review of Provision of Primary Care Team Services for Older Persons resident in Long Term Residential Units’ report confirmed significant deficits in the provision of Primary Care Services for residents in nursing homes (public, private and voluntary). This together with the HIQA findings outline discrimination of older people on the basis of where they reside.

It is important to note under the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations, all nursing homes – public, private and voluntary – must agree a contract of care with each resident that includes the services to be provided, whether under the Nursing Homes Support Scheme or otherwise, and the fees to be charged for such services.

The Care and Welfare Regulations 2013 (as amended) extract:
Contract for provision of services
24. (1) The registered provider shall agree in writing with each resident, on the admission of that resident to the designated centre concerned, the terms, including terms relating to the bedroom to be provided to the resident and the number of other occupants (if any) of that bedroom, on which that resident shall reside in that centre.
(2) The agreement referred to in paragraph (1) shall relate to the care and welfare of the resident in the designated centre concerned and include details of—
(a) the services to be provided, whether under the Nursing Homes Support Scheme or otherwise, to the resident concerned,
(b) the fees, if any, to be charged for such services,

I have also attached correspondence from your Department in 2010 which states. “As stated above, the regulations require that residents are provided with a contract included in which are details of the services to be provided for that resident and the fees to be charged. These services should include optional services and activities and any charges applied for availing of them.
It is appreciated that there may be small items for which administratively it would be disproportionate to collect individual fees and in such cases nursing homes could look at bundling them together as a small package of items. However, this could only be done with the consent of residents.”

Nursing Homes Ireland has provided all NHI Members with a Template Contract for Care. The NHI template Contract for Care details all charges for such services and the Contract for Care must be agreed on admission.

The requirements in the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (as amended) are abundantly clear both in terms of the contracts of care and complaints. All nursing homes are required to have a robust complaints policy and procedures in place that is prominently displayed in the nursing home and included within the ‘Residents Guide’ provided to residents on admission. There are explicit requirements outlined in the regulations in respect of complaints and HIQA are the regulatory authority tasked with monitoring compliance against the Care and Welfare Regulations and their inspections monitor and report on both the contract of care and the complaints procedures as can be evidenced in numerous inspection reports published on their website.

In addition, following the Ombudsman (Amendment) Act 2012 all private and voluntary nursing homes now come under the remit of the Office of the Ombudsman. NHI have engaged regularly with staff in the Ombudsman’s office to assist member nursing homes to update their complaints policy in line with the Ombudsman’s ‘Model Complaints System’.
This provides a standard template of complaints handling and investigation and which specifically highlights that residents now have the option to complain to the Office of the Ombudsman if they remain dissatisfied.

I look forward to meeting with you at the earliest opportunity.

Yours sincerely,
Tadhg Daly
Chief Executive Officer

NHI statement re HIQA’s 2015 overview on the regulation of nursing homes

Nursing Homes Ireland today, 14th April, acknowledges publication of HIQA’s Annual overview report on the regulation of designated centres for older people – 2015. The report provides an overview of HIQA’s extensive regulatory programme encompassing 577 nursing homes that are registered with the Authority. It highlights the very high level of regulation and inspection that is applicable to nursing home care in Ireland and the deep-reported reporting culture within nursing homes. These fundamental principles help ensure residents, relatives and the wider public that the highest standards are being applied and independently observed within these home-from-home settings on an ongoing and continuous basis. Such standards are not applicable for other health services.

The ‘key findings’ within the report inform that the 343 centres that were inspected by HIQA during the course of the year provide reassurance regarding good levels of compliance with the stringent regulations and standards that are applicable to nursing homes. It is important to note the report focusses on areas requiring improvement and it states numerous specific examples of good practice in nursing home care are not documented within it, but published within individual inspection reports. It does provide an analysis of good practice, further endorsing high quality care that is provided by dedicated, committed and caring management and staff within nursing homes.

The report highlights high standards of care, providing further reassurance for residents, their relatives and friends and wider public.

It is important to note Annual overview report on the regulation of designated centres for older people – 2015 highlights the critical issue of adequate staffing levels. NHI recently engaged direct with the Authority with regard to it advancing the present crisis in the registration of nurses with the Nursing and Midwifery Board of Ireland (NMBI). We are urging the Authority to push for resolution of the persisting crisis. 2,000+ applications are within the system with almost 600 candidates at an advanced stage in the registration process. Applications are taking up to a year or beyond for processing. The extraordinary delays are threatening healthcare delivery and we again urge the health regulator to seek resolution to this crisis presenting.

NHI has long-standing proactive engagement with the Authority in advancing healthcare delivery within nursing homes and will continue to engage with it to drive continuous improvements in care of older persons.

NHI Article: Privacy and Dignity of residents compromised in some HSE nursing homes

8th June 2015

Nursing Homes Ireland (NHI) is concerned but regrettably not surprised by reports today stating 82 public (HSE) nursing homes risk deregistration or registration with significant conditions because of failure to comply with July 1st 2015 deadline for compliance with HIQA National Quality Standards for Residential Care Settings for Older People in respect of the Physical Environment Standards.

Tadhg Daly, NHI CEO stated: “The privacy and dignity of residents in some public nursing homes is being compromised because of State failure over a six year period to address its requirements to comply with the physical environment standards. Their deliberate ignoring of this impending issue has been reprehensible. The privacy and dignity of residents is being compromised by the HSE failing to comply with the HIQA Physical Environment Standards. Despite being required by NTPF to provide care at rates that are up to 50% below those provided to public counterparts together with the bank lending crisis and recession, private and voluntary nursing homes have invested significantly to ensure compliance with HIQA Physical Environment Standards providing high quality person centred in a ‘home from home’ setting to over 22,000 residents. Two years ago the HSE publicly stated €834m would be required to maintain its provision and address capacity issues. The challenges facing the public sector in meeting the July 2015 Physical Environment Standards have been well versed and long-standing. Short of a month before the deadline, the extent of the crisis in public nursing homes meeting the deadline that has been in place for six years is being further laid bare. This crisis has been fast coming down the track. It presents considerable, unwarranted uncertainty, worry and anxiety for thousands of older persons in HSE nursing homes.”

Mr Daly further stated: “NHI wishes to reiterate its concern regarding the manner in which the Standard 25; Physical Environment of the National Quality Standards for Residential Care Settings for Older People is being applied in practice. In order for the public to have full confidence in the proper administration of the regulatory regime governing residential care settings for older persons, it is essential that the Standards are applied consistently and fairly across all designated centres be they public, private or voluntary.”

NHI is awaiting response to a Freedom of Information request it has brought to HIQA requesting the number and list of HSE nursing homes that require works to meet standards and timescales in such regard.

Mr Daly added: “For a number of years NHI has called upon Department of Health not to bury its head in the sand and to face up to the challenges of providing long-term residential care for our population. It is imperative a roadmap that brings together a framework that will enable providers meet the considerable challenges of growing requirement of long-term residential care provision is prioritised. The Department of Health has informed Minister Varadkar 7,600 nursing home beds are a necessity and this imminent crisis facing provision of public nursing homes must trigger the alarm bell that signals the time to appropriately plan is now long upon us1.”

Only 11% of Nursing Homes Have Dedicated Dementia Care Units According to First National Survey

Trinity Study Found Private Sector Provides Majority of Special Care Units But Receives Least Funding

DUBLIN, January 29th 2015 – The first national survey to map demographic trends in the provision of specialist long-term care for people with dementia in Ireland has found low numbers of dementia-specific care units (SCUs) throughout the Republic of Ireland.

The study also showed:
•Most of the high level care required for the growing number of people now living with dementia in Ireland is provided by the private sector
•Significantly fewer SCUs in Leinster (and increased waiting times) compared with other areas

These findings are contained in a new report entitled ‘An Irish National Survey of Dementia in Long-Term Residential Care’, which was launched by Adjunct Professor in Medical Gerontology at Trinity College Dublin, Davis Coakley, at an event in the Trinity Long Room Hub today [Thursday, January 29th, 2015]. The report was published by the Dementia Services Information and Development Centre (DSIDC) and the School of Social Work and Social Policy at Trinity College.

Commenting on how the Irish findings compare with international practice, lead author, Research Associate Professor Cahill (School of Social Work and Social Policy, Trinity and Director of the Dementia Services Information and Development Centre), said: “Of some concern is the fact that only 11% of all the Irish facilities surveyed have dedicated dementia units and, despite an expected increase in demand for long-term dementia care arising as a result of population ageing, only a small minority of Irish nursing homes intend opening dementia units.”

There are currently 48,000 people living with dementia and 50,000 carers in Ireland. However, despite a significant increase in the number of people with dementia in Ireland, there is currently a lack of comprehensive information available to both the medical community and families about the state of dementia care nationally. This research, carried out in late 2013, set out to address this gap and to identify the demographic and infrastructural trends in the sector. The researchers surveyed a total of 602 nursing homes in Ireland. They found that only 54 nursing homes (11% of all those surveyed) provided dementia specific segregated care in small scale domestic units. This compares with up to 33% in other countries like the Netherlands and Norway where their respective governments have set targets to increase this type of long-term care.

The survey also identified that by far the main bulk of the specialist care (63%) was provided by the private sector. Significantly, the authors noted that the private sector receives considerably less funding for the care of older people from the National Treatment and Purchase Fund.

Commenting on the report, Tadhg Daly, (CEO, Nursing Homes Ireland) said: “This report is very timely and yet another ‘eye-opener’ for Government and policy stakeholders. We wholeheartedly welcome the research findings that the complex and high dependency needs of persons with dementia need to be realistically reflected in better resource allocation. The recommendation for a payment model that is commensurate with levels of care, staff training and skill mix, and type of non-pharmacological interventions is in keeping with Oireachtas Health Committee recommendation for evidence-based payments for nursing homes that incorporate real cost of care. This report highlights the willingness of our sector to meet the significant challenge of meeting the long-term care requirements of persons with dementia but the urgent necessity for appropriate policy and planning is outstanding.”

NHI Statement re Oireachtas Health Committee & Fair Deal (12 February 2015)

Director General has warned 2,200 will be waiting for funding support by year end and period will be 20 weeks

Inevitable consequences for acute services

Tadhg Daly, NHI CEO, today, 12th February stated: “Older person care is consistently veering towards crisis and this is manifestation of failure to appropriately resource for our older population’s healthcare requirements. The Government must finally show the required conviction to grasp the issue and ensure the Fair Deal scheme budget meets health needs of older people. This is about health service delivery and the most efficient use of health spend. Fair Deal delivers efficient and transparent spend within the health budget – 80% more cost effective than spend in acute hospitals – while ensuring older persons are provided with care appropriate to their healthcare requirements. Minister Lynch and Mr O’Brien have acknowledged that Fair Deal must be demand-led and if we want to ensure we finally get on top of the A & E crises that beset the health system on a constant basis this has to become reality.

“Government cannot continue to overlook the under-resourcing of the Fair Deal scheme. Timely access to the specialist, dedicated care in the community is integral to health service delivery. It is damning that the Department of Health’s A & E Emergency Taskforce has no representation from the private and voluntary nursing home sector, with utilisation of its 23,000 beds in communities across Ireland being integral to addressing problems besetting our acute hospitals. Long-standing independent research has pointed to the huge growth in requirement for nursing home care that is constantly growing in tandem with significant rise in our older population. The Department of Health warned Minister Varadkar last July 7,600 additional beds will be required to year 2021. NHI’s long-standing call for establishment of a forum that will bring stakeholders together to plan for the long-term residential care requirements of our older population has been avoided. Responsible planning and foresight is absent from the health culture within Ireland and this is highlighted in the repeating overcrowding crises occurring within acute care. The onus is upon the Government to lead in this regard and the consequences of failure to do so will be catastrophic for health services and society.”

Exclusion of Nursing Homes from Emergency Taskforce Unfathomable

Nursing Homes Ireland, the representative organisation for 440 private and voluntary nursing homes providing 23,000 residential care beds across the country, has been notified by Department of Health Officials it will not be included on the Department’s Emergency Taskforce.

Tadhg Daly, NHI CEO stated: “It is unfathomable as to how a viable solution will emerge to the waiting lists crisis when all the participants aren’t at the table. It equates to opening a hospital with politicians, managers, doctors and nurses all present but there being no beds in the wards. This recent crisis has highlighted hundreds of older people in hospitals awaiting access to nursing home care. The numbers requiring this specialist care will grow rapidly in a short period and this is acknowledged by the Department. Yet here we have a Taskforce looking at addressing the issue but excluding the key sector providing nursing home care in our communities. NHI and our Members have played a lead role in supporting the HSE in addressing the A & E crisis as collectively we seek to enable older people gain more timely access to nursing home care. Furthermore, Minister Lynch has stated she has no issue with our participation on the Taskforce, acknowledging we are key to addressing the issue of overcrowding*. It is completely illogical that the planning to address the very severe issues arising in healthcare that are affecting hundreds of older people requiring nursing home care and putting their lives at risk will ignore the input of the representative body for thousands of specialist healthcare providers in our local communities.”

“Our sector can play a bigger role as part of a system-wide discussion on managing discharges and the crisis in our hospitals. It is beyond me how the Minister for Health hopes to find a viable solution quickly when there is a failure to engage with all the potential solutions. The suffering of older people and their families because they are in inappropriate high-risk settings and unable to access nursing home care in a timely manner must be alleviated as quickly as possible and can only be done through wider consultation.”

“Unfortunately, this decision to exclude voluntary and private nursing homes is part of an ongoing failure to plan for our growing ageing population. A much wider Taskforce needs to be established with all parties, including representatives of older people, patients, nursing homes and all the arms of the State to plan for the future of care as growing numbers of people live to greater ages.”

Minister Needs to Prioritise Older Person Crisis in Budget 2015

Massive Escalation in Fair Deal Waiting Lists; Rate of Increase at Boiling point

The Chief Executive of Nursing Homes Ireland Tadhg Daly has said the rate of increase in waiting lists for older persons for nursing home care is at boiling point.

The list has increased by 25 per cent since July standing at 2,007 people waiting now. The month on month increase is 254. The trend in waiting lists since February has been to show a trebling of numbers and of approval times: in February of this year, there were 654 waiting, with 29 days to get approval, in April, there were 913 waiting and 6 weeks for approval, in May it was 1,265 and 7 to 8 weeks approval times, in June it was 1,465 with 12 weeks for approval, in September it was 1,753 and 14 weeks for approval and now it is 2,007 waiting and 15 weeks at least for approval.

“The waiting times have gone out of control, ” Mr Daly said. “Last February, at the height of the winter, there was a waiting list of 654. As we head into the winter, there is already a serious crisis and there is a risk of catastrophe for families all across the country.”

“Monies get returned towards the end of every year by Departments that were not able to spend their budgets. This money should now be allocated to Fair Deal to take the stress off older people and to remove the pressure on families and the acute hospital system. This new Minister for Health has to grasp this issue for the short term but also for the 2015 Budget and make appropriate allocations for the Fair Deal scheme. Otherwise, it will spiral further out of control and create problems across the country, across healthcare and across communities in Ireland,” Mr Daly warned.

“This is unfair to older people who have worked all their lives. This Minister for Health has to appropriately resource older person care as it is clear that if a person’s healthcare needs are not met in a timely and appropriate manner, they may deteriorate, and present this winter in hospitals with greater levels of acuity and complexity, and require more expensive acute treatment.”

“Older people who have been assessed by the HSE as requiring nursing home care are waiting four months. This is unacceptable and offensive. At the start of the year the Fair Deal budget was significantly cut and sadly our warnings advising of the implication of this illogical measure have come to fruition. We warned it would unavoidably lead to an increase in the number of older persons presenting to acute hospitals and have detrimental consequences for older persons health and wellbeing.”

“An opportunity is available now with the funds unspent across Government Departments for 2014 and with the Budget for 2015 about to be decided. In Budget 2015, the Minister for Health has to deliver reassurance to older people by ensuring Fair Deal in the year ahead is appropriately resourced to ensure they can access nursing home care in a timely manner. This must be a priority and the Department of Health cannot keep kicking the tin down the road and into the faces of families with older members who need nursing home care. Ensuring the correct resources are there can lead to a positive impact upon health service delivery and spend, addressing the high number of persons delayed discharged within our acute hospitals. Such an approach would be responsible, appropriate and play a role in supporting Government commitment to ensure Ireland is the best small country in the world to grow old.”