Opening Statement by Tadhg Daly, CEO, Nursing Homes Ireland for Oireachtas Special Committee on Covid-19 Response Tuesday May 26, 2020

26th May 2020

Mr Chairman and Committee Members, thank you for the opportunity to address you today. I am joined by my colleague Ms Anne Costello, NHI Nursing Committee Director.

The work of this Committee will represent one of the most important analyses of a national emergency that will forever be engrained in our country’s history. I wish you well in your work in the weeks ahead.

Nursing homes are traditionally very positive settings – homes of inspiration and happiness to the community within them. Covid-19 has brought huge levels of upset, sadness and worry in through their doors. I now take this opportunity to call upon us to forever commemorate all who tragically lost their lives in our nursing homes and in our country because of this cruel virus.

We should take this opportunity to laud the considerable sacrifices of nursing home residents. The loss of loved ones personal touch and for many the loss of friends has caused huge upset and worry for thousands of our most special people. Under very pressurised circumstances, our staff have made extra time to sit with residents and have prioritised the use of technology to connect residents with loved ones, often taking time outside of working hours to fulfil such. In recent days, a newspaper has reported on an NHI memo from very early in the crisis regarding communication. That memo was replaced following further guidance in April.

We applaud the staff across all our nursing homes – HSE, private and voluntary. These 40,000 people are on the Covid-19 frontline. They’ve made supreme sacrifices willingly and with great commitment to continue providing person-focussed care, comfort and support to people who are most susceptible to this cruel disease. Mr Chairman we, as a society, owe all frontline workers a great debt of gratitude. I would like to particularly thank staff in nursing homes for the care and support provided to residents over the past weeks and months, with many providing care to residents with Covid. The recent months have presented a very stressful and demanding time and these people ensured residents received excellent care in the most challenging circumstances. I know the majority of you here today understand the inter-connected role our homes fulfil in assisting the public health system to function in dealing with the Covid crisis. I particularly acknowledge our providers who, despite challenges with resources at every-level, ensured excellent care continued to be provided and hundreds of discharges were facilitated from our acute hospitals. This was despite refusal to test patients prior to discharge from hospitals to nursing homes and we know the extent of community transmissions.

Covid-19 has presented tragedy for nursing home residents. But it should not be lost upon us four out of every five nursing home residents who contracted Covid-19 recovered from the virus. This is testament to the tremendous dedication and professionalism fulfilled by staff under extremely strenuous circumstances to continue providing specialist care to our most vulnerable during this health pandemic. There needs to be greater appreciation that care of the older person is complex. Nurses in our nursing homes have very specific clinical expertise and a broad knowledge-base, based on the science and art of a person-centred gerontological care model. Supporting them are dedicated healthcare assistants and team members across the home, coupled with medical experts from the community.

Mr Chairman, I sit here today representing one of the most vital elements of the health service in Ireland. Our health service cannot function properly without the critical role fulfilled by our nursing homes. During the first three months of the year, over 2,500 people entered nursing home care under Fair Deal. 1,000 people every month transfer from our acute hospitals into private and voluntary nursing homes. 460 private and voluntary operated nursing homes provide essential and specialised clinical, health and social care to 25,000 older people. Even during the national emergency, just 7% of Covid-19 cases entailed transfer of the resident to hospital.

Covid-19 has presented the most seismic challenge for our health services and specifically for nursing homes. Stories from overseas emerged early in the year regarding the devastating impact it possessed for older persons and for all residential care settings. Cognisant of what was emerging, in January we in NHI began engagement with nursing homes to provide Covid-specific guidance. In February concerted engagement was undertaken with the HSE to deliver specific Covid-19 education and guidance for nursing homes. We requested the Department of Health to provide dedicated guidance for residential care settings.

An easily transmissible virus that we knew could take the lives of nursing home residents was in our communities. Preliminary research indicates up to 40 per cent of transmission is passed by asymptomatic persons. The mass testing of nursing home residents has seen asymptomatic residents and staff test positive. Nursing homes have huge levels of experience in managing the outbreak of flu and norovirus every winter and have extensive experience and clinical expertise in implementing Infection Prevention Control measures on an annual basis. But as a global pandemic, Covid-19 is on a different scale to any previously encountered in the sector.

We were exasperated. The sector required a specific plan. We knew that Covid19 disproportionately impacts on older people. The planning and focus was almost exclusively on our acute hospitals. Multiple clusters initially emerged in our hospitals. But the numbers in nursing homes started to increase.

We were already aware people in our homes would be amongst the most susceptible to the virus and a national strategy and response was required. In the absence of such, the challenges emerged. These were versed publicly:
• insufficient testing of residents and staff;
• mass shortfall of PPE – providers have suppliers they would utilise to source such equipment but they were informed of a global shortage when they sought to source such and the HSE had priority over limited supplies
• aggressive recruitment of nursing home staff initially by the HSE;
• discharges from acute hospitals to nursing homes without testing.

Our decision to restrict visitors on Friday 6th March was informed by our Nursing Committee, comprising of clinical experts representing nursing homes across the country. It was not taken lightly; Covid-19 was within our communities and the weekend presenting would see thousands of people engage in close contact with residents and staff.

At the NPHET briefing of 10th March, the decision was taken to publicly challenge the decision to restrict visitors as premature. This is despite HIQA, presented as the representative voice for our sector at NPHET, announcing that same day it would suspend visits by its inspectors to hospitals, citing the safety and wellbeing of people using services and staff. Two days later – 12th March – it cancelled inspections of all social care services. Its first specific guidance regarding care management was issued 23rd March, weeks into the national emergency.

The NTPF, the authority responsible for the commissioning of nursing home care, fell silent as homes incurred considerable and responsible costs to manage the pandemic. The Department of Health eventually intervened.

Key State organisations left the nursing home sector and its residents isolated in those early days. The dismay will live forever with us. But we welcome Minister Harris lead in eventually bringing senior officials from his Department and the HSE around the table to support the sector in coping with Covid-19. The evidence from Ireland and internationally is no individual health sector can manage the crisis presented by Covid-19 alone. The supports provided by HSE community services for residents are appreciated and have delivered valued resourcing supports. The support framework implemented by the Minister and colleagues has fulfilled a lead role in managing and curtailing the prevalence of the disease in our nursing homes.

Covid-19 continues to live with us. We give early welcome to the Minister’s commitment to establish a nursing-home expert panel to support good planning and safeguards to protect people who call nursing home, home. However, one significant voice is absent; that representing nurses from our nursing homes, which continue to operate on the frontline.

Oireachtas members will be aware from our engagement year on year, for the past decade, of Nursing Homes Ireland’s request that the Government to lead in establishing a forum to plan for the long-term care needs of older people. Our call has gone unheeded. Today we reiterate it.

We wish to move forward but Covid-19 now lives among us. We are actively engaged with Minister Harris, his officials and colleagues in the HSE in presenting measures that can ease visitor restrictions in our nursing homes. Clear policy is required. There is requirement to delicately balance health, safety and risk to life against the mental wellbeing and happiness of residents. Social connection for nursing home residents is critical. We see continuous testing of staff and residents and timely turnaround of results as imperative within any roadmap forward. A national strategy is immediately required in this regard.

Concerted focus and engagement must persist in tackling Covid-19’s threat to the lives of nursing home residents and staff.

The Covid tragedy must focus minds. Nursing homes are integral to the provision of specialised health and social care in our communities and a well-functioning health service. Our members and staff take great pride in fulfilling their essential role in Irish society. There is requirement to look at the structures to support our residents and skilled staff in meeting the specialised needs of people who require access to 24/7 nursing and multidisciplinary care. Timely access to community services such as GP, geriatricians and specialised therapies must be enshrined.

Lessons can be learned from the closer engagement brought upon us by Covid. There is requirement for a better and more integrated working relationship between the State and our sector. The core focus has to be on meeting the complex health and social care needs of nursing home residents. We will be stronger working together.

ENDS

Beaumont Residential Care Coronavirus Update, 28 March 2020

Just a brief note to again thank families for your continued support and understanding at this difficult time. Your kind messages are very much appreciated.

Overall, residents are bearing up very well, helped by the steady increase in families’ phoning and your sending in letters, texts, and cards.

We will continue to facilitate calls on WhatsApp if requested though, importantly, this would need to be set up ahead of time with nursing staff (eg afternoons are quieter than mornings). Please send all emails and general enquiries to reception@brccork.com and WhatsApp messages/texts to the BRC mobile phone on 087 6072823.

It is absolutely critical we do everything we can to keep the Covid-19 virus outside of the home and, given that the majority of transmissions are now community spread, we are today stepping up restrictions further. All visits to the home are stopped until further notice.

As members of Nursing Homes Ireland (NHI), rest assured we continue to liaise on a daily basis with the health authorities and seek their advice where necessary.

Taking such measures at this time will hopefully result in much improved outcomes for your loved ones and staff.

Stay safe,

Kieran & Fiona O’Brien

Beaumont Residential Care Coronavirus Update 13 March 2020

Please be advised that the visiting restrictions set out in Wednesday’s communication (11 March 2020) still apply, with the following expanded definition of what constitutes an “affected area”

– China, Hong Kong, Singapore, South Korea, Iran, Japan
– All of Italy, Spain, Germany, France
– Cheltenham

We ask family members not to visit the home if they have recently visited one of the above affected areas. In the absence of any clear advice on those who attended the Cheltenham festival we are also including this in our areas of concern.

Thanks again for your patience and understanding with the above and we will continue to keep you up to date should the situation change.

Kieran & Fiona O’Brien

Beaumont Residential Care Coronavirus Update 11 March 2020

11th March 2020: Following a review of the latest Coronavirus information and expert advice, Beaumont Residential Care has decided to maintain its current policy of curtailing non-essential visits to the home. As evidenced from other jurisdictions, nursing home residents are particularly vulnerable to this virus and, while accepting this can be stressful for residents and their families, we firmly believe this is the correct course of action.
Importantly, we remind families/friends:
• not to visit the home if you have recently visited an affected area, or have had any direct or indirect contact with infected persons in Ireland. If in doubt please speak to our senior nursing staff.
• not to visit the home if you have any symptoms of respiratory infection (fever, cough, shortness of breath)
• where a visit is deemed “essential” by our nursing staff, the same person should visit i.e., not seven different people weekly (in order minimise the risk of spread)
• to please sign in and out at Reception. This is important should the authorities need to identify possible contacts in the event of an outbreak.
• to at all times disinfect well on entry and follow recommended hygiene practices.
• if at all possible, to meet residents in their bedrooms and limit travelling around the home.

Thank you for your patience and understanding with the above and we will of course continue to keep you up to date should the situation change.

COVID-19 / Coronavirus: Visitor Restrictions announced by Nursing Homes Ireland

6th March 2020: For the protection of nursing home residents, NHI has confirmed that visiting restrictions are now in place in nursing homes nationwide. No non-essential visiting, children or groups will be allowed.

All visitors are asked to contact prior to attending. Visitors should only seek to attend in urgent circumstances and the management reserve the right to impose full restrictions where necessary.

We urge prospective visitors to nursing homes to be cognisant and understanding of the measure that is required in the interest of resident and staff safety. Older people and people in nursing homes with pre-existing medical conditions are particularly vulnerable if they contact the virus. The virus presents an unprecedented situation for our nursing homes and the care provided within them. Nursing homes are imposing the visitor restrictions in the best interests of residents and staff. We thank people for their understanding and patience during this period of unprecedent challenges presented by Covid19.

Nursing Homes Ireland is monitoring the evolving situation on an ongoing basis and is in continuous contact with the Department of Health, National Public Health Emergency Team (NPHET), HSE and all relevant health authorities.

NHI accuses HSE of trying to once again bury cost of public nursing home care

Thursday February 27, 2020

Nursing Homes Ireland has tonight, 27th February, accused the HSE of trying to bury the amount it pays pubic nursing homes by releasing the figures late in the evening on a busy news day where virus issues dominate. NHI has also questioned the legality of the HSE’s actions by using money outside Fair Deal, separate to wage budgets, to top up the fees payable to public nursing homes under the scheme. It has demanded the Government immediately publish the long-overdue review of the Fair Deal pricing mechanism, now approaching three years past its date for completion and continuing to be covered up by the Department of Health.

Tonight the HSE revealed it has again increased the national average fee payable to its nursing homes. Private and voluntary nursing homes were paid fees 66% below those payable to HSE counterparts when the fees were last published in June last year.

In the growing inequality of treatment between public and private and voluntary homes, the HSE has revealed it is paying wage increases to staff in its nursing homes from another budget outside of Fair Deal. This budget is not open to private and voluntary homes to do the same. Despite there being a statutory requirement to bring before the Houses of the Oireachtas the cost components for each of its nursing homes, including pay, the HSE is openly flouting this statutory requirement. It has given no explanation as to why elements of pay are being funded separately from the Fair Deal Budget in the HSE nursing homes. This raises serious legal issues as to the reality of HSE costs that have not been presented before the Oireachtas.

Tadhg Daly, Nursing Homes Ireland CEO states: “The HSE continues to utilise the €1 billion Fair Deal budget to increase payments to its nursing homes minus accountability. As the Fair Deal budget comes under huge strain and older people have faced weeks waiting to avail of its financial support, the HSE uses the budget to pay its nursing homes much greater fees than those payable to private and voluntary counterparts operating beside them. The Oireachtas Public Accounts Committee has expressed strong concerns regarding the value provided by the HSE in its utilisation of the Fair Deal budget. Yet instead of the gross disparity being addressed, State discrimination in the operation of the scheme is growing.”

“The Fair Deal scheme is fundamentally flawed, with no recourse for private sector and voluntary providers to independently appeal the fee set by the NTPF under the Scheme. Providers seeking fair fees to provide specialised care are dismayed that fees under the Scheme are not commensurate with the reality of costs incurred. As it stands, Fair Deal is leading to the closure of private and voluntary nursing homes and placing unsustainable cost pressures upon nursing home providers. We are insisting that the next Government introduces a commitment to the introduction of an independent appeal process for nursing home providers under the Nursing Home Support Scheme (Fair Deal). This is a very legitimate and fair ask for private and voluntary providers within a scheme that is inherently unfair.

“From what budget are pay increases being met? There are serious questions to be asked of the HSE with regard to how it is funding nursing home care in its homes. Are operational and administrative costs entailed within the published fees or funded from a budget separate to Fair Deal? It is important a new Public Accounts Committee is appointed soon to question the HSE increasing its own payments to its nursing homes without any oversight from anyone.”

ENDS

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