Hiqa adopts ‘get tough’ stance on nursing homes

Thousands of beds in State- run nursing homes are facing closure because facilities have not been upgraded to meet new accommodation standards set by the public health watchdog.

The Health Information and Quality Authority (Hiqa), the licensing authority for all public and private nursing homes, is adopting a “get tough” policy in relation to the standards, which took effect on July 1st.

Over the past month, the authority has issued two proposals to refuse registration to two centres run by the Health Service Executive, a spokesman said.

It has proposed that 10 further centres be prohibited from admitting new residents to homes, or specific wards within those homes, due to substandard accommodation.

Decisions in relation to a further 36 HSE-run centres are at a final stage before a proposal is issued, the spokesman said.

Nursing homes can avert bed closures by agreeing to a schedule of improvements but Hiqa is growing increasingly frustrated at inaction within the health service on the issue, despite years of warnings.

Bed closures

Any bed closures would have a knock-on effect on hospital overcrowding, which is largely due to older patients not having anywhere to go to after treatment due to the shortage of step-down care facilities.

Many HSE-operated homes are in historic old buildings, often with dorm accommodation, and regarded as unsuitable for older people.

Upgrading or rebuilding the 11 public nursing homes with the most substandard accommodation would cost about €500 million, Minister of State at the Department of Health Kathleen Lynch has said.

The department has sought more than €250 million in funding to upgrade 1,500 community care unit beds from the Department of Public Expenditure in discussions on the Government’s next capital programme.

However, with a number of other substantial health capital projects in planning – including the new national children’s hospital and the transfer of the National Maternity Hospital to St Vincent’s hospital in Dublin – it is not clear how much capital funding is available for nursing home accommodation.

Priority list

The upgrading of nursing homes did not figure in the priority list of five capital projects drawn up by Minister for Health

Leo Varadkar

after he was appointed last year.

The standards applying to nursing homes were introduced in 2009 but a six-year derogation was given to existing homes to allow them time to improve. Since July 1st, when the derogation ran out, homes have to provide a specified minimum area of bedroom space per resident and may not generally accommodate more than two people in the same bedroom.

The Hiqa standards cover a variety of areas, including residents’ rights, governance, staffing and quality of life.

However, it is accommodation standards that has proved most controversial and carries the biggest cost implications.

A department source said it was hopeful Hiqa and the HSE could work out a mechanism for dealing with nursing homes that do not meet the standards.

Hiqa, which plans to deal with homes on a case-by-case basis, issued a final warning to operators in 2013 telling them to put in place plans to improve facilities well in advance of the deadline.