Nursing home report calls for extra funding for Fair Deal scheme

An independent expert panel on the impact of Covid-19 on the nursing home sector has recommended extra funding be pumped into the State’s Fair Deal scheme, and called for greater financial transparency from private sector homes.

The wide ranging report, which contains some 86 recommendations, was published on Tuesday.

In a section on the funding of the Nursing Home Support Scheme (NHSS), also known as the ‘Fair Deal’ scheme, which contributes more than €1 billion a year to the sector, the report states that “in the panels view, additional funding will be required” and states that “the sustainability of such scale of intervention poses significant challenges”.

It notes that “in the absence of published financial accounts”, contributions to the scheme from private providers are “unknown”, but says that “investment will be required to ensure nursing home adherence to HIQA’s nursing home standards and further ongoing costs arising from Covid-19.”

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The report also recommends that increased integration of private and voluntary homes into the wider health system “requires enhanced transparency of operation, funding and finances of these nursing homes”, and that how these homes are funded and spend both public and private money “should be clearly transparent and measures should be considered to ensure this”.

Asked about the possibility of increased exchequer funding for the sector, Minister for Health Stephen Donnelly said he would “most certainly” advocate for a greater budget at cabinet.

He said that while an implementation group was due to examine the costs of putting the report’s recommendations in place, that once it goes to cabinet, “yes it will be going with a request to my cabinet colleagues for additional funding”.

Tadhg Daly, the chief executive of industry lobby group Nursing Homes Ireland, defended private operators transparency. “The fair deal is a statutory regime of support set up under legislation and the accounts and records of all nursing homes are submitted to NTPF around negotiation of fee rates. There is full transparency and they (the expert panel) are ill informed in that particular recommendation,” he said.

”The issue around the contribution in terms of fair deal was highlighted by the C&AG, who stated it was the HSE where it was difficult to get a sense of budgets in their own units,” he said.

The report called for improved standards in education and professionalisation among staff in the sector, with providers mandated to ensure that staff either hold or are working towards a QQI level five qualification within 18 months.

In a move that was welcomed by unions, the report recommended a review of employment terms and conditions of nurse and healthcare assistant staffing grades.

Siptu deputy general secretary for the public service John King said that the union “believe(s) the Department of Health and the HSE must now move to provide the necessary resources and capacity to make sure the provision of health care for our older people is protected and improved to the appropriate level of care that our most vulnerable deserve.”

The report also recommended that for the next 18 months, or until the pandemic is over, staff should be precluded from working across multiple sites and should be given single-site employment contracts.

It makes a landmark recommendation that consideration should be given to making the influenza vaccine mandatory for staff in nursing homes, a step which has not been taken by the State previously due to constitutional concerns.

There will also be changes to admission policy, with new patients only admitted to nursing homes which can demonstrate their infection control measures are of sufficiently high standard to ensure there is no risk of onward infection.

Hiqa will be asked to maintain a register of nursing homes it deems to have demonstrated sufficient infection control standards, to support decision making on this issue.