How Nursing Homes Ireland is Helping Ireland Deal With Demographic Changes


An ageing population is putting increased pressure on Ireland’s healthcare services. Tadhg Daly, chief executive of Nursing Homes Ireland, explains how his members are helping the country meet current challenges and demographic changes.

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The healthcare challenges presented by Ireland’s ageing population are particularly significant at present, as is the case in much of the developed world.

“I’m not fond of the phrase ‘demographic timebomb’,” says Tadhg Daly, the chief executive of Nursing Homes Ireland (NHI), the organisation that represents more than 80% of the country’s private and voluntary nursing home sector. “We should be celebrating the fact that, as a nation, we are ageing and ageing well. But that obviously brings challenges and it shouldn’t be beyond us as a society to plan for those challenges.”

The sector represented by the NHI has roughly 24,500 beds across almost 450 nursing homes, Daly says, with the vast majority being run by small and medium-size enterprises (SMEs). The organisation’s mission is to work in partnership with members, the government and the regulator to ensure all residents of nursing homes are receiving high-quality person-centred care in their local community.


“The ESRI [Economic and Social Research Institute] and the government have recently undertaken a capacity review and both are suggesting that there will be a significant increase in demand for beds by 2030,” says Daly. An ESRI report published in November found that as many as 6,300 extra beds will be required in public and private hospitals and care providers by the end of the next decade. That said, we need to ensure the sustainability of the current provision in the first instance.

“At the same time, there is a lot of support for the new Sláintecare policy, which will see a reorientation of the health service from the acute to community-based care – and obviously nursing homes have a significant role to play in that.”

Funding – a fair deal?

In November, the NHI organised its annual conference in Dublin, and Daly says there were three key issues that delegates returned to during the event. “These were the funding environment, the regulatory system for nursing homes, and members’ ability to attract and retain the right staff.”

Pictured: Tadhg Daly, Chief Executive of Nursing Homes Ireland.

The NHI has been particularly vocal in recent years about the need for the government to reform the Fair Deal funding system for care in later life. Daly explains: “There are two main issues with Fair Deal: we do need an increased budget due to the demographic pressures, but the government also needs to take into account the cost pressures that home operators are facing.

“At the moment, we have a very inequitable scheme: the Health Service Executive is the provider of 5,000 beds, but it doesn’t negotiate with any other entities – it sets its fees itself and takes one third of the total budget. On average, the HSE pays themselves up to 60% more than they expect the private sector to survive on.

“While the debate around healthcare provision is often fixated on the number of beds or hospitals or nursing homes, we still vitally need engaged, committed, qualified and supportive staff” 

Tadhg Daly, Chief Executive, Nursing Homes Ireland

“On top of that, you have a scheme that lacks transparency: the state is setting the fees with no reference to cost of capital or dependency levels. The current system of funding long-term care for the elderly is discriminatory against the private sector, is lacking in transparency and does not represent the best value for money for the state.”

Daly points out that the government is currently waiting to publish the Fair Deal review that was originally due to come out in 2017. “The fact that the government is reviewing the system is an acknowledgement that it’s not currently fit for purpose. But our frustration is the review hasn’t been published yet. The current pricing model threatens the viability and sustainability of the private and voluntary sector. In the words of the Department of Health report undertaken by DKM Economic Consultants, the ‘current pricing model operates in an ad hoc manner, lacks rationale, consistency and fairness, only applies to the private sector, and in the long run is unsustainable’.”

Another change the NHI would like to see is the introduction of a formal, independent appeals process that providers can use to challenge funding decisions. “At the moment, if you can’t agree a fee with the state, you’re outside the scheme – and that means you’re out of business.”

Recommended reading: What Next for Irish Healthcare Providers?

Recruitment and regulation

As is the case elsewhere, recruitment of trained healthcare assistants (HCAs) is another significant challenge for employers across Ireland’s health sector, and not just in nursing homes. “While the debate around healthcare provision is often fixated on the number of beds or hospitals or nursing homes, it’s important to bear in mind that even if we had all those things, we still vitally need engaged, committed, qualified and supportive staff,” says Daly.

“We’re finding that in the last two years in particular, the issue of staff has become very challenging. NHI is in concerted engagement with the Department of Health and lobbying on the requirement to remove HCAs from the ineligible categories of employment listing with immediate effect to address the staffing crisis.”

Daly adds the NHI has been engaging with the government to discuss the potential to increase the number of overseas HCA candidates. “We haven’t managed to convince them yet, particularly when it comes to non-European staff. But that’s certainly an issue that’s especially live for the sector at the moment.”

On the regulatory front, Daly says that the sector is highly regulated – “as it should be” – and also that the standard of care has improved greatly in the past few years, and this has been acknowledged by HIQA, the independent regulator.

And while the message here is ultimately positive, Daly believes there remains a disconnect between the necessity of maintaining high standards of care and the availability of funding to support this: “You can’t have the state saying through the regulator that we need higher standards and better care, but on the other hand, we’re not going to pay for it.”

Recommended reading: 6 Factors Healthcare Providers Should Consider For a New ITSM Solution

Credit where credit is due

Daly also believes that not enough attention is paid to the economic contribution made by the nursing home sector. “Our members are major employers right across Ireland, especially in many rural communities. And the care we provide ensures that sons and daughters or brothers and sisters of those in care can get out to work.”

By Chris Torney



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