I must now deal with a postponed division relating to the motion regarding nursing homes. On Wednesday, 2 July 2025, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 85(2), that division must be taken now.
Nursing Homes: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Marie Sherlock on Wednesday, 2 July 2025:
That Dáil Éireann:
notes that:
— investigative journalism by RTÉ has again exposed distressing and unacceptable practices and conditions in private Irish nursing homes, 20 years on since the Leas Cross scandal;
— the failure of the State to provide sufficient public long term residential care places has led to the growing privatisation of nursing home care, while the State picks up the majority of costs through the Fair Deal scheme;
— 30 per cent of nursing homes were privately owned 20 years ago, rising to nearly 80 per cent now, with Emeis Ireland one of the largest operators, with 27 nursing homes;
— research by the Economic and Social Research Institute, since the Covid-19 pandemic, outlines the consolidation of the sector into larger operator groups, and the decline of independently owned, family run nursing homes;
— there are serious shortcomings in the inspection and enforcement regime by the Health Information and Quality Authority (HIQA), with inadequate regulatory oversight, ambiguity in the application of existing powers, and a lack of appropriate powers beyond the power to stop admissions or remove a license;
— there are no minimum staffing levels required in nursing homes, or binding guidance provided to operators;
— there is no sectoral pay agreement in place, and the 2023 PwC report entitled "Challenges for Nursing Homes in the Provision of Older Persons Care - Private and Voluntary Nursing Home Sector", documents a staff turnover rate in the private nursing home sector of up to 38 per cent for nurses, and 54 per cent for healthcare assistants; and
— the Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, updated in 2024, documents that over 1,200 people under 65 remain in nursing homes due to a lack of appropriate alternatives;
recalls that:
— the French parent company of Emeis Ireland, formerly known as Orpea, required a State-led bailout in 2022, after the publication of Gravediggers, a book exposing the mistreatment of care residents, where the company maximised its profits and dividends to shareholders, based on a complex strategy of drastic cost cutting and the maximum use of public funding; and
— the Law Reform Commission published a comprehensive report on A Regulatory Framework for Adult Safeguarding in April 2024, and the Programme for Government commits to a new national policy in the health and social sector;
recognises that:
— the nursing home sector has become dominated by big business, and a for-profit model will not provide the standard of care demanded by families and carers;
— with an increased role for home care support for older persons in future years, the profile of nursing home patients will become more complex, more dependent, and in need of greater levels of specialised care in the future;
— increased powers and resourcing for HIQA alone will not resolve concerns about a profit-led model of care;
— the Covid-19 pandemic exposed the vulnerability of residents in private nursing homes; and
— the Commission on Care for Older People is examining the provision of health and social care services and supports for older people; and
calls on the Government to:
— take clear steps to ensure the State takes over the 27 nursing homes controlled by Emeis Ireland;
— prioritise the quality and safety of care of older persons in overhauling how nursing homes are funded and regulated, and provide HIQA with stronger enforcement powers;
— fundamentally reform the Fair Deal funding model for nursing homes – public, private and voluntary, starting with an end to the individualised negotiation process between the National Treatment Purchase Fund and provider, the introduction of service level agreements, ringfencing of funding for labour costs, and the introduction of specific rules relating to the control of the nursing home property and operating company;
— legislate to ensure minimum safe staffing levels, and implement the outstanding recommendations in the Covid-19 Nursing Homes Expert Panel report, and the 2022 Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants;
— require nursing home operators, in receipt of public funding, to recognise trade unions and engage in collective bargaining, to ensure competitive rates of pay, terms and conditions;
— ensure nursing home operators provide professional development education for staff within working hours, including mandatory safeguarding, infection prevention and control, and dignity at work training;
— limit all new nursing homes operations to 84 beds, and set out a schedule for all existing nursing homes to transition to an agreed appropriate size with HIQA;
— ensure the revised National Development Plan includes a funded programme to develop new public long term residential care, through community nursing homes, to meet the needs of our aging population;
— implement the Law Reform Commission report, by passing the required legislation as a priority in the autumn and establishing an independent national agency;
— introduce a new Fair Deal for care by implementing the long delayed statutory Home Support Service for Older People scheme, to support older people to age positively in their own home and community;
— adequately resource the home care sector, to deliver more care in the community and introduce a Fair Deal one-stop-shop, to support families and reduce red tape; and
— finally implement the recommendations of the 2021 Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, and commit to fully funding the under 65s programme office.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"recognises that:
— a national policy on adult safeguarding will be introduced for the health and social care sector, as set out in the Programme for Government, and this policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies, and procedures already in place in the sector for preventing, reporting, and responding to abuse;
— a framework for safe nurse staffing and skill mix will be developed for nursing homes, and this framework is a systematic, evidence-based approach to determine the number of nurses and Health Care Assistants required to provide safe and quality care, based on patient need/dependency; and
— the remaining provision, Section 68 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, will be commenced, providing additional powers for the Health Information and Quality Authority (HIQA)/Chief Inspector with regard to serious patient safety incidents in nursing homes, and the Chief Inspector will have the power to carry out a review of an incident which may have caused an unintended or unanticipated death or serious injury to the patient, and which occurred in the course of the provision of care to that patient;
notes that:
— a review will be established of the effectiveness of the Chief Inspector's inspection and monitoring processes, and this review will include such elements as how to further strengthen the monitoring of leadership, culture and governance in designated centres, how to better capture indicators of staff culture and other areas of service delivery, which is critical for safe and good quality support for residents;
— a plan for additional public nursing home bed capacity will be published, and the Department of Health, alongside the Health Service Executive, is currently developing a new public long-term residential care additional capacity plan, which will be published in 2025, and the delivery of additional public long-term residential care capacity is required to deliver on Programme for Government, Sláintecare, and Project Ireland 2040 commitments;
— new design standards for long-term residential care settings for older people across all sectors will be created, describing what good building design looks like for long-term residential care settings for older people, and providing a common benchmark against which the standard of these settings can be measured, and the Department of Health report entitled 'Design Guide for Long-Term Residential Care Settings for Older People Public Consultation Report', was published in January 2025;
— ownership structures will be reviewed to enhance transparency and strengthen accountability in the long-term residential care sector, and carrying out an evaluation of the implications of complex corporate ownership structures against current regulatory powers will identify opportunities for regulatory reform;
— the Government has reiterated its well-established commitment to the development of the statutory home care scheme in the 2025 Programme for Government, and the first element in delivering this is the Health (Amendment) (Licensing of Professional Home Support Providers) Bill 2024, which will establish a licensing framework for professional home support services and provide for regulation by HIQA;
— the Programme for Government commits to strengthening the nursing home sector, by increasing funding for the Nursing Homes Support Scheme, also known as Fair Deal, while investment in Budget 2025 was €67.6 million, and this followed on from an increase in 2024 of €45 million; and
— the Government established an independent Commission on Care for Older People, which is charged with examining the provision of health and social care services and supports for older people, and with making recommendations to the Government for their strategic development, including long term residential care; and
further notes that from 2021 to 2025, the Government provided funding of €21.4 million, to enable people under the age of 65 to transition to an alternative community-based placement and provide in situ supports as appropriate.".
(Minister of State at the Department of Health, Deputy Kieran O'Donnell)
Amendment put:
The Dáil divided: Tá, 84; Níl, 64; Staon, 0.
Tá
- Aird, William.
- Ardagh, Catherine.
- Boland, Grace.
- Brabazon, Tom.
- Brennan, Brian.
- Brennan, Shay.
- Brophy, Colm.
- Browne, James.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Butterly, Paula.
- Buttimer, Jerry.
- Byrne, Malcolm.
- Byrne, Thomas.
- Cahill, Michael.
- Callaghan, Catherine.
- Calleary, Dara.
- Canney, Seán.
- Carrigy, Micheál.
- Carroll MacNeill, Jennifer.
- Chambers, Jack.
- Clendennen, John.
- Collins, Niall.
- Connolly, John.
- Cooney, Joe.
- Cummins, John.
- Currie, Emer.
- Daly, Martin.
- Dempsey, Aisling.
- Devlin, Cormac.
- Dillon, Alan.
- Dolan, Albert.
- Donohoe, Paschal.
- Dooley, Timmy.
- Feighan, Frankie.
- Fleming, Seán.
- Foley, Norma.
- Gallagher, Pat the Cope.
- Geoghegan, James.
- Grealish, Noel.
- Harkin, Marian.
- Healy-Rae, Michael.
- Heneghan, Barry.
- Heydon, Martin.
- Keogh, Keira.
- Lahart, John.
- Lawless, James.
- Lowry, Michael.
- Maxwell, David.
- McAuliffe, Paul.
- McCarthy, Noel.
- McConalogue, Charlie.
- McCormack, Tony.
- McEntee, Helen.
- McGrath, Séamus.
- McGreehan, Erin.
- Moran, Kevin Boxer.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Moynihan, Shane.
- Murnane O'Connor, Jennifer.
- Murphy, Michael.
- Naughton, Hildegarde.
- Neville, Joe.
- O'Brien, Darragh.
- O'Callaghan, Jim.
- O'Connell, Maeve.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Meara, Ryan.
- O'Shea, John Paul.
- O'Sullivan, Pádraig.
- Ó Cearúil, Naoise.
- Ó Fearghaíl, Seán.
- Ó Muirí, Naoise.
- Roche, Peter.
- Scanlon, Eamon.
- Smith, Brendan.
- Smyth, Niamh.
- Timmins, Edward.
- Toole, Gillian.
Níl
- Ahern, Ciarán.
- Bacik, Ivana.
- Brady, John.
- Buckley, Pat.
- Byrne, Joanna.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Michael.
- Connolly, Catherine.
- Conway-Walsh, Rose.
- Coppinger, Ruth.
- Cronin, Réada.
- Cullinane, David.
- Cummins, Jen.
- Daly, Pa.
- Devine, Máire.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrelly, Aidan.
- Gannon, Gary.
- Gibney, Sinéad.
- Graves, Ann.
- Hayes, Eoin.
- Hearne, Rory.
- Kelly, Alan.
- Kenny, Eoghan.
- Kenny, Martin.
- Kerrane, Claire.
- Lawless, Paul.
- Lawlor, George.
- Mac Lochlainn, Pádraig.
- McGettigan, Donna.
- McGrath, Mattie.
- McGuinness, Conor D.
- Mitchell, Denise.
- Murphy, Paul.
- Mythen, Johnny.
- Nash, Ged.
- Newsome Drennan, Natasha.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Robert.
- O'Flynn, Ken.
- O'Gorman, Roderic.
- O'Hara, Louis.
- O'Reilly, Louise.
- O'Rourke, Darren.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Ó Súilleabháin, Fionntán.
- Quaide, Liam.
- Quinlivan, Maurice.
- Rice, Pádraig.
- Sheehan, Conor.
- Sherlock, Marie.
- Smith, Duncan.
- Stanley, Brian.
- Tóibín, Peadar.
- Wall, Mark.
- Ward, Charles.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Mary Butler and Emer Currie; Níl, Deputies Duncan Smith and Ivana Bacik.
Amendment declared carried.
Motion, as amended, put and declared carried.
Is féidir teacht ar Cheisteanna Scríofa ar [www.oireachtas.ie].
Written Answers are published on the Oireachtas website.
Cuireadh an Dáil ar athló ar 10.43 p.m. go dtí 8.47 a.m., Déardaoin, an 3 Iúil 2025.
The Dáil adjourned at 10.43 p.m. until 8.47 a.m. on Thursday, 3 July 2025.