Dáil Éireann Debate, Thursday - 26 June 2025
72. Deputy Michael Collins asked the Minister for Health the plans in place to end the disparity in funding between private and public nursing homes and thus protect the viability of all private and voluntary nursing homes (details supplied). [35007/25]
Amharc ar fhreagraIntroduced in 2009, The Nursing Homes Support Scheme (NHSS), commonly referred to as ‘Fair Deal’, is a system of financial support for people who require long-term residential care. It is unique in Europe in that it is a fair, single, unified system for funding and making long-term residential care more accessible.
Fair Deal was designed to protect and support vulnerable older people to ensure equal access to nursing home care based on what they could afford.
The NHSS supports approximately 24,000 long term residents.
Around 80% of those are supported in private and voluntary nursing homes, with the remainder in public HSE-run facilities (both systems are funded through the NHSS). Regardless of whether a person resides in a public CNU or a private/voluntary nursing home, their contribution to the cost of their own care is calculated under the same criteria, therefore the cost to the resident remains the same.
The Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes with HSE operated Community Nursing Units (CNUs) generally having a higher cost of care.
In December 2021, the Department published the independently chaired Value for Money (VFM) review on nursing home costs. The review found that the cost differential is largely driven by HSE pay rates, variances in staff-to-resident ratios and the skill mix in public and private nursing homes.
The Productivity and Savings Taskforce was established in January 2024. The Minister for Health requested the Secretary General of the Department of Health and the CEO of the Health Services Executive to co-chair a programme to drive savings and productivity improvements across the HSE.
A key action is to secure a reduction in the cost of care in HSE Long Term Residential Care Facilities for Older People. The Taskforce will provide monthly updates to the Minister for Health. Updates can be found by following this link: www.gov.ie/en/department-of-health/collections/productivity-and-savings-taskforce-and-medicines-taskforce/#productivity-and-savings-action-plan
The Nursing Homes Support Scheme Act 2009 sets out the basis for determining the cost of care in public centres under section 33 of the Act, which is managed by the HSE.
The National Treatment Purchase Fund (NTPF) is the body designated, under Section 40 of the Nursing Homes Support Scheme Act 2009, to negotiate with persons carrying on the business of a nursing home, for the purposes of reaching an agreement on the maximum prices to be charged for nursing home care, and are based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. This is the only mechanism for funding from the public purse for nursing home residents.
Nevertheless, the Government is conscious of the challenges and risks faced by the nursing home sector and the residents that call long term residential care settings their homes.
The Department of Health has regular interaction with all stakeholders including HSE, HIQA, the National Treatment Purchase Fund (NTPF) and Nursing Home representatives to discuss ways to support the sector.
The Government has secured year-on-year funding increases for Fair Deal, that has seen the budget increase from €968 million in 2019 to €1.223 billion for 2025.
Between 2020 and 2023, €236m in additional funding was provided to the Nursing Home Sector to cover costs related to Covid-19 and the energy crises.
In a 30-month period from March 2022 to July 2024, the average increase in the maximum rates a Nursing Home can charge for Fair Deal has increased approx. 12% or €122 per resident per week.
Every nursing home in the country has a minimum price of at least €1,098 per resident, per week.
€10 million of additional support for private and voluntary nursing homes has been allocated in 2025. The new Nursing Home Residential Premises Upgrade (RPU) Scheme will support nursing homes to upgrade their premises, and to improve compliance with standards published by HIQA under Regulation 17 (Premises).
Each qualifying nursing home can claim up to €25,000 for eligible works carried out under the Scheme between 1 January 2024 and 14 November 2025 (Scheme closing date).
This follows a successful scheme in 2024. The Residential Safety Improvement Scheme allocated €10 million to support structural improvements in nursing homes to assist their meeting HIQA compliance plans in respect of protection against infection and fire precautions.
The Department of Health is consistently seeking to identify improvements and introduce enhancements to the scheme, where feasible, which aims to ensure that long-term nursing home care is sustainable, accessible and affordable for everyone and that people continue to be cared for in the most appropriate settings.
