The view of long-term care provided by private operators in Ireland must change

The COVID-19 pandemic in Ireland has brought to light and emphasised significant deficiencies in the delivery of suitable, community-oriented, and sustainable long-term care services for an increasingly large population facing a decline in functional capacity. As we strive to reconstruct and enhance healthcare and long-term care systems, it becomes crucial to foster extensive discussions, establish a shared vision for transformation, and implement targeted initiatives to overcome existing disparities e.g. the funding model (the Nursing Home Supporting Scheme, “Fair Deal”).

A fundamental overhaul of healthcare and social care systems is imperative to ensure that patients/residents have universal access to high-quality care, promoting better health and well-being throughout their lives. To fulfil, what should be key priorities, it is crucial to bridge the gaps between healthcare, long-term care, and social care systems, placing individuals at the core of a seamless and coordinated continuum of care across their lifespan. Drawing from the lessons of the COVID-19 pandemic, the Pan-European Commission on Health and Sustainable Development emphasises integration as a pivotal aspect of its vision for investing in robust, resilient, and inclusive national health systems. The commission recommends that European countries prioritise the integration of health and social care services, with a focus on patient-centered care and strengthening primary care.

Similar calls to action have resonated on a global level through the WHO Global Strategy and Action Plan on Ageing and Health, as well as the WHO-led United Nations Decade of Healthy Ageing. These initiatives underscore the importance of delivering person-centered, integrated care and primary health services that are responsive to the needs of older people. Additionally, they highlight the necessity of ensuring access to long-term care for older individuals who require it, as crucial measures for enhancing the health and well-being of this population. In Ireland, this must mean supporting all providers, of informal and formal care, and both public and private. This support must come by way of a meaningful “seat at the table” for all vested interests, including Nursing Homes Ireland, which represents private operators, providing formal care to approximately 26,000 people daily. This forum is where best practice and policy should be decided. Ireland can no longer develop and define policy for long-term care without the inclusion of all stakeholders and any forum should include at a minimum: the HSE, HIQA, Department of Health, Nursing Homes Ireland, Home and Community Care Ireland, Sage, NTPF etc.

Person-centered long-term care also requires a funding model that is appropriate to allow providers to deliver person-centered care. The current funding model, the Nursing Home Support Scheme (Fair Deal), does not provide this and bears some astonishing inequalities in terms of location, and inequities between public and private operators, with private operators paid 60-70% less than their public sector counterparts per resident per week.

A significant number of people in Ireland live with disabilities, facing limitations to their independence and often requiring support to enhance their functioning. Within European Union countries, 7% of the adult population reports severe and long-standing activity limitations, typically associated with the need for regular care and assistance. The prevalence of these long-term limitations increases with age.

Ireland will continue to undergo rapid population aging, particularly among those aged 80 years and older. A significant proportion of this demographic lives with illness and disability, relying increasingly on access to affordable, high-quality long-term care to sustain their health, well-being, and social engagement.

The provision of long-term care and support for individuals with functional limitations, traditionally fulfilled by families (predominantly women) and local social networks, has become more formalized through care services offered within healthcare and long-term care settings. However, the pace of service development has not adequately compensated for the diminishing availability of informal and family support, while the demand for care continues to rise.

Consequently, there is an urgent need to strengthen long-term care provisions in response to the escalating care requirements. Unfortunately, due to the broken funding model it appears that not only are we not strengthening long-term care provisions, but it is becoming more and more unsustainable with some smaller operators closing their facilities and leaving the sector and one operator earlier this month (11 May 2023) opting to leave the Nursing Home Support Scheme entirely due to cost pressures not covered by the Scheme. How can we justify the provision of highly regulated person-centered long-term care in a system which has capped private operators’ turnover (Fair Deal), in a system where they have variable and significantly increasing costs.

Reform and investment in long-term care have become even more crucial in the aftermath of the COVID-19 pandemic, which exposed fragmentation, significant capacity gaps, profound inequalities, and structural vulnerabilities.

Building a foundation of quality, effectiveness, and sustainability necessitates an integrated approach to long-term care service provision. This approach should prioritise improved coordination across sectors and governance levels, as well as foster collaboration between formal and informal caregivers through the provision of an appropriate cost of care model.

Conclusion - To enhance access to high-quality care and promote improved health and well-being across all stages of life, it is crucial that Ireland prioritises person-centeredness, user involvement, prevention, healthy aging, and enablement. This necessitates aligning and coordinating care systems, governance levels (all players, including the private operator), and care settings, while also implementing a tailored approach to funding long-term care which reinforces the integrated delivery of this care. It is important to recognise and adapt to the changing characteristics of Ireland’s long-term care system. The time is now.