The nursing home sector in Ireland has evolved in recent years with the majority of nursing home services now being provided by the private sector. While this sector still faces many challenges, new supports have recently been introduced to enable the sector to focus on providing high quality care to meet the needs of Ireland’s growing population. In addition, draft guidance on the design of nursing homes has also been published and is under consideration. In this article, we look at these developments and how they will likely affect long-term residential care services in Ireland.

New design guide for long-term residential care settings

Quality design, planning, and construction is critical when creating safe, high-quality care and ensuring positive experiences for our older population. The Department of Health, in conjunction with the Health Service Executive (HSE) and Health Information and Quality Authority (HIQA) published a draft Design Guide for Long-Term Residential Care Settings for Older People (the Design Guide) at the end of 2023. The proposed Design Guide will apply to long-term residential care settings for older people in public, private, and voluntary facilities. It will be relevant for those:

• Designing a new long-term residential care setting for older people.
• Extending an existing long-term residential care setting for older people.
• Converting/adapting a building that is not currently registered as a residential care setting, for example, a hotel.
• Refurbishing/retrofitting/renovating an existing long-term residential care setting for older people.

Key points

• It is proposed that HIQA will use the Design Guide to inform applications to register a new designated centre for older people (nursing home) or vary an existing centre’s registration.
• The Design Guide will not be applied retrospectively.
• New build long-term residential care settings, extensions to existing residential care settings, and conversions/adaptations of a building that is not currently registered as a residential care setting for older people will be expected to comply with the Design Guide.
• HIQA will ask applicants to provide detailed plans and information so that inspectors can consider the suitability of the applicant’s plans and can suggest improvements, where appropriate. The inspector’s comments during the pre-application registration advice process will not guarantee registration. However, they will be able to alert applicants to areas that do not comply with the relevant regulations, standards, and best practice.
• HIQA’s pre-application registration advice process should be completed before a planning application is submitted to a planning authority, and before inspectors approve in principle the design and proposed location of the facility.
• It is expected that planning authorities will consult the Design Guide when making a decision on a planning application or during the pre-planning advice process.
• It is recommended that long-term residential care settings for older people should have no more than 84 residents in total.
• The Design Guide includes recommendations for interior design, bedroom layout, communal areas, infection control and staff areas and the following are particularly noteworthy:
  • Long-term residential care settings adopt the Household/Teaghlach model of residential care with a maximum of 12 residents per household.
  • Each household should be accessible without having to travel through other households and must have the ability to operate independently and be self-contained if required. The design guide refers to each household requiring an identifiable entry.
  • Newly built residential care settings should consist of single-person bedrooms unless there is a specific requirement for some twin/double bedrooms to meet the needs of some residents.
  • Buildings of more than one floor should provide safe, independently accessible outdoor space, such as a balcony or roof garden, that provides contact with nature for each small group setting.

The public consultation on the Design Guide closed on 15 February 2024 and we understand that the feedback is under review.

It will be interesting to see if the sectors’ concerns about the proposed household model and the cap on nursing home beds will be addressed with HIQA when the Design Guide is published. We need to wait to see how the Government will deal with such challenges to ensure that the sector develops as it should. Due to economies of scale, compliance with the Design Guide will prove challenging for investors and operators without supplementary supports.

Resident Safety Improvement Scheme (RSI Scheme)

A new €10 million scheme has recently been established to support improvements in resident safety through funding support for the implementation of compliance plans consistent with the standards published by HIQA regulations published in 2013.

Key points

• The launch date for the RSI Scheme is 1 January 2024, and the closing date for applications is 15 November 2024.
• The RSI Scheme is open to all operational voluntary and private nursing homes registered with HIQA and the National Treatment Purchase Fund (NTPF) as of 1 January 2024.
• Nursing homes that have previously conducted structural works covered under the RSI Scheme can claim the cost of these works if they were carried out from 1 January 2020 to the commencement of this scheme (1 January 2024).
• All works claimed will be subject to inspection.
• This vouched scheme will have claims processed by the NTPF and all payments from the scheme shall be approved and processed and distributed by the HSE on a quarterly basis.
• All claims under this scheme must not have been submitted or previously reimbursed for under any previous scheme or grant.
• The upper limit available for each individual nursing home to claim is €25,000. All claims must be made for each nursing home facility individually.

The permitted works covered under the RSI Scheme are as follows:

• The installation of additional/sufficient clinical hand wash sinks that meet the required standard.
• The upgrading of sluice facilities within appropriate nursing homes.
• The upgrading of cleaners’ rooms within the nursing home for the following items:
  1. Improving the ventilation within the cleaner’s room.
  2. The installation of a stainless-steel sink / wash hand basin within the cleaning room for hand sanitisation purposes.
• The installation of additional signage for infection control measures.
• The installation of approved fire doors by a competent fire safety professional.
• The provision of appropriate fire safety / firefighting equipment.
• The improvement of emergency lighting and fire alarm systems and installation by a competent fire safety professional.
• The installation of appropriate fire safe fillings into holes created for essential wiring and plumbing facilities by a competent fire safety professional.
• Reconfigurations required to comply with certain aspects of the HIQA regulations published in 2013.

New postgraduate programme aimed at the nursing home sector

The Government recently announced €3.2 million in State support for a new postgraduate programme aimed at the nursing home sector. It has been developed in response to recommendations in the COVID-19 Nursing Homes Expert Panel report and will provide support for over 440 registered nurses in private nursing homes to obtain a Postgraduate Diploma in Gerontological Nursing.

Key points

• This new programme will be managed by LHP Skillnet on behalf of the Department of Health.
• The funding allocation will be provided over two years and will provide funded places in the academic years 2024/2025 and 2025/2026.

All private nursing homes will be invited to apply for one QQI Level 9 Gerontological Nursing Qualification placement over this period.

Comment

The nursing home sector’s dissatisfaction with the NTPF (or Fair Deal) scheme and its challenges with rising employment costs and the staff accommodation crisis are well publicised. Operators, investors, the Government and other stakeholders must work together to continue to develop the sector to meet the needs of our growing elderly population. The new measures and supports which have recently been introduced or are proposed demonstrate positive steps towards such collaboration and it will be interesting to see the impact the various changes and supports will have on the sector in the coming months.

For more information, contact a member of our Healthcare or Corporate teams.

The content of this article is provided for information purposes only and does not constitute legal or other advice.