About a quarter of all publicly run facilities providing long-stay accommodation for older people are now more than 120 years old.
With a potential bill of hundreds of millions of euro for refurbishment or rebuilding looming in advance of new official standards, the Government will have to decide whether the State should retain its role in the provision of long-term residential care.
At present, the public healthcare system provides about 25 per cent of residential facilities nationwide. However many of these are old, have a “poor physical environment” and without investment seem set to fail new official standards scheduled to come into effect in two years’ time.
Simultaneously, demand for services for older people is expected to grow significantly as the population ages, while staffing levels in the HSE are set to fall by a further 7,000.
Growing gap
This is against a backdrop of a "continuous reduction" in community services for older people over recent years and an "unsustainable" gap between the cost of providing care in public facilities and that in the private sector.
A confidential report for the Government shows the future viability of public long-stay units will rely on a number of developments. These include the Government making a commitment to protect residential care services; capital investment to refurbish facilities; health watchdog the Health Information and Quality Authority enforcing regulations to come into force in 2015; State facilities being able to strip out costs; and the provision of adequate staffing.
The viability report by senior health service officials is stark in its finding. If the authority enforces the new standards, in the absence of significant investment, publicly- run long-stay facilities will “effectively be put out of business”.
Only 10 out of more than 100 State-run long-stay units currently in place would be able to operate after 2015.
On the other hand, the cost of meeting the authority’s standards would be very high.
According to the report, “refurbishment costs to bring all potentially compliant up to Hiqa standards is approximately €210 million. Replacement costs to rebuild units where it is cheaper to rebuild is approximately €525 million.”
The report indicates that the west of the country is facing the greatest difficulties.
"All long-stay units in HSE West are currently registered with Hiqa for the next three years. However from 2015, only one unit (St Brendan's, Galway) will be fully compliant without further investment and five units will not be compliant at all including the two public units in Limerick. The remaining units will require investment ranging from €300,000 to €3.5 million to achieve compliance."
The report says that in HSE West there are eight “old-type institutions with over 90 beds and significant funding will be required to bring these up to standard. “However because of the high number of beds they supply, it would have a huge impact to take them out of the system.”
The report says in HSE South, 10 units have significant non-compliance issues; 11 have medium compliance issues. It says it would cost €243 million to replace all existing facilities while the bill for refurbishment would be €136 million.
Five of the 24 units in Dublin/Mid Leinster will be compliant with standards and 10 would require "substantial capital investment".
In Dublin/North East, 573 of 1,152 beds in public units will be compliant while 291 more "can be made compliant [with] funding . . . of €2.5 million per year for the next five years.
Scenarios
The report sets out 5 planning scenarios. It says to do nothing would see a substantial decline in the number of public beds after 2015.
Alternatively the Government could implement regional viability plans with funding from the exchequer, a PPP (public-private partnership) arrangement or the sale of lands. The third scenario would involve the closure of specific units with the private sector taking over in these areas.
The fourth would involve the rationalisation of existing public facilities with savings used to “drive a reconfiguration of existing services”.
The report also suggested “eliminating the provision of public residential care and the exploration of provision on a contracted basis by the private sector as an alternative.”
