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NEWSNHI News published by: Nursing Homes Ireland,Unit A5, Centrepoint Business Park, Oak Road, Dublin 12.Tel: 01 4292570 | Fax: 01 4291845 | E-mail: info@nhi.ieVisit us online: www.nhi.ie

GERONTOLOGICALNURSING

BESTPRACTICE

IMMENSE SATISFACTIONIN CHANGING LIVES

SHORTSIGHTED& ILLOGICALHSE SERVICE PLAN 2014 STIMULATING

RECOLLECTIONS

HEALTH’S EMERGENCYREPORT WARNS OF EMERGING CRISIS

Book of evidence highlights requirement forimmediate State action

Tadhg Daly,Chief Executive Officer,Nursing Homes Ireland

COMMENT

01 — NHI NEWS

outstanding. In May 2012 the HSE published its report advisingconsultation process in respect of the future of community nursingunits in the Midlands.

As illustrated, since it has assumed office, this Government has failedto act with required urgency to grasp and address the very seriousissues facing the provision of nursing home care. The crisis is on ourdoorstep. The 2013 Operational Plan stated under supply of long-termresidential care beds is already an issue in urban centres. This isevidenced by the unacceptable, and avoidable, issues concerningincreased numbers on trolleys in our acute hospitals.

NHI commissioned BDO to conduct this essential independentanalysis to bring together objective research and evidence to inform ofthe growth in requirement for nursing home care, assess public policysurrounding long-term residential care, provide recommendations andto outline consequences of inaction. BDO analysed key statisticalindependent data, national and international reports, governmentcommissioned reports and reviews. Health’s Ageing Crisis is a vital andcrucial contribution to debate and policy planning surrounding long-term residential care and wider healthcare delivery. Key stakeholdersinputted to BDO’s body of work, including the Department of Health,HSE, HIQA, NTPF, IMO.

The debate surrounding requirement for nursing home care is oftenskewed. Only one in 20 persons aged 65+ requires long-term residentialcare. Understandably this increases to around four in 20 persons for our85+ population. Looking at the population projections, BDO points tothe CSO analysis that the population aged 85+ will increase 46% by2021; this is 7 years away - yes only 7 years. “The level of frailty andcomplexity of the medical needs for those of that age increases,prompting a greater and often essential need for residential care,” thereport states. “The evidence is clear. The need for nursing home careincreases within the older age cohorts…In short, demand for nursinghome care from those segments of the population whose care needscan only be met in a long-term residential care setting is forecast toincrease substantially in the short to medium term.” This is a warningour Government cannot ignore. Health’s Ageing Crisis forewarns of theimplications for State of failure to implement appropriate policy.Ireland already has one of the lowest numbers of long-term beds per1,000 of the population when benchmarked against comparatorcountries, the analysis informs. It refers to Government commitmentto develop an integrated care model that treats patients at the lowestlevel of complexity that is safe, timely, efficient and as close to home aspossible. It points to Sweden, where acute capacity was reduced, butlong-term residential care capacity was increased, with 7.5% ofpopulation aged 65+ receiving long-term care in residential homes and9.5% formal care at home.

BDO’s analysis warns of consequences of diversion of funding tosupport persons requiring long-term residential care, outlining it willresult in much higher social and economic costs now and into thefuture. “Even if the government and its agencies are successful indeveloping alternative or complimentary models of care for our olderpopulation, the increases in the cohorts of our 85+ population, whosecomplex care needs can be best met in a nursing home, will continue togenerate strong levels of demand for nursing beds,”the report states.“Itis clear that the current Fair Deal Budget is inadequate in the contextof an ageing population, with associated higher dependency levels.

The report quotes Age Action Ireland concern at diversion of FairDeal 2014 funding. It stated: “We are extremely concerned that theswitch in some of the funding from nursing home supports tocommunity supports which the HSE is planning will be insufficient tomeet the needs of the sickest of older people who will beaffected…Older people whose needs are not met in the community will

“Planning is bringing the future into the present so that youcan do something about it now”, American writer Alan Lakeinonce wrote. It is an apt truism that has been further brought tobear for the Irish long-term residential care and wider healthsector arising from the recent publication of Health’s AgeingCrisis: Time for Action – A Future Strategy for Ireland’s Long-TermResidential Care Sector.

The BDO report’s publication coincides with a critical and definitivemoment in time for long-term residential care in Ireland. Its findingsmake compelling reading for those operating in our sector, the widerhealth service and for a Government aiming to make ‘Ireland the bestsmall country in the world to grow old’.

The first sentence of the report’s executive summary encapsulatesthe critical crossroads our sector finds itself at: “The provision ofresidential care for our ageing population is rapidly heading for crisis;however this is a situation that can, with the appropriate actions,be avoided.”

For our sector, a series of long-standing key issues remainunaddressed. This report now provides independent timely analysis.Readers of NHI News will already be aware the HSE in its NationalOperational Plan 2013 warned of a“significant national deficit of longstay beds by 2016”. The Fair Deal review that Department of Healthstated would be completed before year end 2012 remains outstanding.Last May a HSE presentation outlined glaringly the stark scenariofacing the State in the provision of public long-term residential care,when costs of €1.68bn were outlined to maintain current provision anda 20% public presence within the sector. As the report acknowledges,at a time of straitened financial circumstances we must ask the questionis this the best use of scarce public resources.

In November 2011 – over two years ago – Minister Reilly told theOireachtas Health Committee“we have to ask why 50% additional costspertain in public long-term institutions and facilities for the care of theelderly which do not apply in the private sector, and have to examineand address that”. The terms of reference for the Fair Deal review,published June 2012, commit“to examine the overall cost of long-termresidential care in public and private nursing homes. While the updatedfees (Fair Deal) agreed between HSE and all private and voluntarynursing homes are publicly published on a consistent basis – the mostrecent being February 2014 - it remains an outstanding issue that publicnursing home fees are not subject to the same transparency, with themost recently published dating back to March 2011. The weekly cost ofpublic nursing home care is 3 years out of date – what are the HSEhiding? The HSE committed to NHI February 2013 it would publish upto date fees for public units within weeks, advising a review of capacityhad looked at costs of such homes, but the commitment remains

CONTENTS be admitted to acute hospitals while others willbe left struggling at home on ever-lengtheningwaiting lists for a nursing home bed”.

BDO’s warnings are stark: “Diverting moneyfrom the Fair Deal to support home carepackages (a sector that remains unregulated) willonly further increase the delays in securing long-term residential care for those who need it most.The net weekly cost to the Exchequer of privatenursing home care is averaged at c.€750(excluding the resident’s contribution) perresident versus a weekly cost of c.€6,000+ in theacute hospital sector. This means that for every1,000 of the population who cannot accessnursing home care and therefore must remain inacute care, the State is incurring a cost of up to€6m per annum.”

NHI has warned the Government it cannot‘buryits head in the sand’ concerning the very seriousissues it is faced with in respect of long-termresidential care. This independent analysishighlights lack of a clear policy and national strategyfor the long-term care of our older population andcites current uncertainty around future fundingarrangements for nursing home care.

The nursing home sector does not exist inisolation. It is integral to a proper functioninghealth service. Failure to address the issuesoutstanding will have very serious consequencesfor our acute hospital sector and impactnegatively upon wider population.

Health’s Ageing Crisis is a crucial body ofresearch that cannot be ignored. This reportoutlines in stark terms the crisis that is imminent.The issues highlighted are of national importanceand will impact upon wider health sectorand Irish society. It warns the time for action isnow and offers a series of consideredrecommendations.

A key message is with the appropriate actionand policy crisis will be avoided. NHI and the careprovided by our members are a key part of thesolution. The appropriate action and policy willensure older persons are provided withappropriate care in their local communities. Oursector does not exist in isolation and is essentialto health service delivery and must be central toGovernment plans to reform our health service.Health’s Ageing Crisis outlines in stark termsmassive cost implications for the State if it failsto plan with immediacy for our residential carerequirements.

I echo the comments of Robin Webster, AgeAction Ireland CEO, who stated at Health’sAgeing Crisis launch the report must be givenconsideration in the context of a national debate.NHI is now focussed on bringing its findings andrecommendations to stakeholders and widerpublic attention. This report can provide themomentum and impetus to escalate requiredaction to meet our older persons carerequirements.

We cannot and must not prevaricate anylonger. As the report title states – ‘Time forAction’.

Tadhg Daly,NHI CEO

Thanks to all supporters of NHI, many of whom are featured inthis newsletter. Please note, NHI is not responsible for thirdparty services advertised in this publication. Inclusion in thisnewsletter does not endorse, recommend or imply any approvalof the suppliers listed in this publication.

NHI NEWS — 02

NHI NEWSNews from Nursing Homes Ireland, the representative organisation for theprivate and voluntary nursing home sector.

HEALTH’S AGEING CRISISThe Government’s current short-term approach with respect to policy andfunding for the residential care needs of our ageing population will, if continued,result in a much higher social and economic cost in coming years, the BDO reportHealth’s Ageing Crisis: Time for Action states.

READ ALL ABOUT USThe fundraising endeavours of residents and staff of a Dublin nursing home, who tookto the streets to raise money and support those affected by Typhoon Haiyan in thePhilippines; a proud resident of a Co Cork nursing home becomes a first-time author;2013 saw visits to Ashford Castle, Knock & publication of a newmagazine in a CoMayo nursing home; Coral Haven in Co Galway celebrates its 10th anniversary.

DATES FOR YOUR DIARYNHI Members note key dates on the NHI calendar for the year 2014.

NEWS UPDATENurse prescribing raised in the Oireachtas and national audit shows shorter stay inacute hospitals for persons with dementia admitted from nursing homes.

HSE SERVICE PLAN 2014NHI & Age Action are warning of the consequences for the wider health sector ofthe €35m cut to the Fair Deal budget for the year 2014.

QUALITY IMPROVEMENT GRADUATIONNHI Members were amongst the first Irish graduates of a course in qualityimprovement science that was jointly run by HIQA & IHI.

MY NURSING HOME LIFENHI’s Director of Nursing / Person in Charge 2013 AwardWinner advises of theemphasis that is placed upon continuous professional development in nursing home care.

NHI ANNUAL CONFERENCE 2013The Department of Health is favourably disposed to bringing key stakeholders inthe provision of long-term residential care around the table to plan forrequirement, the NHI Annual Conference heard.

BEST PRACTICEAt Moorehall Lodge Ardee the approach is to live in the moment and capture theessence of it by using visual triggers to stimulate recollections and makeemotional connections. It was the inaugural NHI Care Awards Innovations inDementia Care Award winner.

ART & DEMENTIAAs the Creative Director for dementia specific programs and an artist, MichelleBurns truly believes in the therapeutic nature of art. For those with dementia, theexpression it affords provides them with a new voice, the Creative Director at SeniorAccess, an Adult Day Programme in San Rafael, California, writes.

NHI CARE AWARDS 2013Glitz and glamour at the annual celebration of nursing home care: the NHI CareAwards 2013

NHI ACKNOWLEDGESSUPPORT OF

NHI UPDATESCommitted to excellence in care

NHI calls upon Government to heed ESRIacute hospital report findings

03 — NHI NEWS

wwwwww..nnhhii..iiee @@NNuurrssiinnggHHoommeessIIrree

Two-thirds of extended stays in acute public hospitals in 2012 were byolder persons, the ESRI has reported. The extent of older personsutilising acute hospital services and high level of dependence placedupon these health settings to meet their healthcare requirements hasbeen outlined by the latest report by the ESRI into activity in acutepublic hospitals. The Activity in Acute Public Hospitals in Ireland 2012 Annual Reportwas

published 10th December and key findings included:P Two-thirds of the total extended stay days in public hospitals in

2012 (66.7% - 657,614) were by persons aged 65+. 10,140 of thestays during the year were by persons aged 65+.

P Over half the total acute stay days were by persons aged 65+ (50.2%- 1,086,927). 34.7% of the such stays were by persons aged 65+(167,378).

P The 65+ age group represented 36.4% (511,145) of total dischargesin 2012. This represented a 6.4% increase on 2011 number and 5%increase since year 2008.

P Persons aged 65+ accounted for the largest proportion of total beddays (47.3%), which was an increase of 1.9% on the 2011 figure

P Persons 65+ accounted for 1,744,541 (39.7%) in-patient bed days in2012.

P 4.6% (23,121) of in-patients were discharged to long-stayaccommodation (national total – 497,875)

Nursing Homes Ireland warned the Government that it cannot ignorethe ESRI-identified need for increasing care services for an ageingpopulation. NHI said that the Department of Public Expenditure andReform is represented on the ESRI Council and should take note whenallocating health resources.

“If official reports produced by public institutes over the years hadnot been ignored then the recession may not have been so severe, so it’stime to stop ignoring these reports,” said Tadhg Daly, NHI CEO said.“Too many reports get ignored in this country and it is pointless havingthese institutes if nothing happens at Government-level about theirreports.”

“It is fantasy for the Government to simply wish older persons willbe able to stay in their own homes when it is evident there isconsiderable dependence being placed upon acute hospitals to providethem with care,” said Mr Daly. “The nursing home sector has a verysignificant role to play in alleviating the pressures upon acute hospitalsand to consequently bring significant reductions to health spending.”

“Older persons must be able to access the support of the Fair Dealscheme in a very timely manner. Any cut to the Fair Deal scheme furtherincreases the numbers awaiting the specialist care of nursing homesand in turn leads to further increases in numbers being cared for in theinappropriate settings of public hospitals. The cut to Fair Deal in the2014 Service Plan poses a serious threat to the positive developments inrespect of A&E and hospital waiting times.”

Welsh First Minister Carwyn Jones attendedthe most recent Five Nations Care ForumMeeting that NHI was represented at. TheCare Forum brings together representativeorganisations for Northern Ireland, England,Scotland, Wales and the Republic of Irelandto explore matters such as care delivery,registration, regulation and governmentpolicy, and to identify common areas ofconcern. NHI is the forum memberorganisation for the Republic of Ireland. FirstMinister Jones spoke with Tadhg Daly, NHICEO, and Owen McGartoll, NHI Chairman, atthe conference that took place in Cardiff lastOctober. Mr Daly and Mr McGartoll informedof the private and voluntary nursing homesector in the Republic of Ireland andregulation and policy. Speaking at theconference, Minister Jones praised the workof Care Forum Wales, which celebrated its20th anniversary in 2013.www.fivenationscareforum.com

Welsh First Minister at Five Nations Care Forum

Pictured from left, are, Tadhg Daly, CEO, Nursing Homes Ireland; Bridget Warr, Chief Executive, United Kingdom Home Care Association;Robin Sidebottom, Vice Chair, Scottish Care; Christine Thompson, Independent Health and Care Providers; Wales First Minister CarwynJones; Mario Kreft MBE, Chair, Care Forum Wales; Nigel Newman, Senior Business Development Manager, Boots UK; Des Kelly, Execu-tive Director, National Care Forum; Martin Green, Chief Executive, English Community Care Association.

NHI NEWS — 04

NHI features on Drivetime RTE Radio 1 re access to therapiesHealth Policy Analyst Sara Burke brought to public attention anunpublished HSE Audit of Primary Care Team Service provision thatrevealed the majority of nursing home residents do not have accessto essential therapies provided by the HSE. Ms revealed details of theHSE audit on her health slot on Drivetime, RTE Radio 1, on Thursday21st November.

She informed therapies such as speech and language therapy, OT,physio, and dietetics are essential for the health and wellbeing ofolder persons in nursing home care and make a huge difference totheir quality of life. However the HSE audit states just a third ofresidents in private and voluntary nursing homes have access tothese HSE provided services, whereas half of those in public homescan access. When she queried the HSE in respect of the auditfindings, she advised she was informed emphasis is on providingsuch services to people in the community. Ms Burke said thisemphasis is proving to the detriment of older persons in nursinghome care. She informed the Fair Deal scheme does not encompass

such essential care and despite the vast majority of nursing homeresidents holding medical cards, they cannot avail of services theyare entitled to in an appropriate time.

Tadhg Daly, NHI CEO, responded to Ms Burke's report on theshow. He informed residents in nursing home care have complexneeds and are high dependency and such therapies are re-enablingand life-saving. He said the challenge is to engage with stakeholdersto ensure residents can avail of such services and older persons innursing homes must be capable of accessing such services in a shorttimeframe from the comfort of their home - the nursing home. Headvised of a "postcode lottery", whereby access can differsignificantly for residents in nursing homes within short proximityto each other because of differing HSE authorities. He said the HSEhas a responsibility to ensure persons in such care have timelyaccess to these life enabling and saving therapies. Mr Daly said theongoing Fair Deal review presents further opportunity to addressthis critical issue.

For the third year running, First ChoicePurchasing was a winner at the NationalProcurement Awards. First ChoicePurchasing partners with NHI to deliver thegroup purchasing scheme that is exclusiveto NHI members, delivering cost savingsand benefits to members in the day-to-dayrunning of their business. Pictured receivingthe Excellence in Private Procurement withSME’s Award is Eoghan Donnellan of FirstChoice Purchasing and Edward Heffernan,Associate Director with Morgan McKinley.

NHI Members can sign up for the schemeand can do so by mailing EoghanDonnellan ateeddoonnnneellllaann@@fifirrssttcchhooiicceeppuurrcchhaassiinngg..ccoomm or by contacting him at 008866 22229955663388..

NHI procurementpartner winsnational award

NHI presents to Oireachtas re End of Life CareNHI presented to the Oireachtas Joint Committee on Health and Children’s Public Hearingson End of Life Care in Leinster House on 5th November. Mary Burke, Chairperson NHINational Nursing Committee, appeared before the Committee to discuss end of life care innursing homes and offer recommendations in respect of providing such care. NHI's recommendations brought to the Committee included:P The role of GP in providing services to residents in nursing homes is clarified and that this

is done in tandem with a full review of the GP contract and education for GPs involved.

P Registered Nurse Prescribers working in private healthcare facilities are issued with aprescription pad and enabled to prescribe residents with Medical Cards.

P The HSE publish the findings of the QPSA (2013) audit on Primary Care Team Servicesand outlines the actions taken to address the deficits in service provision.

P A formal mechanism for GPs to communicate with out-of-hours services is implementedwithout delay

P The development of a Department of Health led Forum/ Expert Group on long-term care.

P The role of the GP in providing services to residents in nursing homes is clarified and thatthis is done in tandem with a full review of the GP contract and education for GPs involved.

P There is an increase in the number of Geriatricians nationally to improve access todiagnosis and chronic illness management in the nursing home thereby reducing un-necessary hospital admissions. An extensionand replication of Connolly Hospital out-reachservice is the preferable option.

P Consideration be given to the prioritisation ofpalliative care patients on the Fair Deal waitinglist to facilitate death in a more appropriateplace.

P Legislation pertaining to Advanced CareDirectives is implemented in Ireland and itspublication is accompanied by a general publicawareness campaign and specialised educationfor healthcare professionals.

P There is a public awareness campaign andtailored education for health careprofessionals prior to enactment of theAssisted Decision Making (Capacity) Bill.

P Immediate action is taken to address thedeficits in ‘Adaptation’ and ‘Return to Practice’nursing programmes.

You can read NHI's submission to the Committeein respect of End of Life Care via the news sectionof the NHI website, wwwwww..nnhhii..iiee..

AAbboovvee:: Mary Burke, Chair NHI NationalNursing Committee, is pictured, right, atLeinster House ahead of her presentation

to the Oireachtas Health Committee reEnd of Life Care with, left, Paul Gregan,Primary Palliative Care Initiative, and,

centre, Mary O’Dowd, InstituteCommunity Health Nursing.

05 — NHI NEWS

NHI partners jobs programme to supportdisadvantaged jobseekersNHI is partnering the STEP Supported EmploymentNursing Home Pilot Programme, an initiative designed tosupport disadvantaged job seekers to gain skills,experience and qualifications to meet the increasingdemand for workers in the elderly care sector.

The programme started in February and commencedwith six months focussing on work experienceplacements at St Mary’s Nursing Home, Merrion Rd,Dublin. The participants are being supported by a jobcoach, a facilitator from Southside Partnership, workbuddies, a project assistant and project manager, in unionwith the nursing home staff and residents. Fifteen monthswill be spent working towards a HIQA qualification withwork-placements provided through open training collegein Goatstown.

Tadhg Daly, NHI CEO stated: “Private and voluntarynursing homes provide wide-ranging employment inurban and rural communities across Ireland. Withinnovative support frameworks such as the STEPSupported Employment Nursing Home Pilot Programmetheir role in enabling job seekers develop skills andsecure gainful employment can be enhanced.”

The programme was launched by An Tánaiste EamonGilmore on 11th February at St Mary’s Centre, Dublin.

NHI UPDATES

NHI Members show intergenerational solidarity asgesture of support for Filipino colleaguesNHI Members raised over €17,000 to support the people of thePhilippines who were visited by the great tragedy that was typhoonHaiyan. The tragedy brought great sorrow and distress to people workingin NHI Member homes who are members of the Filipino community.

The €17,000+ raised through the fundraising efforts andgenerosity of NHI Member homes staff, residents and visitors hasbeen presented to UNICEF to support its relief efforts on the groundin the Philippines.

NHI’s Member support of the NGO that saves and protects thelives of children is a statement of intergenerational solidarity. Thefundraising of older persons living in Irish nursing homes and staffproviding them with care is supporting children who are nowhomeless and extremely vulnerable to life-threatening diseasesbecause of the impact of typhoon Haiyan.

Speaking at the cheque presentation, Peter Power, Executive

Director, UNICEF Ireland said: “I would like to sincerely thankNursing Homes Ireland and its members for supporting UNICEFIreland’s humanitarian work in response to the devastating typhoonwhich caused so much destruction in the Philippines.

“Many members of the Filipino community here in Ireland workin nursing homes throughout the Country and we are grateful fortheir support. The money raised will go directly to UNICEF’slifesaving work in the Philippines as we help the millions ofchildren and families who have lost everything to recover from this disaster.”

Tadhg Daly, NHI CEO said: “I thank Members for your generosityin supporting the NHI Philippines Relief Fund and showingsolidarity with your colleagues during this time of sorrow, distressand worry. Our Filipino colleagues are dear friends and bring greatcare and compassion to residents living in nursing homes.”

NNHHII PPhhiilliippppiinneess cchheeqquuee pprreesseennttaattiioonnPictured at the cheque presentation in The MarlayNursing Home are, from left, staff of the nursinghome Teresita Cruz, Ronaldo Bundoe, Ailen Lumires, DulceValmonte, Colette Clabby (Director of Nursing), TadhgDaly, CEO of Nursing Homes Ireland, Peter Power,Executive Director UNICEF Ireland, Ed, Julien Wardag,Rolando Patolilic. The Marlay Nursing Home staff,residents and visitors contributed generouslytowards the Philippines Relief Fund.

Pictured at the launch of the programme are, from left, Claire Hopkins,Open Training College; Mary O’Halloran, STEP Supported Employment;

Teresa Mallon, Menni Services; An Tánaiste Eamon Gilmore; Sarah Togher,

Irish Association of Associated Employment; Tadhg Daly, NHI CEO.

NHI NEWS — 06

Prominent health & finance speakers to feature at NHI Members Seminar 2014, as Members gather for AGM – 9th April 2014, GalwayLeading health policy analyst Sara Burke and renowned economist DrAlan Ahearne will speak at the NHI Members Seminar 2014, as Memberswill travel to Galway for the Seminar and company AGM.

Both events will take place Wednesday 9th April at the ArdilaunHotel, with Seminar registration from 9am and the AGM commencing at2.30pm. Speakers of particular interest for private and voluntary nursinghome proprietors have been lined up by NHI to speak at the MembersSeminar and they include Sara Burke, journalist, broadcaster and healthpolicy analyst, who has a weekly health slot on RTE Radio 1’s Drivetime.Sara also writes a fortnightly column for the Medical Independent and is apart-time research fellow in the Centre for Health Policy in Trinity CollegeDublin.

Dr Alan Ahearne is Head of Economics at the National University ofIreland, Galway. At the AGM he will speak to NHI Members re theeconomic outlook for SME’s and moving on from the recession. He willspeak about cost of capital, interest rates, wages and inflation.

Dr Ahearne is a Member of the Commission (that is, the Board ofDirectors) of the Central Bank of Ireland. He is also a member of theCentral Bank’s Audit and Risk Committees. Prior to taking up his rolewith NUIG, he was Senior Economist at the Federal Reserve Board inWashington, DC, where he worked for seven years. At the Fed he advisedAlan Greenspan, Ben Bernanke and other Fed Governors ondevelopments in the global economy. He was the principal economist atthe Fed covering the Japanese and Chinese economies. He served asSpecial Advisor to former Minister for Finance, the late Brian Lenihan,from March 2009 to March 2011.In this role, he advised the Minister on

economic, budgetary and financial policy in responding to the economicand financial crisis. Among other things, he played an advisory role inrelation to the three budgets during the period, the National RecoveryPlan, the creation of the National Asset Management Agency and othermeasures to address the financial crisis.

NHI Regions have put forward a series of diverse motions fordiscussion and ratification at the 2014 AGM.

MMeemmbbeerrss wwiillll bbee iinnffoorrmmeedd ffuurrtthheerr ooff ootthheerr ssppeeaakkeerrss iinn tthhee nneeaarrffuuttuurree aanndd NNHHII aaddvviisseess iitt iiss iimmppeerraattiivvee tthhaatt yyoouu bbooookk iinn aaddvvaannccee ffoorr tthheeSSeemmiinnaarr // AAGGMM.. YYoouu ccaann bbooookk bbyy mmaaiilliinngg iinnffoo@@nnhhii..iiee oorr ccoonnttaaccttiinngg hheeaaddoofffificcee aatt ((0011)) 44229922557700.. YYoouu aarree aasskkeedd ttoo aaddvviissee wwhhoo wwiillll bbee rreepprreesseennttiinnggyyoouurr nnuurrssiinngg hhoommee aatt tthhee AAGGMM//MMeemmbbeerrss SSeemmiinnaarr..

Leading health commentator SaraBurke will address NHI Members at

Members Seminar 2014

Nursing Homes Week 2014NHI is delighted to announce Nursing Homes Week 2014 will runfrom Monday 16th to Sunday 22nd June. The 2014 celebrationswill follow on from the very successful inaugural Nursing HomesWeek 2013. Once again a series of events and activities acrossthe country will celebrate nursing home life and the excellent careprovided by NHI Members in Irish communities. Residents, theirrelatives and friends, staff and extended communities will cometogether in celebration during Nursing Homes Week 2014. Therole of the nursing home sector in healthcare delivery, jobfacilitation and enabling person-centred, life-changing andenhancing care will be promoted during the week. Supportmaterial and further information will be provided to NHI Membersin advance of Nursing Homes Week 2014 and we will once againbe encouraging all to join in the celebrations.

Below: Nursing Homes Week 2013 celebrations at St Attracta’sNursing Home, Co Mayo

Diverting Essential Nursing Home Funding Will Have Huge CostThe Government’s current short-term approach with respect to policy and funding for the residential careneeds of our ageing population will, if continued, result in a much higher social and economic cost in coming years, the BDO report Health’s Ageing Crisis: Time for Action states.

The NHI commissioned report estimates that for every 1,000 peoplewho cannot access nursing home care due to the State’s strategy, thecost to the Exchequer will be €273 million annually in addition to theimmeasurable impact on people and their families.

Health’s Ageing Crisis: Time For Action, A Future Strategy for Ireland’sLong-Term Residential Care Sector presents independent research andevidence to lead the debate on public policy in respect of current andfuture requirements for long term residential care. Derry Gray, Managing Partner BDO, said Government, Departmentof Health, the HSE and related agencies must engage constructivelywith the nursing home sector to prevent a crisis and to ensure thatnursing home capacity is able to meet future demand. “Recentdecisions by Government to divert money from nursing home careto alternative home care packages and other community facilities willbe counterproductive and ultimately result in considerable waitingtimes for residential care.”

“This will consequently increase pressure on acute hospitalsadding further to the numbers of delayed discharges within thatsector,” Gray added. “Unfortunately such issues are already evidentwithin our acute hospital sector. From a capital and operationalfunding perspective, encouraging and supporting the private andvoluntary nursing home sector to develop the bed capacity needed tomeet the current and future requirements of our ageing populationrepresents a more effective use of limited Exchequer resources. Aclearly defined role for the nursing home sector, in the context of anew and emerging continuum of care model, should form a keyelement of future health care strategy.”

The BDO report also notes that, unlike other elements of oldercare provision, nursing homes provide high levels of specialised careand operate within what is a highly regulated and safe environment.

“Uncertainty around the financing of Long Term Care underthe Fair Deal scheme and the absence of a formal cost modelthreatens sustainability of current provision and continues to temperinvestor sentiment, acting as a barrier to investing in the nursinghome sector,” said Tadhg Daly, Nursing Homes Ireland (NHI) CEO.“Significant capital investment in the nursing home sector is nowurgently required. The political expediency associated with cuttingfinancial support for the Nursing Home Support Scheme (Fair Deal)runs the risk of real long-term damage to Ireland’s capacity to carefor our growing ageing population. Older persons must be affordedopportunity to access nursing home care in a timely manner andfailure to ensure this will have serious consequences for their healthand wellbeing. Furthermore, a key weakness in terms of theprovision of the entire range of older people services in Ireland is theabsence of regulation of or national quality standards for assurancein other older care settings, primarily homecare,” said Daly. “Inactionis no longer a policy or solution - the findings in this report verymuch emphasise the time for action is now.”

“Government policy and funding must provide a sustainablebasis for the delivery of high quality nursing home care and allow foron-going investment in new capacity and service development. Theprivate and voluntary nursing home sector is a vital part of healthservice provision, a notable employer, contributing significantly tolocal economies and is the most cost efficient provider of long-termresidential care for our ageing population,” added Daly.

The BDO report stipulates that bed capacity within the nursinghome sector is no longer keeping pace with increasing demand forlong-term residential care. Ireland has, relative to other Europeancountries, an extremely low number of long-term beds per 1,000 ofthe population. But critically, economic and funding constraints havein recent years been compounding this deficit, warns the report.

The report finds that demand for nursing home beds is nowexceeding supply in parts of the country, with the gap rapidlywidening. Analysis conducted as part of the study predicts a shortfallin the number of nursing home beds of approximately 4,000 beds intwo years (2016) and 8,000 beds by 2021.

The implications are clear, according to the report. People inneed of residential care, because they can no longer be cared for athome, will be forced to remain in or seek care within an acutehospital setting. This will have an inevitable wider impact on demandfor acute hospital beds and over-crowding throughout Ireland’saccident and emergency departments. The report notes that the costsof providing care in an acute hospital are a multiple of between fiveand eight times the cost of providing nursing home care, eitherpublicly or privately.

The report also highlights the vital role currently played byIreland’s nursing home sector which provides long-term residentialcare for over 27,000 people including public, private and voluntarybeds. The report estimates that approximately 22,000 people aredirectly employed by the private and voluntary nursing home sector,contributing over €170 million annually to the Exchequer throughdirect taxation paid.

The objective of the report was for an NHI commissionedindependent, fact-based review of the Irish nursing home sector. Thereport’s analysis was based on publicly available data and literatureand included primary research, which took the form of extensiveengagement with key stakeholders throughout the nursing homesector, older persons care and wider health sector.

Read a comprehensive analysis of the report and its key findings andrecommendations in this issue of NHI News.

HEALTH’S AGEING CRISIS

EXECUTIVE SUMMARYHEALTH’S AGEING CRISIS:

TIME FOR ACTIONA Future Strategy for Ireland’s

Long-Term Residential Care Sector

Prepared by BDO

07 — NHI NEWS

www.fresenius-kabi.com

Date of Preparation: Feb 2013.

EN/2kcal/002.13

References: 1. Raynaud-Simon A: Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr 2011, 30:321-319. 2. Hubbard GP. A systematic review of compliance to oral nutritional supplements. Clin Nutr 2012,31:293-312.

ONS should supply an additional food intake of at least 400kcal/day1

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1 Patient, 1 Bottle, 1 Day

GMS Approved

The Minimum Effective Dose of Oral Nutritional

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READ ALL ABOUT US!What activities are taking place in your home?How are residents fullling their lives? Whatcelebrations are taking place? Read all about us! offers NHI Nursing Homes the opportunity to publicise thewide-ranging activities that are taking place in homes across the country. It provides an excellent opportunityto publicise nursing home life in the positive light it should be seen in and members are encouraged to make usaware of what is going on. You can send any articles or pictures of interest to michael@nhi.ie.

Braving the cold, staff pushed residents in theirwheelchairs around neighbouring streets to thelocal shopping centre of Cornelscourt.

“Armed with our banner, we shouted andshook our baskets to get the attention ofpasser-bys and people in their cars togive us whatever they could afford,”Lisa Fitzgerald, activities co-ordinatorat the nursing home explained. “Itwarmed our hearts to see howgenerous people are, even in thesetough recessionary times. We weregreeted with smiles andencouragement. The Gardaí alsokindly agreed to help us out and theycreated space on the road for us towalk. We are also very grateful for thegenerosity of the staff of CornelscourtShopping Centre who provided us with tea,mince pies and cake when we stopped to have a muchneeded break.”

A number of staff in Cairnhill Nursing Home areFilipino and Lisa described them as very respected and

valued. “They have made Ireland their home andthey have become our friends,” she said. “When

Typhoon Haiyan hit the Philippines onNovember 8th it left thousands of people

dead and forced millions from theirhomes. It broke the hearts of theFilipino staff to see their peoplesuffering such a tremendous lossand being so far away from theirhome brought feelings of greatsadness and helplessness. We knewat Cairnhill we had to do something

to help and so the idea of a charityWheelchair Push came to mind. We are

delighted we got to contribute in someway and it brought us all a little closer

together. We have raised €3,000 and we areover the moon about that.”

See NHI News section re: Philippines Relief Fund.

Nursing Homes big push to support Philippines

09 — NHI NEWS

Residents and staff of Cairnhill Nursing Home in Foxrock, Dublin, took to the streets toraise money for the victims of Typhoon Haiyan, the exceptionally powerful hurricane thatdisplaced an estimated four million people in the Philippines.

NHI NEWS — 08

Proud Bill seesdream come true asdebut novelpublishedThe publication of Bill O Donnell’s novel The Small Kingdom is alifelong achievement for a gregarious gentleman in his late 80’s.On finding it impossible to continue living in the community, Billmade his home at Deerpark House Nursing Home in his belovedBantry. He settled in very quickly and found himself at ease andhaving time to look towards completing the novel he started 30years previously.

Being very involved in activity sessions such as creativewriting and life story, Bill met with likeminded people and one ofthese was Tom Weld, who was facilitating sessions. With Tom’ssupport, encouragement and his research on printing possibilities,things started to happen.

Bill was a publican for 55 years at the very well known andloved Anchor Bar in Bantry. His story-telling and people lovingskills served both him and the community well over the years. Thenow completed novel draws on Bills intimate knowledge of thelives of the seafaring people of the special part of the world that isSouth Cork and is laced with wonderful authentic detail. BernieCronin, Activities Leader comments: “It is written with humour andrare warmth, and with great story-telling skills, honed during hisworldwide travels and in five decades of running the ‘mosthappening’ public house in Bantry.”

Where better was there to hold the book launch than in hisbeloved bar setting amongst his family and friends. Bill, with thehelp of the activities team at Deerpark House, set about creatinghis guest list for the launch.

“A great evening was had where 50 guests toasted Bill’sachievement over cheese and wine, as Bill signed his book; hisdream had come true,” Bernie adds. “Demand being so great, asecond print was needed. A contented Bill read from his novel togreat applause and admiration from his family and many friends,in his beloved Anchor Bar.”

A portion of the proceeds from the sale of the book will go to the Irish Lifeboat Association, a worthy association close toBill’s heart P

Anna May Egan, a resident of Ashford House Nursing Homecelebrated her 100th birthday on 17th December 2013. Her day inthe Co Dublin nursing home began with visits from relatives,friends and local clergy. Then a special Mass for Anna May wascelebrated in Ashford House by Fr Manoj Ponkattil and this wasfollowed by a wonderful birthday party during which Anna Maywas presented with a letter of congratulations signed by PresidentMichael D. Higgins.

Anna May was born in 1913 – the year of the Dublin Lockout.King George V was on the throne in England and September 1913,one of the most famous poems of William Butler Yeats, waspublished. It was the year when suffragette Emmeline Pankhurstwas jailed and another suffragette Emily Davison ran in front ofthe King’s horse at the Epsom Derby and was killed. P

Resident born in yearof lock-out celebrates

Bill O’Donnell,resident of DeerparkNursing Home, CoCork, sits proudlywith his novel ‘TheSmall Kingdom.’

The staff of AshfordHouse celebratewith birthday girlAnna May Egan

Anna Maycelebrates with staffmembers Dinah Dio Clarito and Fe Balazo.

11 — NHI NEWS

READ ALL ABOUT US

Castle, museum and arts: a year of activityat Mayo Nursing Home2013 was a very exciting year for the residents and staff atBrooklodge Nursing Home; it was certainly a very busy place, writesAnn Cummins, Director of Nursing.

With the help of our artist Pam O’Connell, the residentsproduced an art book and a calendar displaying their beautifulartwork.

Brooklodge Nursing Home is situated very close to BallygluninRailway Station where the opening scenes of The Quiet Man werefilmed. With it so close in proximity, we decided to take a trip toAshford Castle in Cong , Co. Mayo, and witness where all theoutdoor scenes were filmed. This was the highlight of the year forthe residents and staff. They enjoyed silver service dining in theGeorge V Dining Room and this was followed by relaxation, chatand card playing in the drawing room.

During the year our residents also visited Knock Shrine and tooka tour of Knock Museum. This brought back many memories of turffires, churns and ploughs. Mary Roche, a local lady, came and made

butter the old fashioned way with a churn and our residents helpedout. Some declined – saying they did enough churning in their day!

It was a year one of our activity coordinators produced our firstbi-annual magazine Siamsa, showcasing our ongoing activity.

Our Christmas Mass and party on 8th December was extremelyenjoyable, with residents participating in the readings of the Massand the choir. Afterwards the families, staff and residents enjoyeddancing, singing and entertainment from local musicians anddancers. Annagh Hill Boys and Girls National School and CahergalNational School visited the nursing home before Christmas andentertained the residents with music, dancing, and gymnastics.Everyone had a wonderful time.

Throughout the year our residents help out with feeding thehens, collecting eggs and we also have ponies during the summer inthe fabulous gardens surrounding the nursing home.

We hope to continue our good work in 2014 and ensure ourresidents are living in a home where they are happy P

NHI NEWS — 10

READ ALL ABOUT US

10th Birthday celebrations at Coral Haven2013 saw Coral Haven Nursing Home celebrate its 10thbirthday. A highlight of the Co Galway-based nursinghome’s 10th anniversary year was a day of celebration on21st June. The occasion was marked by a Mass celebrationand was followed by the official launch of Coral Haven’snew website, www.coralhavengalway.ie. The website waslaunched by the Mayor of Galway, Councillor Terry OFlaherty. Also in attendance was Minister for Training &Skills at the Department of Education & Skills DeputyCiaran Cannon. Coral Haven was proud to present longservice awards to three members of staff who have beenemployed since its opening in 2003. Music andentertainment was provided in a marquee by StephenMcCormack, Matt Keane and Irish and Sean Nós dancingwas courtesy of Emma O’Sullivan.

Coral Haven is a 60 bed nursing home under theownership of Joe and Bridie Corcoran. It providesemployment to 68 staff. Coral Haven has enjoyed greatsuccess over the years, producing very high standards ofcare and obtaining excellent outcomes from HIQAinspections. During its ten years it has continuallyimproved and enhanced the variety of services available toresidents of the home P

DATES FOR YOUR DIARYNHI Upcoming events of interest

Quality and End of Life Care Education DayNHI will deliver a Quality and End of Life Care Education Day in conjunction with the Irish HospiceFoundation. The Education Day will take place at Moran’s Red Cow Hotel and is designed to supportMembers in meeting HIQA’s thematic inspection requirements.

NHI AGM & Members Seminar 2014The NHI AGM & Members Seminar 2014 will take place Wednesday 9th April in Galway. The venue is theArdilaun Hotel. The line-up of speakers for the Members Seminar includes Sara Burke, journalist,broadcaster and health policy analyst, and Dr Alan Ahearne, Head of Economics at the National Universityof Ireland, Galway.

NHI Education Day: Revised Care and Welfare Regulations: Exploring the Impact for Nursing HomesNHI will run an Education Day Thursday 15th May in Citywest Hotel, Co Dublin, titled: Revised Care andWelfare Regulations: Exploring the Impact for Nursing Homes. Further details will be announced in lead upto event.

NHI Annual Conference 2014NHI will again bring together an excellent line-up of speakers to discuss key issues pertaining tohealthcare and care provision.

NHI Care Awards 2014 in association with Homecare Medical SuppliesThe excellent care provided in nursing homes across Ireland will once againbe honoured and recognised at this prestigious national awards ceremony.

www.nhicareawards.ie

April

4April

9May

15November

6November

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Pictured are the celebrations from left: Mayor of Galway Councillor Terry O’Flaherty, Minister of State Ciaran Cannon, Proprietors Joe & Bridie Corcoran,and Director of Care Siobhan Finnerty.

NEWS UPDATE TTHHEE LLAATTEESSTT HHAAPPPPEENNIINNGGSS IINN TTHHEE CCAARREE SSEECCTTOORR

The first national audit of the quality of dementia care hashighlighted people with dementia admitted from nursinghomes to acute hospitals have the shortest length of stay inhospital. It also found that 35% of people who were admittedto acute hospital with dementia were discharged to nursing homes.

Co-principal investigators on the audit were Professor inGeriatric Medicine Des O’Neill and Dr Sean Kennelly, ClinicalSenior Lecture in Medical Gerontology from Trinity CollegeDublin along with Dr Suzanne Timmons and Paul Gallagherfrom University College Cork. Professor O’Neill and Dr Kennelly are members of both EngAGE, Trinity’s Centre for Research in Ageing, and the Trinity College Institute of Neuroscience.

The audit showed Ireland does not yet have standardisedcare for dementia in acute hospitals and highlighted pooraccess to diagnostic and support services. It highlightedinadequate assessment of cognition, delirium, mood, andbehavioural and psychological symptoms, in people withdementia during their admission, and where assessed anddiscovered, issues were not highlighted on discharge. Peoplewith dementia admitted from nursing homes were least likelyto have cognitive and social assessments. The average length ofstay for a person with dementia admitted from home anddischarged to a nursing home was 59 days, compared to 22 daysfor a person admitted from home and discharged home. Only43% of the people with dementia had a standardised cognitive

test recorded in their healthcare records and this dropped 20%to those admitted from residential care. 30% were assessed forindicators of delirium, 14% were assessed for recent changesin mood and 20% received a social and environmentalassessment.

The report highlighted over a third of wards - 35% - hadunfilled nursing vacancies and 26% had unfilled healthcareassistant vacancies. Only 69% met their agreed minimumstaffing levels. While the majority of wards - 96% - reportedthey had some level of access to liaison psychiatry, 26% had noaccess to psychiatry of old age services. The results alsohighlighted a significant lack of psychology services (91% ofwards had no access), specialist continence services (66% ofwards had no access), and social work services (47% of wardshad no access).

In 2013, the Irish National Audit of Dementia audited 35acute hospitals in the Republic of Ireland, interviewing thesenior hospital managers and geriatricians; directly observingthe environment/ interviewing the clinical nurse manager of77 wards, and reviewing 660 healthcare records of people withdementia who had been admitted to the hospitals.

The Irish National Audit of Dementia is a joint initiativecarried out by the Centre for Gerontology and Rehabilitation,University College Cork, The Centre for Ageing, Neuroscienceand the Humanities, Trinity Centre for Health Sciences,Tallaght Hospital Dublin and the HSE Quality and Patient Safety Directorate.

15 — NHI NEWS

SSiiggnniifificcaanntt iinnccrreeaassee iinn nnuummbbeerrss aaffffeecctteedd bbyy AAllzzhheeiimmeerrss Alzheimer's Disease International (ADI) has announced that the number of peopleliving with dementia worldwide in 2013 is now estimated at 44 million (estimatedat 35 million in 2010) and will reach 76 million in 2030 (estimate was 66 million)and 135 million by 2050 (estimate was 115 million).

Recently published research entitled ‘The Global Impact of Dementia 2013-2050’reports a 17% increase in global estimates of people living with dementia, comparedto the original ADI estimates in the 2009 World Alzheimer’s Report.

The Alzheimer’s Society of Ireland (ASI) stated: “A key part of planning and beingable to cope with the crisis coming down the tracks is the introduction andimplementation of a National Dementia Strategy in Ireland, which would bringIreland in line with other key European partners including the UK, France and the Netherlands.”

Currently The Alzheimer Society of Ireland is working closely with the Governmentand other key stakeholders to create the first National Dementia strategy which willbe launched in the first quarter of 2014.

“We are looking for a strategy that shows political leadership on dementia insupport of the thousands of people in Ireland currently living with Alzheimer’s orwaiting to access services,” said Gerry Martin, CEO, The Alzheimer Society of Ireland.

The Society states today in Ireland there are 41,700 people with Alzheimer’s anddementia. In less than 10 years the figure will have reached 70,000 and by 2041, willbe at 140,000 due to our ageing population. The overall cost of dementia care inIreland is just over €1.69bn per year. However if funding is ring-fenced to implementthe Strategy currently under development, it will enable savings without resorting tofurther cuts on badly needed hours of care nationwide, ASI has stated.

SSiinnggllee AAsssseessssmmeenntt TToooollttoo ccoommmmeennccee llaattee22001144:: MMiinniisstteerr LLyynncchhThe first phase of implementation of theSingle Assessment Tool (SAT) willcommence in late 2014, Minister forOlder Persons Kathleen Lynch hasinformed Dáil Éireann. A minimum of50% of all new entries to the NursingHomes Support Scheme, Home CarePackage and Home Help Schemes will be assessed by the SAT in the last quarterof 2014, Minister Lynch informed DáilEireann 19th December. Fullimplementation of SAT will be in placeby the end of 2015, she added.

Deputy Billy Kelleher, Fianna Fáilspokesperson on Health, asked theMinister for Health when it would berolled out.

He also asked the Minister if he willprovide the findings of the review of thefair deal scheme to assess its applicabilityto other sectors such as the disability andmental health residential sectors.

NNaattiioonnaall aauuddiitt sshhoowwss sshhoorrtteerr ssttaayy iinn aaccuuttee hhoossppiittaallss ffoorr ppeerrssoonnss wwiitthhddeemmeennttiiaa aaddmmiitttteedd ffrroomm nnuurrssiinngg hhoommeess

NHI NEWS — 14

The Department of Health has stated it supports, in principle,nurse prescribers in private nursing homes having access toprimary care prescription pads, subject to robust governanceand accountability structures being put in place. TheDepartment informed of its stance arising fromrepresentation by Senator Jillian Van Turnhout at theOireachtas Health Committee in respect of the issue at thequarterly committee meeting on 16th January.

Senator Van Turnhout asked “the reason for the HSE Policythat Registered Nurse Prescribers who work in privatehealthcare facilities including nursing homes are not issuedwith prescription pads”. She asked if the Minister would agreethat this discriminates against qualified registered nurseprescribers working in private facilities and may impact onpatient care by preventing timely symptom relief for residentswith medical cards living in private and voluntary nursinghomes where access to a GP may not be immediately available;and if he has plans to ask the HSE to change this?”

In a written response the Department of Health stated:“The Department supports, in principle, nurse prescribers inprivate nursing homes having access to primary careprescription pads, subject to robust governance andaccountability structures being put in place. The provision ofnurse prescribing services in nursing homes would greatlyenhance continuity of care from the hospital sector through

to the nursing home sector. Medicines legislation currentlyin place does not differentiate between prescribing by nurseprescribers in public or private setting. Nor does it deal withreimbursement under the Community Drugs Schemes ofprescriptions by nurses. The issue of reimbursement throughthe Primary Care Reimbursement Service (PCRS) is a matterthat will be progressed through engagement with the HSE bythe Primary Care Division in this Department.”

The matter was raised at the Debate and Dr SiobhánO’Halloran, Chief Nursing Officer at the Department stated:“With regard to nurse prescribing, there is a legal andregulatory framework in place. It has been in place since 2007.We currently have 650 nurse prescribers and 425 in training.There is no doubt that the introduction of nurse prescribing inthe nursing home sector can yield the same benefits as in theacute sector, where it is more prevalent. It can also yieldadditional benefits in terms of continuity between the acuteand nursing home sectors. There is an issue at the momentwith nurses accessing primary-care prescription pads for thepurpose of reimburse ment of medical card patients that weneed to resolve. In resolving that issue, we also need to ensurethat the governance of that issue is robust. In this regard, theDepartment, through engagement with the HSE, will progressthe matter and any other matters that may be slowing downthe expansion of this in the nursing home sector.”

NNuurrssee pprreessccrriibbiinngg iinn nnuurrssiinngg hhoommeess rraaiisseedd aatt OOiirreeaacchhttaass hheeaarriinngg

High social & economic costs for State because of failure to plan: BDO report On 11th February the BDO report Health’s Ageing Crisis: Time for Action – A Future Strategy for Ireland’s Long-Term Residential Care Sectorwas launched. This timely and essential body of work will be of crucialimportance in informing ongoing debate surrounding the care requirements of our older population. It will be utilised by NHI to bring to stakeholder attention urgent necessity to appropriately plan for our ageing population’s long-term residential care requirements.

BDO was commissioned by NursingHomes Ireland to conduct extensiveindependent analysis and rigorousassessment of the Irish long-termresidential care sector, the ageingdemographic and our olderpopulation’s projected healthcarerequirements. The report presentsindependent research and evidence tolead the debate on public policy inrespect of current and futurerequirements for long term residentialcare. Its conclusions inform of verystark consequences for older peopleand the wider health sector because ofcurrent planning and policy deficits. Itwill be of crucial importance ininforming ongoing debatesurrounding the care requirements ofour older population.

Extensive engagement with keystakeholders throughout the nursinghome, older persons care and widerhealth sector was undertaken by BDO.Engagement included the Departmentof Health, HSE, HIQA, NTPF, IMO, andindividual nursing homes. “Thepurpose of the research is to helpinform national future strategy foraged care provision and to provideguidance as to what may represent appropriate future policy responsesand directions, specifically with regards to the future role of Ireland’snursing home sector,” the report states.

The following is a synopsis of the report outlining key areas of analysis.

RREEQQUUIIRREEMMEENNTTInternational healthcare planners plan on the basis that 4.5% ofpopulation aged 65+ will have a requirement for long-term residentialcare. Health’s Ageing Crisis emphasises: “the demand for residential careincreases significantly in the older age cohorts, with researchdemonstrating that approximately 17% of those aged 85-89 and 28.9%of those aged 90+ require long-term residential care”.

“Over the next seven years, CSO forecasts point to Ireland’spopulation aged 65+ increasing by approximately 200,000 people orapproximately 38%,” the report states. “Of particular relevance to thelong-term residential care sector, those in the 80-84 age group areforecast to grow by approximately 20,300 people or 29%, while thenumbers of people aged 85+ will increase by 26,800 or 46%. This willincrease the levels of frailty and the complexity of those who now andwill in the future require long stay residential care. Based on theseforecasts, BDO have estimated that the 85+ segment of the populationalone will generate demand for approximately 18,947 long-term

residential beds or approximately 70%of current capacity in the sector. In short, the demand for nursing home care from those segments of the population whose care needs can only be met in a long-termresidential care setting is forecast toincrease substantially in the short tomedium term.”

The report presents threesupply scenarios to project forthcomingrequirement. The scenarios are basedon demand projections arising fromanalysis of three main data sources forkey demographic assumptions: m CSO Census of Population 2006 &

2011m CSO Population & Labour Force

Projections 2011 – 2046m Towards the Development of Predictive

Model of Long-Term Care Demand forNorthern Ireland and the Republic ofIreland (CARDI).

All scenarios are based onadditions of new private beds andincorporate:m Notwithstanding aspirations, thereis unlikely, based on internationalevidence, to be any significantreduction in the % of 65+ who require

long-term carem The significant increase in population 85+ and their requirement

for nursing home carem Public sector continuing to struggle to maintain existing provisionm Voluntary sector struggling to maintain existing bed numbersm Private sector adding beds but below requirement

Their projections are as follows: m Scenario 1 projects requirement to increase by 4,208 to 2016 and

7,986 to 2021. m Scenario 2 projects requirement to increase by 5,759 beds to 2016

and 10,913 to 2021. m Scenario 3 projects requirement to increase by 3,531 beds to 2016

and 6,058 by 2012.

SSUUSSTTAAIINNAABBIILLIITTYYWhile recognising the financial difficulties facing the State andemphasis on enabling persons avail of home and community care, thereport states the “demographic and international evidence is clear”.“There is increasing demand and need, in Ireland, for long-termresidential care being generated by those cohorts of the populationwhose needs can only be met in a long-term residential care setting.” There are two key factors that are likely to play a key role in

HEALTH’S AGEING CRISIS: TIME FOR ACTION

EXECUTIVE SUMMARYHEALTH’S AGEING CRISIS:

TIME FOR ACTIONA Future Strategy for Ireland’s

Long-Term Residential Care Sector

Prepared by BDO

19 — NHI NEWS

determining and influencing the role of Government in long-termresidential care, Health’s Ageing Crisis states: the financing of nursinghome care – Fair Deal at present, and capital investment required tomaintain and grow public care.

“There is clear evidence to suggest that current governmentpolicy with regards to the provision of older persons care services isbeing driven only by financial considerations rather than with theobjective of providing the most appropriate care for those that need itmost,” it states. It points to compelling demographic, national andinternational evidence to outline urgent requirement for appropriatepolicy planning including:m Our low number of long-term care beds per head of population;m Faster growth rate of 65+ population by comparison with our EU

neighbours;m The doubling of our 85+ population in coming decades and

increased requirement for nursing home care amongst that agecohort;

m Unrealistic objective of reducing percentage of population 65+(4.5%) requiring nursing home care;

m Lack of investment in public bed provision, with €834m requiredjust to meet HIQA physical environment standards and a further€850m to maintain 20% public provision;

m Fulfilling Government healthcare objectives will result inincreased demand for nursing home care.

“The lack of a clear policy and national strategy for the long-termcare of our older population, combined with current uncertainty aroundfuture funding arrangements poses one of the biggest challenges to thelong-term sustainability of the nursing home sector,” it states.

Based on estimates and future population projections, itestimated the cost of the funding of Fair Deal, based on currentapproach, will reach €1.20bn by 2021. It excludes capital costs andinvestment required for public homes to meet HIQA physicalenvironment standards (€834m) and to maintain public provision at20% (€850m). With the HSE National Service Plan 2014 stating therewill be no new additional resources to invest in older person services,the report questions where money will come from to meet capitalfunding requirements.

Diverting money from Fair Deal to home care and otherelements of care will result in increased waiting times for residentialcare and add further to increasing demand being placed on acutehospital sector, adding further to numbers being delayed discharge itstates. “The HSE’s own figures estimate the cost of a hospital stay pernight at €800-€900 amounting to a conservative total cost of at least€540,000 each night the 685 patients remain in hospital,” it adds.“This equates to approximately 720 weeks of nursing home care.Private nursing home care provides a more cost effective andappropriate form of care for these patients and if used effectively canresult in significant cost savings for the HSE and Department of Health.”

It states the net weekly cost to the Exchequer of private nursinghome care is averaged at c€750 (excluding resident contribution) perresident versus a weekly cost of c€6,000 in the acute hospital sector.“This means that for every 1,000 of the population who cannot accessnursing home care and therefore must remain in acute care, the Stateis incurring a cost of €6m per annum,” it informs. “The comparablecost of accommodating the very same population in appropriateprivate nursing home care is €750,000. The cost savings and benefitsto the Exchequer, on an annualised basis, are enormous.”

Given the significant capital investment required to maintainand grow public bed provision, the report questions if theGovernment should look at alternative models of care, citing publicprivate partnerships, joint ventures, incentivising private sector.

FFIINNAANNCCIINNGG NNUURRSSIINNGG HHOOMMEE CCAARREEThe ability of the private and voluntary nursing home sector to makethe investment now required to meet current and future capacity

requirements is entirely dependent upon bank funding and equityinvestment, Health’s Ageing Crisis states.

Uncertainty regarding long-term funding arrangements (FairDeal) and a challenging lending environment are cited as two keyfactors adversely impacting on investor sentiment and capacity tomake essential capital investment that is urgently required. It is alsocreating much uncertainty for existing operators and is causing someto question their ability to continue to operate.

HBC analysis published in 2007 for Age Action Ireland informeda “fair price” per resident per week for nursing home care of €1,101 inthe Greater Dublin Area and €994 for homes operating outside it. “Itis important to note that these estimates were made in 2006 and arepre the establishment of HIQA,” the report states. “They are thereforenot reflective of the additional costs that have been imposed onnursing home operators as a result of meeting the requirements of amore regulatory environment. Nor for that matter do they takeaccount of general inflationary cost increases that have occurred inthe intervening period. When the various cost components andrecommendations of HBC are considered, it is clear, based on ratescurrently being negotiated by the NTPF, that there is a gap betweenthe actual cost of providing care, based on 2006 costs, and the current fees.”

The report informs the State is paying between 58% and 103%more per resident in a public nursing home than the comparable feepaid to a private or voluntary home. It references Minister for HealthDr James Reilly questioning why 50% additional costs pertain topublic nursing home care and the Comptroller and Auditor Generalhighlighting the anomaly. Stating care requirements and dependencylevels of some residents in public nursing homes may be higher thansome residents in private homes, the report asks can or should theState continue to afford to pay between 58% and 103% more for care.

“In discussions with banks and other funders to nursing homeprojects, what came across clearly is that notwithstanding thefavourable demographic factors and an overall positive perception ofthe industry, their willingness to invest in the sector is tempered bythe significant influence and control the state exerts over the sector,”Health’s Ageing Crisis comments. “In particular concerns have beenraised regarding the funding and future of the Fair Deal, and thecurrent process by which the NTPF sets rates with individualoperators. Uncertainty with regard to the fees negotiated between theState and the nursing home operator undermines the confidence offinancial institutions, equity investors and nursing home operatorsand has contributed to the slowdown in investment in the sector and as a consequence the number of new nursing home beds enteringthe market.

“Reductions in the budget for the Fair Deal and recent decisionsto divert monies from the Fair Deal to support home care packagescan only further add to this uncertainty. In order to fund new nursinghome projects, our research has indicated that banks are actively seeking upwards of 30% equity investment and short financing periods.

“It is clear from our research that the process adopted by theNTPF in negotiating and setting Fair Deal rates with individualnursing home operators does not factor in capital costs or capitalrepayments. The current methodology is focussed on meeting the costof care only. As a result the financial returns available to nursing homeoperators and funders are not as attractive as are available in othersectors, and considerably below the 12% proposed by Laing andBuisson as representing an acceptable return. Securing funding fornew projects is one issue, but should not be considered in isolation.Another important consideration is the ability and capacity of allnursing home operators to invest in and maintain the existing long-term residential bed provision.”

Referring to NHI’s Annual Private Nursing Home Survey2009/2010, it highlights the “onerous costs”, “capital costs” and “majorstructural redesign” that private and voluntary nursing home

operators will face in complying andmeeting HIQA requirements,advising of the €834m expenditureexisting public nursing homes willincur in this respect. “Thisexpenditure is on-going, but doesnot contribute to increasing thenumber of beds in the system andmay in fact lead to reductions in bednumbers, as operators are forced toreduce overall capacity to meetstandards in terms of room size,layout and occupancy,” it states.“This has serious implications interms of the sustainability of theexisting public bed provision, andthe potential knock-on effects toboth the private nursing homesector and acute hospital sectorshould overall bed provision bereduced.”

“With continued downward pressure being exerted by the NTPFon the rates paid under the Fair Deal, banks, equity investors andoperators remain reluctant to invest in the sector,” it adds. “This isbecause the significant investment that is required to provide complexcare to some of our most vulnerable members of society, meet strictregulatory requirements and generate a reasonable financial return iscurrently not available or recognised in the current NTPF negotiation process.”

The report states Fair Deal, when originally conceived, wasdesigned to meet requirements of residents with high and maximumdependency but in the determining fees the NTPF has not used costingmodels to inform the process. It refers to “clear evidence” thatdemonstrates the dependency levels of nursing home residents areincreasing and historic and existing data may underestimate actuallevels. “In keeping with the concept of “money follows the patient” andthe rolling out of a single assessment tool, a strong argument can nowbe made to move towards a move towards a framework ofindividualised payments, based on the needs/dependency profile ofthe resident, which truly reflect the actual cost of meeting the careneeds of each nursing home resident,” it adds.

“The demographic evidence could not be clearer,” the reportstates. “The demand for nursing home care is now, in a number oflocations, beginning to outstrip capacity. The HSE NationalOperational Plan 2013 states “Based on population projections, therewill be a significant national deficit of long stay beds by 2016”. This issupported by BDO’s own research which shows that by 2016, there islikely to be a shortfall of up to 4,208 beds. The ability of the private andvoluntary nursing home sector to make the investment which is nowrequired to meet current and future capacity requirements is entirelydependent upon bank funding and equity investment.

“In discussion with banks and other funders, what came acrossclearly is their positive perception of the industry,” it states. “Howevertheir willingness to invest in the sector is heavily tempered by theability of potential operators to develop, register and profitably operatenew nursing home developments given a near monopoly purchaserof service and limited ability to recover costs from the provision ofadditional services or enhanced offerings.”

HHOOMMEE CCAARREEHealth’s Ageing Crisis informs of the nursing home sector being now oneof the most regulated sectors before adding “care standards andregulations are not evenly applied across all older people services andsupports, with the home care sector, for example, currently unregulated”.“The HSE’s Service Plan for 2014 places even further emphasis ondeveloping and supporting community and home based care supports

for the elderly. Although fundedby the Government, the numberof other older person’s services(Home Help, Home CarePackages) are provided, at what isa significant cost in what is anunregulated market.” Referring toGovernment commitment todevelop an integrated care modelthat treats people at the lowestlevel of complexity, the reportstates it is vital “all patients areassured of and benefit from thesame levels of protection enjoyedby nursing home residents”.

The report provides a cost ofcare comparison analysis,examining hourly and weeklycosts identified by PA Consultingin analysis of the Irish home care

market, which found the average hourly rate charged by private sectorto be estimated at €21. “Assuming the provision of home care five daysa week for eight hours a day, this equates to a “weekly” cost of €1,178for HSE/Non-Profit home care services, and a weekly rate of €840 forhome care services provided by private providers,” it states. “Thesecosts are only marginally below the weekly costs of public and privatenursing home care. Again it is important to emphasise that nursinghomes operate in a highly regulated market, providing full nursinghome care 24 hours a day seven days a week to those cohorts of thepopulation who have been independently assessed as requiringnursing home care. Even if some of these people could be cared forthrough the provision of home care support, it is highly unlikely, basedon their care needs and dependency levels that this care could beprovided at rate below that paid within a nursing home setting.”

CCAAPPAACCIITTYYWhen benchmarked against comparator European countries, Irelandhas one of the lowest numbers of long-term beds per 1,000 of thepopulation aged 65+, it states. Only Italy with 16 per 1,000 and Spainwith 21.3 have fewer.

Ireland is now catching up with other European countries interms of population ageing and the percentage in older age cohorts,the report states. These changes are evident in increasing demand forlong-term residential care. “While capacity in the nursing home sector,particularly in the private sector, grew rapidly in the period 2003-2009,recent years have been characterised by a significant slowdown in thedevelopment of new nursing home beds, and there is now strongevidence to demonstrate that the demand for long-term residentialcare is exceeding capacity in many locations throughout Ireland,” thereport warns.

Over the last three years the level of net additions has largelybeen driven by private providers but the level of additions has fallento approximately 339 per year on average, which has largely come inthe form of incremental additions to existing facilities.

Health’s Ageing Crisis points to demand in nursing home care in anumber of locations outstripping capacity, referring to HSE NationalOperational Plan 2013 informing of “significant national deficit of longstay beds by 2016”. It informs of Department of Health and HSE policyobjective and desire to provide approximately 20% of overall long-termresidential bed capacity, stating it is not clear the extent to which it is arealistic or achievable objective, “given the significant financial andoperational challenges that exist in terms of bringing some of thecurrent capacity up to HIQA’s physical environment standard by2015…Unless significant new additions are made in areas of high-demand, it will be difficult to raise the level of effective supply – and thiswill require some form of targeted capital support.”

HEALTH’S AGEING CRISIS: TIME FOR ACTION

Derry Gray, Managing Partner BDO, outlines the key findingsand recommendations emanating from Health’s Ageing Crisisat its launch at Stephen’s Green Hibernian Club, 11th February

21 — NHI NEWS

CCOONNCCLLUUSSIIOONNSSThe report's conclusions include: m Nursing home care provides a more appropriate and cost effective

form of care, not only for those in our population that need itmost, but also for many people currently cared for within theacute hospital system. Deficiencies in long-term residential caresupply contribute to delays in discharging people from acutehospital beds, resulting in increasing delayed discharges andcontributing to the situation of over-crowding which is prevalentthroughout accident and emergency departments. This has knockon effects throughout the acute hospital and wider healthcaresector.

m The level of private sector investment required to provide thenumber of new nursing home beds needed by our ageingpopulation will not happen unless greater clarity is provided inrelation to the funding and financing of long-term care.

m Given the HSE’s own cost estimates, it is highly unlikely that theState will be in a position to fund the cost of not only maintainingthe existing provision of public nursing home beds, let alonemaintain its 20% share of total supply in the future. This willresult in substantial shortfalls in nursing home beds relative tomarket need. At a time of straitened financial circumstances, thequestion that must be asked, is this an appropriate use of scarcepublic resources?

m Further falls in current nursing home bed supply are inevitable ifthe deadline for meeting HIQA Standard 25 on the physicalenvironment is to be met. This has drastic implications for overallnursing home bed provision, with figures from the HSEsuggesting that it could result in the loss of 3,000 public bedsalone. The private and voluntary nursing home sector will nothave the capacity or ability, in the short-term, to make up thisshortfall.

m It will therefore fall back on families or the acute hospital sectorto meet the care needs of those urgently requiring but unable toaccess appropriate nursing home care. This has significantsocioeconomic and financial cost implications.

m There will always be a cohort of the population (particularly thoseaged 85+) whose care needs can only be met in a long-termresidential care setting. Within Ireland this cohort of thepopulation is growing rapidly. Domiciliary/home care (which iscurrently unregulated) is not always appropriate or suitable tomeeting the care needs of this population. A sustainable andviable nursing home sector has a key role to play in avoidingadverse outcomes for our older population.

m Gaps in long-term residential care are not just an issue for ourolder population. Shortfalls in nursing home beds will impact onthe availability of beds within the acute hospital sector. This hasimplications for all requiring acute hospital care.

m The lack of a clear policy and national strategy on the long-termcare of our older population, combined with current uncertaintyaround future funding arrangements poses one of the biggestchallenges to the long term sustainability of the nursing homesector.

RREECCOOMMMMEENNDDAATTIIOONNSSThe report brings forward the following recommendations:m It is vital that the Government, policy makers and key

stakeholders come together to map out the future of nursinghome care and implement an appropriate framework to meet thesignificant growing requirement for it. The nursing home sectorhas a key role to play in developing this strategy and offers a realsolution to the challenges created due to an ageing population.Nursing home operators must be afforded the opportunity toshape this strategy.

m Careful consideration must now be given to identifying how theState can support or encourage new investment in nursinghomes in areas where there is clear evidence of strong demandfor long-term residential care.

m The development, by the NTPF of a clear and transparent pricingpolicy/model which provides a fair price for patient centred care,must be undertaken as a matter of priority.

m Operators who are dissatisfied with the rate proposed by theNTPF must be afforded the opportunity for fair right of appealindependent of the NTPF.

m It is vital that the government addresses as a matter of priorityhow the €1.68 billion investment required for public homes tomeet HIQA standards and maintain provision is to be made andhow it proposes to ensure that all public nursing home beds canbecome HIQA compliant by the July 2015 deadline.

m A model and appropriate budget for funding nursing home carethat recognises the costs of providing resident centred care, butwhich is sustainable in the context of an ageing population, mustbe developed as a priority.

m It is vital that the Fair Deal for nursing homes remains intact. Effortsto increase the level of funding to other older care services orprovisions must not be at the expense of a reduction in the overallfunding available to those requiring long-term residential care.

DDoowwnnllooaadd tthhee rreeppoorrtt aatt wwwwww..nnhhii..iiee uunnddeerr tthhee ppuubblliiccaattiioonnss sseeccttiioonn..

LLeefftt::Robin Webster, ChiefExecutive Age Action,warned at report launchHealth’s Ageing Crisismust be considered incontext of national debateand national action plan

RRiigghhtt::From left Senator ColmBurke, Age Action Chief

Executive Robin Webster,and NHI CEO Tadhg Daly

discuss report

Postgraduate Certificate and Postgraduate DiplomaGerontological Nursing (mostly online)Contact Teresa Wills Course coordinatorTel. 021 4901472. Email: t.wills@ucc.ie

Certificate in Nurse PrescribingContact Rena Creedon Course coordinatorTel. 021 4901495. Email: r.creedon@ucc.ie

Postgraduate Certificate in Nursing in the Community Contact Dr Mary Rose Day Course coordinator Tel. 021 4901473. Email: MR.Day@ucc.ie

BSc Nursing Studies (Top-up Degree) for Registered Nurses also available. For more info visit: www.ucc.ie/en/nursingstudies/

More info: Tel. 00353 21 4901560/1555/2159 Email: nursing.studies@ucc.ie

POSTGRADUATE NURSING PROGRAMMES

REGISTERED NURSES. ARE YOU INTERESTED IN FURTHER EDUCATION RELEVANT TO WORKING WITH OLDER PEOPLE?

Application material will be available from early March through the central Applications Centre. See: www.pac.ie

A TRADITION OF INDEPENDENT

THINKING

Closing date: 2nd May 2014

23 — NHI NEWS

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HSE Service Plan 2014: Illogical and shocking cut to Fair Deal Move will have consequences for older persons health and impact negatively upon wider health sector

NHI has stated it is shocked and appalled at the enormous cut insupport that will be provided to people requiring nursing home care in2014. The HSE Service Plan 2014, published 18th December, isprojecting a reduction of 939 – 1,702 persons to be supported byNursing Home Support Scheme (Fair Deal) to year end 2014.

The projected outturn for numbers to be supported by Fair Dealin 2013 is 23,000 and the expected activity by year end 2014 is 22,061.By comparison with numbers supported by the scheme at end of

October – the HSE’s most recently available figures published at timeof publication of Service Plan – 1,702 fewer persons will be supported.

“Such a drastic cut to the scheme that enables older people availof the specialist care of nursing homes is very difficult to countenance,”Tadhg Daly, NHI CEO commented. “It is illogical and short-sighted andwill result in 900 – 1,700 fewer persons being supported by Fair Dealin 2014. It will unavoidably lead to an increase in the number of olderpersons presenting at our alreadystretched and overcrowded acutehospitals. We have real fears this verysignificant cut to Fair Deal will havevery serious consequences for thehealth and wellbeing of older people.We are shocked by the drastic nature ofthe cut in support.”

NHI has expresseddisappointment and extreme concernfor older persons requiring nursinghome care arising from the €35.5mmillion cut contained within theService Plan for the Fair Deal 2014budget.

The cut to numbers supported byFair Deal is drastic when you look atthe numbers that were supported bythe scheme at the end of the October –the most up-to-date figures availablefrom the HSE at time of publication ofthe 2014 plan. Some 23,763 peoplewere supported by the scheme at theend of the month, it stated. This wouldreflect a reduction of 1,702 persons.

Age Action Ireland said the cut toFair Deal will result in acute hospitalsand community-based supports thatare already under pressure facing evengreater pressure in 2014. “Older peoplewhose needs are not met in thecommunity will be admitted to acutehospitals, while others will be left struggling at home on ever-lengthening waiting lists for a nursing home bed,” Eamon Timmins,Age Action spokesperson warned. “There is a considerable gap betweenthose who will benefit from these initiatives and those left waiting fora nursing home bed as a result of these changes. What is not clear inthis plan is what is going to happen to the 700 to 1,700 people who willnot get a nursing home bed next year and how they will be cared for.”He said the planned provision of home care packages and home helphours for 2014 has remained at the same levels budgeted for 2013“While the HSE plans to provide 10,870 home care packages in 2013,

11,372 were provided up to the end of September this year,” he stated. Mr Daly further commented: “It is laudable that the Government

is committed to supporting older people to remain in their homes aslong as possible. However, the recently published ESRI reportinforming of activity in public hospitals (Activity in Acute Hospitals inIreland 2012 Annual Report)highlighted older persons’ requirement forcontinuous, specialist care over an extended period. The ESRIprojection for significant growth in requirement for nursing homecare is backed up by the Centre for Ageing Research and Developmentin Ireland (CARDI) which has previously issued a warning this ServicePlan is ignoring: “Even with greater emphasis on care at home andmore resources provided to realise it, the demand for residential careis going to increase significantly in the next decade.”*

Requirement for nursing home care is growing considerably. Atthe end of September 745 persons were Fair Deal approved but

awaiting payment. Minister for OlderPeople Kathleen Lynch informed theDáil 13th November a further 523persons were awaiting Fair Dealfunding approval.

“The cut will undoubtedlyresult in longer waiting times for FairDeal,” Mr Daly added. “For an olderperson in a hospital or home setting, itis crucial they can avail of the specialistcare provided by a nursing homewithin a short timeframe. If this is notenabled, it can have very seriousconsequences for the person’s healthand wellbeing. Older people approvedfor Fair Deal have been assessed by amulti-disciplinary team as requiringthe dedicated care nursing homesprovide in their local community.

“The severe and drasticmeasure further underlines the criticalimportance of bringing keystakeholders together through aconsultative commission to planappropriately to address the carerequirements of older persons. NHIreiterates its call for responsible policyand planning to be brought togetherthrough the immediate establishmentof a Department of Health-ledCommission on Long-Term ResidentialCare. This has already received the

support of key health, policy and older person representatives. We’reliving longer and this is increasing considerably our requirements forthe specialist care provided by nursing homes. We must planimmediately for this.

“A cut of this magnitude will bring to bear great distress andangst for older persons requiring the support of Fair Deal. Denyingaccess to the specialist healthcare of nursing homes will bring to olderpeople in 2014 great distress, worry and concern. This smacks of afailure to see the wood from the trees in respect of health planning.”*Future demand for long-term care in Ireland, CARDI, October 2012

25 — NHI NEWS

HSE SERVICE PLAN 2014

“Older people whose needs are not met in the community will beadmitted to acute hospitals, while others will be left struggling athome on ever-lengthening waiting lists for a nursing home bed,”Eamon Timmins, Age Action Ireland

“A cut of this magnitude will bring to bear great distress and angstfor older persons requiring the support of Fair Deal,” Tadhg Daly,NHI CEO

NHI criticises Fair Deal cut as large numbers await hospital bedEarly 2014, the Irish Nurses and Midwives Organisation (INMO) reported substantial number of patients on trolleys and trolleys in wardsawaiting admission to a hospital bed. On January 7th its daily trolley and ward watch report informed 359 patients were on trolleys inemergency departments. This represented a significant increase on the numbers on the corresponding number for the previous year,which was at 284 patients on 7th January 2013. 102 persons were on trolleys on hospital wards, resulting in a total of 467 personswaiting on a hospital bed.

The figures made national news and Tadhg Daly, NHI CEO commented: “Very regrettably we are not surprised by the mediareports highlighting the increase in persons on hospital trolleys awaiting admission to a hospital bed and are concerned this will bereplicated in the news throughout 2014. The reports specifically highlight hospitals are reporting an increase in admissions of frail elderlypersons. Given the substantial cut to this year’s Fair Deal budget contained within the HSE Service Plan 2014, unfortunately we believethis occurrence will be repeated in the year ahead as more and more older persons will present to acute hospitals because of inability toaccess nursing home care. We’re facing into a year in which 939 to 1,702 fewer persons will be supported by Fair Deal. Many of these older persons will have no other option but to remain within the acute hospital sector or present at their local‘A & E’. For many older people in 2014, they will be waiting a number of weeks and likely months to avail of Fair Deal funding to enablethem access the specialist, continuous care of nursing homes. This will have a very significant impact upon the wider health sector andour acute hospitals in particular. It is not too late for Ministers Reilly or Lynch to halt this crude and illogical cut to the scheme - a measurethat will only bring distress, concern and hardship to older persons. We call upon the Government to put older persons healthcarerequirements ahead of health budget arithmetic and ensure the Fair Deal scheme 2014 is appropriately resourced.”

Mr Daly spoke on Morning Ireland, RTE Radio 1, in respect of the crisis. He informed listeners the substantial cut to the Fair Deal2014 budget was illogical and shortsighted and regretably NHI's fears re its impact were coming to fruition very early in the year. Hedescribed HSE announcement it will fund extra beds within the community to alleviate the overcrowding within hospitals as anacceptance of the shortcomings of its 2014 Service Plan. Good work in alleviating overcrowding will come undone if there are notenough beds in the community to support older persons healthcare requirements, he stated. Mr Daly reiterated NHI's call for theestablishment of a forum to plan for the significant increase in numbers growning older and their healthcare requirements. Other mediaplatforms also reported NHI’s comments and you can listen back to the Morning Ireland interview and see other media coverage in thenews section of wwwwww..nnhhii..iiee..

NHI NEWS — 32

90 staff from ten pilot sites of six nursinghomes and four acute hospitals receivedtheir graduation certificates at aceremony in Farmleigh House, CoDublin, on 6th February. The graduatesundertook the course on a voluntarybasis to learn about increasing the qualityof care they provide. Participatingnursing homes included Tara WinthropPrivate Clinic, Co Dublin, and St Luke’sHome, Co Cork.

Marie Kehoe-O’Sullivan, Director ofSafety and Quality Improvement withHIQA, said: “This collaboration betweenHIQA and the IHI is the first time thatthe IHI has worked in partnership on anational level to roll out thisonline programme and it represents animportant, concrete step in supportingquality improvement in Ireland’s healthand social services.”

Course participants were nurses,pharmacists, health care assistants,doctors, physiotherapists, dieticians, bedmanagers, administrative andmanagement staff. They were givenaccess to specific knowledge, skills andmethodologies that have been proven toeffect positive change in health and socialcare in other countries. The participantswere provided with qualityimprovement knowledge and tools todesign and implement new qualityimprovement initiatives, measure howwell they were meeting the standards,implement changes needed and provideevidence of their progress.

“HIQA has a responsibility to supportquality improvement in Ireland’s healthand social services by providingeducation in quality improvement andthis partnership with the IHI delivers

that,” Ms Kehoe-O’Sullivan added. “Itbegan for the first time last year, withparticipants completing a minimum of16 modules in order to achieve theHIQA/IHI Certificate of Completion inPatient Safety, Improvement Capability,Quality Cost and Value, and Person andFamily Centred Care. We congratulatethe first graduates and we will continueto work with the IHI to promote a betterexperience for patients and residents inOlder Person services and their familiesand deliver improved outcomes from ourhealth and social care services.”

The Institute for HealthcareImprovement (IHI) is a based inMassachusetts and a leading innovator inhealthcare improvement.

Above: The proud graduates celebrateat Farmleigh House

NHI Members were amongst the first Irishgraduates of a course in qualityimprovement science that was jointly runby the Health Information and QualityAuthority (HIQA) and the Institute forHealthcare Improvement (IHI).

Nursing homegraduateshonoured atHIQA graduation

QUALITY IMPROVEMENT GRADUATION

Pictured at the HIQA/IHI graduation are, front row from left,Rena Galvin, Adrienne Stack, Mary McCormack, CatherineDunleavy, Vikki McGinn, Dr Tomasz Tomasiuk, Bincy Joseph,Rosamma Jacob – all Tara Winthrop Private Clinic, and TreacyCooper, HIQA. Pictured back row, left to right, are Brian McEnery,HIQA, Dr Ambrose McLoughlin, Department of Health, Marie Kehoe O’Sullivan, Director of Safety & QualityImprovement, HIQA.

St Luke’s Home graduates, from left, Eileen Ferguson,Fiona O’Mahony , Sally Rodgers, Catherine Carey, Colette Culver

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What is your job title?Director of Nursing/Person in Charge at Annabeg Nursing Home. �What was your view of gerontological nursing prior to you takingup the position within Oaklodge Nursing Home?I qualified as a Registered General Nurse at St Vincent’s University Hospital. I worked inoncology for many years. This was a very difficult and emotional area to work in and as aresult I decided nursing might not be for me so I returned to college to commence CertifiedAccountancy. After two years of ‘number crunching’ I returned to where my heart was andreturned fulltime to nursing. While funding my accountancy studies I worked as an agencynurse mostly in Care of the Elderly and this was where I got a true taste for GerontologicalNursing and I’m happy to say I’ve never looked back since. I am currently undertaking aCertificate course in Care of the Older Person in a residential care setting. I have completeda Diploma in Management and Employee Relations and Certificates in Palliative Care andDementia. I have also completed other An Bord Altranais accredited courses while workingin care of the elderly. �

I would stress that the one ‘qualification’ any person needs to work in care of theelderly is the natural ability to work with your heart. If your heart is not in it then nursing isnot for you. It’s all about caring. It’s about appreciating that you are a huge part of eachresidents’ day and a huge part of their life. We make their day and let us not forget that weare working in their home so our mood, our attitude, our sense of caring, ourcommunication skills have a huge impact on each residents day.�

Did you work elsewhere prior to fulfilling your role at Annabeg?I worked in the Oncology Unit at St Vincent’s University Hospital and was a student nursere-employed at St Vincent’s University Hospital. One of my strongest memories is while astudent nurse working in the oncology unit the Ward Sister at that time asking ‘which nurseis from Leitrim?’ I whispered ‘I am’ to which she said ‘I’m not sure what words you said toMrs X but you really gave her encouragement and hope; Well done’. I was absolutelydelighted and tearful. I absolutely love nursing and the fact that I made an impact on thatperson’s life was overwhelming. Needless to say oncology nursing is difficult and quite anemotional area to work in and thereafter I entered the gerontological area of nursing. Myfirst role was as a director of nursing was when I was 29 and I have remained in this role forthe past 12 years.

What attracted you to employment in the nursing home sector?While working in the acute sector I was completely frustrated by the red tape when tryingto implement changes in practice and care. I suppose I found it difficult when the answerwas always “no” or simple suggestions or ideas had to go through various committees thatseemed to take forever to respond. I’m the type of person who if I see an area of care thatcan be improved upon and it is realistically achievable I want the changes madeimmediately and working in the nursing home sector allows for change. Residents comefirst and if changes can improve care or quality of service then immediate action is taken.Gerontological nursing is truly rewarding and I feel privileged that I work in this area.�Another big attraction to this area was the emphasis on continuous professionaldevelopment. It is to the fore in every nursing home, with nursing skills and experience onpar and above those working in the acute setting. Nurses are more exposed to emergencysituations without the backup that is available in the acute setting and therefore mustmake decisions using their clinical judgement and knowledge. The high standard of care inthe nursing home sector must be highlighted as it is truly immeasurable. I feel very proudto be a part of this nursing sector. Staff are more open to change and teamwork is crucial.It is also a ‘no nonsense’ field of care. You work with your heart and don’t just leave. Youget to know your residents and you build relationships that are inseverable. The bondbecomes very strong - almost like they are your second family. The people we care for areamazing people with amazing legacies and a generation from which we can learn a lot.�

It would be remiss of me not to mention the attraction flexible working arrangements.A lot of consideration is given to staff rostering in this sector. At Annabeg staff never workmore than two consecutive days and have every second weekend off. Days off are rosteredaround annual leave to ensure staff get extra time off and maximumise their Annual Leave.So one week’s annual leave gets turned into 12 days leave from the facility. Caring for yourstaff is crucial and eliminates issues such as sick leave and high staff turnovers. Being‘family friendly’ is also key to a happy team. Happy staff equal delivery of a high standardof care which equals very happy residents. �

Sinead Beirne fulfils the Director ofNursing/Person in Charge role at AnnabegNursing Home, Co Dublin. The Co Leitrim nativestresses the most important ‘qualification’ anyperson needs to work in care of the elderly isto ensure your heart is in the care you areproviding. She outlines her qualifications, therole she fulfils and responsibilities, and wouldadvise trainee and graduate nurses to learnthe life lessons that come with nursing in thenursing home sector. Sinead was the Directorof Nursing/Person in Charge award winner atthe NHI Care Awards 2013.

MY NURSING HOME LIFE

‘A huge privilegewith hugeresponsibilities’

29 — NHI NEWS

My Nursing Home Life affords persons working within a nursing home setting

the opportunity to discuss their role andadvise the wider public of what it entails and employment within such a setting.

Has your perception of the sector differed from reality?Absolutely. The nursing home sector can come in for very negative coverage from mediaand there is significant generalisation around the quality of care provided with ALL nursinghomes often tarred with the same brush. The Leas Cross report did massive damage to thesector but it is up to each individual nursing home to prove themselves in relation to theexcellent standard of care it provides and prove media wrong.

Many older persons living at home are cold, lonely and barely cook for themselves dueto being alone and perhaps due to financial constraints. After the death of a partner somemay not cook for themselves, may stay in bed to save on heating bills and become verylonely. I’ve often been told ‘it’s the night-time I dread’. People come and go during the daybut everyone goes home and they’re home alone and it’s a long night. And many of thesepeople don’t sleep well because they might be fearful. Compare that to residents in carefacilities who are truly well cared for. Their hygiene needs are met, they are warm, have anextensive menu choice and they are constantly entertained and offered activities. They livein very clean and homely facilities with no security issues or laundry and cleaning worries.These residents have choices. They make the rules. They dictate how their day should runand are very much empowered by the residents’ forum in the nursing home. After all thefacility is THEIR home not ours. Residents are very much consulted on their care.

I compare working in the nursing home sector to areas of care that colleagues of minework within and the contrast is startling. The nursing home sector is certainly moreproactive in areas of risk management, health & safety, fire safety, infection control andcontinuous professional development. Staff are exceptionally well trained and veryconfident in emergency planning. There is also `no profession discrimination or distinctionbetween those employed. All team members are treated as equal, with all staff receivingthe same training- with slight variances for nurses. Each profession employed have crucialroles to play in delivering an excellent service and a very high standard of care. Nurses donot lose their skills while working in this area but rather become more confident andstronger in dealing with different situations as they are more exposed to reality and have tomake informed decisions.

Working in the nursing home sector allows for a more organised, productive day whererisks are minimal due to the high standards of care and systems in place. Due to the highlevel of organisation and accountability there is certainly less occupational stress and amore confident, empowered team. Happy staff ‘deliver’ happy residents and that’s what it’sall about. If you have unhappy residents then there are ‘system’ failures. I firmly believethat if we stick to the basic principles of ensuring excellent care, the rest will follow. If youfail on basic care principles then you have a problem that inevitably leads to biggerproblems. Often that can be forgotten in other areas of care.

What are your responsibilities?Where do I start??! Most people would run a mile from the role of Director of Nursing dueto the level of responsibility attached to the role. But one must not panic about thesethings and my rule of thumb is to never forget the basic principles of care. I instil this intostaff. If you fail on that then you run into problems such as pressure sores or malnutrition -eventually leading to higher mortality rates. All any resident wishes for is to be well caredfor, to be respected, to be listened to, to be treated with dignity & respect. Without this youhave nothing and no other frills or marketing ploys make up that huge shortfall.

In my role you are entrusted with peoples’ lives. This is a huge privilege but alsobrings a huge level of responsibility. Unlike the C.E.O of a large firm, my responsibility is forpeople with pulses, not a product. Therefore there is no room for error, there is no room formistakes. How do I gauge the level of service I and my team provide? One of the mostimportant key quality indicator’s is number of complaints received. This gives a clearguidance to system successes or failures. And are the residents happy? If not, then whynot? Engaging with residents on a one-to-one level is vital and there is no better way to dothis than by taking time out with them. It is not achieved by popping your head in now andagain in an official capacity.

Other areas of responsibility include ensuring compliance with the National Standardsfor Older Persons in Residential Care Settings, compliance with the Health Act, nursing homeregulations, fire regulations, health & safety and employment law. Auditing is a large part ofmy role, as is meeting with residents and their families to review their care. I also haveoverall responsibility for staff training and ensuring continuous professional development.My role also involves functioning as a ‘bed manager’. While it may sound exhaustive, there isan exceptional team behind me. If you lead by example you reap the rewards.

What are the challenges presented in your employment?One of the biggest challenges is perhaps getting the balance right between ‘paperwork’ anddelivering care. While I advocate the changes in our regulations and the improvements theyhave brought I do feel that we now spend too much time on documentation which could bespent on our residents and this saddens me. The question must be asked if it looks good onpaper, what is the reality on the ground?

Another challenge in this sector is undoubtedly funding. Funding must support oursector in improving upon the excellent standards of care we are striving to provide.

One of the most frustrating challenges in the nursing home sector is our constantbattle with A&E departments and a flippant attitude at times towards residents who comefrom the nursing home sector. On many occasions staff have to challenge A&E decisions todischarge residents back to the nursing home without proper assessment. There is also afrustration residents are not being assessed as the most appropriate healthcare setting andbeing referred to overcrowded A&E units.

Is there a typical day?

Absolutely not! Every day is different and time flies. It is great to get up and head to workand love your job.

What are the most pleasing aspects of your work?

It is hard to sum up. Some real examples for me include

m When you get the opportunity to take a resident out who hasn’t been out in society formany years that’s immense job satisfaction! To experience the look on their face andto see their delight, it truly wrenches the heart. You cannot measure the satisfactionand joy on being able to make that impact on someone’s life.

m Making residents wishes come true. If it’s attainable then I will pull out all the stopsto grant that wish. Achieving it and seeing the residents reaction deliversimmeasurable satisfaction.

m Receiving cards with words of thanks can be very emotional and a little reminder ofwhy you care and why it’s worth it.

m Caring for people terminally ill is a privilege and probably the most important care youwill ever give.

m Planning entertainment, outings and surprises give me a particular sense ofsatisfaction as I like to think outside of the box. Sometimes it’s not always aboutbudget and there are ways around it.

What advice would you provide to any trainee/graduate nurseconsidering employment within the Nursing Home Sector?I would say go for it! You will attain nursing skills and experiences for life. You will becomemore confident and stronger in clinical decision making. You will become an excellentmentor and leader. You will not work in the shadow of others. Your continuous professionaldevelopment will expand immensely. You will have pride in the care you deliver and youWILL care. Your standard of care will grow. You will have less occupational stress. You willhave a very fair roster and your bank account will be healthier. And you will enjoy your job!You will learn lessons from life from those who have truly lived life.

NHI NEWS — 22

NHI ANNUAL CONFERENCE 2013

31 — NHI NEWS

Forum receives positive response from Health Secretary GeneralThe Department of Health is favourably disposed to bringing key stakeholders in the provision of long-term residential care around the table to plan for the requirement for such care, Dr Ambrose McLoughlin, Secretary General of the Department of Health stated at the NHI Annual Conference in November. The decision to establish a forum as requested by the NHI will ultimately be a political one, he said.

Dr McLoughlin was speaking at Shaping the Future

of Nursing Home Care, on 7th November at

Citywest Hotel. He delivered the opening address

and participated in a question and answers session with the

conference chair, broadcaster and historian John Bowman.

Over 400 representatives of the nursing home and health

sectors attended the conference.

During the question and answer session, Mr Bowman

referenced NHI’s long-standing call for the Department of

Health to bring key stakeholders in the provision of long-

term residential care together through the establishment of

a ‘Forum on Long-Term Residential Care’. Mr Bowman

asked “why there is not a more formalised relationship

between this sector [private and voluntary nursing homes]

as one of the key stakeholders in a forum to help develop

public policy”. “I certainly will give very close scrutiny to the

request of NHI and I have had discussions at political level,”

Dr McLoughlin responded. “This is essentially a political

decision. There are complexities in this because of issues

around competition law, EU law and how we handle these;

we have to be very careful and do have a huge challenge

in this area.” He added: “Now we mightn’t call it a ‘forum’

but I think you can take it Minister [for Older Persons] Lynch

will be disposed to putting an entity in place, it is ultimately

her decision and a matter for her. It will be grounded on the

basis of cooperation and collaboration.”

In respect of the review of the Nursing Home Support

Scheme (Fair Deal), Dr McLoughlin said “it is very important

we get this review right”, adding, “it’s going to be the basis

on which we will plan significant investment decisions”. “Do

you accept that the people here at today’s conference in

this sector cannot be expected to be making investment

decisions if they do not have certainty about the policy in

the middle term,” Mr Bowman asked. “I accept that and the

problem that we face as a Department is that until we

stabilise the situation in respect of the health budget and

our colleagues across Government do the same it is very

difficult for us to be certain about the numbers and the

monies that will be available,” Dr McLoughlin replied. “But

you can take it that we are in dialogue with the Department

of Public Expenditure and we do hope to see a stimulus

package approved by Government in the near future and

I’m conscious of the fact that there needs to be some

commitments made by Government in the medium and

long-term in terms of funding long-term care. I would say

there won’t be a decision on this until early in the new year

but there will be a decision probably early to mid-2014.”

The Secretary General said the Department is

“working closely” with the HSE to develop an overall plan

regarding future public provision of long-term residential

care. “The plan will reflect both national and regional

requirements and will have regard to the current severe

financial constraints,

restrictions on public

sector staffing and

recruitment and the

ongoing need to meet

service and safety

standards, all of which

pose challenges for

community nursing units

across the country,” he

added.

He encouraged

delegates to look to

emerging technologies to

support them in care

provision and said there’s

great opportunity for small and medium industry in Ireland

to partner with the nursing home and health sectors.

Questioned in respect of key issues facing the sector, Dr

McLoughlin encouraged private and voluntary nursing

home operators to look at how they can extend their

services by utilising their expertise in home settings.

Dr AmbroseMcLoughlin (left)addresses theconference audienceduring his discussionwith John Bowman,event chair.

NHI Care Awards2013

A night of glitz & glamourFor a full list of

winners and more pictures log on to:

www.nhicareawards.ie

33 — NHI NEWS

At Moorehall Lodge Ardee the approach is to live in themoment and capture the essence of it by using visualtriggers to stimulate recollections and to make emotionalconnections for the person in care. It was the recipient ofthe inaugural Nursing Homes Ireland Care AwardsInnovations in Dementia Care Award.

Award winningMoorehall‘butterflies’stimulaterecollections

When Moorehall Lodge Ardee recently receivedthe NHI award for Innovations in DementiaCare, it marked a milestone in a journey thatbegan with the proverbial single butterfly

flapping its wings.Moorehall Lodge Ardee is part of the family-owned

Moorehall Living Group, an innovative business wherepeople flourish in a caring environment that seeks toconstantly push new boundaries in the care of older people.Moorehall Lodge Ardee (MHLA) was established in 1998 byMichael and Tanya McCoy as one of the first purpose-builtnursing homes in the north-east. By 2000 a household caringmodel specifically for people with dementia was opened.Moorehall Lodge Drogheda was then opened in 2012,featuring a further two households specialising in dementiacare.

Over the past four years, MHLA has undergone a physicaland culture change resulting in a remodelling of the layout ofthe building and the approach to care. There are no longersigns of staff uniforms, badges, signs, notice boards, nurses’stations. It now has four households, each with its own frontdoor, kitchen, living space and private bedroom areas. Withthe support and commitment of staff, families and residents,care provision has been transformed.

“The journey undertaken by staff, residents and theirfamilies to achieve the status of Ireland’s first accreditedButterfly Programme centre has, we believe, brought a newdimension to dementia care,” says Carol McLoughlin, Directorof Care. “We all live in the moment – moments matter. Foreveryone with or without a dementia what we have now is soimportant. Our approach is to live in the moment – capturingthe essence of that moment using visual triggers to stimulaterecollections and to make emotional connections for thatperson. We’ve recognised that we cannot yet ‘fix’ dementia asa condition but we can certainly improve our approach tocare. Our fantastic staff have embraced the challenge tochange the way we care for people living with dementia.”

Bright ButterfliesCentral to Moorehall Lodge’s approach to implementing theButterfly Programme is a belief that people with dementiafunction primarily at an emotional level rather than at athinking and logical level. If you take the example of somebodyneeding to use the bathroom, it takes around 37 differentinstructions from the brain for someone to recognise the needto use the toilet, get up and fully go through the process.

Moorehall Lodge’s experience is people with dementia havea reduced and impaired ability to go through those 37 processes.What they do possess, though, is the ability to emotionallyprocess things. “Some may have the ability to say: ‘I need to goto the toilet’, but may not be able to remember where it is orwhat to do next,” says Carol. “They can become quite agitated bynot knowing what to do. We have found that by communicatingemotionally, reading body language and recognising theperson's emotional state, it's possible to help that personthrough that kind of day-to-day activity whilst at the same timeretaining their dignity.

“Our view is that if the person caring for that person is tunedinto that individual they can stay a step ahead, look for facialexpressions, look at the way someone is sitting, and see maybethat they are becoming agitated. Taking this approach allowsstaff to read the signs and not explicitly say, 'come on and we'llgo to the toilet', which can cause distress. Instead they reframethe interaction by saying something like 'let's go for a walk', andthen guide the person safely to the bathroom.”

Often people don't understand that the person withdementia doesn't have the ability to interact with the world inthe way they used to. This idea of connecting with people on anemotional level - getting into their world - means that we canachieve real improvements in their quality of life, Carol says.

Moorehall Lodge staff learn to act as ‘butterflies’, she adds.Dressed brightly to hold attention, they flit in and out of people’s“moments,” making constant connections and reaching the places within their mind that will trigger off memories and ideas.

BEST PRACTICE

NHI NEWS — 24

Best Practice is a feature in NHI News thatfocusses on best and innovative practices innursing homes. Nursing Homes are invited tomake us aware of practices the wider publicshould be aware of and can contactmichael@nhi.ie if interested in contributingan article P

Central to staff training is the use of memoryboxes. “Each member of staff is asked to bring insix things that are connected to strong memoriesin their own life,” says Carol. “We then ask them topull something out of the box and explain why it'ssignificant to them – why it triggers memories.More often than not these memories aresurrounded by emotions which when accessed canlead to a stronger sense of self.

“Moving on from this, training is focused onunderstanding how the same process works withresidents. For example, if a resident had been ateacher or a builder, then there are plenty of itemsassociated with each profession outside theirbedroom or living room that they can come and gopast, touch, wear and enable them live in themoment. These items are hugely significant topeople with dementia as they trigger powerfulmemories. It can be something as simple as atowel, or a football jersey; these items triggerstrong emotional connections for that person.”

Unified SupportWalking into the dementia-specific households inArdee, you might think that the communal areascan seem chaotic – with rummage boxes, domesticitems, musical instruments, work items fromresidents’ past careers and a lot of colour andsound being features. But this atmosphere bringsgreat calm and peace to the residents and theirfamilies who recognise that the moments ofhappiness that the Butterfly Programme brings,Carol explains.

For her and the Moorehall Lodge Ardee team,the great success of the approach to dementia ishow it has involved the families and staff at everystep, creating a unified atmosphere of support.

Moorehall Lodge’s approach to dementia care hasbeen the subject of national awards, mediacoverage and Ministerial visits, but satisfactioncomes in smaller forms for Michael McCoy: “Forus, success is measured in quality of life – both forour residents, their families and our staff. For me,a smile says is all.”

For more information in respect of the ButterflyScheme visit www.butterflyscheme.org.uk

Clockwise from left:

...

The ButterflyProgramme featuringstaff and residentsinteracting inMoorehall Lodge Ardee

Visual triggersstimulate recollectionsand make emotionalconnections

35 — NHI NEWS

ART & DEMENTIA

As the Creative Director for dementia specific programs and an artist, Michelle Burns truly believes in thetherapeutic nature of art. For those with dementia, the expression it affords provides them with a newvoice, the Creative Director at Senior Access, an Adult Day Programme in San Rafael, California, writes.

Creating an enriching & expressive environment

Art allows the individual to communicate visually whatis difficult or impossible to communicate verbally. It

provides a safe place for expression of feelings and is awonderful way to rekindle memories from the past. Thecreative process provides an avenue to address therapeuticconcerns such as gross and fine motor skills,engagement and cognitive functioning. Art canalso be a very effective tool to addresspsychosocial issues such as autonomy,independence, peer connections and selfworth. These were all things I witnessed withour artists and, as our creative programgrew, I saw art effect another change.

Art was providing opportunities for staffto work with our members in unique ways.They found that the artistic process becamean opportunity to build a deeply meaningfulconnection with the artist. This became ashared journey that was much more than just a‘time-passing’ activity. In the moments ofcollaboration, staff members developed a deeperunderstanding of where the individual was, both physicallyand mentally. Instead of fixating on an individual’s declineand how that would affect the ability to accomplish a task,they focused on what the individual was capable of. Theylearned to reframe direction or explanation in a constructive

and encouraging way. Most importantly they learned to useart as a common language that focused on the positiveexperiences of the artist’s journey. By diminishing theperceived loss of abilities, a natural buffer was created thatopened eyes to surprising talents and skills that remained.

Art is an integral part of an innovativedementia care program, but projects can be

challenging to execute successfully. The keyis to find the balance between overly

simplistic projects that risk infantilizingand projects that protect the adultsensibility. Approaching art as a processrather than as an outcome keeps artistsfrom feeling overwhelmed, while stillproviding satisfying outcomes. Thisprocess is achieved through simple steps

that are modified to meet the individualartist’s needs. Supporting staff by training

them to understand the process of thesesteps and how to implement them creates an

enriching experience for everyone. The artists canthrive in an environment that uses dignity as its core

philosophy and staff members gain valuable tools to helpindividuals enjoy meaningful activities. This paradigm shiftfocuses on building relationships as the cornerstone of bestpractices in care.

IInntteerrnnaattiioonnaall DDeemmeennttiiaa CCaarree CCoonnffeerreenncceeMs Burns will be speaking at the 6th International Dementia Care Conference in Dublin. Entitled Supportingstaff as enablers of change: Towards flourishing dementia care cultures, the conference takes place in the CrownePlaza Hotel Dublin on Monday 28th and Tuesday 29th April. Early bird rates are now available. TToo bbooookk,, ccaallll 0011 226600 88113388 oorr vviissiitt wwwwww..ssoonnaassaappcc..iiee

PPrroofifillee:: MMiicchheellllee BBuurrnnssMichelle Burns is the Creative Director at Senior Access, an adult day programme,and is a dementia art specialist with other centres in San Rafael, California. With aseries of third level qualifications in this area, she has contributed to universitycurricula and produced guidelines for community organisations working withpeople with dementia. Ms Burns has presented her innovative approach to arts anddementia at international conferences and delivers training workshops tocaregivers, healthcare professionals and people living with dementia. Herpublications include a handbook outlining expressive art projects to use indementia care settings and an article in the recently published book The Gifts ofAutism and Alzheimer’s. In curating and contributing art created by people withdementia at exhibitions in art galleries and museums in San Rafael, Ms Burns hasbeen instrumental in increasing public awareness and understanding aboutdementia in the community.

work space life

LifeCare

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Mater Adult Hospital: ward furniture supplied

to over 200 rooms

eCarLif eeCar

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