Public and private nursing home fees

Adrian Ahern looks at the different pricing rules which apply to HSE and private/voluntary nursing homes.

Adrian Ahern
Adrian Ahern

Nursing Homes, private and voluntary which participate in the Nursing Home Support Scheme (Fair Deal) have their maximum fees established by the National Treatment Purchase Fund (NTPF) which negotiates on behalf of the State under Section 40 of the Nursing Home Support Scheme Act. Both parties enter into an “Approved Nursing Home Agreement” and the N.T.P.F. notifies the HSE of the agreed rate.

To be a participant in the scheme the facility must be registered with HIQA, and de facto compliant with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older people) Regulations and the National Quality Standards for Residential Settings for Older People. The scheme does provide for a review process for those Nursing Homes which are dissatisfied with the rate offered by the NTPF.

HSE facilities where residents also avail of the NHSS do not undergo the NTPF process but set their own rates.

The price set by the NTPF considers whether the price represents value for money for the tax payer and takes into account the following:

  • The price already being charged by the nursing home
  • The local market price
  • Costs reasonably and prudently incurred by the facility
  • Evidence of value for money
  • Budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.

The NTPF process does not take account of individual resident needs but uses a “one size fits all” approach. Consequently the price does not take into account the dependency level of the person availing of the scheme, their requirements for specialist nursing or provision of specialist therapies such as speech and language, dietetics, occupational therapy and physiotherapy. Transport including care assistant costs to outpatient appointments etc. are also not included and so many nursing homes and residents/families are unhappy with this process.

The dilemma faced by nursing homes is being required by the State through legislation (and HIQA) and encouraged by best practice to provide a range of services to residents but not to have these essentials taken into consideration by another representative of the State which sets their fees.

HSE facilities where residents also avail of the NHSS do not undergo the NTPF process but set their own rates and it is unclear whether these residents incur additional costs for therapies etc. It would appear that the HSE may have a conflict of interest as it is both the administrator of the scheme and also a care provider.

The most recently published list of HSE Nursing Unit fees dates from March 2011 and these would show that HSE charges were 40% greater than those of private and voluntary facilities. Interestingly the HSE also publishes on its web site the fees charged by private and Voluntary Nursing Homes which was last updated October 15, 2015!

Adrian Ahern, R.P.N., R.G.N., B.Sc.(Hons) Econ, M.A.