The recent Primetime Investigates expose on nursing home care was shocking but maybe not surprising. The suspicion is that this could be just the tip of the iceberg.
The nursing home sector is supposed to be highly regulated yet things like this are still happening. This must raise questions as to why we are creating artificial demand for nursing home care over for example home care with our funding allocations. Presently, 23,000 older people are supported with €1B of funding for nursing homes, while roughly 60,000 people are supported with €480M of funding through home care despite the latter being people’s clear preference.
Funding for older people needs to follow families’ choices and not be artificially skewed by the State.
The issues in the expose also raise serious questions over the type of regulation we have in place as well as the significant focus on profit making within the sector.
Our system of regulation that focusses primarily on form filling and audits, is clearly not fit for purpose and incentivises profit driven providers to play the system. Regulation that focusses principally on inputs just because they are easily measured does not always result in great outcomes.
Maybe it’s time for our regulation to focus more on what practical actions can be taken that do directly affect outcomes. Actions like ensuring frontline workers are properly paid and with decent employment conditions. Treating staff costs as an accounting item that needs to be squeezed is no way to achieve great outcomes. Why doesn’t regulation address this point?
One of the most important pillars of quality care is continuity. Regulation presently insists on carers having certain qualifications and carers being supervised but doesn’t insist on the same carer delivering care constantly. That’s because for providers to provide real continuity, it would necessitate them paying good wages and providing excellent employment conditions. Why doesn’t regulation insist on continuity of care?
Our regulation should focus mainly on outcomes and accept great outcomes can be achieved in a variety of ways. Yes, outcomes are more difficult to measure than inputs but we should put more weight on feedback from people and families using a service as well as from frontline workers delivering that service.
Our size fits all regulation as presently set up, heavily favours large corporate providers who can afford specialised departments to deal with the administrative burdens of regulation and ways of circumventing it. Regulation must be more about fostering a much wider ecosystem of providers that provide real choice to families and people needing care. Regulation must be about generating great practical outcomes from multiple models of provision even if this necessitates more hands-on involvement from regulators.
With regards the possible conflict of interest between profit making and good care, I believe in private business as one way of creating quality services but not if market conditions are stacked in their favour, allowing them make super profits. The system they work within must encourage them to do the right thing even when they are not under the microscope of regulators.
While the expose will have consequences for the nursing home sector, it will also have implications for the upcoming regulation of the home care sector and highlight the need to ensure we don’t fall into the same traps, especially if home care is to play a larger role in the care of our older people going forward. We need to be clear where we want control to lie, with providers or families and if we want home care to be profit or people driven?
The two essential pillars of great care for our older population that regulation needs to foster are, a valued, well rewarded and happy workforce and families and people needing support having real choices and being in control.