About one in 20 older people in Ireland spend time in a nursing home.
Nursing homes have hit the headlines over the recent wave of closures, over fees and charges to families, and over problems identified by state inspectors at individual centres.
We asked you for your experiences with the sector and we received many responses from family members of residents sharing both gratitude for the care and kindness received and heartbreak at poor treatment. We also heard from people working in the sector about the financial pressures it faces.
We didn’t hear from anyone who has spent time staying in a nursing home or step-down facility for leaving hospital.
Thank you to everyone in got in touch. Here’s what you told us.
Several readers got in touch to share their positive experiences of nursing homes, praising the quality of care received by their elderly relatives, the way birthdays were celebrated, the daily activities available to residents and communication by the staff.
Several said they were comforted that their relative had spent their last months or years in a clean, supportive and friendly environment.
However, a few people who had mostly positive experiences still remarked that nursing home staff often seemed stretched.
Adam McBride said he was “so happy” with the care his father is receiving from a nursing home in Donegal, which was “patient-led” and provided activities such as painting, live music and bingo nearly every day, as well as occassional trips out for those who are able for it and parties to mark special occasions. His father is a private resident.
“The staff are friendly, compassionate and understanding and really do their best to make it feel like home for the residents,” McBride said.
Eamon from Goatstown said his grandmother lived at the Ashbury Nursing Home, a private nursing home in Deansgrange, Co Dublin, until she passed away last year.
“They treated her with the utmost respect, love, and care, and my family is forever grateful for that.
“On her 90th birthday, she boasted that she received 50+ birthday cards (most of them from the staff). They threw a surprise party for her, and many of the old staff came back for it,” he said.
Darren McHugh said his father is “the best I’ve seen him in years” since he moved to a nursing home in Westmeath 10 weeks ago.
“It has been a confusing time with lots of ups and downs,” McHugh said, adding that navigating Fair Deal and the new Decision Support Service for people with reduced capacity to make decisions had been difficult.
He said the “caring support and guiding hand” of the nursing home in navigating this unknown territory had been an “unexpected saving grace”.
“I would strongly advocate that we all change our preconceived ideas about nursing homes and the quality of life we have post-independent living,” he said.
Margaret Donohoe said her late mother-in-law received “excellent care” in St Brendan’s nursing home in Loughrea, Co Galway, a HSE-run facility, between February and November 2023.
“She was very happy there, always spotless, well fed and socially engaged with by the staff. The staff group who came from multiple nationalities provided wonderful care to her and were always available for an update with her family. There was always plenty of staff around – nursing, support, catering and cleaning.”
Audrey Ward from Dublin explained how her father, who had Alzheimers, was discharged to a step-down unit after several weeks in hospital.
The facility “looked beautiful and was clean but definitely wasn’t for Azheimer’s patients”, she said.
“The food would be left for my dad at the bottom of the bed. At that stage he was weak so couldn’t get at the food. It was in plastic packaging, sure that’s no use.”
Her father was in bed “24-7″ and the family feared they were losing him.
Matters improved when he got a place at Talbot Lodge in Kinsealy in north Dublin.
“The staff were great. They had activities every day, they showered every day and the staff make sure the patients eat. We can’t speak more highly about it.”
A reader from Kerry said her father, who had dementia, spent the last seven weeks of his life in a nursing home in the county before he died in 2017. The reader asked not to be named because she lives in a small town.
“We were charged for ‘activities’ like quizzes and art where he just sat there. We were charged for a dietician to tell us he could have solid food, which we told them he could eat. We were told we could visit whenever we wanted to and then they restricted us.
“He told me that one of the workers was rough with him and he had an unexplained bruise on his rib area. I said it to them and they told me the doctor would look at it. As far as I know it never happened.”
The reader said the family were not given sufficient notice to bring her father home when he was approaching the end of us life.
“He died with us there and there was a curtain between us and another man he shared with. I still cry and feel guilty about his last miserable weeks,” she said.
Some readers expressed concern that their elderly parents were not getting the stimulation and physical activity they needed in the dedicated dementia homes where they were staying, or as many trips out as they would like.
Several readers took issue with the additional charges levied by nursing homes for treatments such as chiropody or physiotherapy, as well as for extras such as entertainment.
A reader whose parent is in the Tara Winthrop clinic in Swords, which was the subject of a damning Hiqa inspection report last week, said that “while the care received is adequate the facility is seriously understaffed, and it’s notable”.
“The facility charges a non-discretionary €100 a month per resident which equates to €15k per month for social activities, but very little happens as was outlined in the Hiqa report, and when you complain or refuse to pay the charge you are met with silence,” the reader said.
The Journal has not named the reader to protect identities.
Hiqa reported last week that at the time of an inspection earlier this year residents could not shower as frequently as they wanted to and there were not enough meaningful activities for residents due to shortages.
Residents told inspectors that their days were repetitive and they spent a lot of time watching TV and there “isn’t much to do”. Residents expressed a wish for outdoor trips and activities such as afternoon tea with their loved ones.
Hiqa had already criticised the Tara Winthrop home in an earlier inspection report last year for failing to allow residents to shower when they wanted and for inadequate activities, with an inspector finding many residents sitting on chairs in rows in a room where the television was turned off.
In a statement on Friday, the nursing home said it was “confident in the level of social engagement and activities” now provided to its residents, having increased the number of activities coordinators working on site from two to five, with these staff members organising activities such as bingo, concerts and day trips seven days a week.
The nursing home acknowledged that this aspect of its care had needed development after the impact of the pandemic on the sector. It added that it has hired 30 healthcare assistants and nurses over the past three years and will invest a further €80,000 in the centre before the end of the year. It said that “while it has taken time to rebuild” residents will benefit and it will deliver “excellent, person-centrered care”.
Several readers got in touch to point out the disparity in funding to the public and private nursing home sectors, and to express frustration at the bureaucracy of the state’s Fair Deal sytem.
Under Fair Deal the state shares the cost of nursing home care with residents, based on an assessment by the HSE of the resident’s ability to pay, taking into account their savings and property.
Over 25,000 people receive care in 440 privately operated nursing homes, with a further 125 public facilities operated by the HSE. An ESRI report earlier this year estimated the price of providing a public bed under Fair Deal to be 55% higher.
Albert Connaughton, the former owner of Belmont House nursing home in South Dublin, which he sold in 2021, noted that the cost of public beds was fair greater than those in the private sector.
“The HSE pays their own public nursing homes directly from the Fair Deal scheme funding without any negotiation, whereas private nursing homes must negotiate with the National Treatment Purchase Fund (NTPF) to secure a rate for the beds to be provided to the state through the HSE,” Connaughton said.
He added that staff was the largest cost to any nursing home business and it was difficult for private facilities to compete with the HSE.
“How is it feasible for private nursing homes to continue to recruit nursing and care staff at huge cost, to train those staff and then have those staff recruited by the HSE to staff the local public nursing home? The public nursing home, with better funding, can afford to offer better terms and conditions. How is this fair?” he said.
“Media outlets always focus in on the fact that private nursing homes charge for extras such as therapies, social programes, newspapers, etc. Private nursing homes have no choice but to charge for these extras – they are excluded from the Fair Deal contract with the HSE.”
He claimed this additional funding did not result in better outcomes for older people in the public sector.
He said small private rural nursing homes, where the cost per bed was higher given the lack of economy of scale, could not survive under the current funding model and more would close, preventing older people from staying in their own communities.
“Our older persons deserve better,” Connaughton said.
A HSE worker, who asked not to be named, noted the wide discrepancy in cost between public and private sectors to the Fair Deal and suggested the private sector should be allowed to provide new beds, with the money saved pumped into the sector to improve standards.
“The reason government won’t is because public beds are vote getters, but if a politician argues that they should be providing public beds then what has he to say to the [thousands] who are stuck in private beds? Everybody should be in the same model for equity and the same investment should go into each bed.”
Several readers expressed hope that the state would provide nursing homes and the families who need them with the support they need.
The NTPF has been approached for comment.
Shane O’Flaherty, whose father has been a resident of the private St Mary’s Nursing Home in Galway for three years, said his family has experienced “countless moments of joy and comfort”.
“Even though Dad has dementia, it is very clear to us all that he is receiving the very best of care. What truly stands out is the kindness shown to our Dad and this kindness is extended to every one of us in the family,” O’Flaherty said.
He said politicians and policymakers needed to be asked if they were “truly satisfied with the level of care and support being provided to our elderly”.
“What actions are they taking to ensure that every person in Ireland can grow old with genuine kindness, dignity and happiness?”
The Department of Health said Mary Butler, the junior minister for older people, had “regular interaction with the NTPF to discuss ways to support the [nursing home] sector”.
“The government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale.
“A significant change that the NTPF has made to its negotiation process is to offer nursing home providers contracts of a shorter duration, which will aim to ensure that NTPF rate increases stay aligned with any cost pressure increases that occur over the course of the contracted period.”
The Department said several other supports had been provided in the last Budget, including a €45.6m increase in funding to the Fair Deal.
It acknowledged the variation in the cost of care between the public and private sectors, and said that while the HSE “needs to be equipped” to act as the statutory provider of last resort, a HSE productivity and savings taskforce is examining how to secure a reduction in the cost of care in HSE long-term nursing homes.
The HSE said the higher cost of care in its facilities had several reasons, including higher ratios of nursing and other staff to patients, and higher rates of pay and leave entitlements.
It added that under the Fair Deal, the amount a resident pays towards the cost of their care is based on the value of their assets and income, not by the cost of care in that home.
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