As a Dáil report calls for an inquiry into COVID-19 in nursing homes, why did 56% of all deaths (985 people) in the first wave came from a group that makes up just 0.65% of the population? Bríd Smith TD argues that it is the for-profit system which is to blame.
A Dáil report into deaths in nursing homes has highlighted the catastrophic toll COVID-19 has had on elderly residents in nursing homes.
I successfully argued that there must be a full inquiry into each death, the circumstances of the spread of the virus, and the medical care each resident had. I also successfully called for an inquiry into the impact the privatisation of nursing homes had on the care available to our elderly.
The inquiry can’t come too soon. The disastrous effects of the virus in care homes across Ireland have been known from the beginning of the pandemic – in early April I was among many who wrote about the scandal.
Thirty years ago, 80% of residents in long-term care were in publicly funded and run homes. Today the numbers are exactly reversed: 80% are in private homes.
Over the last 2 decades, huge financial incentives from the government, such as tax-breaks amounting to 50% of construction costs, were given to developers of new private nursing homes. Starting under the Fianna Fáil-Progressive Democrat government and continued since, care of the elderly and most vulnerable was handed over to private for-profit operators.
This shift to privatised care had huge implications for the type of care available. COVID-19 has exposed the weaknesses in such a system.
Failings
Much of the coverage of the COVID disaster in nursing homes has concentrated on the lack of oversight of the sector by both the HSE and by HIQA or the shortage of staff as they became sick. But the virus spread was exacerbated by a multitude of factors, of which these are only some.
Several reports have criticised the lack of medical services and expertise in many homes. The Government even changed regulations around the qualifications that staff caring for the elderly needed, altering previous rules stating that the person in charge at any time would need a formal gerontology qualification or that a registered nurses had to be on site.
The demands of a for-profit model meant an increased use of agency staff – often migrant workers on low pay, long hours and precarious contracts. The availability of certain services and medical expertise was impacted as a result. When COVID-19 hit the homes, it wasn’t just shortages of basic PPE that hindered the fight, but also access to oxygen, IV treatments, and equipment such as infusion pumps.
There was the large scale discharge of patients from acute hospitals into homes without being tested, where the home had little-to-no isolation facilities, and the use of agency workers in multiple homes some of whom had shared accommodation and no access to sick-pay schemes.
Of the 985 deaths, only a minority were ever taken to acute hospitals for treatment. Of 5,608 confirmed cases in nursing homes, a total of only 422 were hospitalised. While this may be reasonable in many instances in order to minimise the distress etc, it seems like a very large proportion of those infected with the virus were not moved to hospitals.
COVID-19 exposed the underlying condition of Irelands unequal health system and its over reliance on private, for-profit care. The inquiry will need to examine whether the disastrous decisions listed above were made by appropriate medical experts. It will also need to determine whether or not they were driven by the lack of ICU capacity in the system, or any other reasons.
Full steam ahead
The latest trends are moving even further down the road of making the care of the elderly a big business and investment opportunity. No lessons have been learned.
While the best practice seems to be to move to smaller settings of less than 100 beds, in areas as close as possible to where people lived, the trend in the private sector is for larger congregated settings of 100+ beds in the big towns and cities. This is not driven by the needs of the elderly but for economies of scale and corporate interests.
The McCreevey FF/PD Govt of the 1990s laid the groundwork for a flood of what was called “ Grey entrepreneurs” into the business of elderly care with huge tax breaks. But recent developments have seen the arrival of even bigger corporations keen to make profits from the elderly, resulting in the building of larger and larger homes and the buying up of more and more of the state’s nursing homes.
If the State doesn’t provide for the care of the elderly, who has it been left to?
The Profiteers
Richard Barrett of Bartra Capital. Barrett is formerly of Treasury Holdings, the property company at the heard of bankrupting the country in 2009 when it collapsed in the recession leaving 2.7 Billion euro of debts to the state.
Bartra opened its first nursing home in Summer 2019 (a 123-bed centre) in Loughshinny, North Dublin. It expected to open a second (118 beds) at Northwood, Santry, North Dublin this year. Construction work on a third (221 beds) got under way in 2019 next to Beaumont Hospital, and planning permission has been approved by An Bord Pleanála for a fourth (146 bed) facility in Clondalkin.
The German-based healthcare investor IMMAC Group which recently bought St Gabriel’s Nursing Home in Raheny, Dublin, and Beechpark Nursing Home in Kildare. The acquisitions will bring the number facilities it owns here to five, with 312 residential beds.
Primonial Reim (a French investment fund) entered the market in 2017, when it purchased six properties in the FirstCare group.
InfraVia (a French infrastructure fund, and owner of the Mater Private hospital group) paid €70m in 2017 for CareChoice, a chain of six nursing homes, and has since added a further three homes, including the Marlay in Rathfarnham. It has “ambitions to treble the size of the business.”
Axa (the French insurance giant) did a similar deal in January, acquiring 10 homes here, consisting of 600 beds and 52 independent living units. It immediately leased the properties back to Limerick-based Mowlam Healthcare, the country’s biggest care home operator.
While private owners and investors have demanded greater state funds for running homes, we have no idea how much, if any, of the profits generated are re-invested into facilities or training of staff. There is no obligation on private homes to publish their accounts; they are unlimited entities, and not required to. Many have structured shareholdings registered in offshore havens such as the Isle of Man, or in Mowlam Healthcare’s case, the British Virgin Islands.
End the For-Profit Care Homes System
The Covid crisis shows we can’t afford to let investors, whose only concerns are making profits, run our nursing homes or our hospitals.
Instead, we need to learn the lessons of the past six months and move to a publicly funded and run system of care. This should be centred on both nursing homes and in-home care, taking over the existing private facilities and putting them into public hands. We also need to make sure the workers who care for our elderly and vulnerable are properly looked after as well, with decent pay and conditions and access to sick-pay schemes that protect them.
