A 'massive vacuum' in Government nursing home policy has let large, private operators create new 'barrack-like institutions' for profit.
A new ESRI report has found that one-in-five small private nursing homes in rural areas shut their doors in a two-year period.
It notes that almost 700 public nursing home beds were closed between February 2020 and December 2022.
The report warns that there is now a growing reliance on large private 'for-profit' operators "driven by recent entrants into the Irish market who are mainly financed by international private equity".
These operators opened several large private nursing homes recently, the ESRI said.
On Newstalk Breakfast, Irish Society of Physicians in Geriatric Medicine (ISPGM) Chair Professor Des O'Neill said responsibility for the problem rests at door of the Department of Health.
"My concern is this shows a massive vacuum of policies in the Department of Health, who've ignored this area for a long time," he said.
"Instead of creating a framework of what we should have in nursing homes, into this vacuum has come in large, private operators making huge barrack-like institutions of hundreds of beds".
'An absolute reboot'
Prof O'Neill said we need "an absolute reboot of how we view optimal nursing home care".
"The one bright spark in the area is finally - and I really hope that people will respond to this - the Department of health has come out with a document on what the design of nursing homes should be,” he said.
"They've stipulated a maximum size of 72 beds of six domestically scaled units.
"This is really a small spark of hope in really what is a most worrying report, and suggests that drastic action is needed."
Rural areas
Prof O'Neill said the picture is "much more complex" for rural nursing homes.
"There was indeed an element of over-supply in the rural areas when [consultants] looked at this a number of years back," he said.
"It was about 9% of the older population, whereas it should be around 4%.
"The most worrying part of the report is the loss of the public beds.
"In fact, one of the Sláintecare recommendations was belatedly to recognise that we've left the field far too much to the profit and private sector and that we needed to restore the balance towards public beds.
"So, what has happened has been a direct contravention of Sláintecare policy".
'Fitter and healthier'
Prof O'Neill said he believes there is no need for "apocalyptic talk about the future".
"In fact, current generations of older Irish people are actually getting fitter and healthier," he said.
"In many Western countries nursing home use is actually stable or dropping.
"So, I think it's not as apocalyptic as it sounds and it can be planned for".
Dr O’Neill the ideal scenario would be "a largely public and not-for-profit sector" with a maximum of 72 units which resemble a house environment.
'Black cloud over the sector'
Nursing Homes Ireland CEO Tadhg Daly has said he welcomes the issue being addressed.
"ESRI rightly calls out... that the Government needs to put in place policies that harmonise financial incentives for nursing home providers with the primary objective of fulfilling residents’ health and social care demands within a more integrated care environment," he said.
"This is consistent with NHI calls over a number of years and the lack of action continues to place a black cloud over the sector, threatening it in an extreme way."
Mr Daly said the nursing home closures are also having an impact on older people and their families, with people having to travel further to access care and for families to visit.
Listen back here:
