Changes and challenges facing the Irish long-term residential care sector since COVID-19

January 09, 2024

Health and Quality of Life
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The Economic and Social Research Institute (ESRI) has published new research funded through a Research Collaborative in Quality and Patient Safety (RCQPS) award examining the changes and challenges facing the long-term residential care (LTRC – ‘nursing home’) sector since the onset of the COVID-19 pandemic. Building on previous research that examined COVID-19 outbreaks in LTRC homes, this report highlights that LTRC supply and care home ownership has changed significantly in recent years. Large nursing home operators are now the dominant providers of LTRC. Large differences in Fair Deal funding between public and private care homes, and across counties remain evident. State aid such as the Temporary Assistance Payment Scheme (TAPS) was key to sustaining the sector during the pandemic.

Key findings

Supply

  • Between February 2020 and December 2022, almost one in five of all smaller (<30 beds) private LTRC homes closed, mainly in rural areas, and almost 700 beds were closed in public LTRC homes.
  • There has been a consolidation of private (for-profit) LTRC home operators driven by recent entrants into the Irish market who are mainly financed by international private equity. These operators opened several large private LTRC homes recently.
  • 74% of all LTRC beds are now provided in private LTRC homes and 14 large private operators now provide approximately 40% of all LTRC beds nationally. Two-thirds of all LTRC beds in Meath, Monaghan and Laois are now provided by large private operators. 

Funding

  • Disparities in Fair Deal funding between public and private nursing homes remain, and average prices for a Fair Deal-funded bed in public LTRC homes is 55% higher than in private LTRC homes. General inflation between 2020 and 2022 significantly outpaced Fair Deal funding increases made to nursing homes.
  • TAPS was extensively used by private LTRC homes. Over €132 million was provided through the scheme by the end of 2021, with cleaning/infection control and staffing costs (nursing, healthcare assistants, and agency) making up the majority of TAPS expenditure. TAPS use was highest following a COVID-19 outbreak, with no evidence that TAPS funding reduced the chances of a COVID-19 outbreak taking place.

Dr Brendan Walsh, an author of the report and Senior Research Officer at the ESRI said: 

“Ireland is at an important juncture in establishing a sustainable long-term care system for older people. The COVID-19 pandemic had a terrible impact on LTRC residents and workers. But this period also saw large changes in supply, ownership, and financing, and the LTRC sector faces a number of challenges as it emerges from the pandemic. We now have a LTRC system increasingly reliant on a small number of profit-driven operators. 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 are required.”