The Health Information and Quality Authority has today published its overview report of its regulation of public and private nursing homes for 2014. The analysis of compliance with regulations and standards indicates that while nursing homes have become safer for residents, many centres must now improve care quality and the quality of life for residents.

While most centres had an acceptable level of overall compliance with the regulations and the National Standards for Residential Care Settings for Older People in Ireland, many needed to improve their individualised person-centred care planning and how that care is delivered. Improvements in their approach to risk assessment and risk management were also required.

Mary Dunnion, HIQA’s Director of Regulation, said: “In 2014, we carried out 758 inspections of 549 centres, 58% of which were unannounced and 42% announced. We inspected 93% of nursing homes and published 707 inspection reports. The results show that in 4,371 cases regulations and standards were met, while there were 3,436 non-compliances. We asked providers to take 5,864 corrective actions to address non-compliances.

“Other findings show that providers will need to invest more in recruitment and training, and in ensuring that enough staff with the relevant skill mix are available to support residents. Improvements are also needed in end-of-life care and food and nutrition. Nursing homes must continue to ensure that the basics of safe care are in place, while prioritising and developing a culture of quality improvement and person-centred care.”

Inspection findings during 2014 signal that centres need to further develop their expertise in risk management, and must make the transition from complying with regulations and standards to providing a truly individualised service for each specific resident. Some residents still live in large and outdated open-plan wards, with little privacy and dignity. Despite a five-year lead-in time to comply with requirements, at the end of 2014 a number of centres had yet to meet the physical environment requirements to protect and promote the privacy and dignity of residents.

Sixcentres that had been on the register in December 2013 had closed by December 2014. These centres were all privately operated. By December 2014, five new privately operated centres had been added to the register. Formal enforcement procedures were used in respect of one private centre, which was issued with a notice of cancellation of registration by the Authority in September 2014, with the provider in question accepting the decision.

Mary Dunnion continued: “Also, during the year, we found examples of good care, such as dedicated person-centred plans for residents at end of life. Good compliance was seen in relation to suitable persons in charge, information provided to residents, complaints procedures, and safeguarding and safety. However, compliance data on safeguarding vulnerable older people indicates a need within the sector to better understand how to safeguard dependent older persons in their care.”

There was a sharp increase in the level of concerns brought to HIQA about nursing homes in 2014. HIQA received 609 items of unsolicited information relating to 303 centres, of which just over half (55%) came from concerned relatives of residents. This is a 71% increase on the year before. In 2014, HIQA inspected 92% of centres which had been the subject of unsolicited information.

During 2014, HIQA continued to focus on end-of-life care and food and nutrition, which were looked at together in inspections of 197 centres. Good practice in both areas was found in most centres inspected, and at least 84% of centres were found to be fully or substantially compliant during the inspections. However, data analysed showed 470 corrective actions were issued by the Authority in this regard.

Procedures to ensure that residents did not experience poor nutrition or hydration were not always adequately followed. In 11 centres out of 195 centres inspected on this theme, residents at nutritional risk did not have an adequate nutritional care plan in place. Residents in all except one centre had access to fresh drinking water, while in nine centres, not all residents were offered a choice outside of the main meal.

During 2014, the Authority began developing a revised programme of thematic inspection of the care of residents with dementia, and focused inspections on medication management and fire safety are also being planned. Overall, inspections which focus on specific areas of care are helping to improve outcomes for residents and are providing a focus for providers and staff to improve the care they provide.

Mary Dunnion concluded: “Registration and inspection of nursing homes is an important mechanism in providing assurance to residents, their families and society at large about the care that residents in nursing homes receive. Later this year, the Authority will publish revised standards for nursing homes. These standards – alongside our evolving programme of regulation – will target our inspection resources to ensure services are not only safe but that nursing homes focus on improving the quality of life for all residents. This is with a view to upholding residents’ rights, independence, autonomy, and personal identity, and their capability to remain connected with society, within and outside of the care setting.”

Further Information: 

Suzanne O’Brien, Communications Manager, HIQA
01 814 7488 / 087 624 1216 sobrien@hiqa.ie

Notes to the Editor: 

• In 2014, there was a substantial increase in registration activity. HIQA processed 268 registration applications, mostly driven by centres renewing their registrations (in 2013, 82 applications were processed).
• HIQA attached specific registration conditions to 22 centres in 2014. These conditions generally restricted the number of residents in a centre, or reconfigured the design and layout of centres. They also restricted the number of residents that could be accommodated in day-care services, where those services impacted adversely on the residents living in the centres.
• There was little change in the number of registered centres, 566 in 2013 versus 565 in 2014. However, 275 extra nursing home beds entered the system in 2014 (a 1% increase), compared to the end of 2013.
• HIQA received 5,485 legally-required notifications of certain adverse events in nursing homes in 2014, a small increase (2.2%) on the year before, when 5,362 were recorded.
• Notifications included 625 in relation to an unexpected death; 122 in relation to an unexplained absence of a resident; 357 regarding allegations, suspected or confirmed abuse of a resident; and four in relation to a member of staff being subject of review by a professional body.