Opinion: pay and conditions for staff at private nursing homes must be part of the discussion on how we provide care for the elderly
In recent weeks, Nursing Home Ireland (NHI) has taken out newspaper advertisements requesting emergency state support for their industry, with special attention paid to the closure of small nursing homes in rural areas. A significant part of their case rests on the fact that public sector nursing homes receive substantially more funding from the Fair Deal Scheme than NHI members in the private and voluntary sectors. They have even lodged a complaint with the European Commission, claiming that this funding disparity represents unfair state aid to public sector nursing homes.
But NHI has been allowed to make their case for increased funding without being challenged on the pay and working conditions within their industry. When problems around affordability of care and staff retention emerged in the childcare sector, the poor pay and working conditions of childcare assistants was highlighted as a significant problem for that industry. But the pay and conditions of healthcare assistants in private nursing homes has yet to become a serious part of the public debate on how we provide for the care of the elderly.
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From RTÉ Six One News, nursing homes call on Government to address rising costs
Pay in private nursing homes
Unfortunately, there is no reliable data for the average pay rates of healthcare assistants in the private sector. The chronic staff shortages caused by the pandemic and recruitment campaigns by the public sector would suggest that pay rates must have risen in recent years.
However, recruitment agencies working in the private sector advertise wages that start at €12 per hour, which is only 70 cent more than minimum wage. It is perhaps unsurprising that these low rates of pay are in an industry that is predominately staffed by women and migrant workers , who are more likely to be underpaid for their labour.
In contrast, the starting rate for a public sector healthcare assistant is €14 per hour, with a basic yearly salary of €28,000. When overtime, shift allowance, and bank holiday work are included, it is not unreasonable to assume that an entry level carer could earn around €34,000 per year. So, NHI is right when they argue that the extra Fair Deal Scheme funding does subsidise significantly better pay in public sector nursing homes.
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From RTÉ Radio 1's Morning Ireland, Nursing Homes Ireland says Fair Deal Scheme is 'utterly broken'
But should this be viewed as a problem? The money involved is relatively modest (there could be a case made for paying carers even more), and it seems only right that people providing socially necessary labour that helps our most vulnerable citizens should get paid a living wage. Bearing in mind that in terms of numbers employed, it is far more likely that it was a healthcare assistant and not a nurse holding the hands of scared elderly people during the Covid crisis. This is especially true in nursing home settings where nurses are more likely to act as supervisors of care work rather than as actual carers.
There is a strong case for the State increasing the Fair Deal Scheme funding to private nursing homes to ensure a higher quality of care for elderly citizens. However, if the government does increase funding to private nursing homes, then they should be treated the same as childcare providers.
As a response to increased funding for private creches, the Government signed an Employment Regulation Order to determine payrates in that industry. This set mandatory standards of pay for childcare assistants, providing a minimum entry level rate of €13 per hour. Both childcare and healthcare assistants are legally required to complete a FETAC Level 5 as part of their training, so it seems reasonable to bring the pay of healthcare assistants in the private sector at least into line with their colleagues in private creches.
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From RTÉ Radio 1's This Week, why are so many small nursing homes closing?
Working conditions in private nursing homes
It could be argued that the higher ratio of staff to residents in public nursing homes is an example of over staffing in the public sector. It seems a strange position to take that elderly people could suffer from an abundance of care but, given the extent of staff shortages, it seems far more likely that the private sector is chronically understaffed.
HIQA, the state agency responsible for monitoring standards in nursing homes, has no remit to assess working conditions or staffing levels, unless they can show that a shortage of staff is directly affecting the care of residents. This is a minimalist approach which doesn't deal with staffing levels that are just about safe for the residents, but approaching unsustainable levels for the workers.
HIQA reports also don't detail the number of on-the-job injuries sustained by healthcare assistants, which would be a good way of measuring how seriously nursing home managers take patient handling policy within their facilities. Ignoring worker injuries during nursing home inspections is especially surprising when you consider that health work has the second highest levels of non-fatal workplace injuries in Ireland (at 13.4 injuries per 1,000 workers). Only construction has a higher injury rate.
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From RTÉ One's Nine News, HIQA reports an increase in number of unexpected nursing homes deaths in 2020 and 2021
Increasing the role of HIQA to include working conditions could create a more holistic and common-sense approach to assessing care quality. It seems obvious that underpaid and overworked carers will deliver a lower quality of care than workers who are treated with respect and dignity.
In summary, if the government does decide to increase Fair Deal funding to private nursing homes, then conditionality agreements need to be added to this new bargain so that increases in funding aren’t used to bolster the profit margins of private nursing homes. Essentially, the government should trade increased state funding for commitments on pay and conditions for healthcare assistants.
By establishing a Joint Labour Committee (JLC) to draw up an Employment Regulation Order for the private nursing home sector and by expanding the role of HIQA to assess working conditions, the state can use pre-existing mechanisms to deliver a better quality of care for the elderly and a better deal for workers in the industry.
This piece is based on research by the author into care of the elderly policy in Europe.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
