The future sustainability of private and voluntary nursing homes across the country is a rapidly growing concern. Owners and operators of nursing homes are struggling to stay afloat. Many see no way forward. I have received numerous calls and correspondence from nursing homes across County Tipperary. All are desperate for support to save their businesses. They are not making extravagant demands; they are simply seeking equality with public nursing homes.

This is a national issue. The kernel of the problem is the discrimination by the State under the fair deal scheme in the resourcing of private, as opposed to public, nursing home resident care. At present, public nursing homes receive 62% more per resident per week than what is available to pay for the care of an elderly person in a private nursing home. Private nursing home owners are being tasked with doing the impossible and a growing number are holding on by their fingertips in the hope that their voices will finally be heard.

Private nursing homes are providing elderly care for fees of up to €700 per week per resident, less than the amount allocated to their public counterparts. It does not take a genius to see that, from a business perspective, there is no future for private nursing homes in Ireland if this alarming discrepancy is not addressed urgently.

There is also a significant differential in pay for HSE and private and voluntary health care assistants. Approximately one in every two employees in nursing homes are healthcare assistants. The pay differential is unfair and compounds the problem. Private nursing homes are losing staff to better paid jobs in the HSE and elsewhere. Staff in private nursing homes are outstanding.

They are under enormous pressure. Their patients are treated like family members. Staff give the patients professional care and attention. These staff deserve to have their work properly valued.

Negotiations have been ongoing for years, but the discussions are going around in circles. They are unending and unproductive. I spoke to one nursing home owner who was recently forced to put €90,000 of borrowed money into their business for it to survive. Last week, I visited another loss-making home which is now dependent on the religious congregation to support the nursing home financially. The financial loss is growing to such an extent that the congregation cannot make up that loss indefinitely. They have spoken about the current and ongoing rises in the costs of heat, electricity and food. They are simply unable to absorb the increased costs of those necessities in the private sector. Private nursing homes must provide the same level of complex care many elderly residents require. Public nursing homes have specialised needs provided at no cost by the HSE, while private operators must pay for services such as chiropody, physiotherapy, occupational therapy and even basic medical equipment.

I thank the Deputy for raising this important issue. As it transpires, the Minister of State, Deputy Butler, is meeting with the CEO of the National Treatment Purchase Fund, NTPF, Mr. Liam Sloyan, to discuss the issues the Deputy raised and the general issues that face nursing homes and their ongoing relationship with the NTPF. The nursing home representative bodies are also in discussions more generally.

The Nursing Homes Support Scheme Act 2009 is the overall template that governs funding to support people accessing residential care. Prices are negotiated, as the Deputy will know, for delivery by the designated State agency, namely the National Treatment Purchase Fund. Pricing agreements are reached with individual nursing homes by the NTPF, and the rates the fund offers are based on a set of standard criteria that include costs incurred by the nursing home in question. Neither the Minister nor the Department has a role in individual price negotiations. There is a variation between the cost of care in public and private homes. Public nursing homes generally have higher costs and a higher staff-patient ratio. They also deal with far more complex cases, in general. There is about an 80:20 split, that is, 80% of all nursing home care is private and 20% is public, in the form of community nursing units, with a minimum of one in each county. That balance has to be looked at over time but, whether private, voluntary or public care, the resident's financial contribution is the same. The price of care affects only levels of State funding and has no direct impact on the resident.

Last December, the Department published a value-for-money review of nursing home costs. The purpose was to identify and to analyse the reasons for any cost differential between private and public nursing homes. Again, the review found that the cost differential is driven largely by variances in staff-to-resident ratios and the skill mixes in public and private nursing homes. Older infrastructure and the cost of upkeep of older buildings are a contributor in many of our community nursing units. Nine recommendations have come out of that report, and the HSE is, with the Department of Health and the NTPF, working through the recommendations. Delivery of those would lead, I think, to an improvement in the overall value for money delivered by the nursing homes support scheme.

The Department and the Government provided substantial support to the sector over the pandemic, with €134 million to €135 million in additional funding made available to private and voluntary nursing homes. More recently, substantial engagement has taken place on cost increases relating to inflation. The current inflationary cycle is now the subject of discussions between the nursing homes representative bodies and the NTPF.

I welcome the fact that the Minister of State, Deputy Butler, is entering further discussions and negotiations, but will the Government please bring some urgency to the matter and bring it to a conclusion? There have been negotiations for years with no constructive proposals put on the table. We need to get past that stage. In my view, the ongoing medical and personal needs of elderly residents are practically the same, regardless of where they reside.

It certainly does not make any sense to me to say that it costs 62% less in a private nursing home than it does in a public one. The reality is that this is just not sustainable for private operators and it is expecting them to perform a miracle. If the Taoiseach does not bring this matter to a conclusion and if it is not addressed successfully, the doors of private nursing homes in every town and village across Ireland will be forced to close. Public nursing homes will not be able to meet the demand for elderly care and we may then have a very serious issue. The most vulnerable members in our society will be those that will suffer. The Government must act urgently to correct the imbalance that currently exists.

The Minister of State, Deputy Butler, has met with Nursing Homes Ireland, NHI, the representative body, and continues to do so. At the moment the Government is allocating approximately €1 billion for the care of approximately 22,000 residents on an annual basis. The Exchequer contribution as we speak is quite significant and will obviously grow in terms of demographics and of the fact that we are ageing and living for longer as a people, which is in itself a good thing. It will also, however, create pressures.

There is no doubt that the voluntary sector is under pressure and I accept that in the current inflationary cycle many entities and organisations are under much deal pressure. The Minister of State is meeting with Nursing Homes Ireland, the Department and the National Treatment Purchase Fund, NTPF, agency will be giving this very serious consideration. This also has to be seen against a backdrop of what were extraordinary levels of support given to the private nursing home sector by the Government during the pandemic itself.