Review highlights need for tighter nursing home oversight

The Forvis Mazars review into the regulatory inspection process in designated centres for older people was published earlier this month.

This independent review was initiated by the Minister for Health and the Minister for Older People following the RTÉ Investigates programme in June 2025. The programme highlighted serious failings in care, staffing, and oversight in two nursing homes owned by Emeis Ireland.

The purpose of the review was to provide an independent assessment of the regulatory processes of HIQA’s Chief Inspector of Social Services. It was charged with identifying areas where the Chief Inspector could improve and to consider whether the regulatory framework should be strengthened to reflect changes in the operating environment.

Overall, the review finds that the Chief Inspector’s regulatory inspection processes are effective.

However, the report makes a series of recommendations to improve oversight and regulation, particularly in light of changes in the sector. It points out that the growth of large corporate providers, often located outside of Ireland, has created new and more complex regulatory challenges.

There was a greater need to hold these providers to account, according to the review.

A key recommendation is that providers are requested to monitor indicators of safe and effective care, such as changes in a provider’s financial capacity, staffing, or resident profile as part of their six-monthly review required by the regulations.

The review also says thematic inspections to promote best practice in key areas of care should be expanded. The criteria of these inspections should also be reviewed to ensure they are meaningful and consistently applied.

The inspection approach to culture and staff behaviour within nursing homes can also be improved, according to the report, particularly regarding capturing the lived experience of residents.

It also recommends the greater use of data analytics and technology to enhance the regulatory oversight and surveillance.

“As a regulator, we must always be open to critically evaluating what we do and how we do it,” according to HIQA CEO Ms Angela Fitzgerald.

“For this reason, we very much welcome this independent review about our regulatory processes and how we do our work….

“We hope that the positive findings about our processes and our regulatory model and approach will provide assurance to those using services, their families, and the wider public. We fully accept that the review also identifies where we need to improve and work is already underway in this regard.”

Alongside the Forvis Mazars review, HIQA published 54 inspection reports on its findings and actions in nursing homes operated by Emeis Ireland.

The regulatory programme found evidence that a number of the centres were operating to a good standard and providing effective care.

However, it also identified that seven centres had “significant challenges” in this regard. As a result, HIQA had to undertake additional inspections, place restrictive conditions on those nursing homes, including a requirement to restrict the admission of new residents until further notice, and requiring the provider to increase staffing.

The poor standard of care exposed by the RTÉ Investigates programme was deeply concerning. It is to be hoped that the actions taken will help prevent similar failings in the future.