The future of the Health Service's role in running residential care homes across Northern Ireland looks in doubt as a major cull gets under way.
At least half of all residential homes could be closed down as part of wide-ranging reforms in care for the elderly.
While 15 of 56 care homes are officially under review, it has been confirmed that the Health and Social Care Board wants to raise that to 28.
The closures are part of the Transforming Your Care (TYC) reforms to encourage the elderly to live at home for as long as possible, rather than in care.
Controversy over the plans was sparked this week when the Northern Health and Social Care Trust confirmed the possible closure of its nine residential homes.
The Northern Trust backed plans to stop long-term admissions to its entire block of nine homes. Half of those facilities will close within three years, before the entire service is closed.
Now the Southern Health and Social Care Trust has announced that its five facilities will close – while three in the Belfast area are being gradually run down.
All six State-owned elderly residential units are under review in the South Eastern Health and Social Care Trust area – which covers Newtownards, Down, North Down and Lisburn. Closures are also expected across the largely rural Western Trust area, which has five residential homes in the Strabane, Derry and Limavady areas.
But the trust would not reveal its plans yesterday. A spokeswoman said: "A proposal will be taken to a trust board meeting next week."
Dementia sufferers will be spared from the closures. Residential homes, including Londonderry's Seymour Gardens for dementia patients and five similar facilities in Belfast, have all been ring-fenced from the plans.
But three residential homes in the Belfast area will now be run down gradually. It is thought that the Belfast Health and Social Care Trust has not officially informed residents of the plans.
While the trust would not confirm the locations of the three homes, they are understood to be Pine Lodge, Chestnut Grove and Grovetree House, which have a total of 20 residents.
Concerns are mounting that just a handful of State-run residential homes will be left in Northern Ireland once current proposals are implemented. Rural areas will be hit the hardest by the changes.
John Compton, chief executive of the Health and Social Care Board, said he anticipates that 28 of Northern Ireland's 56 homes will close. That would reach a 50% closure target as set out in the recent TYC review of residential care achieved.
TYC – which recommended a shift towards caring for the elderly in their homes and communities – is at the centre of the drive towards closures.
Criticism of the plans is growing. Public service union Unison has accused the Southern Health and Social Care Trust (SHCT) of "acting as a passageway for the private sector".
SDLP MLA Conall McDevitt, who sits on the Assembly's health committee, said: "There is strong sense that this looks like stealth privatisation – and that is making people very, very uneasy."
He added: "If a resident does not want to leave a care home, the approach we are told is that they will be offered in-home services.
"But not everyone is suitable for return to their own home or for relocation."