The Nursing Homes Support Scheme, also known as the “Fair Deal”, provides financial support to people who need long-term nursing home care. The scheme is operated by the HSE and replaces the Nursing Home Subvention from 27 October 2009. The following information is sourced from the Citizen's Information Board. For further information, please go to www.citizensinformation.ie or contact their phone service, lo-call: 1890 777 121.
Under this scheme, you make a contribution towards the cost of your care and the State pays the balance. The scheme covers approved private nursing homes, voluntary nursing homes and public nursing homes. You can get the list of approved nursing homes from the HSE - see Where to Apply.
Anyone who is ordinary resident in the State and is assessed as needing long-term nursing home care can apply for the scheme.
The scheme covers long-term nursing home care only. It does not cover short-term care such as respite, convalescent care or day care although these types of services may be provided in some nursing homes.
There is a set level of funding for the scheme each year, so there may be situations where a person’s name must go onto a waiting list until funding becomes available. If this is the case the HSE will let you know when it writes to advise you whether you are eligible for State support.
Rules
You must apply to the HSE on the standard application form.
There are 3 steps in the application process:
Step 1 is an application for a Care Needs Assessment – see below. The Care Needs Assessment identifies whether or not you need long-term nursing home care, that is, whether you can be supported to continue living at home or whether long-term nursing home care is more appropriate.
Step 2 is an application for State support – see below. The information that you give will be used to complete the Financial Assessment – see below - which decides how much you contribute to your care and how much State support you get. The Financial Assessment looks at your income and assets in order to work out what your contribution to the cost of your care will be. The HSE will then pay the balance of your cost of care. This payment by the HSE is called State support.
All applicants must complete Steps 1 and 2.
Step 3 is an optional application for the Nursing Home Loan, that is, if you want to defer paying the part of your contribution which is based on your home or other property.
The application form should be completed and signed by the person who is applying for nursing home care. However, in certain cases, another person, called a Specified Person may apply on their behalf (see below).
Care Needs Assessment
The Care Needs Assessment will be carried out by appropriate healthcare professionals appointed by the HSE, for example, a nurse. It can be completed at any time in a hospital or a community setting such as your own home and may involve a physical examination.
The assessment will take into account:
• your ability to carry out the activities of daily living, for example, bathing, shopping, dressing and moving around
• the medical, health and personal social services being provided to you or available to you both at the time of the carrying out of the assessment and generally
• the family and community support available to you, and
• your wishes and preferences.
When the Care Needs Assessment has been completed a report will be prepared. Based on the report, the HSE must decide whether or not long term nursing home care is the most appropriate option. Once a decision is made, you will be notified in writing within 10 working days. You will be given a copy of the report and the reasons for the decision.
You must be assessed as needing nursing home care in order to be eligible for either State support or the Nursing Home Loan.
The HSE may use the Care Needs Assessment to identify other health or personal social service needs. However, there is no legal requirement for them to provide the services identified.
Financial Assessment
The Financial Assessment looks at your income and assets in order to work out what your contribution to care will be. The HSE will then pay the balance of your cost of care. For example, if the cost of your care was €1,000 and your weekly contribution was €300, the HSE will pay the weekly balance of €700. This payment by the HSE is called State support.
The Financial Assessment looks at all of your income and assets.
In the case of a member of a couple, the assessment will be based on half of the couple’s combined income and assets. For example, if a couple’s income was €600 per week, the assessment of the person needing care would be based on 50% of €600, or €300. In other words, the person needing care would be considered to have a total income of €300 per week.
Income and assets
Income includes any earnings, pension income, social welfare benefits or allowances, rental income, income from holding an office or directorship, income from fees, commissions, dividends or interest, or any income which you have deprived yourself of in the 5 years leading up to your application.
An asset is any material property or wealth, including property or wealth outside of the State. Assets are divided into two distinct categories, namely cash assets and relevant assets.
Cash assets include savings, stocks, shares and securities. Relevant assets include all forms of property other than cash assets, for example a person’s principal residence or land. In both cases, the assessment will also look at assets which you have deprived yourself of in the 5 years leading up to your application.
The assessment will not take into account the income of other relatives such as your children.
Your contribution to care
Having looked at your income and assets, the Financial Assessment will work out your contribution to care. You will contribute:
• 80% of your income (less deductions below) and
• 5% of the value of any assets per annum.
However, the first €36,000 of your assets, or €72,000 for a couple, will not be counted at all in the Financial Assessment.
Where your assets include land and property, the 5% contribution based on such assets may be deferred and paid to Revenue after your death. This is known as the Nursing Home Loan.
Your principal residence will only be included in the financial assessment for the first 3 years of your time in care. This is known as the 15% or ‘three-year cap'. It means that you will pay a 5% contribution based on your principal residence for a maximum of three years regardless of the length of time you spend in nursing home care.
In the case of a couple, the contribution based on the principal residence will be capped at 7.5% where one partner remains in the home while the other enters long-term nursing home care, that is, the ‘three-year cap’ applies. If you opt for the Nursing Home Loan in respect of your principal residence, your spouse or partner can also apply to have the repayment of the Loan deferred for their lifetime.
If you have already been in a nursing home for 3 years, then you do not pay the 5% on your principal residence.
After 3 years, even if you are still getting long-term nursing home care, you will not pay any further contribution based on the principal residence. This ‘three-year cap’ applies regardless of whether you choose to opt for the Nursing Home Loan or not.
All other assets will be taken into account for as long as you are in care.
The ‘three-year cap’ also extends to farms and businesses in certain circumstances.
There are safeguards built in to the Financial Assessment which ensure that:
• nobody will pay more than the actual cost of care
• you will keep a personal allowance of 20% of your income or 20% of the maximum rate of the State Pension (Non-Contributory), whichever is the greater
• if you have a spouse or partner remaining at home, they will be left with 50% of the couple’s income or the maximum rate of the State Pension (Non-Contributory), whichever is the greater.
A couple is defined as a married couple who are living together. It also includes a heterosexual or same sex couple who are cohabiting as life partners for at least 3 years.
Deductions
In relation to income, the following deductions are allowed:
• Income tax, social insurance contributions and levies actually paid
• Where a person owns their principal residence, interest on loans for the purchase, repair or improvement of the principal residence.
• Where a person rents their principal residence (i.e. is living in rented accommodation), rental payments in respect of the residence can be deducted where the person’s partner or a child aged under 21 of the couple lives in the residence.
• Health expenses allowable for tax purposes, excluding contributions payable under the Nursing Homes Support Scheme.
• Maintenance payments in respect of a child, spouse or former spouse made under a separation agreement or a court order.
In the case of assets the net value of the asset is assessed, that is, its value minus any borrowings incurred specifically for the purchase or improvement of the asset.
Existing nursing home residents
You will not be affected if you are already in a public nursing home or a HSE contract bed in a private nursing home. You will contribute to your care on the same basis as you do at present.
If you are already in a private nursing home which is approved for this scheme but do not have a subvention, or you are not happy with the amount of the subvention, you can apply for the Nursing Home Support Scheme. If your private nursing home is not approved for this scheme you can retain your current subvention arrangements or you can opt to apply for the scheme and change to a nursing home which is on the list.
If you have been resident in the nursing home for three years or more, the financial assessment will only be based on income and assets other than your principal residence (and your farm/business in certain circumstances), that is, the ‘three year’ cap will apply.
If you are happy with the amount of subvention that you get, you can continue with that arrangement. You can claim tax relief on nursing home expenses that you pay at your highest rate of tax until January 2010 (after that date relief is only available at the standard rate).
You can choose to take up the new scheme or continue with your present subvention, whichever is the best option for you, financially.
How to apply
You can fill in the application form yourself, or ask someone else to help to fill it in. If a person has reduced mental capacity, then a Specified Person can apply on their behalf.
Applying on behalf of someone else
If the applicant is not able to apply his/herself, a Specified Person can act on his/her behalf for Steps 1 and 2 of the application process.
Only a court appointed Care Representative can act on the applicant’s behalf for the Nursing Home Loan.
After you send in the application form
when the Care Needs and Financial Assessments have been completed, the HSE will write to you and inform you of your contribution to care, and your eligibility for State support and the Nursing Home Loan (if applicable).
At this stage you will also be provided with the list of nursing homes that are participating in the scheme. This list will include public nursing homes, voluntary nursing homes and approved private nursing homes.
You may choose any nursing home from the list subject to the following conditions:
• the home must have a place for you, and
• the home must be able to cater for your particular needs. The nursing home will have to carry out an assessment to determine whether it can meet your particular needs.
Your choice of nursing home is not connected in any way to the level of your contribution to care.
Paying your contribution
If you select a public or voluntary nursing home, you will pay your contribution to the HSE or voluntary nursing home as appropriate each week and the State will pay the balance on your behalf.
If you select an approved private nursing home, you will pay your contribution to the nursing home provider each week and the State will pay the balance on your behalf.
Where to apply
You can download an application form from www.hse.ie They are also available from any health care setting in your area including your Local Health Office and hospitals.
You can find out more about the scheme from the Department of Health and Children website:
www.dohc.ie
or contact the HSE Infoline on 1850 24 1850, Monday to Saturday 8am - 8pm.
Appeals and reviews
Appeals: The HSE will inform you of the appeals process and provide details of your local Appeals Office when it writes to you to inform you of the outcome of your Care Needs and Financial Assessments.
If, for example, your Care Needs Assessment found that you did not need long-term nursing home care you can appeal the decision to your local Appeals Office.
Reviews: Any Care Needs Assessment can be reviewed six months after a previous assessment or earlier if either:
• the HSE is satisfied that there has been a material change in your health or circumstances or
• a registered medical practitioner states that in his/her opinion there has been a material change in your health or circumstances since your most recent care needs assessment.
Reviews are carried out by your local Nursing Home Support Office and you should contact them if you want to have your Care Needs or Financial Assessment reviewed.
Once the HSE has made a decision regarding the review, you will be notified of the decision and the reasons for the decision, in writing, within 10 working days.
