Nursing Homes Support Scheme - Fair Deal

The Nursing Homes Support ‘Fair Deal’ Scheme is a new system of financial support for long-term nursing home care, which was introduced on 27th October 2009.

Participants in the Nursing Homes Support ‘Fair Deal’ Scheme make a contribution towards the cost of care and the State will pay the balance. This applies whether the nursing home is public, private or voluntary.

The scheme has a number of steps, details of which are available on the HSE ‘Fair Deal’ website http://www.hse.ie/eng/services/Find_a_Service/Older_People_Services/nhss/

Applying for the ‘Fair Deal’ Scheme

In order to apply for the ‘Fair Deal’ scheme, you must be resident in the State for at least one year or that you intend to live here for at least a year. Applications can be made to your local Nursing Home Support Office.

Step 1: Application for a Care Needs Assessment

This assessment identifies whether or not an applicant needs long-term nursing care. The purpose is to ensure that long-term nursing home care is necessary and is the right choice for you. The assessment will consider whether you can be supported to continue living at home or whether long-term nursing care is more appropriate. The assessment will be carried out by appropriate healthcare professionals appointed by the HSE. An assessment may be completed at any time in a hospital or a community setting such as your own home.

The assessment will include consideration of the following:

• your ability to carry out the activities of daily living, e.g. bathing, shopping,
• dressing and mobility
• 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

Please note that the assessment may include a physical examination by a healthcare professional. Your assessment must indicate that you need nursing home care in order to be eligible for either State Support or the Nursing Home Loan.

Step 2: Application for State Support

This Financial Assessment determines your contribution to your care and your corresponding level of financial assistance ("State Support"). Steps 1 and 2 must be completed by all applicants.

Financial Assessment

This 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.

Income & Assets

Income includes any earnings, pension income, social welfare benefits/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.

Broadly speaking, an asset is any material property or wealth, including property or wealth outside of the State. If you are 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, which is €300. In other words, the person needing care would be considered to have a total income of €300 per week.
A couple is defined as (a) a married couple who are living together or (b) a heterosexual or same sex couple who are cohabiting as life partners for at least three years. 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 assessable income and 7% 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 in the State, the 7% contribution based on such assets may be deferred and collected from your estate. This is an optional Nursing Home Loan element of the scheme which is legally referred to as "Ancillary State Support". 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 21% or 'three year' cap. It means that you will pay a 7% contribution based on your principal residence for a maximum of three years regardless of the time you spend in nursing home care. 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 loan or not.

There are important safeguards built into the Financial Assessment including:

• 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/partner remaining at home, he/she will be left with 50% of the couple's income or the maximum rate of the State Pension (non-Contributory), whichever is the greater.

Step 3: Nursing Home Loan ("Ancillary State Support")

Where your assets include land and property in the State, the 7% contribution based on such assets may be deferred. This means that you do not have to find the money to pay this contribution during your lifetime. Instead, if approved, the HSE will pay the money to the nursing home on your behalf and it will be collected after your death. This is an optional benefit of the scheme. It is effectively a loan advanced by the State which can be repaid at any time but will ultimately fall due for repayment upon your death. Its purpose is to ensure that you don't have to sell assets such as your house during your lifetime.

The legal term for the Nursing Home Loan is "Ancillary State Support". You may choose to apply for this element of the scheme at the date of initial application or at any stage while resident in the nursing home. You may wish to consider taking independent legal advice if applying for the Nursing Home Loan.

Next Step

Once the Care Needs and Financial Assessments have been processed the HSE will write to you. Firstly, it will advise you as to whether you are eligible for State Support and then it will advise you of your contribution to care. Secondly, if you have applied for the Nursing Home Loan, it will also advise you about your eligibility for this. Thirdly, it will provide you with a list of nursing homes to choose from. The list will include public nursing homes, voluntary nursing homes and approved private nursing homes. Approved private nursing homes are homes which have as agreed the weekly cost with the National Treatment Purchase Fund and are approved for the purposes of the scheme. You can choose care in any nursing home on the list.

However, in order for financial support to be provided:

• 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. If you select a public or voluntary nursing home, you will pay your contribution to the HSE or voluntary home as appropriate each week and the HSE will pay the balance.

If you select an approved private nursing home, you will pay your contribution to the nursing home provider each week and the HSE will pay the balance.

For further information please contact your local HSE Nursing Homes’ Support Office.

Pricing

Haven Bay Care Centre’s weekly room charge will be discussed with you on admission. There is an additional charge of €25 per week for social activities.

Residents or their representatives may apply to HSE for part funding under Nursing Home Support Scheme (Fair Deal). See links section for application forms and information.

Residents will be invoiced monthly in advance (on 1st day of every month) with a deduction for the ‘HSE contribution’. As long as HSE funding remains in place the residents ongoing monthly contribution will be as agreed with HSE. Any changes to the residents funding arrangements must be communicated to the nursing home one month in advance.

The weekly fee includes the following

• Bed and board
• Nursing and personal care appropriate to the level of care needs of the Resident
• Bedding
• Laundry Service
• Basic aids and appliances necessary to assist the Resident with the activities of daily living

For avoidance of doubt the following are additional charges

• Activities Levy (€25 per week)
• Physiotherapy
• Chiropody
• Newpapers
• Incontinence wear (currently re-imbursed by HSE for residents with GMS cards)
• Dry cleaning
• Ophthalmic and dental services
• Transport (including care assistant escort charges)
• Hairdressing and other similar services
• Specialist wheelchairs
• Non GMS medicines and dressings
• Medical Oxygen on a long term basis