Nursing Homes Support 'Fair Deal' Scheme

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. It replaces the subvention scheme.

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

Applying for the 'Fair Deal' Scheme

In order to apply for the 'Fair Deal' scheme, you must be ordinarily resident in the State. This means that you have been living in the State for at least one year or that you intend to live here for at least a year. Applications are 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, for example, a nurse ,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 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.

Please note that the assessment may include a physical examination by a healthcare professional. You must be assessed as needing nursing home care in order to be eligible for either State Support or the Nursing Home Loan.

Step 2: Application for State Support

This will be used to complete the Financial Assessment which 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

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.

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 have a partner, 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.

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 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 in the State, the 5% 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 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 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 in to 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 5% 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 and you are free to do so.

Next Steps

Once the Care Needs and Financial Assessments have been processed the HSE will write to you. Firstly, it will advise you of your contribution to care and whether you are eligible for State Support. 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 agreed the price charged for care 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