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What is the Nursing Home Support Scheme (Fair Deal)?
The NHSS, also known as Fair Deal, is a scheme under which the cost of nursing home care is managed through the HSE paying either the full or part of the cost and by allowing those charged with paying the resident’s portion of the cost to defer the charge.
Eligibility is based on two assessments. The first looks at the care needs of the older person, their capacity to live independently and at available supports at home and in the community.
The second assessment looks at the financial resources (income, property some expenses) available to the older person.
What exactly does the Fair Deal cover?
The Fair Deal covers the level of care appropriate to the individual as well as bed, board and a laundry service. It also covers certain therapeutic activities and some aids and appliances needed to assist with the activities of daily living. If a person has a medical card this should cover the cost of aids and appliances as well as medical care such as GP charges and medication.
If the older person does not have a medical card their medical costs must be covered by the individual or their family. Often the nursing home will invoice the family or representative of the resident.
How long will it take to get the Fair Deal?
At present (January 2017) the waiting time is about four to six weeks but this can vary for individual circumstances. It is important to remember that if an individual was admitted to a nursing home from the community before the Fair Deal application was approved then the cost of the nursing home care will be borne by the older person or their family. The HSE will not cover it.
If the older person is admitted from a hospital the hospital may have access to a transitional care bed in a nursing home to which the older person can be admitted while the application is being processed. If there is no transitional care bed available then the hospital may apply for temporary funding from the local NHSS support office. This funding is not automatically given.
The older person or their representative should ask about this to make sure the hospital does apply for the funding otherwise the nursing home will simply bill the individual or their representatives.
It is possible to apply for the scheme before an individual enters the nursing home and in many ways this is preferable as it will give both the older person and/or their carer time to choose the nursing home that best suits their needs.
What is a Care Representative?
A Care Representative is a person appointed by the Circuit Court to apply for the NHSS on behalf of someone who lacks the capacity to make certain decisions on their own behalf and to complete the necessary forms.
They can be relatives of the older person or professionals (social workers, solicitors, GP etc.) working with the older person. The legislation governing this role may change as the new Assisted Decision Making legislation is rolled out.
How does the financial assessment work?
The financial assessment mentioned above will determine what portion of the cost an individual pays. The financial assessment will look at the entire income of the individual or, if the individual is part of a couple, half of their combined income.
Please note that siblings even if they live in the same household are treated as separate individuals.
As part of the assessment process the individual is asked to list their assets, providing a valuation of each including property (home, property leased out, business premises, farm land etc.), cash (pensions, interest on bonds savings earned income). Failure to list any asset may lead to extra charges being levied later or may delay the application process.
An individual is allowed €36,000 and a couple are allowed €72,000 in savings, which is not assessed. The following deductions are also allowed against income:
- Income tax, social insurance contributions and levies 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;
- Some health expenses are allowed 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.
If an individual has very limited financial means the State will either pay the full cost of the care or large proportion of it. There may be extra charges levied by the nursing home as well as expenses are not covered by the NHSS and to help meet these extra costs every resident is left with 20 per cent of their income.
What is Ancilliary State Support?
This phrase causes some confusion. The portion of the cost covered by the HSE is called ‘State Support’. If the individual wishes to defer the payment of their assessed portion of the cost they can do so by applying for Ancillary State Support.
This means the State pays both its own portion of the cost as well as the resident’s portion. The resident’s portion paid by the State is essentially a loan to the estate of the resident that must be repaid with a year of the resident dying or the value of the assets being realised.
What proportion of the estate must be paid back?
It is a basic principle of the NHSS that nobody will pay more than the cost of their care. The portion of the value of the family home that will be due is capped at 7.5% per year for a maximum of 3 years. For other chargeable assets there is no cap although a cap may apply to farms if the older person is admitted to a nursing home as a result of an accident or emergency.
If the Ancillary State Support is not applied for the 3 year cap still applies. This means that when calculating the amount due from the older person the 7.5% of the value of the home is not included in the calculation after 3 years. So after 3 years the amount of money due should fall.
It is also important to note that the amount due from the value of the family home cannot be collected if a partner or dependent (adult or child) or carer is living there.
If an individual does not have any assets (other than cash income) and their cash income is deemed low they will still have to pay the 80% of their income but in this case the HSE will pay the rest of the cost of care.