Nursing Home Charges and the Fair Deal Scheme – Your Questions Answered

RomaineScallySolicitors > > Nursing Home Charges and the Fair Deal Scheme – Your Questions Answered

Question- My mother is in her late eighties now and was admitted to hospital following a fall which resulted in a hip replacement.  She probably is ready to be discharged but it is unlikely that she can go back to independent living.  The family have not yet been able to come up with a suitable nursing home.  The hospital are now saying however that they will be charging our mother for long term care as she is no longer an acute patient.  Can they do this?

A – Firstly, we are sorry to hear about our mother’s accident.  This is very traumatic for all of you but particularly for your mother who may now need to consider long term residential care.  It is true that once a patient is no longer acute and does not therefore require a hospital bed, the hospital can charge for long term care while the patient is still in hospital.  For that reason, you will need to apply for the Nursing Home Support Scheme (NHSS).  Usually, the social worker attached to the hospital will start the process and invariably starts to put the family under pressure to make decisions regarding the care needs of the patient.  If the social worker has not already been in touch with you then, you need to make contact with him or her.  There is a social worker department attached to most of the larger hospitals so it should be easy enough to make contact with the relevant person assigned to your mother’s case.  However, the important thing is that you apply as soon as possible for the appropriate package under the NHSS Scheme.  Applications can be made on the standard Application Form.  There are three steps in the application process.  Step one is an application for a Care Needs Assessment.  This assessment will be carried out by an appropriate healthcare professional who is 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 the ability of the applicant to carry out the activities of daily living, for example, bathing, shopping, dressing and moving around.  It will also consider the medical, health and social services being provided to the applicant or available to him or her both at the time of the carrying out of the assessment and generally.  The assessment will also take into consideration the family and community support available to the applicant and indeed, most importantly, the applicant’s wishes and preferences.  When the Care Needs Assessment has been completed, a report will be prepared.  Based on the Report, the HSE (Health Service Executive) 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 ten working days.  You will also be given a copy of the report and the reasons for the decision.  It is an essential requirement of any application for support under the Nursing Home Support Scheme, that an assessment is carried out.  Step 2 is the actual application for state support.  This requires the completion of a Financial Assessment Form which decides how much the applicant contributes towards his or her care and how much state support the applicant will get.  The financial assessment looks at the Applicant’s income and assets in order to work out what the appropriate contribution will be for the applicant to the cost of their care.  The HSE will then pay the balance of the cost of care.  The payment by the HSE is called State Support.  Step 3 is an optional application by or on behalf of the applicant for the Nursing Home Loan.  This applies if you want to defer paying the part of the applicant’s contribution which is based on the family home or other property.  This is not essential but some applicants prefer to opt for the loan rather than the percentage contribution of their assets.  The application form should then be completed and signed by the person who is applying for nursing home care, although in certain other cases, a “Specified Person” may apply on their behalf.  We hope that this has been helpful and that you will now be in a position to start the process on behalf of your mother.  We wish you the very best of luck.


Question – We are applying on behalf of my father for the “Fair Deal” Scheme as he has been finding it very difficult to live alone since our mother died three years ago.  We have heard that he might lose the family home is he does move into residential care.  Is this correct?

A – Firstly, we are sorry to hear of your father’s failing health but hope that residential care will provide the supports necessary for him to go on to enjoy life for a long time to come.  As part of the application for the Fair Deal Scheme under the Nursing Home Support Scheme, it is an essential requirement that a financial assessment is carried out on each applicant.  The financial assessment looks at the income and assets of the applicant in order to work out what contribution to care he or she will make.  The HSE will then pay the balance of the cost of care.  For example, if the cost of your father’s care was €1,000.00 a week and the HSE had assessed your father’s contribution at €300.00 then, the HSE will pay the balance of €700.00.  This payment by the HSE is called “State Support”.  This financial statement looks at all the income and assets of each and every applicant.  In the case of a member of a couple, the assessment will be based on half the couple’s combined income and 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 the applicant has derived him or herself in the five years leading up to the 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 the applicant may have deprived him or herself of since applying for State Support in the five years leading up to the application.  For example, if the applicant had transferred his or her family home to a child within the previous five years then, the value of that asset will also be taken into account in assessing the contribution of the applicant irrespective as to whether or not they still own the property.  The assessment does not take into account the income of other relatives such as the children of the applicant.  Having looked at the income and assets, the financial assessment will work out the relevant contribution to care.  The applicant will contribute 80% of the income (less deductions) and 7.5% of the value of any assets per annum (5% if the application was made before the 25th July 2013.  However, the first €36,000.00 of any applicant’s assets or €72,000.00 for a couple will not be counted at all in the financial assessment.  Where the assets include land and property, the 7.5% contribution based on such assets may be deferred and paid to the Revenue after the death of the applicant.  This is known as the Nursing Home Loan.  The principal residence will only be included in the financial assessment for the first three years of the applicant’s time in care.  This is known as the 22.5% or “3 year cap”, (the cap is 15% for applications made before the 25th July 2013).  It means that the applicant will pay a 7.5% contribution based on the principal private residence for a maximum of three years regardless of the length of time the applicant spends in nursing home care.  In other words, this three year contribution will apply whether or not the applicant spends ten years in a nursing home or two.  In the case of a couple, the contribution based on the principal residence will be capped at 11.25% (7.5% for applications before 25th July 2013) where one partner remains in the home while the other enters long term nursing home care.  If the applicant opts for the Nursing Home Loan in respect of the principle residence, the spouse or partner remaining in the home can also apply to have the repayment of the loan deferred for their lifetime.  After three years, even if the applicant is still getting long term nursing home care, he or she will not pay any further contribution based on the principal residence.  This three year cap applies regardless of whether the applicant chooses to opt for the Nursing Home Loan or not.  All other assets will be taken into account for as long as the applicant remains in care.  There are certain safeguards built into the financial assessment which ensure that nobody will pay more than the actual cost of care.  The applicant will keep a personal allowance of 20% of their income or 20% of the maximum rate of the State Pension (non-contributory) whichever is the greater and if the applicant has 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 three years.  Your father’s family home therefore will be taken into account in assessing his contribution towards the Fair Deal Scheme.  We would suggest that you start the process by making contact with the relevant social worker and download the Application Form to make a start on the application.  We hope that this has been helpful and we wish you the best of luck with the process.


Could you explain what the Nursing Home Loan entails under the Nursing Home Support Scheme Act 2009?  My father is applying for long term residential care and mention has been made of a Nursing Home Loan but we are unclear as to what this means.  Could you please advise?

A – Where the assets of any applicant include land and property, the contribution payable by the applicant may be deferred until after the death of the applicant.  If you are approved for The Nursing Home Loan, the HSE will pay the money to the Nursing Home on your behalf and it will be collected after your death.  In certain circumstances, the payment may be deferred for a longer period, for example, if a spouse or partner of your former carer is still living in your principal private residence.  You can apply for the loan when you first apply for the Nursing Home Support Scheme or at any stage while resident in the nursing home.  In order to apply for the Nursing Home Loan, you must provide written consent to having a “Charging Order” registered against your assets.  If you are part of a couple, your spouse/partner must also provide written consent.  The Charging Order is a simple type of mortgage which secures the money loaned by the HSE.  Subject to your consent, the HSE is responsible for making the Charging Order, registering it against your asset and making Nursing Home Loan payments on your behalf.  You will not need to do anything (although the HSE may need to check with you about the information in your application).  If a person does not have the capacity to consent to the Nursing Home Loan and the Charging Order, a care representative will need to be appointed to act on his or her behalf.  The legislation setting out this Scheme does give specific time frame for repayment of the loan.  If the applicant passes on, the repayment must be made within twelve months from the date of death of the applicant or six months if the property is sold at any stage or transferred during the lifetime of the applicant.  If the loan is repaid within these time frames, then no interest will apply.  If however, repayment is not made within the specified time frames, interest will apply and the HSE will apply the consumer price index to the loan to take account of inflation since the loan was made.  We hope that this has been helpful.

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