Information Centre

Services

This web site is owned and operated by Retirement Care Services Ltd

www.retirementservices.ie

www.nursinghomesinireland.com

Disclaimer

Information

The Nursing Home Support Scheme replaces the Subvention scheme from 27 October 2009. People who are already getting a subvention can choose whichever scheme is to their advantage.

People who go into registered private nursing homes may get a subvention from the Health Service Executive (HSE) if they need full time care and attention and if they pass a means test.

The means test takes account of your income and assets into account. Your house will be taken into account except in the specific circumstances outlined below.

The subvention is designed to help with nursing homes costs. It was not designed to meet the full costs. There is a maximum payment of €300, which may be increased in the case of contracted beds or where "enhanced payments" are made.

The Health (Nursing Homes) (Amendment) Act, 2007 (pdf) ensures that the existing subvention scheme for private nursing home care is grounded in primary legislation. It also standardises the implementation the Scheme by the HSE across the country. The HSE has issued national guidelines for the standardised implementation of the Nursing Home Subvention Scheme which are in accordance with it.

It is intended that the way in which people in Ireland access and pay for long-term care will change to some extent.  The  Nursing Homes Support Scheme Act 2009 (pdf), also known as the Fair Deal Act, was signed into law on 1 July 2009. It is expected to open for applications on 27 October 2009. Information on the new Fair Deal scheme is available on the Department of Health and Children's website.

Rules

The HSE's national guidelines, published in 2007, are currently in effect. You should apply for a subvention before going into the nursing home but your application cannot be refused because you do not do so. Normally, payment is made from the date of application. In the case of late applications it can be backdated for up to three months, if it can be shown that there was good cause for the delay in the application, for example, emergency admission. Before 2007 there were stricter rules.

You must be told the result of your application within 8 weeks, however, there may be a delay if you do not supply all the relevant information. If you are refused a subvention you must be told the reason and you must be told about your right to appeal.

Qualifying for a subvention

In order to qualify for a subvention you must be:

• Sufficiently dependent to require maintenance in a nursing home and
• Unable to pay any or part of the cost of maintenance in the home, that is, you must pass a means test.

Dependency

An assessment of your level of dependency is carried out on behalf of the Health Service Executive (HSE) by a doctor, nurse, occupational therapist or physiotherapist. The assessment may involve interviewing you and your nearest relatives. Your medical condition is taken into account and the assessment also includes an evaluation of your ability to carry out the tasks of daily living and of the level of social support available to you.

Daily living

The assessment of your ability to carry out the tasks of daily living takes into account your:

• Degree of mobility
• Ability to dress unaided
• Ability to feed unaided
• Ability to communicate
• Extent of orientation
• Level of co-operation
• Ability to bathe unaided
• Quality of memory
• Degree of continence.

Social Support

The assessment of your social support takes into account:

• Your housing conditions
• The number of people in the household
• The ability of the household members (if any) to care for you
• The extent of support from your community and the services you are receiving.

The person carrying put the assessment compiles a report on your level of dependency. This report must make a recommendation on how your need for care should be met. For example, it may recommend that your need for care could be best met by staying in your own home, by going into a welfare home or by going into a nursing home.

The report is then considered by an assessment team that is appointed by the Health Service Executive (HSE) and includes people with professional experience in the care of dependent people. This team makes the decision on whether or not you meet the dependency requirements for a nursing home subvention and whether you should be offered accommodation in a HSE facility.

The means test

The means test takes into account the income of yourself and your spouse (or cohabiting partner). It may also take account of your assets (but not those of a spouse or partner). Assets in joint names are assessed proportionately.

Income

The means test involves looking at the income that you and your spouse (or cohabiting partner) received in the previous 12 months. Income from all sources is taken into account, including wages, salary, pension, allowances, payments for part-time and seasonal work, income from rentals, investments and savings and all contributions from all sources. Income is assessed net of social insurance (PRSI), income tax and the health contribution.

The income of a married or cohabiting person is taken to be half the total income of the couple.

You may not deliberately try to reduce your income in order to qualify for a subvention, e.g., by diverting it to someone else. If you do, this income may be taken into account anyway, even if you no longer have access to it.

Your total income for the purposes of the means test is your net income less one-fifth of the weekly rate of the State Pension (Non Contributory) payable at the time. In effect, you must be allowed retain this amount, which is sometimes referred to as pocket money.

Farm or business income

Farm, Land or a Business is assessed where the applicant for subvention owns or has legal interest in the Farm, Land or Business.

The income from a farm or business is calculated on the basis of the previous year's accounts if they are available. If they are not, a notional assessment is made of the income.

In the case of a farm where there is an income but where accounts are not available for the previous financial year the total farm income, including headage payments, grants, rental income, etc. will be assessed, less current farm expenditure.

Where the farm or business is not being used, a notional income may be assessed, as above, but which also takes account of the capital value of the land or business.

Assets

The following assets may be taken into account:

• House property (excluding household furniture and goods)
• Stocks, shares or securities
• Money on hand, in trust, lodged, deposited or invested
• Interests in a company or business of any kind (including a farm)
• Interest in land
• Life assurance or endowment policies
• Valuables held as investments
• Current value of equipment of a business or machinery, excluding a car, not covered under a previous heading.

If you disposed of any assets in the previous 5 years, the value of those assets may also be taken into account. That value may include the value of benefit and privilege arising from the transfer.

If a business was transferred without any agreement on benefit and privilege, the Health Service Executive (HSE) may take into account any payment on transfer or may impute a notional value of 5% of the market value on the date of transfer, whichever is the higher.

In the case of a farm transfer, the HSE may take into account any payment on transfer or any continuing income from the earnings of the farm.

The first €11,000 of any assets is not taken into account.

Your home

Your principal private residence is not taken into account if it is occupied immediately before the application and continues to be occupied by your spouse, child aged under 21 or in full-time education or relative in receipt of Disability allowance, Blind Person's pension, Illness Benefit, Invalidity Pension or State Pension (Non Contributory).

To assess the notional annual income of your house, the Health Service Executive (HSE) takes 5% of the estimated market value if it was not occupied before or at the time of the application by one of the people listed. This is calculated net of mortgage, loan rental or purchase repayments. the HSE can only assess the value of your home for a total of three years.

Selling your home

If you sell your home, the proceeds may be taken into account in the assessment of your means for a nursing home subvention. (There is a social welfare rule that allows the proceeds of a house sale to be disregarded in certain circumstances. This does not apply to the nursing homes subvention means test)

Refusal of subvention

The Health Service Executive (HSE) may refuse to pay any subvention if either of the following apply:

• if your principal residence is valued at €500,000 (for properties in the Dublin area) and €365,000 (for the rest of the country) and your income is greater than the basic rate of State Pension (Non-Contributory) or
• the value of your assets (excluding your home) is greater than €36,000.

Level of Subvention

Since 1 January 2007 there is one "maximum" weekly rate of subvention.  (Up to December 2006 there were 3 rates of subvention related to the assessed level of dependency).

• Maximum weekly subvention rate €300.

If your means are less than the weekly rate of the State Pension (Non-contributory) payable at the time, the HSE may pay an extra subvention. If your only income is a State Pension (Non-contributory), your means are assessed, not at the full amount of your pension, but after a sum equivalent to one fifth of the State Pension (Non-contributory) is disregarded. So, you will be able to get higher than the maximum subvention.

If your means are higher than the rate of State Pension (Non-contributory) payable at the time, plus 20% retained for personal use, the subvention may be reduced by the amount of the excess.

Enhanced payments/Contracted Beds

There are circumstances in which the HSE may pay the full cost of a private nursing home bed. This is the case where the HSE has what are called "contracted beds" in private nursing homes. There are no clear rules about who is entitled to a contracted bed or in what circumstances the HSE offers this arrangement.

In some circumstances the HSE may make an 'enhanced' payment. When considering an enhanced payment, the HSE will take account of the cost of care in the area, the availability of public beds, the means of the applicant and any other funds or assets that may be available to the applicant.

There is no entitlement to an enhanced subvention contribution; it is at the discretion of the HSE The availability of enhanced subvention is limited by the amount of funding available for the scheme. 

Pocket Money

When a person is being assessed for subvention, a sum equivalent to one fifth of the State Pension (Non-contributory) is disregarded. This is often referred to as "pocket money".

Choice of nursing home

If you are considered to be eligible for a subvention, the Health Service Executive (HSE) may offer you a place in a HSE institution instead. The rules do not specifically say that you may be refused a subvention if you refuse the HSE offer of a place but the implication is that you may.

If you are not offered a HSE institution place, the HSE must pay the subvention to the nursing home chosen by you or by someone on your behalf, provided it is a registered home. The nursing home does not have to be in your own HSE Area and you are entitled to move to a different nursing home and have the subvention transferred to it. You may choose a nursing home in Northern Ireland if it is registered by a health and social services board there.

Payment of the subvention and payments for care

The subvention is paid to the proprietor of the nursing home and not directly to you.

The charges for staying in the nursing home are agreed by you (or somebody acting on your behalf) and the nursing home. The amount which you have to pay is set out in the contract of care which must be given to you when you go into the nursing home. The contract of care usually includes a clause which allows for charges to be increased from time to time.

You may not be charged any more than the amount as agreed in the contract of care. This means that there can be no further separate charges for bed and board, nursing care appropriate to the level of dependency, incontinence wear and bedding, laundry service and aids and appliances necessary to assist a dependent person with the activities of daily living. A special service or item of equipment must be the subject of a separate agreement between you and the nursing home and must be set out in the contract of care.

If you have a nursing home subvention, you must be treated in the same way as a person who does not have a subvention.

Review

If a major change occurs in your level of dependency or in your means, the Health Service Executive (HSE) may review your entitlement to a subvention. (They also have the power to review every 6 months but this does not happen very often.) The HSE must hold a review if you or the person in charge of the home requests them to do so.

The assessment of dependency and means in the review is carried out in the same way as the initial assessment. As a result of the review, the HSE may increase or decrease the subvention or withdraw it or offer accommodation in a HSE home or make arrangements for your care in your own home. The existing subvention is paid while the review is being conducted. If the HSE decide to reduce or stop the subvention, it must notify you and continue to pay the subvention for 28 days. You are entitled to appeal against any decision to reduce or withdraw the subvention. If the appeal is successful the arrears of subvention due will be paid.

Nursing home care and tax allowances

You or any other person who is paying the costs involved may be able to claim tax relief on the costs of your care in a private nursing home. View information on tax relief on nursing home fees and for dependent relatives here.

Appeals

If you are unhappy with a decision on your application for a subvention, you may appeal to the Appeals Officer in HSE Consumer Affairs in your local area. There is no appeal against the dependency assessment. You may appeal against the assessment of means and/or the amount of the subvention. You should appeal within 28 days of receiving the notification of the decision.

You are entitled to know the details of the decision and the reasons for it. Details of the means assessment should be provided by the HSE but if they are not or they are not clear, you should look for further information.

The regulations do not say that you are entitled to an oral hearing but, if you feel that would be an advantage, you should ask for one.

The appeals officer must give a decision on the appeal within 28 days. Decisions of the appeal officer are subject to review by the Ombudsman and may be subject to judicial review by the courts.

Rates

The maximum weekly rate of subvention is €300.

Higher amounts may be paid in the case of enhanced payments and for contracted beds. (It is important to note that applications for enhanced payments are assessed on an individual basis and are at the discretion of the Health Service Executive (HSE)).

Where to apply

Apply to your Local Health Office for a subvention before going into a nursing home.

If you or your family wish to make an application for an enhanced payment, you should put your application in writing directly to your Local Health Office. Each application is assessed on an individual basis and is at the discretion of the HSE.