Fair Deal

The Nursing Homes Support Scheme is a scheme of financial support for people who need long-term nursing home care. Under the Nursing Homes Support Scheme, you will make a contribution towards the cost of your care and the State will pay the balance. This applies whether the nursing home is public, private or voluntary.

The HSE administers the Fair Deal Scheme within the resources available and in line with the Nursing Home Support Scheme legislation. Applicants cannot avail of State funding for a nursing home place prior to receiving approval of their Fair Deal application.

Under the Nursing Home Support Scheme, prices charged by Private Nursing Homes are agreed between the Private Nursing Home and the National Treatment Purchase Fund.   A weekly price for the cost of care in Public Homes is also provided. Read more about the cost of care.

The scheme has a number of steps and these are set out in the detailed Nursing Homes Support Scheme Information booklet, which you can read or download on this page. Please note that if you were resident in a nursing home before the new scheme started, you should read section 10 of the information booklet carefully

• Applying for the Scheme
• Care Needs Assessment
• Financial Assessment
• Nursing Home Loan
• Next Steps
• Contact your local Nursing Homes Support Office
• Lists of all public and private nursing homes and their weekly costs
• Links to Courts Service Website for Forms relating to Care Representative etc

You can also read or download a QUICK GUIDE TO THE NHSS SCHEMEhere.

Read the National Guidelines for the Standardised Implementation of the Nursing Home Support Scheme

Applying for the Scheme 
In order to apply for the scheme you must be ordinarily resident in the State. Ordinarily resident means that you have been living in the State for at least a year or that you intend to live here for at least a year. Applications are made to your local Nursing Home Support Office on the standard application form. There are three steps to the application process.

Step 1 is an application for a Care Needs Assessment. The Care Needs Assessment identifies whether or not you need long-term nursing home care.

Step 2 is an 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 (if you were resident in a nursing home before the scheme started please see section 10 of the information booklet).

Step 3 is an optional step which should be completed if you wish to apply for the Nursing Home Loan (this is termed “Ancillary State Support” in the legislation).

The application form should be completed and signed by the person applying for nursing home care. However, in certain cases, another person may apply on their behalf.

back to top

Care Needs Assessment 
The Care Needs Assessment identifies whether or not you need longterm nursing home care. Its 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 home care is more appropriate. The Care Needs Assessment will be carried out by appropriate healthcare professionals, for example, a nurse etc., 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.

back to top

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 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 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’sincome 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 7.5% of the value of any assets per annum (5% of assets if the application was made prior to the 25th July 2013). 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 7.5% 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 22.5% or ‘three year’ cap (15% if application was made prior to the 25th July 2013). It means that you will pay a 7.5% 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.

In the case of a couple, the contribution based on the principal residence will be capped at 11.25% (7.5% if the application was made prior to the 25th July 2013) where one member of the couple remains in the home while the other enters long term nursing home care, i.e. the ‘three year’ cap applies.  Where a person opts for the nursing home loan in respect of the principal residence, their spouse or partner can also apply to have the repayment of the loan deferred for their lifetime (see section 9).

All other assets will be taken into account for as long as you are in care.

There are important safeguards built in to the Financial Assessment which are worth noting.

• 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
• If both members of a couple enter nursing home care, they each retain at least 20% of their income, or 20% of the maximum rate of the State Pension (Non-Contributory), whichever is the greater.

 

back to top

Nursing Home Loan (“Ancillary State Support”) 
As outlined above, where your assets include land and property in the State, the 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.
Repayment of Nursing Home Loan
The Nursing Home Loan (Ancillary State Support) together with interest is repayable (unless the applicant has voluntarily repaid the loan prior to it falling due for repayment)

• when the applicant dies, or
• when any part of the charged asset is transferred/sold (HSE must be notified within 10 working days of transfer/sale), or
• if the applicant or his/her partner is made a bankrupt, or
• if the HSE determines that it has been given false/misleading information relating to the loan application

Repayment of the loan must be made to the Revenue Commissioners.

The person who is responsible for repayment of the nursing home loan to the Revenue Commissioners is called the relevant accountable person. The relevant accountable person may be a different person to the applicant, depending on the circumstances as set out in the following examples:

Example 1: Where you transfer or sell part or all of your property, during your lifetime, you and your spouse/partner will be the relevant accountable persons.

Example 2: Where the loan is repayable after the applicant’s death the personal representative of the deceased is the relevant accountable person. A person who inherits or has an interest in the property or any part of it can also be held accountable for repayment of the loan.

When the nursing home loan falls due for repayment, the HSE writes to the relevant accountable person. The HSE notifies him/her that the loan must be repaid and advises of the amount due. In calculating the amount due, the HSE applies the consumer price index to the loan to take account of inflation or deflation since the loan was paid.

The following timeframes apply for repayment of the nursing home loan:

• Where the repayment arises, for example, because of the death of the person in care the loan must be repaid within 12 months of the date of death. Where the repayment is not made within this timeframe, interest on the amount owing will be applied from the date of death.
• Where the loan is repayable because of the sale or transfer of your property during your lifetime, it must be repaid within 6 months of the date of sale or transfer, or Revenue will apply interest back to date of sale/transfer.

The Revenue Commissioners are the collection agent for the HSE in respect of monies advanced by way of a nursing home loan. The Nursing Home Loan must be repaid to Revenue. It should be repaid as soon as possible after notice is received from the HSE and, in any event, within the timeframes outlined above. Further information is available on how to make payments onRevenue’s website.

Where the loan becomes repayable on death, the repayment of monies based on the principal residence can be further deferred in certain cases. You can read more about this in the information booklet.

In relation to further deferrals, the following timeframes apply for repayment of the nursing home loan:

• On the death of the partner of the person who was in receipt of care or on the death of the connected person, the loan must be repaid within 12 months of the date of death of that person. For more information on the definition of a connected person please refer to the information booklet.
• Where a person ceases to be a connected person as defined by the legislation or where an interest in the residence is transferred/sold, the loan must be repaid within 6 months of the date the person ceased to be a connected person or date of transfer/sale.

back to top

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.

The HSE is provided with a set level of funding for the scheme each year. While it is hoped that there would be sufficient funding to support everyone, there may be situations where a person’s name must go onto a national placement list until funding becomes available. If this is the case the HSE will notify you when it writes to advise you whether you are eligible for financial support. You will subsequently be notified by the HSE when you have been approved for financial support under the scheme.

For Further Information on the Scheme, please contact your local HSE Nursing Homes Support Office, details are provided below.

You can also call the HSE infoline 1850 24 1850 or visit the website of theDepartment of Health