Public Affairs

A fair deal?

46-47 Following the launch of the Government scheme that will see the state paying the bulk of nursing home fees, there are concerns that the elderly are not getting a ‘Fair Deal.’

Financial assistance which allows elderly people to defer the cost of their long-term nursing home care until after their death, by placing a charge against their home, has been introduced by the Government under the ‘Fair Deal’ scheme.

Elderly people who are currently in long-term public or voluntary nursing homes or those in hospital waiting for long-term care can apply for help with the cost of their care. Residents in approved private nursing homes can also apply.

The Department of Health says the state will pay the shortfall between what someone can afford to pay and the actual cost of nursing home care.

For example if the cost of care was €1,000 and the elderly person’s weekly contribution was €300, the HSE will pay the weekly balance of €700. However if a person’s contribution is assessed at €1,200 a week and the cost of care is €1,000 then no state support will be paid.

Financial assessment

In order to avail of the scheme, applicants must undergo a financial assessment to determine their contribution to their care. This will consider an individual’s regular income and their assets.

Under the scheme, the elderly are required to contribute 80 per cent of their income and 5 per cent of the value of their assets per annum. Income includes any salary, pension, social welfare benefits, rental income, dividends and interest from savings.

The first €36,000 of assets for a single person or €72,000 for a couple will be excluded from this calculation.

Assets include savings, shares and property, as well as any assets that have been disposed of in the five years before the application is made. If assets include land and property, the 5 per cent contribution can be deferred and collected from the person’s estate.

For couples, when one partner requires nursing home care, the financial assessment will be based on half of the couple’s combined income and assets.

If an applicant wants to include their home in the financial assessment, it will only be registered for the first three years spent in care, therefore payments against their home will be capped at 15 per cent.

Applicants will also need a care needs assessment. This will involve an examination by a HSE nurse who will test their ability to get washed, dressed and move around, and will determine whether or not they need long-term nursing home care.

The HSE has been given €55 million to cover the cost of the scheme this year. However, a waiting list will be implemented if there is an insufficient amount to cover all applicants.

If a person is unable to apply for the scheme in person, members of their family can apply to be their care representative by making an application to the circuit court and applying to be part of ‘Fair Deal’ on their behalf. The cost of the court process will be borne by the applicants themselves.

People who are already living in a public nursing home will continue to contribute to their care on the same basis as they have been. If a person is already resident in a private nursing home, they can continue with the existing arrangement or avail of the new scheme if they wish.


Concerns have been raised by opposition health spokespeople and nursing home officials.

Tadhg Daly, Chief Executive of Nursing Homes Ireland (NHI), has said that people need to be aware that the elderly will still be charged for day-today services.

‘‘This is not an all-in deal that covers every aspect of nursing home care. Many areas that members of the public might reasonably expect to be included are not,” he said.

Costs such as social programmes, physiotherapy, incontinence wear, transport and specialised wheelchairs will not be covered by the scheme.

Fine Gael Health Spokesman Dr James Reilly believes that people are starting to realise that “this isn’t a fair deal, it’s a raw deal.”

He has been contacted by constituents who are worried about the prospect of their land (which is not capped at 5 per cent over three years like the home) being used as an asset.

One scenario, according to Reilly, is: “If three siblings have been living on a farm all their lives and one gets Alzheimer’s and goes into care and stays for 12 years, when they die, their assets will not have been capped.”

He adds: “There is no cap on the land so that’s 60 per cent of that person’s share of the land. This would force the remaining family to sell the farm.”

The average cost of a public nursing home has increased from approximately €155 per week to €1,200 following the introduction of Fair Deal.

Reilly says these are “extraordinary prices”. He cites a Dublin hospice which now costs €3,000 per week as an example of how the Government intends to push up the prices of public nursing homes so that people will choose the cheaper private option and the public homes will close.

Residents are also being charged an extra €194 to pay for the inspection of nursing homes by the Health Information and Quality Authority (HIQA). NHI claimed that Health Minister Mary Harney told them to charge the costs to residents, rather than the nursing home provider.

Sinn Féin Health Spokesman Caoimhghín Ó Caoláin TD states that the Fair Deal scheme is “fundamentally flawed.”

He says: “Nursing homes are passing on to residents the levy they must pay to help fund HIQA’s inspection system. Earlier this year Minister Harney admitted this would happen and appeared to give it the green light, but the Minister of State Áine Brady has said the levy should be paid by nursing homes and not patients. However she has offered no means of protecting residents from this imposition and says it is a contractual matter between the private providers and the residents.”

Ó Caoláin concludes: “The Government has chosen to depend almost entirely on private providers for nursing home care for older people. The result is a lack of proper control on charges. Lack of support for older people in their homes, a situation set to be worsened by cutbacks, will push more people into nursing homes at much greater cost to the state.”

Accessible and affordable

Minister Harney has welcomed the scheme and said that its fundamental purpose is to make long-term nursing home care, “accessible, affordable and anxiety-free.”

She added: “Every person with need for residential care who applies for financial support will make a personal contribution to cost, strictly in accordance with their means. No one will be forced to sell or mortgage their home to pay for care. The families of care recipients will not be means tested or asked to contribute. The contribution related to house value is 5 per cent a year, capped at three years, but this contribution may be deferred for payment from the estate of the person.”

Between October and December over 3,000 applications were recieved by the HSE for the Nursing Homes support scheme. However less tha 400 applicants wanted a deferred loan secured against their home.

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