The Nursing Homes Support Scheme (NHSS), commonly known as the Fair Deal scheme, helps those who need it by contributing towards the cost of long-term care in private, voluntary or public nursing homes.
While you are required to make a contribution towards your care costs, the HSE will pay the difference between your contribution and the overall cost of care. This is essentially a loan that can be repaid at any time but is typically repaid upon the individual’s death from the sale of their assets.
Who Can Apply for the Scheme?
The eligibility criteria are straightforward. To qualify you must:
- Be an Irish citizen living in Ireland as your primary residence
- Require long-term nursing home care
- Own assets. Land or property are the most common assets considered, though other assets can be reviewed on a case-by-case basis
What Does the Fair Deal Scheme Cover?
The Fair Deal scheme covers the level of care appropriate to the applicant’s medical needs, including board, laundry services, accommodation and nursing care.
It also covers certain alternative therapies, activities and specific appliances needed to assist with day-to-day living.
If the applicant holds a medical card, this will ordinarily subsidise the cost of aids, appliances and GP visits. If they do not hold a medical card, these costs will need to be met elsewhere, typically by the individual or a family member. The nursing home will usually discuss this with the family directly, and in some cases invoices are sent straight to the family.
If someone close to you is entering care without a medical card, make sure the facility clearly outlines any costs you may be liable for.
Do I Pay the Same Contribution for the Duration of My Care?
Yes. As long as your circumstances remain the same, your contribution towards care will remain the same. However, the HSE retains the right to review both your care requirements and financial situation at any point.
What Happens if My Circumstances Change?
If your circumstances change, you have a legal obligation to notify the HSE within 10 working days. Changes that must be reported include changes to your health, the level of care required, and your financial situation, including if you or your spouse sell your home.
Failure to report changes to the HSE is a criminal offence and can result in prosecution and a fine.
What Proportion of My Estate Must Be Paid Back?
The amount repaid varies for each individual and depends on your net worth, property value and the level of care required.
Not all of your assets are taken into account. For a single person, the first €36,000 of their assets is excluded from the financial assessment. Similarly, the value of your home is not fully considered when calculating your ability to contribute.
For a couple, the first €72,000 of the main asset is excluded. So if your property is worth €172,000, the financial assessment would be based on a property value of €100,000.
The HSE cannot take more than 11.25% of your calculated property value.
Single Person: Three-Year Cap
For a single person, contributions from certain assets are capped at three years at 7.5%. These assets include your home, land, proceeds from the sale of your home, and any farm or business.
After three years, you will no longer need to contribute from these assets. Other assets may still be taken into account.
If you have already been in care for three years at the point of application, you will not be required to contribute from the value of your home.
If the NHSS grant applies to your home, a partner can opt to defer the loan until the end of their own lifetime, meaning they can continue living in the property until their death or until they themselves require long-term care.
Couples: Three-Year Cap
For couples, a contribution of 3.75% of the home’s value applies for three years. The total contribution over that period is capped at 11.25% of the property’s value.
As with single applicants, if you have already been in care for three years prior to an accepted application, you will not be required to contribute from the value of your main residence.
If both partners require long-term care, the total contribution from their combined assets is capped at 22.5% over three years.
How to Apply
The first step is to complete a paper application form, available from the HSE. The second step is to send supporting documents to your local Nursing Homes Support Office. These include:
- Most recent assessment from the Revenue Service
- RTB registration approval letter
- Rental agreement showing the rental amount
Even if you have not yet registered your property with the RTB, you may still be accepted for the 40% rate on home rental income. Contact the RTB directly for guidance, or register online at www.rtb.ie.
How Does the Application Process Work?
Once your paper application is complete, a two-phase assessment takes place.
The first phase assesses the level of care you require. The second is a financial review to value your assets, most commonly your home, and to calculate what contribution you should make towards your own care.
It is strongly advisable to obtain an independent valuation from a reputable property expert so that you can compare it against the valuation provided by the HSE. At Earnest.ie, we provide free property valuations for Fair Deal applicants.
How to Apply on Behalf of Someone Else
To apply for the scheme on behalf of another person, you must be appointed by the Irish Circuit Court. This person is known as a care representative.
What is a Care Representative?
A care representative is an individual empowered by the Irish Courts to apply for the NHSS on behalf of someone who lacks the mental or physical capacity to do so themselves. They are granted authority over that individual’s care and are responsible for making decisions on their behalf and completing all required paperwork.
A care representative is often a relative of the individual but can also be a court-appointed professional such as a social worker, GP or solicitor.
It is worth keeping an eye on developments in this area, as changes to the Assisted Decision Making legislation are likely to affect how this works going forward.
How Long Will it Take to Get the Fair Deal?
It is important to note that if a person is admitted to a care home before an application is submitted or approved, the HSE will not cover the cost of that care.
If a person is admitted to a nursing home from a hospital, a transitional bed may be available while the NHSS application is processed. If no transitional bed is available, the hospital can apply for temporary funding from the local NHSS office.
For applications made in advance, the timeline will depend on the individual circumstances of each applicant.
What Happens if I am Refused?
Applications are assessed against a set of key criteria. In the vast majority of cases, provided the eligibility criteria are met, around 98% of applications are accepted.
In the small number of cases that have been refused, it has typically been because the applicant was assessed as being able to afford the full cost of their care independently.
How to Appeal a Decision
When an application is received by the HSE, it is reviewed by a case officer who is empowered to make a decision on eligibility. Once a decision is reached, the HSE will write to you with the outcome and details of the appeals process.
If you are unhappy with the decision or believe an error has been made, you can visit your local appeals office to dispute it.
Fair Deal Scheme Advice from Earnest.ie
At Earnest.ie, we understand that decisions around long-term care are among the most difficult you will face. We are committed to helping our clients get the most from their assets so that they can make full use of the Fair Deal scheme while retaining as much value as possible.
We will value your home free of charge and, if you decide to sell, we will make the process as straightforward as possible.
If you would like advice on any of the topics covered in this article, contact Earnest.ie today.