About Fair Deal - key information
What exactly is Ireland’s ‘Fair Deal’ scheme for nursing home care?
Fair Deal is the name given to the State’s Nursing Home Support Scheme (NHSS) which effectively finances long-term care for most of Ireland’s older people. It costs the State just over €1 billion each year. You can apply for financial support to help pay for the cost of care in a nursing home through the Fair Deal scheme.
You need to be approved for Fair Deal before you can receive funding for a nursing home. You can choose to pay privately for care while you wait for funding. Fair Deal funding can't be backdated and will only be paid from the date of approval.
How long will it take to get the approval of your admission to the Fair Deal Scheme?
At present the average waiting time is about four to six weeks but this can vary depending on the number of applications the HSE has at any one time and also based on individual circumstances. And most of all that waiting time starts when a full complete application is made on behalf of the person…. and it can take quite a while to pull all the information together, so the most important thing to do is to be:
(i) be proactive and
(ii) be thorough.
It is important to remember that if an individual was admitted to a nursing home from the community before the Fair Deal application was approved then the cost of the nursing home care will be borne by the older person or their family. The HSE will not cover it.
If the older person is admitted from a hospital the hospital may have access to a transitional care bed in a nursing home to which the older person can be admitted while the application is being processed. If there is no transitional care bed available then the hospital may apply for temporary funding from the local NHSS support office. This funding is not automatically given.
The older person or their representative should ask about this to make sure the hospital does apply for the funding otherwise the nursing home will simply bill the individual or their representatives.
It is possible to apply for the scheme before an individual enters the nursing home and in many ways this is preferable as it will give both the older person and/or their carer time to choose the nursing home that best suits their needs and to have the Fair Deal approval in place before they need to avail of nursing home care.
There are 3 stages to the Fair Deal Application process which must be undertaken in the order that follows:
Care Needs Assessment
Nursing Home Loan (optional)
The Care Needs Assessment
The first step that the applicant needs to do is an application for a Care Needs Assessment. The Care Needs Assessment identifies whether or not an applicant needs long-term 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 an 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:
The applicant's 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 the applicant 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.
The results of the Care Needs Assessment will be submitted to the HSE in the form of a report called a Common Summary Assessment Report (CSAR) or a Care Needs Assessment Report. Based on the report, the HSE decides whether or not long-term nursing home care is the most appropriate option. Once a decision is made, the applicant will be notified, in writing, within 10 working days.
The Applicant will be given a copy of the Report and the reasons for the decision. Where it has been decided by the HSE that an applicant does not need long term nursing home care, a person may not re-apply for a care needs assessment until 6 months after the initial application unless there has been a material change in the person’s health or circumstances.
Remember, you must be assessed as needing nursing home care by the HSE in order to be eligible for either State Support or the Nursing Home Loan.
The ‘Fair Deal’ Scheme – the financial rules
How does the scheme work financially?
People generally contribute up to 80% of their income towards the cost of their care and, depending on their level of income, and up to 7.5% of the value of any assets every year.
Where assets include land and property, the contribution based on these can be deferred until after death under a nursing-home loan. It is important to note that the 7.5% annual contribution from the asset value of the family home is only charged for three years, i.e. it is capped at 22.5%. Hence family members will retain a minimum 77.5% ownership of the family home in the worst possible scenario.
How does the Financial Assessment work?
The Financial Assessment mentioned above will determine what portion of the cost an individual pays. The financial assessment will look at the entire income of the individual or, if the individual is part of a couple, half of their combined income.
As part of the assessment process the individual is asked to list his or her assets, providing a valuation of each including property (home, property leased out, business premises, farm land etc.), cash (pensions, interest on bonds savings earned income). Failure to list any asset may lead to extra charges being levied later or may delay the application process.
An individual is allowed €36,000 and a couple are allowed €72,000 in savings, which is not assessed. The following deductions are also allowed against income:
Income tax, social insurance contributions and levies paid;
Where a person owns his or her principal residence, interest on loans for the purchase, repair or improvement of the principal residence;
Where a person rents their principal residence (i.e. is living in rented accommodation), rental payments in respect of the residence can be deducted where the person’s partner or a child (aged under 21) of the couple lives in the residence;
Some health expenses are allowed excluding contributions payable under the Nursing Homes Support Scheme;
Maintenance payments in respect of a child, spouse or former spouse made under a separation agreement or a court order.
If an individual has very limited financial means the State will either pay the full cost of the care or large proportion of it. There may be extra charges levied by the nursing home as well as expenses are not covered by the NHSS and to help meet these extra costs every resident is left with 20 per cent of their income.
Please note that siblings even if they live in the same household are treated as separate individuals.
What is the Nursing Home Loan (or Ancillary State Support?)
This phrase sometimes causes some confusion. The Nursing Home Loan (Ancillary State Support) is an additional support designed to ensure that people do not have to sell assets such as their home during their lifetime in order to meet their care costs.
The portion of the cost covered by the HSE is called ‘State Support’. If the individual wishes to defer the payment of their assessed portion of the cost they can do so by applying for Ancillary State Support. This is an optional extra feature of the Nursing Homes Support Scheme for people who own property/land based assets in the State. This avoids them having to liquidate assets to pay their share of the costs. It is a loan advanced by the HSE to you.
It is paid to help you meet the portion of your contribution to the cost of care that is based on Irish property/land based assets (i.e. land and property within the Irish State). This means the State pays both its own portion of the cost as well as the resident’s portion. The resident’s portion paid by the State is essentially a loan to the estate of the resident that must be repaid within a year of the resident dying or the value of the assets being realised.
Payment of the Nursing Home Loan (Ancillary State Support) by the HSE results in the creation of a charge (a simple type of mortgage) in favour of the HSE against the interest of the applicant and his/her partner in the asset(s) set out in this application. The HSE will notify the Property Registration Authority of the charge who will register it against the asset(s) specified in this application.
Where the home, farm, business or other asset is owned by more than one person, the HSE requests all joint owners to fill in Part 6B of this form.
The Nursing Home Loan (Ancillary State Support) may be applied for at any time, not just when entering into long-term nursing home care. Applications for the Nursing Home Loan may be granted by the HSE subject to the overall budget available to it.
What Fair Deal does not cover:
Fair Deal does not cover the following:
Short-term care such as respite, convalescent or day-care
Extra fees charged by the nursing home for services like hairdressing, therapies or activities