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Private Nursing Home Subvention

Information

People who go into registered private nursing homes in Ireland may get a subvention from the Health Service Executive (HSE) Area if they are dependent and if they pass a means test.

On 1 January 2005 all health boards in Ireland were abolished and replaced with Health Service Executive (HSE) Areas.These HSE Areas have now assumed responsibility for all former health board services.

The means test always takes account of your income and it may also take your assets into account.Your house may be taken into account and, if it is, there are specific rules about how it is treated, in keeping with the Nursing Home (Subvention) Regulations. The Health Service Executive (HSE) Area has considerable discretion in relation to how assets are treated for the purposes of assessing means.

The subvention is designed to help with nursing homes costs. It was not designed to meet the full costs. However, there are circumstances in which the HSE Area may pay the full cost of a private nursing home bed.This is the case where the HSE Area 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 Areas offers this arrangement.

There are "maximum" rates of subvention related to the level of dependency. However, these maximum payments may be increased in the case of contracted beds and "enhanced payments" may be made in other cases.

Rules

You must apply for a subvention before going into the nursing home, unless there is an emergency. If you go into a nursing home before you apply, you may not be allowed to apply for a subvention for 2 years, unless the Chief Officer of the HSE Area decides otherwise.

You must be told the result of your application within 8 weeks - there may be a delay if you do not supply all the relevant information. If you are refused a subvention or granted less than the maximum applicable to your level of dependency, 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, i.e., 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) Area 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 out 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) Area 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, what your level of dependency is and whether you should be offered accommodation in a HSE Area facility.

Levels of Dependency

Medium Dependency - this exists when your independence is impaired to the extent that you need nursing home care because the appropriate support and nursing care required cannot be provided in the community. Your mobility would be impaired to the extent that you would require supervision or a walking aid.

High Dependency - this exists when your independence is impaired to the extent that you need nursing home care but you are not bed bound. You may have a combination of physical and mental disabilities, may be confused at times and be incontinent. You may require a walking aid and physical assistance to walk.

Maximum Dependency - this exists when your independence is impaired to the extent that you require constant nursing care. You are likely to have very restricted mobility, need assistance with all aspects of physical care or be confused, disturbed and incontinent.

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). The means test is usually carried out by the Community Welfare Officer.

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 Old Age Non Contributory Pension payable at the time. In effect, you must be allowed to retain this amount, which is sometimes referred to as pocket money.

Farm or Business Income

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

The notional assessment of income from a farm involves imputing an income based on the letting value of the land, the asset value of the land, stock, crops, premium payments, buildings and machinery, etc.The regulations do not specify exactly how this assessment is to be done.

The notional assessment of income from a business involves imputing an income based on the assets of the business - the precise manner is not specified.

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) Area 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 health board may take into account any payment on transfer or any continuing income from the earnings of the farm.

The first 11,000 euro of any assets must be disregarded.

Your House

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, disability benefit, invalidity pension or Old Age Non Contributory Pension.

To assess the notional annual income of your house, the Health Service Executive (HSE) Area may take 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.

Selling Your House

If you sell your house, 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 - if you are eligible for an Old Age Non Contributory Pension, blind pension or a disability allowance and you sell your home in order to move into a nursing home or other more suitable accommodation, the amount of money obtained from the sale up to 190,461 euro is not taken into account in the social welfare means test.This does not apply to the nursing homes subvention means test).

Your Children's Income

When the nursing home subvention scheme was introduced in 1993, your subvention could have been reduced if it was considered that your children could contribute to the nursing home costs. An assessment of the income of any children living in Ireland was carried out.This arrangement ended on 1 January 1999.

So, your children's income is no longer relevant to the assessment of your entitlement to a subvention.

Of course, in many cases, children help towards the costs of a nursing home because the patient cannot afford to pay the charges, even with a subvention.That, however, is not the same as taking the children's income into account.

Refusal of Subvention

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

  • If your assets, excluding your house, are greater than 36,000 euro or
  • if the principal residence is valued at 500,000 euro or more (where the residence is located in the Dublin area) or 300,000 euro or more (where the residence is located outside the Dublin area) and is not occupied by any of the people outlined above, and your income is greater than 9,000 euro per year.

Level of Subvention

There are three "maximum" weekly rates of subvention, which are related to the assessed level of dependency:

  • Medium Dependency: 114.30 euro.
  • High Dependency: 152.40 euro.
  • Maximum Dependency: 190.50 euro.

These rates were set in April 2001.

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

If your means as assessed by the HSE Area are equal to or lower than the weekly rate of old age (non-contributory) pension payable at the time, the maximum rate appropriate to the level of dependency must be paid.

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

If your means are higher than the rate of old age (non-contributory) pension 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

A Health Service Executive (HSE) Area may make an arrangement with a private nursing home to care for a person who is entitled to a subvention. Instead of paying the "maximum" subvention, the HSE Area may make an enhanced payment or may pay the full cost of the bed.The issue of enhanced payments has arisen in situations where even with the maximum subvention, the family or individual cannot afford to meet the shortfall in costs of nursing home care and there are long waiting lists for public beds.

Article 22.3 and 22.4 of the Nursing Home (Subvention) Regulations make provision for the payment of 'enhanced subvention' in certain circumstances.There are no clear rules about who is entitled to get enhanced payments or a fully contracted bed.The making of enhanced payments and the contracting of beds are matters for each HSE Area (see 'Where to Apply' below).

Pocket Money

When a person is being assessed for subvention, a sum equivalent to one fifth of the old age (non-contributory) pension is disregarded. In this way, only four-fifths of a person's income is taken into account, the remaining one-fifth is available for the person's use and is often referred to as "pocket money".

Choice of Nursing Home

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

If you are not offered a HSE Area institution place, the HSE Area 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) Area 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 Area 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 Area may increase or decrease the subvention or withdraw it or offer accommodation in a HSE Area 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 Area 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 & 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.This is of use only for people who have an income above the tax exemption limit.

Tax relief for nursing home expenses is claimed under the general scheme for tax relief on certain medical expenses. Maintenance in a hospital or approved nursing home qualifies for relief and most nursing homes are approved for tax relief. You should contact your local tax office for further information on the tax relief available.

Appeals

If you are unhappy with a decision on your application for a subvention, you may appeal.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.

The appeals officer is appointed by the Minister of State with special responsibility for Services for Older People. (Part of the Department of Health and Children).

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 Area 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.

Where to Apply

Apply to your Health Service Executive (HSE) Area 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 the Chief Officer of your HSE Area. Each application is assessed on an individual basis and is at the discretion of the HSE Area.

This content is taken from the Oasis website. Oasis is an Irish eGovernment initiative www.oasis.gov.ie

A review of the Nursing Home Subvention Scheme is ongoing in the Department. The Department of Social and Family Affairs are continuing their work on the future financing of long-term care in Ireland, following on from a study of the same name commissioned by them and written by Mercer Ltd. Effective from December 14th 2005, the property threshold was raised from 95,230.36 euro to 500,000 euro (in the Dublin area) and 300,000 euro (outside of the Dublin area) and the assets criteria were also changed (as outlined above).The income level was raised from 6,348.69 to 9,000 euro per year. The weekly rates of subvention remain the same.