CONTENTS 5. NURSING HOME LOAN ( ANCILLARY STATE SUPPORT )

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2 CONTENTS 1. WHAT IS FAIR DEAL 2. APPLYING FOR FAIR DEAL 3. CARE NEEDS ASSESSMENT 4. FINANCIAL ASSESSMENT 5. NURSING HOME LOAN ( ANCILLARY STATE SUPPORT ) 6. WHAT THE FAIR DEAL WEEKLY BED RATE COVERS 7. NEXT STEPS PLEASE NOTE that this is only intended to be a brief guide to the Scheme. For more detailed information, please refer to the Information Booklet available from the Department of Health. 1

3 ACKNOWLEDGEMENTS Co. Louth Citizens Information Service is funded and supported by the Citizens Information Board. While every effort has been made to ensure the information provided in this booklet is accurate and comprehensive, Co. Louth Citizens Information Service does not take any responsibility for any errors or omissions therein. 2

4 WHAT IS FAIR DEAL? The Nursing Homes Support Scheme, better known as Fair Deal. 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. For clarity, Fair Deal funding does not apply to Convalescent or Respite Care in a nursing home. The Health Service Executive (HSE) administers the Fair Deal Scheme within the resources available and in line with the Nursing Homes Support scheme (NHSS) legislation. It is provided with a set level of funding for the scheme each year. Applicants cannot avail of State funding for a nursing home place prior to receiving approval of their Fair Deal application. If you enter long-term care before funding is granted by the HSE you are liable for the full cost of that care. The great benefit this NHSS legislation affords potential nursing home residents is the opportunity to choose which nursing home they wish to reside in. You can also contact the local HSE Nursing Homes Support Office in Louth who will be available to help you fill in the form or answer questions about the application. Medical Social Workers will also assist people in hospital and their families in completing the form. When completed, send the form to: Louth/Meath HSE Nursing Homes Support Office, Unit 3 Ardee Business Park, Hale Street, Ardee. Tel: /529/525 3

5 APPLYING FOR FAIR DEAL Application forms are available from your local Nursing Home Support Office or you can download forms from: In order to apply for the scheme you must be ordinarily resident in the State. Once you complete and submit your application, each of the other steps will be initiated automatically. There are 2 steps to the application process and an optional 3rd step. Step 1: An application for a Care Needs Assessment. The Care Needs Assessment identifies whether or not you need long-term nursing home care. This assessment is typically undertaken by the relevant healthcare professional e.g. public health nurse and you may hear this assessment being referred to as CSARS. Step 2: 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. Step 3: 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). See section 5 for further details. Take care when completing the form. Applicants must provide accurate information about their financial affairs and ensure that all of the documents listed in the checklist have been attached. If applicants are sending documents with their application, photocopies of those documents are acceptable. There is no need to send original documents. 4

6 The application must be signed and sent to the HSE. If the applicant is unable to sign due to reduced capacity to make decisions (i.e diminished mental capacity), a care representative may sign on his/her behalf. Only a care representative who has been appointed by the Circuit Court, the Committee of a Ward of Court or Attorney appointed under an Enduring Power of Attorney can apply for the Nursing Home Loan on behalf of another person. For further information on care representatives, please refer to the Information Booklet from the Department of Health. CARE NEEDS ASSESSMENT Prior to the Care Need Assessment being carried out you must firstly apply for the Fair Deal Scheme. The HSE office will then make contact with the relevant local healthcare professional who in turn carries out the Care Needs Assessment. The Care Needs Assessment identifies whether or not you need long term nursing home care. 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 is a team approach carried out by appropriate healthcare professionals, for example, a nurse, occupational therapist, physiotherapist, 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. The family and community support available to you, and your wishes and preferences 5

7 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. You must be assessed as needing nursing home care in order to be eligible for either State Support or the Nursing Home Loan. 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. YOUR 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 of which you have deprived yourself 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 have a spouse or a partner living at home, the assessment will be based on half of the couple s combined income and assets. For example, if a couple s income 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. 6

8 Typical list of information required by the HSE for your Financial Assessment: DETAILS OF INCOME: Department of Social Protection pension / allowance / benefit Occupational Pension recent payslip, P60 or P21 Non-Irish pension Employment, trade, profession or vocation Rental income in Ireland or elsewhere Income from holding an Office or Directorship Income from fees, commissions, dividends, interest or income of a similar nature Payments under a settlement, covenant, estate or in respect of maintenance Income from royalties and annuities Income that was transferred from you to another person within the last 5 years Farming / business accounts in respect of previous year Any other income DETAILS OF CASH ASSETS HELD: Bank, Credit Union, Post Office, Other. DETAILS OF NON - CASH ASSETS: Property Land or valuables owned by you and your spouse or partner, whether within the state or outside. YOUR FINANCIAL CONTRIBUTION TO NURSING HOME CARE: Having reviewed your income and assets under the Financial assessment process, the HSE will work out your financial contribution to your 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. 7

9 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% (15% if application was made prior to the 25th July 2013) or three year cap. 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 your principal residence. This three year cap applies regardless of whether you choose to opt for the Ancillary State Support loan or not, (see section 5 for further details). FINANCIAL SAFEGUARDS: 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 joint income or the maximum rate of the State Pension (non-contributory), whichever is the greater, i.e. the person s spouse / partner who remains at home in the principal private residence must not be left with less than the maximum rate of the State Pension (non-contributory). 8 ANCILLARY STATE SUPORT NURSING HOME LOAN 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.

10 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. In order to apply for the Nursing Home Loan, you must provide written consent to having a Charging Order, registered against your asset (a Charging order is a simple type of mortgage which secures the money loaned by the HSE). Subject to your consent, the HSE will make the Charging Order, registering it against your property / land and making the Nursing Home Loan payments on your behalf. You will not need to do anything (although the HSE may need to check with you about the information in your application). You may wish to consider taking independent legal advice if applying for the Nursing Home Loan and you are free to do so. If a person does not have the capacity to consent to the Nursing Home Loan, a care representative will need to be appointed to act on their behalf. For further information on care representatives, please refer to the Information Booklet from the Department of Health and Children. WHAT THE FAIR DEAL WEEKLY BED RATE COVERS The weekly Fair Deal rate for Long Term Residential Care covers: Bed and Board. Nursing and personal care appropriate to the level of care needs of the person. Laundry service. Basic aids and appliances necessary to assist a person with the activities of daily living. If you are concerned regarding what is covered, discuss this matter with the nursing home chosen. 9

11 NEXT STEPS Once your 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 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 nursing homes are homes which have agreed the price charged for care with the National Treatment Purchase Fund (NTPF) and are approved for the purpose 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. If you select a public or voluntary nursing home, you will pay your contribution to the HSE or voluntary home, as appropiate, each week. The HSE will pay the balance regardless of the weekly bed rate by a particular nursing home with the NTPF. 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. 10

12 Quick Guide to Applying for the Nursing Homes Support Scheme Please note that this is only intended to be a brief guide to the Scheme. For more detailed information please refer to the Information Booklet from Dept. of Health APPLYING FOR THE SCHEME Application forms are available from your local Nursing Homes Support Office. The application process contains 2 steps and a 3rd optional step: Step 1 is an application for a Care Needs Assessment. Step 2 is an application for State Support. This will be used to complete the Financial Assessment which determines your contribution to care and your corresponding level of financial assistance ( State support ). Step 3 is an optional step which should be completed if you wish to apply for the Nursing Home Loan ( Ancillary State support ). The loan is explained in section 5 of this booklet. It is important to take care when completing the form. You must provide accurate information about your financial affairs and ensure that all of the documents listed in the checklist have been attached. The application form must be signed by the applicant and sent to the HSE. Where the applicant is unable to sign the form him/herself due to reduced capacity to make decisions (i.e. diminished mental capacity), a specified person may sign on his/her behalf. For further information on specified persons please refer to the Information Booklet from Dept. of Health. STEP 1: CARE NEEDS ASSESSMENT The Care Needs Assessment identifies whether you need long-term nursing home care. It will be carried out by healthcare professionals, for example, a nurse etc., and will consider whether you can be supported to continue living at home or whether long-term nursing home care is more appropriate. Please note that you must be assessed as needing long-term nursing home care to be eligible for State support or the Nursing Home Loan. 11

13 STEP 2: FINANCIAL ASSESSMENT The Financial Assessment looks at your income and assets in order to work out what your contribution to care will be. All of the relevant information will have been supplied on the initial application form. You will contribute up to 80% of your 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). 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. STEP 3: (OPTIONAL) APPLICATION FOR THE NURSING HOME LOAN Where your assets include land and property, 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 on your behalf and it will be collected by the Revenue Commissioners after your death. This is an optional benefit of the scheme called the Nursing Home Loan. In order to apply for the Nursing Home Loan you must provide written consent to having a simple type of mortgage, a Charging Order, registered against your asset. The HSE will make and register the Charging Order. You will not need to do anything (although the HSE may need to check with you about the information in your application). If a person does not have the capacity to consent to the application for the Nursing Home Loan/the creation of a Charging Order, a Care Representative will need to be appointed to act on their behalf. For further information on Care Representatives please refer to the Information Booklet from Dept. of Health. CHOOSE YOUR NURSING HOME The HSE will provide you with a list of nursing homes. This list will include public, voluntary and approved private nursing homes. You can choose care in any nursing home on the list, subject to the following conditions: The home must be able to cater for your particular needs, and must have a vacancy at the time of your application. Once you have chosen your nursing home, you will pay your contribution to the nursing home and the HSE will pay the balance of the cost of care. 12

14 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 on to a waiting 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. Louth/Meath HSE Nursing Homes Support Office, Unit 3 Ardee Business Park, Hale Street, Ardee. Tel: /529/525 County Louth Citizens Information Centre are funded and supported by the Citizens Information Board. Dundalk Citizens Information Centre 3 6 Adelphi Plaza Long Walk Dundalk Tel: Drogheda Citizens Information Centre 86 West Street Drogheda Tel: