Nursig Homes Support Scheme
Cotets 1. Itroductio 2 2. Applyig for the Scheme 2 3. Care Needs Assessmet 4 4. Fiacial Assessmet 5 5. Nursig Home Loa ( Acillary State Support ) 8 6. Care Represetative 9 7. Next Steps Provisio of Support1 2 8. Reviews/Appeals1 3 9. Repaymet of the Nursig Home Loa1 4 10. Existig Nursig Home Residets1 7 11. HSE Nursig Home Support Offices1 9
1. Itroductio The is a ew scheme of fiacial support for people who eed log-term ursig home care. It replaces the Subvetio Scheme which has bee i existece sice 1993. Uder the, you will make a cotributio towards the cost of your care ad the State will pay the balace. This applies whether the ursig home is public, private or volutary. The scheme has a umber of steps ad these are set out i the rest of this booklet. Please ote that if you are residet i a ursig home before the ew scheme starts, you should read sectio 10 of this iformatio booklet carefully. 2. Applyig for the Scheme I order to apply for the scheme you must be ordiarily residet i the State. Ordiarily residet meas that you have bee livig i the State for at least a year or that you ited to live here for at least a year. Applicatios are made to your local Nursig Home Support Office o the stadard applicatio form. There are three steps to the applicatio process. Step 1 is a applicatio for a Care Needs Assessmet. The Care Needs Assessmet idetifies whether or ot you eed log-term ursig home care. Step 2 is a applicatio for State Support. This will be used to complete the Fiacial Assessmet which determies your cotributio to your care ad your correspodig level of fiacial assistace ( State Support ). 2
Steps 1 ad 2 must be completed by all applicats (if you are residet i a ursig home before the scheme starts please see sectio 10 for further iformatio). Step 3 is a optioal step which should be completed if you wish to apply for the Nursig Home Loa (this is termed Acillary State Support i the legislatio). The loa is explaied i sectio 5 of this booklet. The applicatio form should be completed ad siged by the perso applyig for ursig home care. However, i certai cases, aother perso may apply o their behalf as explaied below. Where a perso may eed care, ad because of ill-health, a physical disability or a metal coditio, is uable to make a applicatio for a care eeds assessmet, a specified perso may apply for a care eeds assessmet o their behalf. Where a perso has reduced ability to make decisios (i.e. dimiished metal capacity), the specified perso may also make the applicatio for State Support o their behalf. A specified perso is: a) If you are a ward of court, your Committee, b) A perso appoited uder a valid, registered edurig power of attorey who is ot restricted from applyig for the scheme, c) A care represetative appoited uder the Nursig Homes Support Scheme Act (see sectio 6 of this booklet), d) Your spouse or parter, e) A relative of yours who is 18 years of age or over, f) A ext fried appoited by a court, 3
g) Your legal represetative, or h) A registered medical practitioer, urse or social worker. The people listed at (a)-(c) have first priority over those listed at (d)- (h). This meas that they have the right to act as a specified perso ahead of the other categories. However, the people listed at (a)-(c) may coset i writig to a perso with lesser priority actig as the specified perso. Where a perso has reduced ability to make decisios ad wishes to apply for the Nursig Home Loa, oly the people listed at (a)-(c) above may make the applicatio (see sectio 6 of this booklet for further iformatio). 3. Care Needs Assessmet The Care Needs Assessmet idetifies whether or ot you eed logterm ursig home care. Its purpose is to esure that log-term ursig home care is ecessary ad is the right choice for you. The assessmet will cosider whether you ca be supported to cotiue livig at home or whether log-term ursig home care is more appropriate. The Care Needs Assessmet will be carried out by appropriate healthcare professioals, for example, a urse etc., appoited by the HSE. A assessmet may be completed at ay time i a hospital or a commuity settig such as your ow home. The assessmet will iclude cosideratio of the followig: your ability to carry out the activities of daily livig, e.g. bathig, shoppig, dressig ad movig aroud, the medical, health ad persoal social services beig provided to you or available to you both at the time of the carryig out of the assessmet ad geerally, 4
the family ad commuity support available to you, ad your wishes ad prefereces. Please ote that the assessmet may iclude a physical examiatio by a healthcare professioal. The results of the Care Needs Assessmet will be submitted to the HSE i the form of a report called a Commo Summary Assessmet Report or CSAR. Based o the report, the HSE must decide whether or ot log-term ursig home care is the most appropriate optio. Oce a decisio is made, you will be otified, i writig, withi 10 workig days. You will be give a copy of the Report ad the reasos for the decisio. You must be assessed as eedig ursig home care i order to be eligible for either State Support or the Nursig Home Loa. 4. Fiacial Assessmet The Fiacial Assessmet looks at your icome ad assets i order to work out what your cotributio to care will be. The HSE will the pay the balace of your cost of care. For example, if the cost of your care was 1,000 ad your weekly cotributio was 300, the HSE will pay the weekly balace of 700. This paymet by the HSE is called State Support. The Fiacial Assessmet looks at all of your icome ad assets. Icome ad assets: Icome icludes ay earigs, pesio icome, social welfare beefits/ allowaces, retal icome, icome from holdig a office or directorship, icome from fees, commissios, divideds or iterest, or ay icome which you have deprived yourself of i the 5 years leadig up to your applicatio. 5
Broadly speakig, a asset is ay material property or wealth, icludig property or wealth outside of the State. Withi the legislatio, assets are divided ito two distict categories, amely Cash Assets ad No-Cash Assets. Cash assets iclude savigs, stocks, shares ad securities. No-Cash assets iclude all forms of property other tha cash assets, for example a perso s pricipal residece or lad. I both cases, the assessmet will also look at assets which you have deprived yourself of i the 5 years leadig up to your applicatio. Details of icome ad assets are cotaied i the applicatio form for the scheme. If you are a member of a couple, the assessmet will be based o half of the couple s combied icome ad assets. For example, if a couple s icome was 600 per week, the assessmet of the perso eedig care would be based o 50% of 600, or 300. I other words, the perso eedig care would be cosidered to have a total icome of 300 per week. A couple is defied as (a) a married couple who are livig together or (b) a heterosexual or same sex couple who are cohabitig as life parters for at least three years. The assessmet will ot take ito accout the icome of other relatives such as your childre. Your Cotributio to Care Havig looked at your icome ad assets, the Fiacial Assessmet will work out your cotributio to care. You will cotribute 80% of your assessable icome ad 5% of the value of ay assets per aum. However, the first 36,000 of your assets, or 72,000 for a couple, will ot be couted at all i the fiacial assessmet. Where your assets iclude lad ad property i the State, the 5% cotributio based o such assets may be deferred ad collected from your estate. This is a optioal Nursig Home Loa elemet of the scheme which is legally referred to as Acillary State Support (see sectio 5 below). 6
Your pricipal residece will oly be icluded i the fiacial assessmet for the first 3 years of your time i care. This is kow as the 15% or three year cap. It meas that you will pay a 5% cotributio based o your pricipal residece for a maximum of three years regardless of the time you sped i ursig home care. After 3 years, eve if you are still gettig log-term ursig home care, you will ot pay ay further cotributio based o the pricipal residece. This three year cap applies regardless of whether you choose to opt for the loa or ot (see sectio 5). The three year cap will also exted to farms ad busiesses i circumstaces where: (i) the perso has suffered a sudde illess or disability which causes them to eed log-term ursig home care, ad (ii) the perso or their parter was actively egaged i the daily maagemet of the farm or busiess up util the time of the sudde illess or disability, ad (iii) a family successor certifies that he or she will cotiue the maagemet of the farm or busiess. This measure is iteded to esure the fiacial sustaiability of family farms ad busiesses i cases where a perso suffered a sudde illess ad did ot have a opportuity to put appropriate successio arragemets i place. Fially, there are importat safeguards built i to the Fiacial Assessmet which are worth otig. Nobody will pay more tha the actual cost of care. You will keep a persoal allowace of 20% of your icome or 20% of the maximum rate of the State Pesio (o-cotributory), whichever is the greater. If you have a spouse/parter remaiig at home, he/she will be left with 50% of the couple s icome or the maximum rate of the State Pesio (o-cotributory), whichever is the greater. 7
5. Nursig Home Loa ( Acillary State Support ) As outlied above, where your assets iclude lad ad property i the State, the 5% cotributio based o such assets may be deferred. This meas that you do ot have to fid the moey to pay this cotributio durig your lifetime. Istead, if approved, the HSE will pay the moey to the ursig home o your behalf ad it will be collected after your death. This is a optioal beefit of the scheme. It is effectively a loa advaced by the State which ca be repaid at ay time but will ultimately fall due for repaymet upo your death. Its purpose is to esure that you do t have to sell assets such as your house durig your lifetime. The legal term for the Nursig Home Loa is Acillary State Support. You may choose to apply for this elemet of the scheme at the date of iitial applicatio or at ay stage while residet i the ursig home. I order to apply for the Nursig Home Loa you must provide writte coset to havig a Chargig Order registered agaist your asset. If you are part of a couple, your spouse/parter must also request the paymet of the loa ad you must both coset to havig the Chargig Order registered agaist the iterest of you ad your spouse/parter i the asset. The Chargig Order is a simple type of mortgage which secures the moey loaed by the HSE. Subject to your coset, the HSE is resposible for makig the Chargig Order, registerig it agaist your asset ad makig Nursig Home Loa paymets to the ursig home o your behalf. You will ot eed to do aythig (although the HSE may eed to check with you about the iformatio i your applicatio). If a perso does ot have the capacity to coset to the Nursig Home Loa ad the Chargig Order, a Care Represetative will eed to be appoited to act o his/her behalf. A perso appoited uder Edurig Power of Attorey or the Committee of a Ward of Court ca also make a applicatio i such circumstaces (see sectio 6 below for full details). You may wish to cosider takig idepedet legal advice if applyig for the Nursig Home Loa ad you are free to do so. The repaymet of the Nursig Home Loa is dealt with i sectio 9 of this booklet. 8
6. Care Represetative Role of a Care Represetative A Care Represetative is oly required where a perso has reduced capacity to make certai decisios (i.e. dimiished metal capacity) ad wishes to apply for the Nursig Home Loa. The Care Represetative is appoited by the Circuit Court. Their role is to act o behalf of the perso i respect of the Nursig Homes Support Scheme ad especially i respect of the Nursig Home Loa. They ca also act o behalf of the perso i relatio to makig a applicatio for a Care Needs Assessmet, State Support, or ay other matter relatig to the scheme. The list of people who ca apply to be a Care Represetative is set out i the box below. Persos who ca apply for Appoitmet as a Care Represetative The followig persos, i order of priority, may apply to be appoited as a Care Represetative oce they are 18 years of age or over: 1. Your spouse/parter, 2. Your paret, 3. Your child, 4. Your brother or sister (whether of the whole or half blood), 5. Your iece or ephew, 6. Your gradchild, 7. Your gradparet, 8. Your aut or ucle, 9. A perso who appears to the court to have a good ad sufficiet iterest i your welfare, other tha - the ower of a ursig home i which you reside or are likely to reside, or a medical practitioer who examied you ad prepared a report for the Court i relatio to your capacity. 9
A perso is cosidered to be of dimiished metal capacity if, i relatio to a decisio o applyig for the Nursig Home Loa ad cosetig to the Chargig Order, he or she is uable: a) to uderstad the iformatio relevat to the decisio, b) to retai that iformatio, c) to use or weigh that iformatio as part of the process of makig the decisio, or d) to commuicate his or her decisio (whether by talkig, usig sig laguage, commuicatig through a third party or ay other meas). Two reports from two separate registered medical practitioers are required by the Court as evidece that a perso is of dimiished metal capacity. Your doctor may be able to assist you i obtaiig these reports. Procedure for Appoitmet as a Care Represetative The applicatio for appoitmet must be made to the Couty Registrar i ay couty i the Circuit i which the perso requirig a care represetative ow lives or i which he or she has lived at ay time durig the past three years. I order to make a applicatio, the followig documets must be lodged with the Circuit Court Office for the couty i which the applicatio is beig made. These are as follows: A documet called a Notice of Motio which must be addressed to the Couty Registrar A swor statemet called a Affidavit settig out the reasos for the applicatio; the affidavit should be swor before a Commissioer for Oaths or a practisig solicitor The two Medical Reports metioed above, which must be exhibited to (i.e. attached to) the affidavit prior to the swearig 10
Ay Cosets i writig to the applicatio received from persos with a equal or greater priority to be appoited as care represetative (please see order of priority listed i the box o page 9), which must also be exhibited to (i.e. attached to) the affidavit prior to the swearig. Templates of these documets are available o the Courts Service website (www.courts.ie). Firstly, all the documets (the Notice of Motio, the Affidavit, the attached Medical Reports ad Cosets) should be lodged together i the Circuit Court Office ad this ca be doe either i perso or by post. The Notice of Motio ad the Affidavit must be stamped i advace with the appropriate stamp duty. Iformatio o stamp duty is available o the Courts Service website. Whe the documets are received by the Circuit Court Office, the applicatio shall be listed before the Couty Registrar. Secodly, the perso makig the applicatio must also serve a copy of the Notice of Motio, together with a copy of the Affidavit ad the attached Medical Reports, o the perso i respect of whom the applicatio is beig made as well as o every perso with a equal or greater priority to apply for appoitmet to be the care represetative. The documets must be served persoally o the perso i respect of whom the applicatio is beig made. I every other case they may be served persoally or by registered post. Please ote that you do ot eed to serve copies of the documets o every perso with a equal or greater priority if the perso has already coseted i writig to the applicatio. Fially, the perso makig the applicatio must also serve a documet called a Reply o the perso i respect of whom the applicatio is beig made. I the Reply, the perso ca idicate whether or ot he or she objects to the appoitmet. The Reply should be set to the Couty Registrar seve days before the date o which the matter is to be listed. You do ot eed to obtai legal represetatio i order to be appoited as a Care Represetative. However, ayoe who wishes to seek legal advice/ 11
represetatio is free to do so. Exemptios to Requiremet for Appoitmet as a Care Represetative A Care Represetative is ot eeded i order to apply for the Nursig Home Loa i ay of the followig cases: Where the applicat is of full metal capacity. Where the applicat is a Ward of Court (i such cases the Committee of the applicat may apply where he/she has bee authorised to do so by the Presidet of the High Court). Where a perso is appoited uder a valid, registered Edurig Power of Attorey to act o behalf of the applicat ad is ot restricted by the terms of the Power of Attorey from applyig for the Nursig Home Loa. Where aother perso is already permitted by law to act o behalf of the applicat. 7. Next Steps Oce the Care Needs ad Fiacial Assessmets have bee processed the HSE will write to you. Firstly, it will advise you of your cotributio to care ad whether you are eligible for State Support. Secodly, if you have applied for the Nursig Home Loa, it will also advise you about your eligibility for this. Thirdly, it will provide you with a list of ursig homes to choose from. The list will iclude public ursig homes, volutary ursig homes ad approved private ursig homes. Approved private ursig homes are homes which have agreed the price charged for care with the Natioal Treatmet Purchase Fud ad are approved for the purposes of the scheme. You ca choose care i ay ursig home o the list. However, i order for fiacial support to be provided: 12
The home must have a place for you, ad The home must be able to cater for your particular eeds. The ursig home will have to carry out a assessmet to determie whether it ca meet your particular eeds. Your choice of ursig home is ot coected i ay way to the level of your cotributio to care. If you select a public or volutary ursig home, you will pay your cotributio to the HSE or volutary home as appropriate each week ad the HSE will pay the balace. If you select a approved private ursig home, you will pay your cotributio to the ursig home provider each week ad the HSE will pay the balace. The HSE is provided with a set level of fudig for the scheme each year. While it is hoped that there would be sufficiet fudig to support everyoe, there may be situatios where a perso s ame must go oto a waitig list util fudig becomes available. If this is the case the HSE will otify you whe it writes to advise you whether you are eligible for fiacial support. 8. Reviews/Appeals Reviews If the Care Needs Assessmet determies that you do ot require logterm ursig home care, you ca apply for a review. This ca be doe six moths after the previous assessmet or earlier if a) the HSE is satisfied that there has bee a material chage i your health or circumstaces or b) a registered medical practitioer states that there has bee a material chage i your health or circumstaces sice your last Care Needs Assessmet. If you are i receipt of State Support or the Nursig Home Loa, the HSE ca review, either at your request or o its ow iitiative: 13
your care eeds, your fiacial assessmet, or the amout of the Nursig Home Loa. Appeals Certai decisios of the HSE may be appealed withi 40 workig days of the origial decisio beig give to you. Decisios which may be appealed iclude: the result of your care eeds assessmet, the HSE s decisio ot to cosider a applicatio for State Support, the HSE s decisio ot to carry out a fiacial assessmet, the result of a applicatio for State Support, the result of a applicatio for the Nursig Home Loa, the result of a review. Appeals will be cosidered by suitable people who are appoited by the HSE with the coset of the Miister. The outcome of a appeal may be further appealed to the High Court o a poit of law. You may also take your case to the Office of the Ombudsma. 9. Repaymet of the Nursig Home Loa The purpose of the Nursig Home Loa is to esure that you do t have to sell assets such as your home durig your lifetime. If you opt for the Nursig Home Loa, it will become repayable: after your death, 14
if you sell or trasfer your property (if this occurs before your death), if you or your parter are deemed to be bakrupt, or if the HSE determies that it has bee give false/misleadig iformatio relatig to your applicatio for the loa. However, where the loa becomes repayable o your death, the repaymet of moies based o the pricipal residece oly ca be further deferred or postpoed i certai cases. This is called Further Deferral. Further Deferral There are some people who may qualify for a further deferral of the repaymet of the loa. This meas that the moey provided uder the Nursig Home Loa will ot have to be repaid durig their lifetime. These are: a) Your spouse or parter, b) Your child (or your spouse/ parter s child) if they are uder the age of 21 years or if their assets do ot exceed the asset disregard c) Your siblig if their assets do ot exceed the asset disregard, d) A relative i receipt of a disability or similar allowace, blid perso s pesio, or the State pesio (o-cotributory), or whose icome does t exceed the State pesio (cotributory), e) A relative who is i receipt of a foreig pesio or allowace similar to those outlied i (d) above, f) A relative who ows a buildig to which the pricipal residece is attached (e.g. a gray flat ), or 15
g) Ay perso who cared for a applicat prior to the latter eterig the ursig home (this is defied by referece to relevat social welfare paymets). The idividuals at (b)-(g) above are termed coected persos ad they must also satisfy the followig coditios: The asset i questio must be their oly residece, ad They must have lived there for ot less tha 3 years precedig the origial applicatio for the Nursig Home Loa, ad They must ot have a iterest i ay other property. The HSE should be cotacted for more iformatio i relatio to further Deferral. Repaymet of Loa to the Reveue Commissioers (Reveue) Whe the Nursig Home Loa falls due for repaymet, the HSE will write to the perso resposible for the repaymet (kow as the relevat accoutable perso ). It will otify them that the loa must ow be repaid ad advise them of the amout due. I doig this, the HSE will apply the Cosumer Price Idex to the loa to take accout of the time value of moey (i.e. iflatio or deflatio) sice the loa was made. The relevat accoutable perso is resposible for the repaymet ad may be a differet perso depedig o the circumstaces. For example, if you sell or trasfer your property durig your lifetime, you ad your spouse/ parter will be the relevat accoutable persos. O the other had, where the loa is repayable after your death, your persoal represetative will be the relevat accoutable perso. A perso who iherits the property or ay part of it ca also be held accoutable for repaymet of the loa. Moey owed uder the Nursig Home Loa must be repaid to Reveue. It should be repaid as soo as possible after otice is received from the HSE ad, i ay evet, withi the timeframes outlied i the blue box below. 16
Oce paymet is made withi these time limits, iterest will ot have to be paid. If the repaymet arises, for example, because of the death of the perso i care it must be repaid withi 12 moths of the date of death. Otherwise iterest will apply from the date of death. If the loa is repayable because of the sale or trasfer of your property durig your lifetime, it must be repaid withi 6 moths of the date of sale or trasfer, or iterest will apply back to that date. Where paymet has ot already bee received, the relevat accoutable perso will be advised by Reveue i advace of the 6 ad 12 moth paymet deadlies of the eed to pay o time so as to avoid payig iterest. 10. Existig Nursig Home Residets A commitmet has bee made that ayoe who is i a ursig home before the starts caot be made worse off by the scheme. If you are i a public or volutary ursig home or i a cotracted bed i a private ursig home before the start of the scheme, you ca cotiue with your existig arragemets. If you are i a approved private ursig home before the start of the scheme, you ca choose to trasfer to the Nursig Homes Support Scheme or you ca retai your curret subvetio arragemets. If you apply for the scheme ad have bee i the ursig home for three years or more, the fiacial assessmet will oly be based o icome ad assets other tha your pricipal residece (ad your farm/busiess i certai circumstaces), i.e. the three year cap will apply. 17
If you are i a approved private ursig home before the start of the scheme ad have bee payig the cost of care yourself, you may apply for the scheme or you ca cotiue to fud the complete cost of care. If you apply for the scheme ad have bee i the ursig home for three years or more, the fiacial assessmet will oly be based o icome ad assets other tha your pricipal residece (ad your farm/ busiess i certai circumstaces), i.e. the three year cap will apply. If you are i a private ursig home which is ot approved for the purpose of the scheme, you ca retai your curret subvetio arragemets or you ca opt to apply for the scheme ad chage to a ursig home o the list. Fially, if you are i a approved private ursig home before the start of the ew scheme, you do ot eed to apply for a Care Needs Assessmet. You ca commece the process by applyig for the Fiacial Assessmet. For Further Iformatio o the Scheme, please cotact your local HSE Nursig Homes Support Office, details are provided o the followig page. You ca also call the HSE ifolie 1850 24 1850 or visit www.dohc.ie or www.hse.ie. 18
11. HSE Nursig Homes Support Offices Your Nursig Homes Support Office is available to help you fill i the form or aswer questios about your applicatio. Whe you have completed this form, sed it to the Nursig Homes Support Office for your area: Carlow/Kilkey Cava/ Moagha HSE Nursig Homes Support Office, Commuity Services, James s Gree, Kilkey. Tel: 056 7784761 & 056 7784633 HSE Nursig Homes Support Office, St. Felim s Hospital, Cava. Tel: 049 436 0446/451/456 Cork/Kerry HSE Nursig Homes Support Office, Floor 5, 26 South Mall, Cork. Tel: 021 492 1842/43/44/45 Doegal Dubli South, Wicklow ad Kildare Dubli North City ad Couty Galway Laois/Offaly Limerick, Clare ad North Tipperary HSE Nursig Homes Support Office, Navey House, Navey Street, Ballybofey. Tel: 074 9189172 HSE Nursig Homes Support Office, Oak House, Milleium Park, Naas, Co. Kildare. Tel: 045 880400 HSE Nursig Homes Support Office, Civic Office, Mai Street, Ballymu, Dubli 9. Tel: 01 8467148 HSE Nursig Homes Support Office, Commuity Services, West City Cetre, Seamus Quirke Road, Galway. Tel: 091 548427/28/26 HSE Nursig Homes Support Office, Health Cetre, Arde Road, Tullamore, Co. Offaly. Tel: 057 9359625 HSE Nursig Homes Support Office, St. Joseph s Hospital, Mulgrave Street, Limerick. Tel: 061 461499 19
Logford/ Westmeath Louth Mayo Meath Roscommo Sligo/Leitrim Tipperary South Waterford Wexford HSE Nursig Homes Support Office, Health Cetre, Logford Road, Mulligar, Co. Westmeath. Tel: 044 9394995 HSE Nursig Homes Support Office, Commuity Care, Dubli Road, Dudalk. Tel: 042 9381344 HSE Nursig Homes Support Office, Couty Cliic, Castlebar. Tel: 094 9042261 HSE Nursig Homes Support Office, A Tealach, Commos Road, Nava. Tel: 046 9066272 HSE Nursig Homes Support Office, Commuity Services, Laesboro Road, Roscommo. Tel: 0906 637561 HSE Nursig Homes Support Office, Markievicz House, Barrack St, Sligo. Tel: 071 9155193 HSE Nursig Homes Support Office, Commuity Care Cetre, Wester Road, Clomel. Tel: 052 6177283 HSE Nursig Homes Support Office, Waterford Commuity Services, Cork Road, Waterford. Tel: 051 842963 HSE Nursig Homes Support Office, Wexford Commuity Services, Groga s Road, Wexford. Tel: 053 9123522 You ca read more about this scheme o www.hse.ie. Iformatio is also available from the HSE ifolie o 1850 24 1850, Moday to Saturday, 8am to 8pm 20