The Nursing Home Support Scheme replaced the Subvention scheme from 27 October 2009. No new applicants will be accepted. People who are already getting a subvention can choose whichever scheme is to their advantage.
The rules for qualifying for a subvention were that 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, that is, you must pass a means test.
The means test
The means test described here applies only to people who continued on the subvention scheme after the Nursing Home Support Scheme was introduced on 27 October 2009. It takes into account the income of yourself and your spouse (or partner). It may also take account of your assets (but not those of a spouse or partner). Assets in joint names are assessed proportionately.
The means test involves looking at the income that you and your spouse (or 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 State Pension (Non Contributory) payable at the time. In effect, you must be allowed retain this amount, which is sometimes referred to as pocket money.
Farm or business income
Farm, Land or a Business is assessed where the applicant for subvention owns or has legal interest in the Farm, Land or Business.
The income from a farm or business is calculated on the basis of the previous year's accounts if they are available. If they are not, a notional assessment is made of the income.
In the case of a farm where there is an income but where accounts are not available for the previous financial year the total farm income, including headage payments, grants, rental income, etc. will be assessed, less current farm expenditure.
Where the farm or business is not being used, a notional income may be assessed, as above, but which also takes account of the capital value of the land or business.
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) 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 HSE may take into account any payment on transfer or any continuing income from the earnings of the farm.
The first €11,000 of any assets is not taken into account.
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. Illness Benefit. Invalidity Pension or State Pension (Non Contributory).
To assess the notional annual income of your house, the HSE takes 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. the HSE can only assess the value of your home for a total of three years.
Selling your home
If you sell your home, 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. This does not apply to the nursing homes subvention means test).
Refusal of subvention
The HSE may refuse to pay any subvention if either of the following apply:
- if your principal residence is valued at €500,000 (for properties in the Dublin area) and €365,000 (for the rest of the country) and your income is greater than the basic rate of State Pension (Non-Contributory) or
- the value of your assets (excluding your home) is greater than
Level of Subvention
No new applications for the subvention scheme were accepted after the introduction of the NHSS on 27 October 2009 when the maximum weekly subvention rate was €300.
If your means are less than the weekly rate of the State Pension (Non-contributory) payable at the time, the HSE may pay an extra subvention. If your only income is a State Pension (Non-contributory), your means are assessed, not at the full amount of your pension, but after a sum equivalent to one fifth of the State Pension (Non-contributory) is disregarded. So, you will be able to get higher than the maximum subvention.
If your means are higher than the rate of State Pension (Non-contributory) 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
There are circumstances in which the HSE may pay the full cost of a private nursing home bed. This is the case where the HSE 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 offers this arrangement.
In some circumstances the HSE may make an 'enhanced' payment. When considering an enhanced payment, the HSE will take account of the cost of care in the area, the availability of public beds, the means of the applicant and any other funds or assets that may be available to the applicant.
There is no entitlement to an enhanced subvention contribution; it is at the discretion of the HSE The availability of enhanced subvention is limited by the amount of funding available for the scheme.
When a person is being assessed for subvention, a sum equivalent to one fifth of the State Pension (Non-contributory) is disregarded. This is often referred to as "pocket money".
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.
If a major change occurs in your level of dependency or in your means, the Health Service Executive (HSE) 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 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 may increase or decrease the subvention or withdraw it or offer accommodation in a HSE 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 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 and 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. View information on tax relief on nursing home fees and for dependent relatives here.
If you are unhappy with a decision on your subvention, you may appeal to the Appeals Officer in HSE Consumer Affairs in your local area. 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.
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 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.