Gary Gannon (Dublin Central, Social Democrats)
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1069. To ask the Minister for Health the measures in place to ensure that the financial assessments and contributions required of individuals in nursing homes under the fair deal scheme are fair and just, given the concerning financial situation faced by some elderly residents in nursing homes availing of the scheme; and if he will make a statement on the matter. [44214/24]

Mary Butler (Waterford, Fianna Fail)
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Introduced in 2009, The Nursing Homes Support Scheme (NHSS), commonly referred to as ‘Fair Deal’, is a system of financial support for people who require long-term residential care. It is unique in Europe in that it is a fair, single, unified system for funding and making long-term residential care more accessible.

Fair Deal is specifically designed to support residents, based on an individual’s means, and that people are cared for in the most appropriate settings. By making nursing home care more affordable, the scheme has increased access to necessary care for many older adults.

NHSS participants contribute to the cost of their care according to their means while the State pays the balance of the cost. Since the scheme was introduced over 300,000 people have availed of Fair Deal.

Participants within the NHSS contribute up to 80% of their income (40% if part of a couple) and 7.5% per annum of the value of their assets (3.75% if part of a couple). The first €36,000 (€72,000 if part of a couple) is excluded from assessment. The value of a person's principal residence is only assessed for contributions for their first three years on the scheme. This is known as the three-year cap, which is intended to protect the value of a principal private residence, along with the other safeguards built into the Financial Assessment which ensure that:

•Nobody will pay more than the actual cost of care;

•A participant will keep a personal allowance of 20% of their income or 20% of the maximum rate of the State Pension (Non-Contributory), whichever is the greater, and;

•If a participant has a spouse or partner remaining at home, they will be left with 50% of the couple’s income or the maximum rate of the State Pension (Non-Contributory), whichever is the greater

A participant will only pay contributions for the amount of time they actually spend in care. Data from HSE indicates that, on average, NHSS residents cover around 30% of their cost of care, with the state covering the remaining 70%. This proportion is based on the assessment of residents' assets and income, rather than on the cost of providing their care, and has remained stable over recent years.

This means that the same set of criteria is used to calculate the contribution to the cost of care, therefore the cost to the person will be the same regardless of whether a person resides in a private/voluntary nursing home or a publicly-run Community Nursing Unit, In circumstances where the calculated contribution to the cost of their own care exceeds the cost of care provision, the person is ineligible to receive funding under the scheme.

The NHSS covers the cost of the standard components of long-term residential care which are:

•Nursing and personal care appropriate to the level of care needs of the person;

•Bed and board;

•Basic aids and appliances necessary to assist a person with the activities of daily living; and

•Laundry service.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. Under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Home Support Scheme.

A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home.

Participants who own property/land-based assets in the State also have access to Ancillary State Support, or the Nursing Home Loan, an optional feature of the Fair Deal Scheme. It is a loan advanced by the HSE to help people meet the portion of their contribution to the cost of care that is based on property/land-based assets, most typically against the personal residence. If an individual secures ancillary state support, they will not need to contribute against the value of the relevant property during their time on the scheme, unless the property is sold during that time.

The NHSS currently supports about 23,500 people. Around 80% of those are supported in private nursing homes, with the remainder in public HSE-run facilities (both systems are funded through the NHSS). I have secured year-on-year funding increases for Fair Deal that has seen the budget increase from €968 million in 2019 to €1.223 billion for 2025.

Effective from 1 February 2024, nursing home residents can retain 100% of the income accrued from renting the principal private residence. In previous iterations of the scheme, rental income was assessed at the same rate as other income, and since November 2023 assessed at a reduced rate of 40%.

It should be noted that this provision will only apply to income generated from rental of the principal private residence; any rental income received from a property which is not from a principal residence will continue to be treated as general income and assessed at 80%.

In addition, the commencement of the Nursing Homes Support Scheme (Amendment) Act 2021 includes an amendment in relation to applying the 3-year cap to the proceeds of sale of a house while a resident is in long-term care.

This addresses the first relevant commitment in the Housing for All Strategy (action 19.7).

The 2021 Act now extends the 3-year cap to cover the proceeds of sale, so that a person will be able to sell their home without incurring additional fees from their fourth year in long-term residential care onwards. This applies even if the home is sold before 3 years in care; the proceeds of sale will be assessed up to the 3-year point, but excluded from assessment after that.

The Act also extended the three-year cap on contributions based on farm and business assets where certain conditions are met. The goal of this amendment is to assist in protecting the viability and sustainability of family farms and family-run businesses.

Gary Gannon (Dublin Central, Social Democrats)
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1070. To ask the Minister for Health to provide an update on any reforms being considered to the fair deal scheme to address the financial challenges faced by families, particularly considering situations where miscommunication or administrative errors have led to financial distress; and if he will make a statement on the matter. [44215/24]

Stephen Donnelly (Wicklow, Fianna Fail)
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As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.