Michael Cahill (Kerry, Fianna Fail)
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1321. To ask the Minister for Health to urgently examine the case of a fair deal claim (details supplied); to lend assistance; and if she will make a statement on the matter. [48860/25]

Kieran O'Donnell (Limerick City, Fine Gael)
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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.

Participants contribute to the cost of their care according to their means, while the State pays the balance of the cost. Fair Deal is specifically designed to support residents, based on an individual’s means, and ensures 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.

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. Assets assessed include cash assets as well as non-cash assets such as the principal private residence, other property and land, including farmland.

Transferred assets and income, defined as assets or income transferred to another person up to five years before a person's application to the scheme, are also assessed.

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.

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.

The NHSS currently supports about 24,000 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). Year-on-year funding increases for Fair Deal have been secured that has seen the budget increase from €968 million in 2019 to €1.223 billion for 2025.

Under the Nursing Homes Support Scheme Act (2009), responsibility lies with the HSE to consider each individual Fair Deal application and accept it or reject it on the basis of legislative and operational guidelines. It is important that applicants and their representatives continue to engage with the HSE and their Local Nursing Home Support Office.

I am precluded by the provisions of Section 10B of the Health Act 2004 (as inserted by Section 6 of the Health Service Executive (Governance) Act 2013) from directing the Health Service Executive (HSE) as regards any function of the HSE relating to the provision of treatment or of a health or personal social service to any particular person, or as regards any decision whether or not a particular person is eligible for a particular health or personal social service or the extent to which and the manner in which a person is eligible for such a service.

Under the Health Act 2004, the day-to-day operational responsibility for the management and delivery of health services is a matter for the HSE.

In conjunction with the HSE how Fair Deal's operates is continually analysed and the Department of Health currently has no plans to review the scheme. Nevertheless, the Department of Health consistently seeks to identify improvements and introduce enhancements to Fair Deal, where feasible, which aims to ensure that long-term nursing home care is sustainable, accessible and affordable for everyone and that people continue to be cared for in the most appropriate settings.