• The Nursing Homes Support Scheme, also known as the “Fair Deal”, provides financial support to people who need long-term nursing home care

• To make nursing home care “Affordable, Accessible and Anxiety Free”

• The scheme is operated by the Health Service Executive (HSE).

• Under this scheme, you make a contribution towards the cost of your care and the State pays the balance.

• Resident Choice -once approved the resident chooses where they wish to live be it private nursing homes, voluntary nursing homes or public nursing homes.

Nursing Home Support Scheme (Fair Deal)

Application to HSE on the standard application form. There are 3 steps in the application process: •Step 1 is an application for a Care Needs Assessment. The Care Needs Assessment identifies whether or not you need long-term nursing home care, that is, whether you can be supported to continue living at home or whether long-term nursing home care is more appropriate. •Step 2 is an application for State support. The information that you give will be used to complete the Financial Assessment which decides how much you contribute to your care and how much State support you get. The Financial Assessment looks at your income and assets in order to work out what your contribution to the cost of your care will be. The HSE will then pay the balance of your cost of care. This payment by the HSE is called State support. All applicants must complete Steps 1 and 2.

Fair Deal – Steps 1 and 2

Step 3 is an optional application for the Nursing Home Loan, that is, if you want to defer paying the part of your contribution which is based on your home or other property. The application form should be completed and signed by the person who is applying for nursing home care. However, in certain cases, another person, called a Specified Person may apply on their behalf

Fair Deal – Nursing Home Loan

The Care Needs Assessment will be carried out by appropriate healthcare professionals appointed by the HSE, for example, a nurse. It can be completed at any time in a hospital or a community setting such as your own home. The assessment will take into account: •Your ability to carry out the activities of daily living, for example, bathing,

shopping, dressing and moving around •The medical, health and personal social services being provided to you or available to you both at the time of the carrying out of the assessment and generally •The family and community support available to you •Your wishes and preferences When the Care Needs Assessment has been completed a report will be prepared. Based on the report, the HSE decides whether or not long-term nursing home care is the most appropriate option.

Fair Deal – Care Needs Assessment

The Financial Assessment looks at your income and assets in order to work out what your contribution to care will be. Your contribution to care - Having looked at your income and assets, the Financial Assessment will work out contribution to care. A person will contribute:

•80% of their income and •7.5% of the value of any assets per annum (5% if the application was made before 25 July 2013) However, the first €36,000 of assets, or €72,000 for a couple, will not be counted at all in the Financial Assessment. Where assets include land and property, the 7.5% contribution based on such assets may be deferred, this is known as the Nursing Home Loan.

Fair Deal – Financial Assessment

Principal residence will only be included in the financial assessment for the first 3 years of a person’s time in nursing home. This is known as the 22.5% or ‘three-year cap' (the cap is 15% for applications made before 25 July 2013). It means that you will pay a 7.5% contribution based on your principal residence for a maximum of 3 years regardless of the length of time you spend in nursing home care. In the case of a couple, the contribution based on the principal residence will be capped at 11.25% (7.5% for applications before 25 July 2013) where one partner remains in the home After 3 years, even if you remain cared for in a nursing home, you will not pay any further contribution based on the principal residence. This ‘three-year cap’ applies regardless of whether you choose to opt for the Nursing Home Loan or not.

Fair Deal – Financial Assessment

Resident Choice -once approved the resident chooses where they wish to live be it private nursing homes, voluntary nursing homes or public nursing homes

Fair Deal – Resident Choice

Included under Fair Deal: • Bed and Board; • Nursing and personal care appropriate to

the level of care needs of the person; • Bedding; • Laundry service; and; • Basic aids and appliances necessary to

assist a person with the activities of daily living

Not included under Fair Deal: • Daily delivery of newspapers; • Social programmes, therapies; • Toiletries • incontinence wear • Chiropody; • Dry cleaning; • Ophthalmic and dental services; • Transport (including care assistant costs); • Specialised chairs; seating cushions and

mattresses • Hairdressing and other similar services • Wound dressings • Medical services and medications for

those who do not have a medical card

Fair Deal – what’s included and not included?

• When applying for the Nursing Home support scheme , keep a copy of all documentation you send in with your application

• Only contact the Nursing Home support Scheme Offices after 2pm.

• Contact them once a week to ascertain what progress has been made and if any further supporting documentation is required.

• Write a list of what is important to you for your life in a nursing home .

• Make appointments with a variety of homes , view them and discuss your needs with the person in charge

• Make a list of your top 10 nursing homes and put your name down on their waiting list

Practical Issues

Home Care Option

Excellent Homecare in South Dublin

Overview of Content

Needs assessment – when Homecare is deemed a viable option

Steps involved in arranging Homecare

How care plans are created and what support levels are available

Cost of homecare – scenarios including tax relief

Questions

When is homecare viable?

Homecare like Nursing Home Care is primarily focused on maintaining the dignity, safety and quality of life of the individual.

We respect the choice of each individual to maintain the independence and lifestyle to which they are accustomed, in a manner that is appropriate to their health and wellbeing.

We work with clients, their families and multidisciplinary teams to determine the care and support that will achieve this aim.

Only by knowing all the facts can the best outcome decision be agreed for each individual.

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What services do we provide

Care and support around normal everyday living Companionship Personal Care Assistance with mobility and exercise Medication reminders Housekeeping and household tasks Shopping Meal planning and meal preparation Specialist Alzheimer’s and Dementia Care Convalescence care on discharge from Hospital Respite or relief care End of Life Care

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Steps involved in arranging homecare

1. Initial conversation – usually by phone

2. Care Consultation - Nurse Care Manager will offer advice and resource information and assess risks to health and wellbeing. Normally takes place in the home, or in the hospital / Nursing Home. Family members encouraged to attend.

3. We develop a Care Plan which includes carer responsibilities, proposed weekly schedule and potential cost.

4. Carer introduction. A lot of thought is given to the most “match”

5. Ongoing review and quality assessments

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Developing the Care Plan

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The client is always at the centre of the Care Plan – they must be happy and in agreement with the plan. Where the clients mental capacity is compromised then family members and healthcare professionals are consulted. The initial plan will involve a regular schedule of visits, days and times and a start date are agreed. The care plan will be designed to address health needs of the client with companionship and personality matching automatically prioritised. The care plan may be modified at any stage and is continuously reviewed to match the needs and wishes of the client. Every care plan is individually designed.

Homecare Scenario 1

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Summary of

Situation

Care Plan

weekly cost

before tax

relief

weekly cost

after tax

relief

Currently: 2 X €22.90 X 2 days €92 €54

"Mary" is aged 78 and lives with her husband in Dun Laoghaire. Mary has Vascalar Dementia,

worsened in the past year, and had been suffering from some falls around the time her family

contacted us. Mary's family was referred to us by Carew House.

The need was for Respite for Mary's Husband so that he could confidently leave the house a few

times per week.

Currently: 2 hours homecare, 2 mornings per week Tue and Thu.

Cost of Homecare

Homecare Scenario 2

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Summary of

Situation

Care Plan

weekly cost

before tax

relief

weekly cost

after tax

relief

Initially: 4 hours per day X €22.90 X 7 days €641 €378

After a few weeks: 2 hours per day X €22.90 X 5 days €229 €135

Currently: 1 X €22.90 X 5 days €115 €68

Cost of Homecare

"Maureen" is aged 81 and lives with her husband. Maureen suffered a fall in at home March 2014 and

broke her Left Hip. Repair carried out and Maureen spent 2 weeks in the Beacon Hospital, and then

convalesced in Newtown Park Nursing Home. Initially Marueen's mobility was severely reduced and

she required the assistance of 2 carers while using gutter frame. Maureen has very fragile skin and

the integrity of her pressure areas has been highly compromised since her illness.

Initially: 2 hours morning, 1 hour lunch, 1 hour evening X 7 days.

After a few weeks: 1 hour morning, one hour evening, Mon - Fri.

Currently: 1 hour mornings Mon - Fri

Homecare Scenario 3

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Summary of

Situation

Care Plan

weekly cost

before tax

relief

weekly cost

after tax

relief

Live-in: 4 X 24 hour shifts X €220 / €230 €890 €525

Homecare Package: 9 hours per week €0 €0

"Frank" is an 84 year old man, separated, living alone, 4 adult Children living abroad. "Frank" has

Parkinson’s disease which affects his mobility and puts him at risk of falls. He normally uses 2

crutches or a frame when mobilising, or a buggy when out independently. Need help with

showering / dressing / meal preparation and most Activities of Daily Living. Needs help getting out

of his apartment and communicating with people.

After an initial period with different Care Plans, Frank's Care settled down to 4 X 24 hour shifts of live-

in care (Thursday - Sunday), augmented by 9 hours from HSE Home Care Package spread across 3

days.

This arrangement minimised the cost to the client by taking advantage of Home Care Package.

Currently: 4 X 24 hour live-in shifts Thu - Sun; + 9 hours Home Care Package

Cost of Homecare

Thank You. Any Questions?

Fair Deal Scenario 1

First 3 Years in Nursing Home: Year 4 onwards:

1 Contribution from Pension: 80% X €300 = €240 pw 1 Contribution from Pension: 80% X €300 = €240 pw

2 Deferred charge (from value of house) 2 Deferred charge (from value of house) nil

500,000

-36,000 allowance

464,000 X 7.5% = €34,050 per annum = €655 pw

3 HSE "State Support" (not repayable) €305 pw 3 HSE "State Support" (not repayable) €960 pw

€1,200 pw €1,200 pw

Widow on pension of €300 per week; Owns her own house worth

€500,000

Cost of Nursing Home = €1,200 per week

Maximum payable from estate

3 years X 52 X €655 = €102,180

Fair Deal Scenario 2

First 3 Years in Nursing Home: Year 4 onwards:

1 Contribution from Pension: 80% X (€500/2) = €200 pw 1 Contribution from Pension: 80% X (€500/2) = €200 pw

2 Deferred charge (from value of house) 2 Deferred charge (from value of house) nil

1,200,000

-72,000 allowance

1,128,000 /2 X 7.5% = €42,000 per annum = €813 pw

3 HSE "State Support" (not repayable) €337 pw 3 HSE "State Support" (not repayable) €1,150 pw

€1,350 pw €1,350 pw

Couple on joint pension of €500 per week; Own their own house worth

€1,200,000. Cost of Nursing Home for husband only = €1,350 per week

Maximum payable from estate

3 years X 52 X €813 = €126,828

Fair Deal Scenario 3

First 3 Years in Nursing Home: Year 4 onwards:

1 Contribution from Pension: 80% X €500 = €400 pw 1 Contribution from Pension: 80% X €500 = €400 pw

2 Deferred charge (from value of house / assets) 2 Contribution from assets of €120,000

900,000 house (excluding primary residence)

120,000 savings / shares 120,000 savings / shares

-36,000 allowance -36,000 allowance

984,000 X 7.5% = €73,000 per annum 84,000 X 7.5% = €6,300 per annum

= €1,419 pw €800 pw = €121 pw €121 pw

3 HSE "State Support" (not repayable) nil pw 3 HSE "State Support" (not repayable) €679 pw

€1,200 pw €1,200 pw

Widow with pension of €500 per week; Owns her own house worth

€900,000 + savings and shares worth €120,000.

Cost of Nursing Home = €1,200 per week

Maximum payable from estate

3 years X 52 X €800 = €124,800