Under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care. However, it was never intended that subventions would meet the full costs involved. Apart from contracts entered into under article 22.3 of the Nursing Home (Subvention) Regulations, 1993, which allows a health board enter into an arrangement with a private nursing home, the placement of a person in a private nursing home and the fees charged is a private arrangement between the nursing home and the individual resident.
The Nursing Homes (Subvention) Regulations, 1993, are administered by the health boards and the Eastern Regional Health Authority. There are currently three maximum rates of subvention payable, €114.28, €152.37 and €190.46, in accordance with three levels of dependency, medium, high and maximum, which are eligible for subvention. The First Schedule of the Nursing Home (Subvention) Regulations, 1993, sets out the general rules to be followed by all health boards in assessing the level of dependency of an applicant for a nursing home subvention and the Second Schedule sets out the general rules to be followed in assessing the means of an applicant. "Means" for the purposes of these regulations are the income and the imputed value of assets of a person in respect of whom a subvention is being sought and the income and imputed income of his or her spouse. Means are assessed for this scheme to ensure that the available funding is directed at those older people who have the greatest need of financial assistance.
A health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Home (Subvention) Regulations, 1993, permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for the health board concerned in the context of meeting increasing demands for subventions within the board's revenue allocation as notified annually in the letters of determination. This is in keeping with the provisions of the Health (Amendment) (No. 3) Act, 1996.
