A person in need of extended care may apply to his or her local health board for admission to a public long-stay facility. Admittance to such a facility is based primarily on medical need. Alternatively, such a person may decide to seek care in a private nursing home and to apply for a subvention towards the cost of that care.
Charges for extended care in a public long-stay facility can be made under two sets of regulations, the first of which is the Health (Charges for In-Patient Services) Regulations 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations 1987. These regulations enable charges to be made towards the cost of providing hospital in-patient services for persons with income who have been in receipt of such services for more than 30 days or for periods totalling more than 30 days in the previous 12 months. The regulations provide that a charge is made at a rate not exceeding the person's income. Medical card holders and persons with dependants are exempt from these charges.
Charges may also be made under the Institutional Assistance Regulations 1965 where the patient receives "shelter and maintenance" rather than treatment. These charges apply from the date of admission and are payable by all patients who are in receipt of incomes, including medical card holders and persons with dependants. In deciding the amount to be contributed, health boards have regard to the person's individual circumstances. Allowance is made for any financial commitments the person may have and a reasonable amount is left to meet the person's personal needs. Charges may be waived if, in the opinion of the chief executive officer of the appropriate health board, payment would cause undue hardship.
The role of the health boards in private nursing homes as provided for in the Health (Nursing Homes) Act 1990 is twofold – first, to ensure high standards of accommodation in the homes and, second, to operate a subvention scheme towards the cost of nursing home care. Under the Nursing Homes Act health boards are empowered to pay a subvention where a person has been assessed on the grounds of means and dependency, as provided for in the Nursing Homes (Subvention) Regulations 1993 to 1998, which set down the requirements for this assessment. It is important to point out that, subject to a means test, a subvention will be payable only if they fulfil the dependency criteria laid down in the Subvention Regulations 1993.
With the exception of persons applying for subvention, following determination by the chief executive officer of a health board under Article 4.3 of the subvention regulations, a person must apply for a subvention prior to entering a private nursing home. Article 11.1 of the Nursing Home (Subvention) Regulations provide that a decision on payment and the amount to be paid must be advised to the applicant within eight weeks of the completed application. It is also open to a person to request that a board outline the charges to be imposed on a patient prior to admittance to a health board extended care facility.