The Nursing Homes Support Scheme (NHSS), commonly referred to as A Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.
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.
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. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same 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. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.
Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.
Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaints procedure of the private nursing home concerned.
