A motion calling for the immediate reform of the Fair Deal Nursing Home Support Scheme was successfully carried by 51 votes to 48 in the Dail last Thursday, June 1, despite Fianna Fail’s decision to abstain.

The motion was brought forward by the Rural Independent Group in a bid to remove “clear inequality and discrimination” in how the scheme applies to farming families and the self-employed.

The scheme has a budget of €940 million for 2017 and is expected to provide support to just over 23,600 people by the end of the year. Applicants should not spend more than four weeks on the placement list for funding, according to the Department of Health.

Commenting on the victory for farmers, independent TD Mattie McGrath said: “This demonstrates that the motion we placed before the House represented a clear pathway toward fundamental reform of the Fair Deal Scheme in line with a more just and equitable assessment method.

Farming families and the self-employed can now be absolutely assured that the Dail has mandated for a greater degree of certainty and clarity to be introduced with respect to a reduced charge on the farm/business assets which protects the future viability of the farm/business asset for future generations.

Farming groups have spent years campaigning for changes to the scheme, but what are the exact details as they currently stand?

Specifics of the Fair Deal Scheme

Administered by the Health Service Executive (HSE), it is designed to provide financial assistance to people who require long-term residential care services whereby the person in care makes a contribution to the cost and the state pays the balance.

To avail of support, people must make an application for a Care Needs Assessment, which identifies whether or not they require care. If so, they can apply for support and a financial assessment will be carried out to determine the person’s financial contribution and the level of assistance they will receive from the state.

The financial assessment takes account of income – including pension, social welfare, rental income, and dividends or interest – and assets, which are defined as “any material property or wealth” including those outside the country. Eligible applicants will contribute 80% of their assessable income and 7.5% of the value of their assets per year.

The first €36,000 on assets for an individual, or €72,000 for a couple, are not included in the financial assessment. Furthermore, the 7.5% contribution from land or property owned in the country can be deferred and later collected from the estate under the Nursing Home Loan element of the scheme.

This means people do not have to release cash from their assets in order to pay, but allows the state to recoup the funds once the assets have been sold-off after death.

There is a three-year cap on payments from the principal residence. That means people pay a maximum of 22.5% on the value of their home, regardless of the amount of time spent in care. One of the main safeguards of the scheme is that no one pays more than the actual cost of care, and that people retain a personal allowance of 20% of their income or 20% of the maximum rate of the State Pension (non-contributory), depending on which is higher.

Once the person is advised of their contribution to care and their eligibility for state support, they will be provided with a list of nursing homes to choose from. This will include public, voluntary and private facilities. Private nursing homes are only acceptable where they have agreed the price charged for care with the National Treatment Purchase Fund and are approved for the purposes of the scheme.

Reforms for fairness

Industry pundits point out that many farm families are reluctant to access the scheme over fears that it will erode the value of their businesses. Under the rules of the scheme, the farm will be subject to a financial assessment for up to five years after it has been transferred to another person. Farming groups would like to see this reduced to three years.

They would also like clarity on the definition of ‘sudden illness or disability’ in a provision allowing for a three-year limit on non-residential assets. Currently, farm families are concerned they will be disqualified from the three-year cap if they care for their loved one at home.

Chairman of the Irish Farmers’ Association’s (IFA) Farm, Family and Social Affairs Committee Maura Canning said: “There needs to be a broadened interpretation of ‘sudden illness or disability’ to include those who have been cared for at home for a short period, but subsequently require care in a nursing home.

The scheme must not act as a disincentive to farm families looking after loved ones at home.

The financial assessment has been described as “fundamentally unfair” because the contribution to the cost of long-term care is the same for a farm valued at €1 million as for a farm valued at €4 million, all else being equal.

The IFA would like 75% relief applied to the value of the farm asset in order to protect the “family farm model”, bringing the cost of care to around €18,750, compared to a current amount of an estimated €42,400.

Making a change

Despite recent changes to the head of government, McGrath is committed to ensuring the reforms accepted in the Dail are implemented. He said: “During our motion debate, Minister of State Helen McEntee explicitly accepted that the scheme is indeed discriminatory and that it cannot continue without significant reform.

“While we believe that the issue should have been addressed long before now, we accept the bona fides of Minister McEntee’s commitment to this issue – a commitment that we want to see ring-fenced and implemented regardless of any leadership changes in the Fine Gael party. This matter goes to the heart of a sustainable and just rural economy.

“Farm families and the self-employed deserve nothing less than complete parity of esteem and fair treatment when it comes to sourcing and financing their nursing home support.”