What exactly is the Republic’s Fair Deal scheme?

Fair Deal is the name given to the State’s Nursing Home Support Scheme which effectively finances long-term care for most older people. It costs the State just over €1 billion each year.

How does the scheme work?

People generally contribute 80 per cent of their income towards the cost of their care and 7.5 per cent of the value of any assets every year. Where assets include land and property, the contribution based on these can be deferred until after death under a nursing-home loan. The 7.5 per cent annual contribution from the asset value of the family home is charged only for three years.

What problems have arisen with the scheme?

It was established in 2009 with a budget capped annually. Given the growing number of older people, the scheme has on occasion run out of money, leading to waiting lists for approval for a nursing home place. This sometimes forces people to stay longer than necessary in hospitals, leading to overcrowding there.

Separately, farm families are unhappy that the three-year cap on the 7.5 per cent contribution does not apply to them. Forcing a person to pay a portion of the farm’s value indefinitely affects the ability of young people to take over the family business, they say.

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Private nursing home owners are also unhappy. The scheme covers public and private homes but because public homes are more expensive to run, they are paid an average of 66 per cent more than private homes.

Finally, many experts have argued that the lack of a statutory home care scheme means many older people are being forced into nursing home care due to a lack of supports to continuing living in their own homes.

How have these problems been addressed?

The scheme has received injections of extra cash to cut waiting lists, which stand at four to six weeks. A longer-term solution will require more money to be invested by the exchequer but also possibly by people needing care. However, this would be politically contentious.

Reforms to the rules applying to farmers have been under consideration for some time and the heads of a Bill proposing changes was brought before Cabinet on Tuesday.

The cost disparity between public and private homes, due in part to the fact that many public nursing homes are in older buildings, remains a live issue for private operators. Plans are being drawn up for a statutory home care scheme, but this is unlikely to become a reality for some years.