Q&A: Am I due a nursing home fees refund over late Fair Deal application?

My mother is in a care home since 2013 and we are very happy with her care. We became aware of her right to the Fair Deal scheme last October. Our daughter brought it to our attention.

We applied for and were granted the Fair Deal scheme by the HSE in Tullamore promptly, within weeks. It is a considerable help in covering our mother’s care costs.

In recent years, the care home costs had risen considerably, and we had to subvent the extra required above our mother’s pension income.

The care home write that they have no responsibility in the matter. The HSE in Tullamore state they have no input on any matter before the date of application for the scheme is made. My query is, has our mother a claim for refund of the extra paid due to our delayed application?

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We were never informed from any source of our mother’s right to assistance in this matter until our daughter did so last October.

Ms R.O’D.

Anyone who reads this column regularly will know that I am a big fan of Fair Deal. It’s not perfect, and many families are now finding that they are being asked to pay additional sums over and above the Fair Deal rate to have their relatives accommodated in private care homes but, for most families, it gives them access to professional nursing home care for their loved ones with financial peace of mind.

While the nursing homes will certainly have a case when they argue that the current rates do not meet the actual cost of care, the scheme does constitute a significant financial investment by the State. And given the age profile of the population, it is one that is going to become more important in the coming years.

[ Review of Fair Deal income exemptions to consider ‘unintended consequences’ ]

But it is not an automatic entitlement. Most nursing homes in my experience will ask when you apply for a place whether you plan to fund it under Fair Deal or privately, but I’m not aware that they are obliged to do so and it may be by way of mention in passing rather than outlining what it is in detail. Clearly there is an awful lot of information that families are digesting when they are dealing with nursing home care for the first time, so it is understandable they might miss such things.

And as nursing homes generally stand to do better financially if paid privately, , you can see why they wouldn’t necessarily be hammering the issue home repeatedly with families. However, I can tell you from my more recent experience that the issue was raised several times up to and including confirmation of the contract. I obviously cannot state that that experience is universal.

Nursing home costs are among the most generously accommodated in the income tax code

The bottom line is that Fair Deal is not an automatic entitlement. It is something that a nursing home resident or their family – whoever is meeting the cost – needs to actively seek.

It may not even make financial sense for certain families who have significant assets. But it does make sense to apply for it. For those who do, the HSE is obliged to let you know whether, having crunched the figures, they determine that you would actually pay more under the Fair Deal formula governing income and assets than you would going privately.

In any case, both the nursing home and the HSE office in Tullamore are absolutely correct. They have no role to play in relation to Fair Deal unless and until you actually apply for it.

And if, like you, you apply and are granted the subsidised cover, there is no liability on either the home or the HSE to refund any monies billed before approval. It is quite common that a family will secure a nursing home place for a loved one and only then start the Fair Deal process. This is understandable as, for some people, the move into nursing home care can be sudden and not necessarily planned, but there is no retrospection.

The rules of the scheme state specifically that the State, under Fair Deal, shall not be liable for any costs incurred before approval of a Fair Deal application comes through – a process that can take six weeks or even more.

[ Nursing home residents will be able to keep all rental income under Fair Deal reform ]

So, no, your mother has no claim for the extra monies that were paid due to the delayed application.

However, it is worth exploring whether she – or whoever was actually paying the bills – can claim back some of the cost from the taxman. You do say that some of the cost had to be subvented by other family members.

Nursing home costs are among the most generously accommodated in the income tax code. Where other medical costs are only allowed at the standard 20 per cent income tax rate, nursing home costs are allowable at a person’s marginal, or higher rate – so up to 40 per cent.

For what it is worth, that also applies for those nursing home residents who are on Fair Deal but who are having to pay a premium on top of that for the nursing home bed, an increasingly common occurrence certainly in Dublin.

It is worth remembering in all this – as you clearly do in your letter – that the really important thing is that your mother has been well cared for

Yes, getting the tax relief will involve your mother – or whoever else has paid towards the nursing home costs until now – filing a tax return, but there is nothing really to be feared in that. It is a fairly standard process and one that I expect will soon become compulsory for all taxpayers. If your mother is not in a position to do that herself, whoever is managing her affairs can do so.

Even better, whoever has contributed to the nursing home costs can apply for tax relief not just for this year but for the four years previous – ie any expenses incurred since 2019.

Unfortunately, you won’t be allowed go back further than that, so there is no chance of recovering any of the cost incurred by the family between 2013 when your mother first went into nursing home accommodation and the end of 2018.

[ Can it make more sense to pay privately for nursing home fees? ]

It would be trite to say that the money is not important. However, it is worth remembering in all this – as you clearly do in your letter – that the really important thing is that your mother has been well cared for. All too often we only hear when things go wrong with eldercare. So it is important to remember how critical it is to find care that suits your mother and with which you as a family are happy.

Please send your queries to Dominic Coyle, Q&A, The Irish Times, 24-28 Tara Street Dublin 2, or by email to dominic.coyle@irishtimes.com. This column is a reader service and is not intended to replace professional advice