The Fair Deal scheme explained: what you pay and what the State pays

The Nursing Homes Support Scheme, known as Fair Deal, is how the State helps pay for long-term nursing home care. The HSE runs it. You pay a set amount each week based on your income and assets, and the HSE pays the rest of the home's weekly price. It applies to approved public, voluntary and private nursing homes.

Your contribution is the same whichever approved home you choose. If you're assessed to pay €400 a week, you pay €400 whether the home charges €1,100 or €1,500. The HSE pays the difference.

To apply you must be ordinarily resident in Ireland, which means you have lived here for at least a year or intend to, and you must be assessed as needing long-term nursing home care.

According to Citizens Information, Fair Deal covers:

• accommodation and food ("bed and board")
• nursing and personal care suited to the person's needs
• laundry
• basic aids and appliances needed for everyday living

It does not cover:

• short-term care such as respite, convalescence or day care
• extra charges a home makes for things like activities, hairdressing or therapies

GP visits and medicines are usually covered through the medical card or the Drugs Payment Scheme rather than through Fair Deal. Extra charges can add a lot to the weekly bill, so read our guide to the full costs, including extras.

The HSE's financial assessment looks at your assessable income (your income minus allowed deductions such as tax, USC, health expenses and interest on a loan for your home) and your assets. If you're single, you pay:

• 80% of your assessable income, and
• 7.5% a year of the value of your assets, both cash assets (savings, shares, approved retirement funds) and non-cash assets (your home, land, other property, a farm or business)

The first €36,000 of your assets is not counted. It comes off your cash assets first and then off property. The 7.5% is a yearly figure, so it is divided by 52 to give a weekly amount.

Safeguards

• You never pay more than the actual cost of your care.
• You keep a personal allowance of 20% of your income, or 20% of the maximum State Pension (Non-Contributory) if that is more.
• A spouse or partner still living at home is left with 50% of the couple's income, or the maximum State Pension (Non-Contributory) if that is more.

Gifts and transfers

Assets and income you gave away in the 5 years before you apply still count, as do any you transfer after applying. You must tell the HSE about them.

Renting out your home

Since 1 February 2024, if you rent out your own home (your principal private residence) while you're in care, you can apply to have all of that rental income left out of the assessment. Rent from any other property counts as income in the usual way.

For a married couple, or a couple who have lived together as partners for at least 3 years, the assessment uses half of your combined income and assets. In practice the person going into care pays:

• 40% of the couple's combined assessable income
• 3.75% a year of the couple's combined assets

The first €72,000 of combined assets is not counted. In the HSE's example, a couple with €800 a week, €100,000 in savings and a €200,000 home would pay €484.42 a week: €320 from income, €20.19 from savings and €144.23 from the home.

Your home is only counted for your first 3 years in care. After that it drops out of the assessment automatically and your contribution goes down. You don't need to do anything. So the most you can pay based on your home is 22.5% of its value (7.5% a year for 3 years), or 11.25% for one member of a couple. If both partners are in care, the combined cap is 22.5%.

• If you sell your home while you're in care, the money from the sale also qualifies for the 3-year cap. Tell your nursing homes support office within 10 working days of any sale.
• If you had already been in a nursing home for 3 years when you apply, you pay nothing based on your home.
• All other assets, such as savings, count for as long as you're in care.
• The cap applies whether or not you take out the Nursing Home Loan.

Farms and family businesses

A family farm or business can also get the 3-year cap, but you must apply for it in Part 6 of the form. The main conditions are that a family successor commits to running it for at least 6 years, that you, your partner or the successor actively ran it for at least 3 of the last 5 years, and that the HSE places a charge on it. Since 23 September 2024 more relatives can act as successor, including great-nephews, great-nieces, first cousins and their children. The cap only runs from the date the HSE appoints your successor, and it can't be backdated.

See the HSE's page on the 3-year cap on homes, farms and businesses for the evidence it asks for.

1. Fill in the application form from the HSE's How to apply page. Forms are also available in hospitals and primary care centres. Send it with the documents it lists (bank, pension and social welfare statements, a property valuation) to your local nursing homes support office. Missing documents are the most common cause of delay.
2. Care needs assessment. A healthcare professional, such as a public health nurse, geriatrician or occupational therapist, assesses whether long-term nursing home care is needed. This can happen in hospital or at home. The HSE writes with its decision and a copy of the report.
3. Financial assessment. The HSE works out your weekly contribution and writes to confirm it, then sends a separate letter confirming funding approval.
4. Nursing Home Loan (optional). If you have property in Ireland you can ask to defer the part of your contribution that comes from it. See our guide to the Nursing Home Loan.

If the person can't apply themselves, a "specified person" can apply for them: in order of priority, a decision-making representative appointed by the Circuit Court, an attorney under an enduring power of attorney, a ward of court's committee, then a spouse or partner, an adult child, or a doctor, nurse or social worker. There's no charge to apply.

• You can choose any approved home, as long as it has a place and can meet your care needs. The home will do its own assessment first.
• In a private home you pay your contribution to the home and the HSE pays the rest. In a public or voluntary home you pay your contribution to the HSE.
• You can ask for a new financial review 12 months after your last one. The HSE can review it at any time.
• If a care needs assessment says long-term care isn't needed, you can reapply after 6 months, or sooner if your health changes. You can appeal any decision within 40 working days.
• After the person dies, their personal representative must send the HSE a schedule of assets at least 3 months before distributing the estate.

The maximum weekly price for each private and voluntary home is agreed with the National Treatment Purchase Fund (NTPF), which negotiates on behalf of the State. The HSE publishes these prices, and the costs of public homes, as lists we show on every home's page. For questions about your own application, phone HSE Live on 1800 700 700 or contact your local nursing homes support office.