Going from hospital to a nursing home: the admission process

Many moves into a nursing home start in an acute hospital. After a fall, a stroke or a long illness, the medical team may decide the person no longer needs hospital treatment but can't safely go home either. From then on things can move quickly, and families are often asked to choose a nursing home within days.

It helps to know two things early. First, if someone stays in hospital after they no longer need acute care, they can be charged for long-term care in that hospital. Second, Fair Deal funding is only paid from the date it's approved. So Citizens Information's advice is to apply for Fair Deal as soon as long-term care looks likely, without waiting for a discharge date.

• The medical social worker is usually your main contact. They can help with the Fair Deal form, explain funding, and talk to nursing homes.
• The discharge coordinator or bed manager organises the move and may know which homes have beds.
• The consultant and ward nurses can explain the person's care needs, such as dementia care, mobility, feeding or wound care. You'll need this information when you phone homes.

1. Apply for Fair Deal from the ward. Hospitals have the application form. If the person can't sign it themselves, a spouse or partner, an adult child, or a doctor, nurse or social worker can apply as a "specified person". See our Fair Deal guide.
2. Care needs assessment. In hospital this is normally done by the team caring for the person, and it confirms whether long-term nursing home care is needed. The HSE writes with its decision and a copy of the report.
3. Financial assessment. The nursing homes support office works out the weekly contribution from the income and asset documents you send. Missing documents are the most common cause of delay.
4. Choose homes and check for a bed. Start phoning before funding is approved, because good homes often have waiting lists. Each home will want to assess the person, often on the ward or from their notes, to make sure it can meet their needs.
5. Funding approval and admission. State support starts from the approval date or the admission date, whichever is later.

In a limited number of cases, the HSE pays for a stay in a private nursing home while the Fair Deal application is being processed. This is called transitional care funding. It's meant to free up hospital beds, so it's arranged by the hospital, ideally while the person is still an inpatient. It can also fund a short convalescent stay before someone returns home.

• Ask the medical social worker early whether the person is likely to be approved, and for how long.
• Ask what, if anything, you'll pay during the transitional stay, and what happens if Fair Deal is delayed.
• Funding is limited, so approval isn't guaranteed. Keep the Fair Deal application moving either way.

See our guide to respite and transitional care for more on short stays.

You can choose any approved nursing home that has a place and can meet the person's needs. If your first choice is full, the HSE says you can go to another home for now and ask to transfer when a place comes up. That's often the realistic option when a discharge is urgent.

• Start with homes close to the family who will visit most. Our search lists every home by distance from a town or Eircode, with its Fair Deal price and phone number.
• Save homes to your shortlist and send one enquiry to all of them at once, then follow up by phone.
• Read the latest HIQA inspection report for each home. See how to read a HIQA report.
• Ask for the schedule of extra charges before accepting a place. See the full costs guide.

More tips for moving fast are in choosing a home at short notice.

The Fair Deal form lists everything needed. Start collecting these straight away:

• PPS number, and proof of age and address
• Recent bank, credit union and post office statements for every account
• Pension statements (State, occupational and any foreign pensions) and social welfare payment details
• A valuation of the home and any other property or land
• Details of any gifts or transfers of money or property in the last 5 years
• Details of loans, health expenses and other allowable deductions
• Enduring power of attorney or court appointment, if someone is acting for the person

Questions about the form can go to your local nursing homes support office or HSE Live on 1800 700 700.