S.I. No. 227/1993:

NURSING HOMES (SUBVENTION) REGULATIONS, 1993.

NURSING HOMES (SUBVENTION) REGULATIONS, 1993.

The Minister for Health, in exercise of the powers conferred on him by Section 7 of the Health (Nursing Homes) Act, 1990 (No. 23 of 1990) hereby makes the following Regulations:

1. These Regulations may be cited as the Nursing Homes (Subvention) Regulations, 1993.

2. These Regulations shall come into operation on the first day of September 1993.

3. In these Regulations:--

"the Act" means the Health (Nursing Homes) Act, 1990 (No. 23 of 1990),

"circumstances" for the purpose of these Regulations is the capacity of a son and/or daughter, aged twenty one years and over residing in the jurisdiction, of a person who has qualified for a subvention to contribute towards the cost of nursing home care of his or her parent,

"contract of care", means the contract of care within the meaning of articles 7.1 to 7.3 of the Nursing Homes (Care and Welfare) Regulations, 1993,

"dependency" refers to the level of physical or mental dependency of a person applying for a subvention, in accordance with the meaning given to "dependent person" in Section 1 (1) of the Act,

"designated officer" means an officer of a health board authorised by the chief executive officer of a health board or of a person acting as deputy chief executive officer of a health board in accordance with Section 13 of the Health Act, 1970 to carry out functions under the Act and these Regulations,

"health board" in relation to a nursing home, means a health board within the meaning of the Health Act, 1970 (No. 1 of 1970),

"means" for the purposes of these Regulations are the income and the imputed value of assets of a person in respect of whom a subvention is being sought and the income and imputed income of his or her spouse,

"the Minister" means the Minister for Health,

"person in charge" means the person in charge of the care and welfare of patients in a nursing home,

"nursing home" means a nursing home registered in accordance with Section 4 of the Act,

"responsible health board" means the health board in whose functional area the person, in respect of whom a subvention is being sought, ordinarily resides,

"registered proprietor" has the meaning given to it in Section 1 (1) of the Act,

"subvention" means a payment payable by a health board under Section 7 of the Act and these Regulations.

4.1 With the exception of persons referred to in articles 4.2, 4.3 and 4.4, an application for a subvention shall be made to the responsible health board by or on behalf of a person prior to his or her admission to a registered nursing home.

4.2 A person who is resident in a registered nursing home on the date of commencement of these Regulations or a person acting on his or her behalf may make an application for a subvention to the responsible health board.

4.3 A person who commences residence in a registered nursing home after the date of commencement of these Regulations, and who has not made an application for a subvention prior to his or her admission to the registered nursing home as specified in article 4.1, may not apply for a subvention sooner than two years from the date of his or her admission, unless the chief executive officer of the health board determines otherwise.

4.4 A person who is admitted to a nursing home in emergency circumstances or a person acting on his or her behalf, may apply to the responsible health board for a subvention provided that the health board is satisfied that the person needed to be admitted as a matter of emergency and that the registered proprietor or person in charge had no option but to admit the person at that time.

4.5 On receipt of an application for a subvention in respect of any person, the responsible health board shall make arrangements for the carrying out of an assessment of the dependency and the means and circumstances of the person to whom the application refers, as provided for under these Regulations.

5.1 An applicant for a subvention shall furnish on request to the responsible health board all relevant information as regards the means and dependency of the person in respect of whom a subvention is being sought to enable the health board to make a determination as regards his or her qualification for a subvention.

5.2 A health board may refuse to consider an application for a subvention unless the relevant information has been supplied by the applicant to enable the health board make a determination as regards qualification for a subvention.

6.1 A person in respect of whom a subvention is being sought shall not qualify for a subvention unless the responsible health board is of the opinion that the person to whom the application refers is:--

(i) sufficiently dependent to require maintenance in a nursing home, and

(ii) unable to pay any or part of the cost of maintenance in a nursing home.

7.1 The responsible health board in assessing the level of dependency of a person who has applied for a subvention or on whose behalf an application has been made, shall follow the procedures as set out in the First Schedule to these Regulations to determine whether a person is sufficiently dependent to require maintenance in a nursing home and if so, to which of the three levels of dependency set out in the First Schedule the person's level of dependency corresponds.

7.2 For the purpose of establishing the dependency of a person in respect of whom a subvention is being sought, a designated officer of a health board may request information, conduct interviews and carry out an examination of the person.

7.3 Nothing in article 7.2 authorises any person other than a designated officer who is a medical practitioner to inspect any medical record relating to a person in respect of whom a subvention is being sought.

7.4 Nothing in article 7.2 authorises any person other than a designated officer who is a registered medical practitioner, a registered nurse, an occupational therapist or a chartered physiotherapist to carry out an examination of a person in respect of whom a subvention is being sought.

8.1 A health board, in assessing the means of the person in respect of whom a subvention is being sought, shall do so on the basis of the calculation of means in the Second Schedule to these Regulations.

8.2 A health board in assessing the means of an applicant for a subvention under these Regulations shall disregard income equivalent to one fifth of the weekly rate of the Old Age Non-Contributory Pension payable at the time, such sum to be retained by the person for his or her own personal use.

8.3 For the purpose of establishing the means of a person in respect of whom a subvention is being sought, a designated officer of a health board may request information and conduct interviews with the person and his or her spouse and child or children, if any.

9.1 Having decided that a person qualifies for a subvention, a health board may take into account the circumstances of the person qualifying for the subvention in accordance with the provisions of the Third Schedule to these Regulations.

9.2 For the purposes of establishing the circumstances of a person who has qualified for a subvention, a designated officer of a health board may request information and conduct interviews with the person or his or her spouse and a son and/or daughter aged twenty one years and over.

10.1 The maximum rates of subvention payable in respect of each of the three levels of dependency of persons assessed as requiring maintenance in a nursing home shall be as set out in the Fourth Schedule to these Regulations.

10.2 A health board, in calculating the rate of subvention to be applied in respect of a person whom it has determined as qualifying for a subvention shall base its decision on the level of dependency of that person as assessed in accordance with the First Schedule to these Regulations.

10.3 A person whose sole means as assessed by the health board is a sum equivalent to or lower than the weekly rate payable at the time of the Old Age Non-Contributory Pension shall qualify for the maximum amount of subvention per week set out in the Fourth Schedule to these Regulations which is appropriate to the level of dependency of the person as assessed by the health board in accordance with the First Schedule to these Regulations.

10.4 A health board, in calculating the amount of the subvention to be paid to a person who is not resident in a nursing home, may abate the maximum rate appropriate to that person's level of dependency by no more than the amount by which the person's means and circumstances have been assessed by the board as exceeding the rate of the Old Age Non-Contributory Pension payable at the time.

10.5 A health board, in calculating the amount of subvention to be paid to a person who was resident in a nursing home on the day the Act is commenced or who applied for a subvention in accordance with article 4.3, may abate the maximum rate appropriate to that person's level of dependency by an amount in addition to the amount which that person's means and circumstances have been assessed by the board as exceeding the rate of the Old Age Non-Contributory Pension, by reference to the actual payments payable by or on behalf of the person to the nursing home on the day the Act is commenced, in the case of persons resident in a home on that date, or at the time the application for the subvention is made in the case of persons applying for a subvention under article 4.3.

10.6 If the means and circumstances of an applicant are assessed by a health board as less than the weekly rate of the Old Age Non-Contributory Pension payable at that time, the health board may pay an amount in addition to the maximum rate of subvention appropriate to his or her level of dependency not exceeding the weekly rate of the Old Age Non-Contributory Pension payable at the time.

10.7 If a health board makes a payment to a person in accordance with article 10.6 a sum equivalent to one fifth of the weekly rate payable at the time of the Old Age Non-Contributory Pension shall be allowed for his or her personal use.

10.8 The Minister may adjust the rate of subvention from time to time following the commencement of the Act taking into account the general movement in prices or other relevant factors and may vary the maximum payable rate in respect of any level of dependency.

10.9 The Minister may vary from time to time the rules for the assessment of means in the Second Schedule to these Regulations taking into account the general movement in prices or other relevant factors.

10.10 The amount of the subvention to be paid by a health board in respect of a person shall be calculated per diem.

11.1 A health board shall inform the applicant in writing within eight weeks of the receipt of the application, or, if all the information sought has not been provided with the application, within eight weeks of the receipt of the information requested, of its decision whether or not to pay a subvention to the person to whom the application refers and the amount of any subvention to be paid.

11.2 When a health board has determined that a person does not qualify for a subvention or does not qualify for the maximum rate appropriate to that person's level of dependency under these Regulations, it shall inform the applicant of the grounds for its decision.

11.3 When a health board has determined that a person does not qualify for a subvention, or qualifies for less than the maximum rate of subvention on the grounds of means and circumstances or under the provisions of article 10.5, it shall inform the applicant of his or her right to appeal the decision under article 19.1 of these Regulations.

12.1 When a health board has determined that a person qualifies for a subvention under these Regulations and has not made the person an offer of accommodation under article 17.1, it shall pay the subvention to the nursing home of the person's choice or where the person is unable to exercise choice, the nursing home which is the choice of the person acting on his or her behalf.

12.2 A health board shall not pay a subvention towards the cost of maintaining a person in a nursing home without the prior agreement of the registered proprietor or person in charge to the admission of the person in respect of whom a subvention is to be paid.

12.3 When a person or a person acting on his or her behalf requests the health board paying a subvention in respect of that person in a nursing home to transfer the subvention to another nursing home and the registered proprietor or person in charge of the other nursing home has agreed to admit the person, the health board shall transfer the subvention in respect of that person to the other nursing home.

13.1 When a health board has determined that a person qualifies for the payment of a subvention and has not offered the person alternative accommodation under article 17.1 of these Regulations, the health board shall pay a subvention towards the cost of maintaining that person in a nursing home from the date the person qualifies for a subvention or if the person was resident in the nursing home on the day the Act was commenced, from the date the person applied for a subvention, until the person is discharged from the nursing home or dies, or until the health board withdraws the subvention following a review of the dependency and means and circumstances of the person as provided for under articles 14.1 and 14.2 of these Regulations.

13.2 When a health board has determined that a person qualifies for a subvention under these Regulations, the health board shall pay the subvention on that person's behalf to the registered proprietor of the nursing home to which the person who has qualified for the subvention has been admitted.

13.3 A health board may pay a subvention in respect of a person whom it has determined as qualifying for a subvention under these Regulations in a nursing home in its own functional area, or in the functional area of another health board.

13.4 A health board may pay a subvention in respect of a person whom it has determined as qualifying for a subvention in a nursing home in Northern Ireland which is a nursing home registered by a health and social services board.

13.5 A person who qualifies for a subvention under these Regulations and who was benefiting from a payment under Section 54 of the Health Act, 1970 at the time of application shall no longer benefit from such payments from the date the subvention is paid.

14.1 A health board which is paying a subvention in respect of a person may, with the exception of persons referred to in article 14.3 or 14.4, review the dependency and/or means and/or circumstances of that person no sooner than six months from the date on which a subvention was first paid and at six monthly intervals thereafter.

14.2 A health board shall review the dependency and/or means and/or circumstances of a person after six months from the date on which a subvention was paid or no sooner than six months after the last review if requested to do so by the person in receipt of the subvention, a person acting on his or her behalf or person in charge of the home.

14.3 A review of the dependency and/or means and/or circumstances of a person in respect of whom a health board is paying a subvention may be carried out sooner than six months from the date on which a subvention was first paid if the health board has informed the person and the nursing home proprietor before the first payment of the subvention that, in the opinion of the board, the person is in need of convalescent respite care.

14.4 If a health board is of the opinion that a major change has occurred in the dependency, and/or means and/or circumstances of a person in respect of whom it is paying a subvention, it may, having informed the person concerned and the registered proprietor of the nursing home, initiate a review sooner than six months from the date on which a subvention was first paid or six monthly intervals thereafter.

14.5 In carrying out a review in accordance with article 14.1 a health board shall assess the dependency of the person as provided for under articles 7.1 to 7.4 of these Regulations and the means as provided for under articles 8.1 to 8.3 of these Regulations and the circumstances of the person as provided for under articles 9.1 to 9.2 of these Regulations.

14.6 If, following a review after a six month period referred to in article 14.1, a health board determines that the dependency status and/or means and circumstances of the person have changed, the health board may increase or decrease the amount of subvention in accordance with the provisions of these Regulations, may withdraw the subvention or may make the person an offer of accommodation in a health board institution providing nursing care in its functional area in accordance with articles 17.1 and 17.2 or may make arrangements for the care of the person in his or her home.

14.7 A health board having decided to carry out a review as provided for in article 14.1, shall continue to pay a subvention at the same rate to the person whose dependency and/or means and/or circumstances are being reviewed, while the review is taking place.

14.8 If a health board does not carry out a review, as provided for in article 14.1, a subvention shall continue to be paid at the same rate on behalf of the person concerned.

14.9 When a health board, having carried out a review in accordance with article 14.5, determines that a person no longer qualifies for a subvention, qualifies for a lower rate of subvention or qualifies for a higher rate of subvention, it shall inform the person, or a person acting on his or her behalf, in writing of its decision and of the grounds for its decision.

14.10 A person who qualifies for a subvention from a health board or a person acting on his or her behalf shall inform the health board if there is any change in the means and/or circumstances of the person.

14.11 When a health board, having carried out a review in accordance with article 14.5 determines that a person on the basis of his or her means and/or circumstances no longer qualifies for a subvention or qualifies for a lower rate of subvention, the health board shall inform the person or a person acting on his or her behalf of his or her right to appeal the decision under article 19.1 of these Regulations.

14.12 A health board, having informed a person or a person acting on his or her behalf, of its decision to discontinue a subvention, to pay a lower rate of subvention or to pay a higher rate of subvention shall continue to pay the rate of subvention paid at the time the review under article 14.3 was carried out for twenty eight days from the date on which the person in receipt of the subvention was informed of the decision and shall so inform the person or the person acting on his or her behalf.

14.13 If a person appeals a decision of a health board to discontinue a subvention or to pay a lower rate of subvention under article 19.1 of these Regulations and succeeds in that appeal, the health board shall pay the person in respect of whom an appeal is made an amount equivalent to the total amount of subvention which that person would have been entitled to had the health board not decided to discontinue the payment of subvention or to pay a lower rate of subvention.

15.1 The registered proprietor or the person in charge, in notifying a death to the Medical Officer of Health as required under article 22 of the Nursing Homes (Care and Welfare) Regulations, shall inform him or her if the deceased was in receipt of a subvention from a health board.

15.2 When a registered proprietor or person in charge of a nursing home proposes to discharge a person in receipt of a subvention from a nursing home, the registered proprietor or the person in charge shall notify the health board paying the subvention of the date of the proposed discharge and the reasons for the discharge at least fourteen days before the proposed date of discharge.

15.3 When a person in receipt of a subvention leaves a nursing home for a reason other than referred to in articles 15.1 and 15.2, the registered proprietor or the person in charge shall notify the health board paying the subvention as soon as possible of the person's departure.

15.4 A health board may recoup from a nursing home proprietor the amount of any subvention paid in respect of any person from the date of the death or discharge of the person if the death or discharge is not notified to the health board in accordance with articles 15.1, 15.2 or 15.3.

15.5 A health board may continue to pay a subvention towards the cost of a person in a nursing home during a temporary absence of that person from the nursing home provided the health board has been informed of the date or dates of the temporary absence, the reasons for the temporary absence and approves of the absence.

16.1 A registered proprietor or person in charge shall not seek any payment in addition to the amount of the subvention determined by a health board and the contribution of the person in receipt of a subvention payable under article 13.1 of these Regulations for any service which is considered to be essential to the maintenance of a person in a nursing home and common practice in nursing homes.

16.2 For the purposes of articles 16.1 and 16.3, a service which is considered to be essential to the maintenance of a person in a nursing home and common practice in most nursing homes shall include bed and board, nursing care appropriate to the level of dependency of the person, incontinence wear and bedding, laundry service and aids and appliances necessary to assist a dependent person with the activities of daily living.

16.3 A registered proprietor or person in charge shall not discriminate against a person in the nursing home in receipt of a subvention from a health board in favour of a person in the nursing home not in receipt of such a subvention as regards the provision of any service which is referred to in article 16.2.

16.4 A special service or item of equipment required by a person in receipt of a subvention in a nursing home shall be the subject of a separate arrangement between the health board and the registered proprietor or person in charge which shall be detailed in the contract of care.

17.1 A health board having determined that a person who was resident in a nursing home on the day the Act was commenced qualifies for a subvention, may, instead of paying the subvention, offer that person accommodation in a health board institution providing nursing care within the board's functional area.

17.2 A health board which proposes to make an offer under article 17.1 shall have regard to the general welfare and religious affiliation of the person qualifying for a subvention and the general welfare of his or her spouse and child or children, if any.

18. A health board may refuse to pay a subvention, may cease payment of a subvention or may reduce the rate of subvention if the health board is or becomes of the opinion that false or misleading information has been given in respect of any application for a subvention or on review of a subvention as regards the dependency and/or the means and/or circumstances of the person to whom the application refers.

19.1 A person applying for a subvention, or a person acting on his or her behalf, may appeal to an appeals officer designated by the Minister against a decision of a health board, on the grounds of his or her means and circumstances or in accordance with the provisions of article 10.5, not to pay a subvention, to pay a lower amount of subvention than the maximum rate, to withdraw a subvention or to reduce a subvention, within twenty eight days of the date on which the health board notified the person of its decision and the grounds for its decision.

19.2 The designated appeals officer shall consider an appeal under article 19.1 and shall inform the person making the appeal of his or her decision within twenty-eight days of the receipt of the appeal.

19.3 For the purpose of deciding the appeal, the designated appeals officer may request information from the health board and from the person to whom the appeal refers or a person acting on his or her behalf.

19.4 A decision of an appeals officer shall be final and conclusive.

20. If, under Section 31 of the Health Act, 1970 (No. 1 of 1970 ), the Minister specifies a limit on the expenditure to be incurred in providing services under the Act, a board may, in respect of persons qualifying for a subvention after the date on which the limitation on expenditure is specified, pay such amounts as would enable the board to contain its expenditure within the specified limit.

21.1 A health board may recoup an amount as specified in article 21.3 from a person in respect of whom it has paid a subvention if it becomes of the opinion that the person did not disclose in full his or her means and circumstances at the time of application for subvention or review.

21.2 A health board may recoup an amount specified in article 21.3 from the estate of a person in respect of whom it has paid a subvention after his or her death if it becomes of the opinion that the person did not disclose fully his or her means and circumstances at the time the application for subvention was made.

21.3 A health board may recoup from a person or the estate of a person the difference between the amount of subvention paid in respect of the person and the amount of subvention he or she would have been entitled to if the person's means and circumstances had been fully disclosed at the time of application or review.

22.1 If a health board, before the day of commencement of the Act has entered into an arrangement with a home which was a home notified to a health board under the Health (Homes for Incapacitated Persons) Act, 1964 (No. 8 of 1964), to provide in-patient services under Section 52 of the Health Act, 1970 (No. 1 of 1970 ) such an arrangement shall be considered to be in accordance with the provisions of these Regulations for so long as the home is registered under the Act and provided that with the exception of articles 10.1,10.3 and 12.1 the provisions of these Regulations are observed.

23. These Regulations shall be enforced and executed in the functional area of each health board by the chief executive officer of the health board concerned or by a person acting as deputy chief executive officer of that board in accordance with Section 13 of the Health Act, 1970 .

FIRST SCHEDULE

Procedures for the Assessment of Dependency in respect of an application for a Nursing Home Subvention.

Assessment on Application

1. A health board shall make arrangements for the carrying out of an assessment of the dependency of a person in respect of whom a nursing home subvention is being sought by a designated officer or officers of the board or make arrangements with another agency or persons for the carrying out of such assessments by a qualified person.

2. A designated officer for the purposes of this schedule is a person who is a registered medical practitioner, a registered nurse, an occupational therapist or a chartered physiotherapist.

3. The assessment of the person in respect of whom a nursing home subvention is sought shall include an interview by the designated officer or officers with the person and his or her nearest relatives, if any.

4. The health board to which the application for a subvention has been made shall inform the person making the application of the date and time of an interview in connection with an assessment of dependency and the place in which any interview will take place.

5. The assessment of dependency shall include an evaluation of the ability of the person in respect of whom a subvention has been sought to carry out the tasks of daily living and of the level of social support available to the person.

6. The ability of the person in respect of whom a subvention has been sought to carry out the tasks of daily living shall be assessed on the basis of his or her:

(i) degree of mobility

(ii) ability to dress unaided

(iii) ability to feed unaided

(iv) ability to communicate

(v) extent of orientation

(vi) level of co-operation

(vii) ability to bathe unaided

(viii) quality of memory

(ix) degree of continence.

7. The designated officer or officers shall indicate either numerically or qualitatively the extent of independence or dependence of the person being assessed for each of the headings in paragraph 6.

8. In assessing the social support of the person being assessed, the following indicators shall be taken into account:

(i) the housing conditions of the person being assessed;

(ii) the number of persons in the household of the person being assessed;

(iii) the ability of the members of the household, if any, to care for the person being assessed;

(iv) the extent of support from the community for the person being assessed;

(v) the services which the person being assessed is receiving.

9. The designated officer or officers shall indicate, either numerically or qualitatively, the level of social support available to the person being assessed for each ot the indicators in paragraph 8.

10. The assessment shall include consideration of the medical condition of the person being assessed.

11. The assessment shall include consideration of whether the need for care of the person being assessed can be met otherwise than by admission to a nursing home.

12. The report of the assessment shall include a recommendation by the designated officer of how the need for care, if any, of the person being assessed can best be met.

13. Each report of an assessment shall be considered by an assessment team of the health board which shall decide whether the person in respect of whom a subvention has been sought qualifies on the basis of his or her dependency for a nursing home subvention.

14. An assessment team for the purposes of this schedule shall include persons with professional expertise in the care of dependent people nominated by the chief executive officer or the deputy chief executive officer of a health board.

15. An assessment team may decide that a person who qualifies for a nursing home subvention on the basis of his or her dependency is to be offered accommodation in a health board institution providing nursing care within the board's functional area.

16. If an assessment team decides that a person qualifies for a nursing home subvention and does not decide to offer the person accommodation as referred to in paragraph 15, it shall determine whether the level of dependency of the person assessed is medium, high or maximum.

Definition of Dependency

17. For the purpose of this schedule medium, high and maximum dependency have the following meanings:

( a ) Medium dependency -- describes a person whose independence is impaired to the extent that he or she requires nursing home care because the appropriate support and nursing care required by the person cannot be provided in the community. His or her mobility would be impaired to the extent that he or she would require supervision or a walking aid.

( b ) High dependency -- describes a person whose independence is impaired to the extent that he or she needs nursing home care but who is not bed bound. The person may have a combination of physical and mental disabilities, may be confused at times and be incontinent. He or she may require a walking aid and physical assistance to walk.

( c ) Maximum dependency -- describes a person whose independence is impaired to the extent that he or she requires constant nursing care. The person is likely to have very restricted mobility, require assistance with all aspects of physical care or be confused, disturbed and incontinent.

Assessment on Review

18. In carrying out a review of a person in receipt of a subvention as provided for under articles 14.1 to 14.3 of the Regulations, a health board shall follow the same procedures as set out in paragraphs 1 to 10 of this schedule and shall include consultation with the person in charge of the nursing home.

19. The assessment on review of the person's ability to carry out the tasks of daily living and of the level of social support available to the person, shall include a comparison with the previous assessment.

20. The assessment on review shall include consideration of whether the need for care of the person being assessed can be met otherwise than by continued residence in the nursing home.

21. The report of the assessment by the designated officer or officers shall conclude whether the level of dependency of the person is unchanged, is increased or is decreased since the previous assessment.

22. The report of the assessment may include a recommendation that the person should be offered accommodation in a health board institution providing nursing care or that arrangements should be made for the care of the person in his or her home. No recommendation to this effect should be made unless the spouse and/or an adult son and/or daughter of the person concerned and the person in charge have been consulted.

23. If the designated officer, in his or her report of an assessment on review, concludes that the level of dependency of the person is increased or decreased or recommends other courses of action specified in paragraph 22, the report shall be considered by the assessment team.

24. The assessment team shall decide which course of action is the most appropriate in the light of the report of the assessment on review.

SECOND SCHEDULE

General rules for the Assessment of Means in respect of an application for a Nursing Home Subvention.

General

1. A health board shall apply these rules in the case of every application for a subvention under these Regulations to determine:--

(i) whether or not, on the basis of his or her means, the person in respect of whom an application has been made qualifies for a subvention,

(ii) in respect of a person whom the health board has determined as qualifying for a subvention, the amount of the subvention to be paid by the health board.

Income

2. In calculating the means of a person in respect of whom a subvention has been sought, a health board shall take all sources of income into account, including wages, salary, pension, allowances, payments for part time and seasonal work, income from rentals, investments and savings and all contributions from whomsoever arising.

3. The income of an applicant shall be considered to be the income which he or she received from all sources in the twelve months preceding the date of application.

4. A health board shall assess the income of a married or cohabiting person in respect of whom a subvention has been sought as half the combined income and imputed income of the couple.

5. A health board may take into account any income which a person claiming subvention has deprived himself or herself of in order to qualify for a subvention or in order to be paid a higher amount of subvention.

6. A health board shall assess the means of a person in respect of whom a subvention has been sought and of his or her spouse if any, net of pay related social insurance, statutory contributions and statutory levies.

Assets

7. A health board may consider any asset of the person in respect of whom a subvention has been sought as a source of funding for nursing home care.

8. A health board may take the value of the following assets into account in assessing the means of a person in respect of whom a nursing home subvention has been sought:--

(i) house property, excluding normal household chattels

(ii) stocks, shares or securities

(iii) money on hands, in trust, lodged, deposited or invested

(iv) interests in a company or business of any kind, including a farm

(v) interest in land

(vi) life assurance or endowment policies

(vii) valuables held as investments

(viii) current value of equipment of a business or machinery, excluding a car, not covered under a previous heading.

9. A health board shall disregard the first £6,000 of any asset or assets owned or enjoyed by the person in assessing the value of assets available to a person applying for a nursing home subvention to fund his or her nursing home care.

10. A health board may assess the value of any asset or assets transferred from the ownership of the person in the five years prior to the application in assessing the means of the person.

11. A health board may include any benefit and privilege to the person arising from the transfer of an asset to another person in assessing the means of the person.

12. A health board shall disregard the principal residence in the assessment of a person's means if it is occupied immediately prior to or at the time of the application and continues to be occupied by a spouse, a son or daughter aged less than twenty one years or in full time education or a relative in receipt of the Disabled Person's Maintenance Allowance, Blind Person's Pension, Disability Benefit, Invalidity Pension, or Old Age Non-Contributory Pension.

13. A health board may impute an annual income equivalent to 5 per cent of the estimated market value of the principal residence of the person, if it was not occupied immediately prior to or at the time of the application by a spouse, a son or daughter aged less than twenty one years or in full time education or a relative in receipt of the Disabled Person's Maintenance Allowance, Blind Person's Pension, Disability Benefit, Invalidity Pension or Old Age Non-Contributory Pension.

14. A health board shall calculate the imputed income of a principal residence under paragraph 13 net of mortgage, loan, rental or purchase repayments existing prior to or at the time of application.

15. In assessing the means of a person who owns or whose spouse owns a farm or business the health board shall calculate the income from the farm or business on the basis of the accounts where available and on a notional basis where such accounts are not available.

16. In calculating the notional income of a farm as provided for in paragraph 15 a health board may impute an income based on the letting value of land, the assets of the farm including land, stock, crops, farm produce, milk quotas, subsidies, headage payments, grants, calf premiums, farm buildings, machinery and other farm assets.

17. In calculating the notional income of a business as provided for in paragraph 15 a health board may impute an income based on the assets of the business.

18. If a person, in respect of whom an application for a subvention has been made, has transferred the ownership of a business within the five years prior to the making of an application without an agreement on benefit or privilege, the health board may take into account any payment on transfer or may impute a notional value of five per cent of the market value of the business on the date of transfer, whichever is the higher.

19. If a person in respect of whom an application for a subvention has been made has transferred the ownership of a farm in the five years prior to the application, the health board may take into account any payment on transfer and/or any continuing income from the earnings of the farm.

Members of Religious Orders

20. In assessing the means of a member of a religious order who has applied for a nursing home subvention or on whose behalf an application has been made, a health board shall confine its assessment to the income and assets personally owned of the applicant or of the person on whose behalf the application has been made.

Exclusions

21. A health board may refuse to pay a subvention to a person if the value of his or her assets, excluding the principal residence, exceeds £20,000.

22. A health board may refuse to pay a subvention to a person if his or her principal residence is valued at £75,000 or more and is not occupied by a spouse, a son or daughter aged less than twenty one years or in full time education or a relative in receipt of the Disabled Person's Maintenance Allowance, Blind Person's Pension, Disability Benefit, Invalidity Pension, or Old Age Non-Contributory Pension and the person's income is greater than £5,000 per annum.

THIRD SCHEDULE

General rules for the Assessment of Circumstances of a person who has qualified for a Nursing Home Subvention.

General

1. A health board shall apply these rules in assessing the capacity of a son and/or daughter over twenty one years of age residing in the jurisdiction to contribute towards the cost of care in a nursing home of a parent who has qualified for a nursing home subvention.

Income

2. In assessing the circumstances of a son and/or daughter, a health board shall have regard only to the income of that son or daughter.

3. In assessing the income of a son and/or daughter a health board may take all sources of income into account including wages, salary, pension, allowances, payments for part time and seasonal work, income from rentals, investments and savings and all contributions from whosoever arising provided that the income is personal to the son and/or daughter.

4. The income of a son and/or daughter shall be considered to be the income which he or she received from all sources in the twelve months preceding the date of the application for a nursing home subvention.

5. A health board shall deduct expenditure on the following from the income of a son and/or daughter to calculate disposable income:

(i) income tax payments and social insurance contributions

(ii) mortgage repayments on principal residence not taken into account in income tax exemptions

(iii) rent on place of residence

(iv) interest repayments, other than mortgage repayments

(v) education fees

(vi) payments made towards life insurance or towards membership of the Voluntary Health Insurance scheme not taken into account in income tax exemptions.

6. In calculating disposable income, a health board shall allow the following against income:

(i) £5,000 -- personal allowance

(ii) £3,000 -- for a dependent spouse

(iii) £1,000-- for each child under twenty one years or in full time education

(iv) £2,000 -- for each dependent person not covered above residing with the son or daughter.

7. Based on its assessment of the disposable income of a son and/or daughter the health board shall inform the son and/or daughter whether in its opinion, he or she has the capacity to contribute towards the cost of his or her parent's care in a nursing home and the amount, if any, per week by which the board will abate the amount of subvention appropriate to the parent's level of dependency and means in respect of its assessment of the son and/or daughter's capacity to contribute.

FOURTH SCHEDULE

MAXIMUM RATES OF SUBVENTION (PER WEEK)

GIVEN under the Official Seal of the Minister for Health, this 30th day of July, 1993.

BRENDAN HOWLIN,

Minister for Health.

EXPLANATORY NOTE.

These Regulations provide for the payment of subventions towards the cost of nursing home care to persons who have been assessed by a health board as requiring nursing home care and without the means to pay all or part of the cost. The Regulations set out the procedures which must be followed in applying for a subvention, in assessing the dependency, means and circumstances of an applicant, for determining the rate and amount of subvention, for the payment of subvention to the nursing home of the applicant's choice, for review at six monthly intervals of the level of subvention and for appeals against a health board decision in relation to a subvention.