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Annual Report of the Ombudsman 2008 (text version)

6.4.2 HSE Selected Cases - Community care home resident has in-patient service charge of €96.60 weekly reduced to nil

I was approached by a man who was being charged €96.60 per week by the HSE, in respect of in-patient service charges for his wife, while she was a resident in a community care home. It appears that, in arriving at the charge, the HSE deemed that the patient's personal income was the qualified adult payment of €138.50 per week, which was being paid to her husband as part of his state contributory pension.

A person qualifies for a state contributory pension based on his/her PRSI record. Whether a person qualifies for a payment depends on him/her having a certain number of PRSI contributions. If a person has a spouse, s/he may, subject to some conditions, receive an increase in her/his pension payment. This is known as a qualified adult payment.

Charges for public nursing homes are governed by Article 3 of the Health (Charges for In-Patient Services) Regulations, 2005 (S.I. No. 276 of 2005). These Regulations provide that the HSE may levy a charge at a weekly rate of,

1. €120, or
2. the weekly income of that person, less €35, whichever is the lesser,

for provision of in-patient services.

When I took up the matter with the HSE, it acknowledged that the in-patient charge is levied against the person receiving the service and can only be based on the income of that person. I dealt with this matter in my 2006 and 2007 Annual Reports.

In this particular case, my complainant was in receipt of a qualified adult payment as part of his state contributory pension, in respect of his wife. The HSE acknowledged that this payment could not be considered as the patient's income. It was her husband's income.

Accordingly, it was deemed that the patient was not in receipt of any income of her own. As a result, the HSE decided that the in-patient charge for my complainant's wife should be reduced to nil from the implementation date of the regulations, namely from 14 July 2005. This resulted in a refund of €8,381.91 being made to my complainant. This repayment was made up of the original charges of €7,843.20 plus an adjustment of €538.71 based on the consumer price index.

While I welcomed the HSE’s decision in this case, I was concerned that there might be cases similar to that of my complainants. Accordingly, I asked the HSE to review all other clients who were currently being assessed for in-patient charges in a similar way to my complainant, namely spouses of individuals in receipt of a qualified adult payment.

The HSE expects to complete its review shortly. In the meantime, a further 14 cases have been identified as part of this review, involving repayments of €160,160.00, inclusive of CPI adjustments. Most of these repayments have since been made to patients.

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