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Annual Report of the Ombudsman 2008 (text version)

6.4.3 HSE Selected Cases - Decision not to grant a nursing home subvention revised – weekly allowance of €238.20 granted and arrears of €16,980.26 paid

A man complained to my Office that an application for nursing home subvention (NHS) in respect of his 85 year-old mother, had been wrongly refused by the HSE South. The man had made the application for NHS in December 2006. At that time there were no national guidelines for the scheme, but 'local arrangements' were in place in each HSE region. Prior to making the application, the man had received information about the NHS scheme from the HSE South and, according to the 'local arrangements' in place in that area, the principal residence of an applicant would not be assessed for means purposes if a medical assessment had deemed the applicant to suffer from dementia or alzheimer's disease - the man's mother had been so medically assessed. However, by the time a decision was made on the application in March 2007, new national guidelines for the standardised implementation of the nursing home subvention scheme had been introduced and the application was considered under these. The effect of this was that the man's mother did not qualify for NHS, on the basis of "income/imputed income from principal residence", because the new guidelines did not provide for the exemption of the principal residence of people suffering from dementia or alzheimer's disease.

When I first took up this matter with the HSE, I was advised that the HSE South was obliged to follow the procedures introduced at national level with effect from 1 January 2007, and that this applied to all applications and that any local agreements implemented by the former Southern Health Board in that area were no longer valid from that date. However, when I reviewed the 2007 national guidelines, I noted that the very first provision contained therein stated that "Nothing in these Guidelines shall operate in a way that ... worsens an applicants overall position in 2007 by comparison to 2006". It appeared to me that, in this case, the woman was "an applicant" in 2006. The only rules or guidelines that existed prior to the introduction of the national guidelines were the "local" ones, under which the value of her home would not have been assessed. It was clear therefore that her position was considerably worsened because the 2007 guidelines were applied or operated in her case. Following correspondence between my Office and the HSE South, it accepted the argument for not applying the 2007 guidelines in this case and, consequently, the woman was awarded a NHS at a weekly rate €238.20, and arrears of  €16,980.26 were also paid from the date of application in December 2006.

I was concerned that other people who, like this woman, applied for NHS prior to 2007, could have been adversely affected if their applications were considered under the new National Guidelines, rather than any "local arrangements" that were in place at the time their applications were made. Therefore I asked the HSE to undertake a review of the matter and to let me have a report. I have recently been informed by the HSE that, following an extensive national review of its files, it had identified a small number of cases with similar circumstances to those I had outlined. I was also advised that, in all of the cases identified, arrears had either been paid already, or arrangements were being made to pay any arrears that may be due.

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