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Health Service Executive: Eastern Region East Coast Area

Year Concluded: 2006

Name of Body: Health Service Executive: Eastern Region, East Coast Area

Subject of Complaint: Nursing Home Subvention Refused

Complaint Details:

A retired man from South County Dublin approached my Office regarding his wife's entitlement to nursing home subvention which had been refused by the Health Service Executive (HSE) following an application in June 2003. His wife, a medical card holder, had been diagnosed with Alzheimer's disease and required maximum dependency care. The couple's means had been jointly assessed in accordance with the Regulations which provides that half of the combined income of a couple can be taken into account at the time of application. The man was advised to re-apply when the level of joint savings had depleted by half. In June 2005 he re-applied for nursing home subvention, having spent more than half of the joint savings in the intervening period on nursing home care for his wife, but was refused again. Once more, the HSE advised the complainant that the remaining joint savings would have to decline by another half before his wife might become eligible for subvention.

When I approached the HSE I was very concerned that the repeated division of the couple's joint savings was not in accordance with the legislation and I asked that an urgent review of the application be carried out. I was subsequently advised that the Local Health Manager had taken the view that the couple's total savings at the point of the second application should have been calculated in the same manner as it had been done in the original application, and that was the reason behind the refusal of the application in 2005.

I reminded the HSE that while the legislation does provide for the assessment of half of joint savings against an applicant who is married, it does not allow for the continued halving of joint savings on subsequent applications which was effectively moving the goalposts for the applicant each time a fresh application was made. I viewed this as being inherently unfair and contrary to good and fair administration. I accept that it is important for the HSE to have policies in place to cover such issues of interpretation. However, these should not be so rigid or inflexible so as to cause inequity or unfairness, or to disallow consideration of individual circumstances. It is very important that regular reviews of such polices are undertaken so as to ensure that they are being implemented fairly and in line with best practice.

I was pleased that the HSE agreed to award the complainant's wife nursing home subvention arrears of €5,506 with effect from the date of the second application (June 2005), and went further by awarding her a contract bed in the same nursing home with effect from November 2006.

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