Nursing home costs and Fair Deal

My brother used the Fair Deal when he went into a nursing home six years ago. He died in August so we are dealing with his estate at present.

We were told by the HSE that it didn’t matter, in any case, which payment method one used, Fair Deal or cash, as we would not pay any more than the full nursing home fee. Is this not true?

Mr M.H., email

Clearly, in your case, this is something of an academic discussion as your brother made the decision and spent the six years in a nursing home under Fair Deal before he died.

Parents changed mind on giving us a home – after we had moved in

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Nursing home care: Can paying privately be better than Fair Deal?

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Does my wife fall short on access to new, improved pension?

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Falling short of dwelling house exemption

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However, it is a relevant consideration for anyone considering going down the route of paying privately – either because of the amount of assets they have which would make Fair Deal the more expensive option, or possibly because they own a farm or small business.

Of course, there are also those who simply wish to keep the home unencumbered. On its own, this makes little financial sense but then, when it comes to property, we Irish are not always rational.

In any case, many would presume that, as you have been told, there is no difference in the headline cost – regardless of the option taken.

My understanding is that this is not so. Essentially it comes down to purchasing power. If you are a once-off customer, you are likely to pay list price. If, on the other hand, you are buying in bulk, you are quite likely to get a discount.

And that appears to be the case here. With so many people using Fair Deal, the State is likely to be able to negotiate better rates than the headline figure you would pay as a private patient.

In a separate piece, my colleague Fiona Reddan has spoken to Fair Deal adviser Tom Murray, who says that the National Treatment Purchase Fund, which negotiates Fair Deal spaces with nursing homes across the State, has managed to drive down the cost of nursing home beds under the scheme.

“The Fair Deal rate you’re paying can be substantially less than the private rate,” says Murray. About 80 per cent of patients opt for the Fair Deal, which means that “very few nursing homes can afford not to be part of it”.

Mr Murray says the difference in cost could be as much as €25,000, though I’ve no idea on what variables he is basing that figure.

Please send your queries to Dominic Coyle, Q&A, The Irish Times, 24-28 Tara Street, Dublin 2, or email dcoyle@irishtimes.com. This column is a reader service and is not intended to replace professional advice