Fighting faceless bureaucracy at HSE over incorrect bill

Back in 2019 you wrote a piece headlined, “What’s a Fair Deal if wife follows late husband into nursing home care?”

We are in a situation where my mother was in a nursing home and, on her death, the amount owing – 7.5 per cent – was paid to the HSE. At the time, the maximum contribution from the family home was 15 per cent and, as my father owned half the property, 7.5 per cent was the amount owing.

Since then my father had to go into a nursing home and has died. The HSE is insisting that as he is the sole owner of the property (in that my mother had already died), 22.5 per cent of its value is due to them.

On reading your article, I had thought that the maximum due would either be the value of 22.5 per cent minus the amount already paid or 11.25 per cent. I wasn’t clear which.

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Can you confirm whether 22.5 per cent is still the maximum the HSE will take from the value of the property or if it has changed since then? I cannot establish whether the situation has changed but I feel that it is unfair to be charged on the same property twice (for half at least).

I am sure we are not the only family in this situation.

Ms B.M.

I sincerely hope you are the only family to find themselves in this position though I suspect if it has happened once, it might well have happened on other occasions.

We’re not talking pennies here. The difference between what you should have paid and what the HSE wanted was tens of thousands of euro.

Put simply, something has clearly gone wrong. And, for the avoidance of doubt, while there have been changes to the Fair Deal scheme of State support for long-term nursing-home care since I wrote that piece in 2019, there has been no amendment to the level of patient contribution required or its upper limit.

The system is very clear. Fair Deal takes 80 per cent of a long-term resident’s income and 7.5 per cent of the value of their assets in excess of €36,000 each year. In addition, it takes 7.5 per cent of the value of the family home for a maximum of three years – coincidentally the average time people who are in long-term nursing home care live – for a maximum charge against the home of 22.5 per cent.

Where the nursing-home resident is one of a couple, the figures are halved and the charge-exempt savings doubled. So you pay 40 per cent of the family income and 3.75 per cent of asset value over an exempt threshold on assets of €72,000. The charge against the family home in this scenario is 3.75 per cent annually for three years, or 11.25 per cent of the Fair Deal valuation of the property.

As you say, back when your mum was in nursing home care, the charge of assets was lower – 5 per cent annually and 5 per cent for three years on the house (up to a maximum of three years, or 15 per cent). Again, as in your case, those numbers are halved when it is a case of one member of a couple going into care. So the liability in respect of your mum was 7.5 per cent of the family home valuation.

Stalemate

The issue here appears to be that the person you were dealing with in the Fair Deal support office got themselves in a mess and, as you tell it, simply would not budge despite the evidence presented to them.

Their position appears to have been that by the time your father entered long-term nursing home care under the Fair Deal, he was the sole owner of the family – which he was, obviously, as your mum had already died. The end result is that they wanted to take 30 per cent of the property’s value to pay off Fair Deal – 22.5 per cent against your father’s account on top of the 7.5 per cent taken against the cost of your mother’s care.

This is clearly wrong. There is no provision anywhere in the Fair Deal legislation to take a penny more than 22.5 per cent of the Fair Deal valuation of the family home in any circumstances.

I think I can see what happened here. Normally, when the first member of a couple dies while availing of Fair Deal, the charge on the home is not executed because the person remaining in the family home asks for a deferral. This is provided for in the legislation and runs until they die or sell the property. At that point the debt is payable within a year (on death) or six months (on the sale of the property).

The money owing under Fair Deal is left as a charge on the property to ensure it cannot be sold without the Fair Deal debt being honoured.

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In this case, it would have rolled over until your father died and then the full charge of 22.5 per cent between them would have kicked in.

So there was no obligation on your father, or family, to sort your mother’s Fair Deal debt when she died. I suspect the decision to pay her Fair Deal debt immediately and against normal practice simply got lost in her Fair Deal file.

There was some suggestion that the Fair Deal office simply did not put two and two together and realise that the files for your mum and your dad related to a couple and to the same property and should be read together. That’s possible, I guess, up to a point. But where the situation moved from inadvertent error to stubborn refusal to engage with the customer is at the point where the Fair Deal office point blank refused to accept the evidence before their eyes.

Apart from making it clear to them that the two debts related to your parents and to the same property, you tell me you provided a receipt for the payment made in respect of your mum. I gather from you that the Fair Deal office checked this with Revenue and confirmed to your solicitor that it had been paid. Yet, they continued to erroneously demand the full 22.5 per cent payment in respect of your dad.

Putting things right

Somewhat gratifyingly, you tell me the only reason you didn’t fold or doubt yourself was that 2019 article I wrote on the rules governing couples where only one of them goes into Fair Deal.

Now I have to say that the HSE has been exceedingly helpful since I got in touch with it on your query, both in dealing with the issue and, as importantly, in staying in contact with you so that you knew what was happening. That is our health service at its very best. People at senior levels in the health service have given significant time to stay on top of this and make sure it was resolved. They deserve great credit for acting speedily to do so.

As you suspected, the correct interpretation of the rules was that your father’s estate was liable to pay 22.5 per cent of the value of his home towards his care, minus any sum already paid previously in relation to your mother. I understand a letter confirming this is on its way to you.

The HSE has also made the point that even if you had wrongly or inadvertently accepted the excessive charge being levied by the Fair Deal support office, when the estate went to probate, Revenue would have noticed the anomaly, corrected it and refunded you.

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That may well be so but the fact is the system should work properly from the front end and not rely on a third party, Revenue, to catch its mistakes.

The unfortunate thing is that it took such intervention to right such a very clear wrong. On this issue at least, it seems there is a need for more training on the rules of the scheme for those at the coalface liaising with often stressed, grieving or confused family members.

Fortunately, following the intervention of senior executives in the Fair Deal section, the situation is being resolved and you have been given reassurance about the sum actually owed, which is just over half of what they had been seeking – a difference of tens of thousands of euro.

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