Man denied HSE Nursing Home support despite medical evidence showing need for full time care

Background

I received a complaint from a family regarding the Health Service Executive’s decision to refuse assistance to their father under the Nursing Home Support Scheme. The Nursing Home Support Scheme provides financial support to people who need long-term nursing home care. The scheme is operated by the Health Service Executive.

Assistance under the Scheme was refused on the basis that the man had expressed a wish to eventually return to his home. According to the HSE, all applicants have a right to selfdetermination and such cases could not be considered eligible under the Scheme. However, the man had a serious medical condition and needed respite care over a number of years and, in particular, during the winter months. Sadly, the man passed away and his family brought a complaint to my Office.

Examination

I requested the relevant Nursing Home Support Scheme file and the medical records from two hospitals which treated the man in the last year of his life. I formed the view that the refusal by the HSE to grant assistance under the Nursing Home Support Scheme was at odds with the medical evidence on record. In particular, the evidence recorded that the man needed full-time supportive care and that he had lived in nursing homes previously under the “Winter Beds Initiative”. His family helped to care for him at home at other times of the year. His application also followed several admissions to hospital in the previous months. In addition, it was clear from the application form for the Scheme that, while the man expressed a preference for staying at home, he also indicated that he was willing to stay in the nursing home for a few months.

Outcome

I asked the HSE to review its decision. Following this review, the HSE accepted that, having regard to the medical evidence, the application for assistance under the Nursing Homes Support Scheme should not have been refused. As a result, the HSE made the appropriate payment of €5,043.90 to his estate.