Long-term nursing home care is an expensive eventuality that nobody likes to plan for, and it can be a financial disaster zone.

The financial worries of vulnerable elderly people and their families were made worse by health board practices between 1993 and 1999. If you or an elderly member of your family was receiving long-term nursing care during this time, the State may owe you money even if the person concerned has since died.

To understand what your entitlement to arrears might be, you need to know a little bit about the system. Older people in need of full-time nursing care are by definition very vulnerable and their families are under great strain. They need help, but they won't necessarily get it from the State.

There is a grant but it is stringently means-tested and only covers a fraction of the full cost. There are public beds but not enough of them. The "lucky" ones in the State system who can't find a nursing home place may end up with inappropriate care in a psychiatric ward or an acute medical ward.

The health boards pay a contribution towards private nursing home costs to people with little or no assets through the Nursing Home Subvention Scheme. Under the scheme, there are three levels of dependency and the maximum weekly subvention available is now £150 (€190.50).

According to the Department of Health, 6,192 people are currently receiving the subvention. Average private nursing home costs are between £300 and £450 per week but can be much higher, and it is up to the elderly person or their family to make up the shortfall.

So where did the health boards go wrong and where does that leave families today? The Ombudsman's recently published report on the payment of nursing home subventions found that the actions of the Department of Health and the health boards were "improperly discriminatory", "taken without proper authority" and were generally "contrary to fair or sound administration".

From 1993 to 1999, the Department and the health boards had wrongly imposed means tests on the adult children of elderly people in need of a nursing home bed. In many cases the results made the applicant ineligible for a subvention or reduced the level of the subvention.

Another issue covered by the report was whether the subvention system was intended to operate in a way that would enable nursing home patients to retain a minimum level of their own income as "pocket money". It emerged that six of the health boards adopted a practice that excluded this possibility. Patients were entitled to retain the equivalent of one-fifth of the non-contributory old age pension from their weekly income for personal use.

In response to the Ombudsman's report, the Minister for Health and Children Mr Martin said the immediate priority was to ensure that the two aspects of the regulations that have the most direct impact on nursing home patients and their families are fully addressed without delay.

"Arrangements have already been made to enable nursing home patients and their families who may be due payments arising from the provisions in the regulations relating to the retention of one-fifth of the rate of non-contributory old age pension for personal use to be refunded speedily." The Minister said it had also been decided that payments should be made to those who were adversely affected by the provision in the regulations that allowed for the assessment of circumstances of adult sons and daughters. This provision was removed from January 1st, 1999.

The Department's estimate for the cost of these reimbursements is £6 million. According to the Minister, "every effort will be made to make payments as quickly as possible".

Regarding arrears, health boards have been instructed to review all files and make payments as appropriate. If you feel that you may be entitled to a payment and you have not been contacted by your local health board, you should immediately make contact with the board's Nursing Home Subvention section and ask that your case be reviewed without delay. This avenue is open to the surviving spouse or family if the patient has since died.

The Alzheimer Society of Ireland recommends this course of action and is advising families to take a complaint to the Ombudsman if they have any difficulties. The chief executive of the Alzheimer Society, Mr Maurice O'Connell, believes the debate about the responsibility of the State to provide long-term care for the elderly infirm is being avoided.

"As a relatively young country, we have a window of opportunity now to plan for the next 20 years, but instead of taking advantage of that we are in a situation where we cannot cope long before the crisis has arrived."

Mr O'Connell suggests that the subvention could be used in a much more creative way to supplement care at home. "The carer's allowance is means-tested, but if an elderly person qualifies for a subvention, that money could be paid to the family and with sufficient support the person might be able to stay at home."

As reported last week, approved long-term care policies will qualify for tax relief at the standard rate, under a new provision in the Finance Act. This move may encourage insurance companies to come forward with products for long-term care, but such niche insurance is likely to be expensive.

From July, everyone over 70 will be entitled to a medical card. This means they will also be entitled to free in-patient care from the State if they need it. There are 11,415 health board extended care beds in the system at the moment and 12,637 private or voluntary places.

The data are available to do the number-crunching today for the needs of the future but in the meantime, let's not forget about the needs of people relying on existing services and those experiencing a deficit of care.