‘Fair Deal’ scheme is far from fair

Sir, – Proposed changes by Minister for Health Stephen Donnelly to the current Nursing Home Support Scheme – or the “Fair Deal” as most people know it – may look promising on paper.

But the reality is that this scheme is far from fair because it fails to consider the additional charges that are not covered by “Fair Deal” and that many nursing home residents are currently forced to pay.

The proposed changes to the “Fair Deal” are designed to even the playing field, so to speak, for farmers and small business owners because a new three-year cap will be introduced on the contribution they will have to pay toward any nursing home care they may need in the future.

But for the thousands of nursing home residents who have to pay additional charges to nursing homes outside of the “Fair Deal”, the proposed changes will be of little comfort.


Sage Advocacy knows from its work that there are major difficulties in how nursing home charges are negotiated and operate.

Currently under “Fair Deal”, the State provides financial support totalling €1.4 billion each year towards the cost of “bed and board” basic nursing and personal care for nursing home residents.

But if nursing home residents require additional supports, such as specialised wheelchairs or beds, none of this – not even basic personal care items such as incontinence wear – is covered under the current so-called Fair Deal scheme.

Many people do not realise that once they or their loved one enters a nursing home, they will have little or no direct access to primary care professionals, from physiotherapy to social workers.

Nursing home residents may also have to pay additional charges for transport to appointments and organised social activities.

Because of the inconsistencies in the current scheme some residents end up having to pay additional charges outside of the Fair Deal, which Sage Advocacy knows from its case work can range from an additional €20 per week to €175 per month.

None of this adds up to a fair deal for a nursing home resident who may have a low income or depend on their pension to cover additional expenses which can ultimately push them and their families into a “Fair Deal” poverty trap.

The Government’s proposed changes to the “Fair Deal” scheme may help some farmers and small business owners in the future but what is fundamentally needed is a new deal – one that provides a community-based model of long-term support and care for older people and vulnerable adults. – Yours, etc,


Executive Director,

Sage Advocacy,

Dublin 7.