Nursing home contracts

Finding a suitable nursing home place, often at short notice, can be stressful for you and your family. This page has information about your consumer rights when it comes to nursing home contracts and fees.

Nursing homes are available either privately or through the HSE. If you move into a private nursing home, you can still apply for help with the fees through the Nursing Home Support Scheme, better known as the Fair Deal Scheme.

Most of the legal arrangements between you and the nursing home are covered by the contract of care, which you will agree before taking up residence. It’s possible that not all the services provided by the nursing home will be paid for by the Fair Deal Scheme. It is common for extra charges to apply for things like social activities. This is why the contract of care is an important document.

Choosing a nursing home

You can get a list of nursing homes on the Health Information and Quality Assurance (HIQA) website. HIQA carries out inspections of nursing homes, and these inspection reports are available to read.

If you can, you should visit the nursing home you are interested in. The HSE has a checklist you can use to keep notes about your visit. You should ask the staff questions and, where possible, talk to some of the residents. Ask about the things that are most important to you. This might include:

• Social activities
• Visits
• Therapy services, like chiropody services
• Staffing levels
• Food

The contract of care

The contract of care is a legal document that sets out the terms and conditions of your stay, including the fee you will pay. Most contracts of care are standard form contracts. This means that most of the terms of the contract are the same in every case, and there isn’t much room to negotiate. It is a consumer contract, and you have consumer rights that apply.

The written contract is part of your agreement with the nursing home. Any discussion you have with the nursing home that informs your decision to accept their services also forms part of your consumer contract.

Get the advice of family and friends or get legal advice if you have any concerns about the contract of care. Don’t be afraid to ask the nursing home for further information.

Capacity to sign the contract

The resident is the only person who can sign the contract of care. If the resident is not capable of understanding the contract, another person can only sign on their behalf under a decision support agreement, like an enduring power of attorney.

Your next of kin, spouse or guarantor cannot sign on your behalf unless they have the legal authority to do so under a decision support arrangement.

You can read about decision support arrangements on the Decision Support Service’s website.

Fairness

The terms of the contract should be fair. A term is considered unfair if it puts you at an unfair disadvantage or is harmful to your interests. This means that terms should not cause a significant imbalance between your rights and the rights of the nursing home to your detriment.

The contract should not include terms that are on the black list. The black list is a list of terms that are always considered unfair. There is also a grey list, which includes contract terms that may be unfair. For grey list terms, an assessment is needed to decide if the term is unfair in the context of the individual contract.

Unfair terms in consumer contracts cannot be enforced. In other words, if a term is found to be unfair then that term must be set aside and can’t be relied on by the nursing home. It is up to the courts to decide if a term is unfair. The CCPC has the power to apply to the courts for an injunction to prevent a trader (in this case, the nursing home) from using an unfair contract term. The CCPC also has enforcement powers where it considers that a term is unfair.

If you are unsure of any of the terms of the contract of care, you should get legal advice. You can also contact the CCPC for information on fair terms.

What’s included in the contract of care

The following information must be included in the contract of care:

• The main characteristics of the service
• The nursing home’s full legal name (and its trading name if it is different), address and telephone number
• The total price of the and how it should be paid
• The nursing home’s complaints policy
• The duration of the contract
• How the contract can be terminated

The contract should also state that the trader is obliged to perform the service in accordance with the contract.

Things to look out for

The CCPC has guidance for nursing homes to help them to avoid including unfair terms in their contracts. The guidance highlights some of the areas where issues are most likely to arise.

Nursing home fees

Nursing homes are very expensive, but you can apply for help through the Nursing Home Support Scheme, commonly called the Fair Deal Scheme. Through this scheme, you will pay what you can afford towards your care, and the state will pay the rest. The amount you pay depends on your income and your assets.

You can read in detail about how this assessment works on the HSE website. Citizens Information also has information about the Fair Deal Scheme.

What does the Fair Deal include?

The Fair Deal pays for nursing home services, including:

• Your accommodation and food
• Your nursing care
• Your laundry
• The basic aids you need for everyday use

Nursing home residents can apply for the Drugs Payment Scheme or the Medical Card to help with the cost of medication and other health services.

You may still find that some services you will receive are not covered and you may have to pay extra for them. This includes things like hairdressing, social activities and outings.

Charges for extra services

Your contract of care must list the extra services your nursing home provides and clearly state how much you will be charged for them. You should know the total cost of these services before you sign the contract. The nursing home cannot make any additional changes without your consent.

You should look for how the nursing home charges for services that are optional, particularly services you don’t need or want. Take your time reading through these charges. If there is anything that is unclear, you should ask to have it clarified in the contract before you sign it.

You should ask the nursing home what happens if you decide you no longer want a particular service in the future, or you are unable to avail of a service or activity.

It is common for nursing homes to have a mix of mandatory and optional extra services. If this is the case, it should be clearly stated in the contract which services are optional. You should talk to the nursing home about any mandatory charges that are listed in the contract for services that you do not want or cannot avail of.

Nursing home fee increases

The nursing home fee is agreed as part of the contract of care. If the nursing home decides to increase its fees, it must do so fairly and transparently. You must get at least 30 days’ notice of the increase. This includes increases to any additional fees the nursing home charges for services not covered by the Fair Deal Scheme.

The nursing home should only increase fees when it is necessary to do so to continue to meet your needs.

The nursing home should tell you the reasons for the increase and give you information about how the increase was calculated.

Fee increases in the contract of care

When you get the contract of care, you should pay particular attention to what it says about fee increases. It should clearly explain:

• The circumstances under which a fee increase might happen
• The notice period
• How increases will be calculated

If the sections of the contract that deal with fee increases are vague, they may be unfair and unenforceable. For example, the contract of care should not say something like the ‘nursing home reserves the right to review and increase its fees’. If you are worried about any term in the contract of care, you can contact the CCPC.

Negotiating fees

Your contract of care includes your fees. This means that any change to your fees is a change to your contract of care. Like any other change to your contract, it can only be made with your agreement. You should not sign a new contract without understanding what has changed.

If your nursing home tells you that they intend to increase their fees, you should:

• Ask why the fees are increasing
• Get this information in writing
• Check your contract of care to see what it says about fee increases
• Insist that the nursing home clearly set out the reasons for the increase, and which services are covered (are they fees that fall under the Fair Deal Scheme, or fees for additional services)
• Attempt to renegotiate if you think the increase is unfair

The nursing home must give you 30 days’ notice, but if you need more time don’t be afraid to ask for it.  If you think the increase is unfair, you should make this clear to the nursing home. The nursing home should only request an increased fee if it is necessary for them to provide their services to you.

You can contact the CCPC for advice on your consumer rights if the nursing home notifies you that it plans to change your contract.

Complaining about nursing homes

Your nursing home must have a complaints procedure. You can ask your nursing home for a copy of it, if you haven’t received it already. It’s always best to try to resolve any issues directly with the nursing home first. You can raise issues informally, just by having a chat with a member of staff. If the issue is not resolved, you can make a formal complaint in writing. The nursing home complaints procedure will have more information on how to go about doing this. You should keep a record of your complaint, including who you spoke to and when, and a copy of any letters you send or receive.

If the nursing home cannot resolve your complaint, you can take the matter further.

You can complain to the Health Information and Quality Authority (HIQA) about the care you are getting. HIQA is the organisation that carries out inspections of nursing homes.

For administrative issues (like fees and charges, contracts) you can complain to the Office of the Ombudsman.

You can contact the CCPC if you have a complaint about the terms of your contract, or if the nursing home does to abide by the terms of the contract.

You can get legal advice if you wish to take action through the courts. Free Legal Advice Centres operate throughout Ireland.