Aside from the services provided specifically by social security, social legislation provides for mixed services which span the boundary between social aid and assistance. These mixed services are provided by the National Solidarity Fund (Fonds national de solidarité – FNS), such as the guaranteed minimum wage (GMI – revenu minimum garanti), the maintenance/support advance, the 'Mammerent' education allowance, the cost-of-living allowance, and the income for severely disabled people.

In that regard, there is also a 'gerontology admission supplement' paid under certain conditions to people who are admitted to medical institutions (retirement homes, nursing homes, or other medical-social establishments providing daytime and night-time care) or to the hospital, but whose do not have the personal resources to cover the cost of admission and their personal needs.

Who is concerned

The gerontology admission supplement is primarily intended for the elderly but may also cover younger people who are dependent and require ongoing care. It may be paid:

• to people who are staying in an approved institution that provides daytime and night-time care;
• to people who are staying in the hospital in the context of a simple hospital stay.

Prerequisites

The applicant must:

• be admitted for an indeterminate period into a retirement home, a nursing home, a medical-social establishment providing daytime and night-time care, or the hospital for a simple stay;
• not have sufficient income and/or savings to cover the price of gerontology services.

Costs

The 'gerontology admission' supplement is covered by the FNS, which pays the institution directly rather than paying the applicant.

This supplement may be combined with services from long-term care insurance, among others.

The amount of the supplement is determined on the basis of the level of benefits provided and the applicant's personal resources.

How to proceed

Filing a claim

Applicants file their request for the 'gerontology admission' supplement with the FNS using a form that can be downloaded or obtained from the FNS.

The application for the supplement must be dated and signed by the applicant. However, where applicants require representation, the application may be signed by their representative or legal administrator.

The application may be sent by post or delivered in person to the FNS. The application is deemed to be filed on the date of delivery, provided that it is signed and accompanied by all necessary supporting documents. In the event that the necessary documents are not attached, the application will be deemed complete on the date on which such documents are delivered to the FNS.

The following supporting documents must be submitted with the application:

• documents attesting to all of the applicant's sources of income, as well as those of the applicant's spouse/partner (payslips, coupons, annuities, etc.);
• documents attesting to special expenses such as rental instalments or ongoing charges pursuant to a specific obligation, ongoing amounts paid in connection with a divorce, interest payments, etc. (a copy of the judgement setting the amount of maintenance/support and proof of its payment, amount of rent excluding charges, monthly mortgage payment, etc.);
• with respect to the net worth of the applicant and the applicant's spouse/partner:
  • cash in bank accounts: copies of bank statements indicating balances in current accounts, savings books/accounts, shares, bonds, etc.;
  • if the applicant owns real estate: a copy of the property tax assessment indicating the unit value of the property, and a copy of the deed of sale;
• income certificate prepared by the competent tax office.

Investigation of the application

The FNS will investigate the application and determine what documents the applicant needs to provide. Where applicable, the investigation includes a social inquiry that may be carried out at the applicant's home.

Decisions to grant or refuse the supplement are notified to the applicant no later than 3 months after the date on which all of the requested documents have been provided.

The notice includes, in particular, the amount and the start date for payment of the supplement.

The supplement is paid directly to the institutions and centres providing services to the applicant.

Services and actions included in gerontology admission

The actions and services that are mandatory for the establishment or institution to provide are established in advance, and their cost is included as a lump-sum amount in the base price charged.  The minimum monthly cost for services provided in connection with gerontology admission thus include accommodation in a private, furnished room of at least 12 square metres (as from 1 January 2014), including central heating and a connection to hot and cold water, as well as the gerontology admission services provided.

Gerontology admission services include, in particular:

• accommodation, which included, for example:
  • at least 3 meals per day, including at least one hot meal;
  • meal service at the establishment for reasons of health or dependency, separate from the benefits provided for by long-term care insurance;
  • the provision of accommodation suited to the specific needs of the elderly, ill, or disabled;
• health and safety, including, in particular:
  • the 24-hour availability of assistance and care;
  • aid and care required for reasons of illness or dependency and not covered by long-term care insurance;
  • assistance with bathing at least once per week, in accordance with the user's needs or at the user's request;
  • the implementation of a call for help/assistance system;
• assistance with day-to-day activities;
• sociocultural support.

Calculation of the supplement amount

The supplement paid by the FNS is determined based on the following parameters:

• the personal resources of the beneficiary of the admission;
• a monthly amount of EUR 57 at the index base 100, irrespective of the applicant's own income. This amount is intended to cover personal needs (pocket money), which cannot be covered by other means;
• an amount representing the monthly base price for the admission services, called the 'monthly minimum reference amount'.

The amount of the supplement is the difference between the cost of the accommodation and the applicant's income (less the monthly amount of EUR 57 at the index base 100).

For the purposes of calculating the supplement, all of the applicant's personal resources are taken into consideration – namely all net annual income of the applicant, alone or together with their spouse.

Determination of the monthly base price for admission services

The amount of the supplement is determined based on a monthly base price, called the monthly minimum reference price, which is set by law. That amount is used as a basis for calculating the maximum monthly cost of the services provided in connection with the admission, taking the FNS' contribution into account.

Therefore, calculating the amount of the supplement requires a monthly base price to be determined, the maximum of which is determined as follows:

• base price set by law (monthly minimum reference amount): EUR 248.48 at the index base 100 or EUR 215 if the applicant shares the room with another person;
• Quality points related to the support provided and the staff's qualifications and expertise may be added to the base price. A maximum of 20 quality points may be allocated. One point is worth EUR 4.52 at the index base 100.

A maximum supplement of EUR 20.14 at the index base 100 may still be requested if the applicant needs assistance in carrying out administrative procedures, travel or financial management (the individual competence supplement).

For couples in which only one of the spouses is admitted to an institution, the total household income is split and the financial costs of external housing are taken into consideration. Moreover, a minimum amount equal to that of the guaranteed minimum income is provided to the spouse who remains at home.

As a result, the FNS assesses the personal resources of the beneficiary of the aid, such that the spouse who remains at home has the right to a guaranteed monthly share equal to the GMI.

This guaranteed share may be increased by a contribution of a maximum of EUR 100 at the index base 100, intended for payment of rent or repayment of a mortgage.

If both spouses are admitted to a healthcare institution, the FNS assesses the personal resources of each spouse using an amount equal to 50% of the total household income.

Demand for repayment of the supplement

Beneficiaries or their heirs or successors may be asked to repay the supplement if their fortunes improve.

The FNS may not request repayment of a 1^st bracket of the beneficiary's estate, set at EUR 29,747 at the index base 100, from the surviving spouse or direct descendants of the beneficiary.

If the surviving spouse or one of the minor descendants is fully dependent on the applicant, and their income is less than 2.5 times the guaranteed minimum income, no repayment may be requested for an amount proportional to that person's rights in the succession.

In the event that the surviving spouse or descendant continues to live in property owned by the applicant (belonging to the applicant alone or to the applicant and their spouse), the FNS may not, for so long as such situation continues, request repayment out of that property or the movable property that it contains. However, to guarantee rights to later repayment, the FNS will place a lien on the property. If the property is located outside of Luxembourg, a life annuity is recorded for calculation of the supplement, determined by conversion of the property's market value.

Appeal

Decisions rendered by the FNS may be appealed to the Social security arbitration tribunal (Conseil arbitral de la Sécurité sociale – CASS) within 40 days of notification of each decision.

CASS decisions can, themselves, be appealed (if the amount in dispute is in excess of EUR 1,250) to the High Council of Social Security (Conseil supérieur de la Sécurité sociale) within 40 days of the notification of each decision.

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