The Office of National Statistics calculated in 2011 that there were 291,000 people aged 65 and over living in care homes. Today, this figure is now likely to be over 300,000.

Councils spent over £14 billion on long term community and residential care last year, according to the Adult Social Care Activity and Finance Report 2017-2018.

Those who pay for care themselves are charged on average £846 per week (Competition and Market Authority 2018), while Councils are only able to pay homes around £550.
This means care homes must charge self-funders a higher fee to cross-subsidise the shortfall and stay afloat.

As illustrated in the BBC’s Panorama ‘Crisis in Care’ (May 2019), the budget falls drastically short of the amounts required to sustain an adequate care system.

This can be a very complex area and many are left unprepared because of a lack of information. It is for this reason that Robert has decided to shed light on the issues surrounding care fees by explaining the differences between Council and NHS funding, as well as assessments and appeals.

Council Funding

The Council will only contribute towards the cost of care if capital is below the means test threshold of £23,250. The value of the home must be included as capital, unless any disregards apply such as if a spouse or partner is still living in the property. Most homeowners are likely to exceed the capital threshold.

The statistics show 41% pay for care themselves, 49% receive some council funding and the remaining 10% from the NHS (Competition and Markets Authority 2018).

Even if a person in care falls below the capital threshold, their families might be asked to pay a top-up fee towards the costs if there is a cheaper alternative available and they refuse to move.

To make matters worse, there is currently no cap on the total costs a self-funding resident could pay. A cap was proposed within the Care Act 2014, but this has been postponed seemingly indefinitely. The Government Green Paper ‘Long Term Funding of Adult Social Care’ aims to address many of these issues, but even this report continues to be delayed.

The statistics show that the pressure on the social care system is set to increase exponentially (Kings Fund report 2018). People are living longer than ever. In 20 years, more than three million people will be over 85 (Office for National Statistics 2018).

Around 80% more people in the UK will be living with dementia, and 50% living with other age-related illnesses such as arthritis and heart disease.

NHS Funding

It is important to be aware that the NHS can also fund the cost of care regardless of means in certain circumstances, via NHS Continuing Healthcare.

The criteria used to decide this is known as the Primary Health Need test. In essence, if a person’s primary need is for nursing care, the NHS should fund the cost of such care regardless of the person’s circumstances.

The NHS must assess how complex, intense and unpredictable those nursing needs are, and ultimately whether they are of a nature which a Council could be expected to provide.

A common misconception is that all persons with dementia or any other illness should qualify. Unfortunately, this is not the case. What is important is the type quantity and intensity of care a person requires, not the diagnosis itself.

Social care could typically include support with dressing, feeding, bathing, toileting, orientating, and communicating.Nursing care could include (but is by no means limited to) the treatment of pressure sores, choking or swallowing problems, strokes, severe pain, violent behaviour or psychiatric issues.

NHS Assessments & Appeals

An assessment can be requested by contacting the GP, social worker or another healthcare professional. They will first complete a screening document known as a checklist. If the initial threshold is met, the NHS will convene a full assessment comprising of a panel of medical and social care professionals. They will score the care resident using a document known as a Decision Support Tool. A decision letter will then be issued.

NHS Continuing Healthcare decisions can and should be appealed where disputed. Appeals should be made within six months of the decision letter. Legal representation is not essential, but it is strongly recommended to maximise your chances of success due to the complexity of the criteria.

Crucially, NHS Continuing Healthcare assessments can also be requested retrospectively back to April 2012, for those who were not assessed at the time. If the care resident has since died, claims can be brought on behalf of the estate by the executors. A claim for three years of fees, for example, could result in a reimbursement of over £100,000.

How can Walker Foster help?

Our care funding specialists can help care residents and their families obtain both Council and NHS funding. We can assist in challenging Council financial assessments and top-up fees, and advise on NHS claims and appeals, including representation.

We can also advise on long term care and inheritance tax planning to help families pass wealth to future generations.
For more information on Care Fees, please click the link below or give Robert a call on 01943 609969.