Care Home fees – Council and NHS Funding

Care Home fees – Council and NHS Funding

11:47 31 May in Blog

Many of us will need some form of professional care in our lifetime, and we will all almost certainly know of a friend or relative receiving care.

Unfortunately, the cost of residential and nursing care can be extremely expensive. Average costs are £500.00 per week, but can easily exceed £1000.00 per week in some areas.  

It is important to be aware that care can be funded by the Council when income and capital fall below a certain threshold.

It is also important to be aware that in some circumstances, regardless of means, the NHS must fund the cost of care. This is known as ‘NHS Continuing Healthcare’.  The NHS can even fund care retrospectively after a person has passed away. Retrospective claims can still be made back to April 2012 for any periods in care which were not assessed at the time.

When should the Council pay towards care fees?

The Means Test

The Council must carry out a financial assessment to determine whether they should contribute towards the cost of care.

The capital threshold for Council funding is currently £23,250. If you have savings or capital below this amount, the Council should pay towards your care costs. Once your capital falls below £14,250, the Council should only charge you an assessed contribution towards the cost of care out of your income.

What about my home?

The value of your home will normally be taken into account as capital when assessing your means.

If you have limited savings and most of your money is tied up in your house, the Council could either ask you to sell the property to pay the fees, or offer a ‘Deferred Payment Arrangement’ loan against property which will have to be repaid on death (plus interest).

Please note: in certain situations, the value of your home should be disregarded entirely, particularly if another relative still resides in the property. Please contact us if you require further advice in this area.

Could my family be asked to pay a ‘Top Up’ towards the fees?

The Council is usually only willing to contribute towards the cost of care up to a maximum monthly threshold.

If you or your relative reside in a care home where costs are higher than average your family may be asked to pay a ‘top up’ fee once your savings fall below £23,250 to ensure you can remain in that home.

Please note: In some circumstances these fees can be appealed. Please contact us for further advice in this area.

NHS Continuing Healthcare: When should the NHS pay for care?

What is NHS Continuing Healthcare funding?

NHS Continuing Healthcare is defined by the NHS as a ‘package of care for adults aged 18 or over which is arranged and funded solely by the NHS’.

Unlike Council funding, NHS funding is not based on a person’s income or capital, but instead on their health and nursing needs.

If a person’s primary need is for nursing care, the NHS should fund the full cost of such care regardless of means. 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 manage. This is known as the ‘Primary Health Need’ test, as established in the cases of Coughlan and Grogan and the National Framework.

What is the difference between Nursing and Social care?

To qualify for NHS funding, it is important to demonstrate that the person in care requires a high level of nursing care. The medical diagnosis itself (e.g. dementia) is not enough, what is important is the type of care the person needs and how severe/complex it is.

Social care could typically include support with:

  • Dressing, feeding, bathing, toileting, orientating, communicating, mobilising, remembering

Nursing care could include (but is by no means limited to) the treatment of:

  • Pressure sores
  • Complex drug management
  • Intensive pain control such as use of morphine
  • Problematic incontinence such as difficulties using catheters
  • Violent behaviour and severe psychiatric problems
  • Unmanageable weight loss
  • Swallowing or choking problems
  • Severe breathing problems such as use of oxygen, inhalers etc.
  • Complications resulting from illnesses such as severe diabetes
  • Frequent strokes/loss of consciousness
  • Palliative care

How can I request an assessment for NHS Continuing Healthcare?

You can request an assessment by contacting the GP involved, or another healthcare professional such a District Nurse. Social Workers can also be contacted.

They should then complete a ‘checklist’ to consider whether it is appropriate to fully assess. If the threshold is met, the NHS should assess via a multidisciplinary panel.

Can I claim NHS funding for past care fees?

Yes. Claims can be made for NHS funding retrospectively from April 2012 – present for any periods which were not assessed at the time.

This is the case even if the person who was in care is no longer alive. In such circumstances, claims can be brought on behalf of the estate by the executors/administrators.

Assessments are made based on historic care and medical records. You must also have records of the cost of care at the time such as care invoices and bank statements to demonstrate fees paid.

Can I appeal an NHS CHC decision?

Yes. Appeals can be made within 6 months of the decision outcome.

How Walker Foster can help

  • Free initial consultations
  • Challenging Council funding decisions
  • Claims for Retrospective NHS Continuing Healthcare on a ‘no win no fee’
  • Appealing NHS Continuing Healthcare decisions (both current and retrospective) on a ‘no win no fee’
  • Wills and lifetime planning advice

If you would like to know more, Robert can be contacted at

E:  [email protected]

T: 01756 700200

 

Walker Foster Solicitors

[email protected]