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Is there funding available for care home fees?

YES. NHS continuing healthcare funding is not means tested and it can cover up to 100% of care costs…

There is a pot of NHS money allocated for the payment of care home fees in their entirety if an individual meets some stringent criteria, namely that their need for care is primarily a health need (as opposed to a social care need).

This funding is called NHS continuing healthcare.

NHS continuing healthcare is free healthcare provided by the NHS to individuals who have significant healthcare needs. The NHS continuing healthcare package of care can be received in any setting outside of hospital including care homes, hospices or even within your own home. A person’s health needs, not their location, is the key factor to receiving continuing healthcare funding.

Importantly, it doesn’t matter what your income is or what savings you have, if you meet the criteria, you are entitled to free NHS CHC funding. NHS continuing healthcare funding is not means tested and it can cover up to 100% of care costs

Unfortunately, applying for NHS funding can be an extremely complex process and establishing eligibility for continuing healthcare is not as simple as showing that an individual is being cared for by nurses or medical practitioners; nor is it as straightforward as having a certain medical diagnosis. (See our recent article on dementia and continuing healthcare)

To help decide which services the NHS should provide – and pay for –  and which services local authorities will provide, and charge for, the patient will be assessed against the National Framework for continuing healthcare to determine if they have a ‘primary health need’.

The process for determining if an individual has a primary health need involves an initial checklist followed by a full assessment which is carried out by an NHS multi-disciplinary team comprising two or more health or social care professionals familiar with the patient’s needs.

The information taken from the full assessment is used by the multi-disciplinary team to complete a ‘Decision Support Tool’ which is split into twelve domains. Each domain is divided into levels of need from: ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’. The levels reflect the nature, intensity, complexity and unpredictability of a need.

The multi-disciplinary team will allocate a level of need to each of the twelve care domains to determine if the individual has a ‘primary health need’ and then make a recommendation to the Clinical Commissioning Group stating whether the individual should be entitled to NHS continuing healthcare.

The National Framework guidelines state that where it has been established that the primary need for care is a health need, the NHS has responsibility for providing care regardless of the location of the individual, they may be in a Local Authority care home, a private nursing home, or receiving care at home.

Problems arise largely due to the lack of easy to access information regarding NHS continuing healthcare within hospitals or GP surgeries. Individuals sell their houses and start paying hundreds of pounds in care fees each week without realising that they may be eligible for free care. The average cost of a nursing home in England and Wales is more than £800 a week, or £41,600 a year and people do not realise how eye wateringly expensive care for the elderly is until encountering first-hand the cost of securing 24-hour care for a relative.

If you are refused NHS continuing healthcare or if you are unaware of its existence and start to pay for your relative’s care, the value of the family home will be taken into consideration by your local council when calculating if an individual has assets exceeding the means testing threshold of £23,250.  The average home in the UK is worth more than £250,000 so typically anyone who owns their home will be liable for the full cost of their care.

Additionally, once the individual’s assets fall below £23,250 they must continue to contribute towards the care costs from their assets until they fall to the lower level of £14,000.  Once the capital assets are below £14,000 the individual will continue to pay towards their care from any income they receive, normally from any pension they may have.

As such, if an individual has significant ongoing health needs, it is crucial to secure their entitlement to continuing health care to avoid the liability of paying for care homes.  The issue is that the NHS is increasingly restricting access to the funding and individuals who ought to be eligible are denied continuing healthcare.  

To ensure the highest prospect of success in securing NHS continuing healthcare funding, it pays dividends to receive expert advice from industry experts like Compass CHC who have a strong track record of securing funding on behalf of their clients. With 78% of NHS professionals reporting that the NHS Continuing Healthcare process is ‘difficult or very difficult’ for patients and their families to understand (CHC Alliance ‘Continuing to Care Report’), it is understandable that so many patients turn to industry specialists like Compass Continuing Healthcare for help.

If you have significant ongoing health needs we, at Compass CHC, can help you obtain NHS continuing healthcare funding. Complete our free, confidential and no obligation assessment today and an expert member of our team will contact you to outline your options.

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