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Claim NHS care home funding

NHS funding for care will be provided to an individual to meet the cost in full where their need for care is primarily a health need.

Contact our team of experts at Compass Continuing Healthcare today to see if your relative is eligible for  NHS care home funding. Our office number is 0121 227 8940. Alternatively please complete our FREE assessment and we will contact you.

NHS funding for care homes will be provided to an individual to meet the cost of their care in full where their need is primarily a health need. This funding is known as NHS Continuing Healthcare Funding and is provided by the NHS, not the local authority, social care or health services.

NHS funding for care home fees is not means tested. Many people believe and perhaps have been incorrectly informed, that if they own their own home or have assets over the funding threshold of £23,250, they cannot receive NHS Funding for care homes. This is not correct. It is not relevant what assets the individual has. The position reverts to the NHS principle of “free care for all”. So if an individual’s need for care is primarily a health need then the NHS should step in and meet the cost of the care home fees fully.

Securing NHS funding for care homes is a complex process and it pays dividends to have an expert in your corner fighting for you. The Compass Continuing Healthcare team can assist with the process from day one to get your relative the funding they are entitled to.

What is a primary health need?

A primary healthcare need is determined by the individual’s health needs across a broad spectrum of issues being considered and scored. The overall picture of the individual’s health is then reviewed and the question of whether the health issues are sufficiently complex, intense, and unpredictable in their nature is deemed to be at a higher rate.  If it is deemed that the individual is recorded as having a primary health need and meet the eligibility criteria, then they are entitled to funding.

The process to reach this point takes place via assessments conducted by either NHS staff or social workers. The first stage is a Continuing Healthcare Funding assessment. A further in-depth explanation of this procedure can be found on our website via this link: “What is a continuing healthcare funding assessment?” To summarise the process, the assessment takes place and the individual’s needs are scored as being either A, B or C, A being the highest score. If an individual scores 2 or more As, 1 A and 4 Bs or 5 Bs, their condition is deemed serious enough to warrant a full further assessment. This is the next stage in the process and is known as a decision support tool assessment. Further information about this can be found via our website via this link: “What is a decision support tool assessment?”

The decision support tool assessment is completed by a multi-disciplinary team of clinicians. They score the individual’s needs on the basis of priority; severe, high, moderate, low or none. They then recommend to the Continuing Healthcare Funding panel whether the individual should be awarded funding based upon their assessment.

As such it cannot be said that because an individual has a particular medical condition or disease, they are automatically deemed to have a health need. Conditions and diseases such as dementia, Alzheimer’s disease and Parkinson’s disease do not automatically entitle a person to full NHS funding for care homes or registered nursing care contribution. Often people with these conditions will qualify for Continuing Healthcare Funding but this is based upon how the disease or condition affects them across the domains that they are assessed, such as behaviour, cognition and mobility, they are deemed to qualify the criteria.

The process of securing NHS funding for care homes is complex and set out by The National Framework for NHS Continuing Healthcare Funding and NHS-funded nursing care contribution. It is a Department of Health policy document first introduced in October 2007.

Unfortunately with the limited budgets available to NHS trusts, in  our experience, a higher standard of eligibility is often incorrectly applied during the assessment process, and an individual’s needs can be downplayed and underscored so that they do not satisfy the eligibility and are not awarded the NHS funding for care homes they ought to receive. Clearly, this is not fair and if an individual is eligible for Continuing Healthcare Funding they should receive it as the alternative is they will be forced to pay for their nursing home costs in full from their assets. At a rate often exceeding £80,000 to £100,000 a year for nursing home care, very quickly an individual’s entire life savings, including their home, could have to be sold to fund their care.

For this reason, it is crucial that if you believe your relative ought to be assessed for NHS funding for care home costs because their need for care is primarily a health need you should contact us to assist with the process of securing the funding as soon as possible. At Compass Continuing Healthcare, we are experts in the complex area of Continuing Healthcare Funding and have a high success rate of securing funding where an individual ought to be receiving NHS funding for care homes. Call us today on 0121 227 8940 or complete our free assessment and a member of our team will contact you.

Author: Tim Davies LLB

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