Not if her requirement for care has been assessed as a primary health need
Thousands of properties are sold each year to enable people to meet the exorbitant cost of their care fees. However, it’s possible that many of these family homes should not have been sold as the individuals concerned may be eligible for “NHS continuing healthcare” – the package of funding where the NHS covers all costs, including care home fees.
Unfortunately, applying for NHS funding is 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. If an individual has a disability or has been diagnosed with a long-term illness or condition, it doesn’t automatically mean that they’ll be eligible for NHS continuing healthcare.
To help decide which services the NHS should provide – and pay for – and which services local authorities will provide, and charge individuals for, the patient – who must be over 18 – 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 is fairly protracted and 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 gleaned from the full assessment is used by the multi- disciplinary team to complete a ‘Decision Support Tool’ (DST). The DST 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 care domain to determine if the individual has a ‘primary health need’ and then make a recommendation to the CCG as to whether the individual should be entitled to NHS continuing healthcare.
If the recommendation is positive – i.e. that the individual qualifies for continuing healthcare – the package of care will cover up to 100% of care costs and can be received in any setting outside of hospital including care homes, hospices or even within your own 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 knowing that they may be eligible for free care. 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. The average cost of a nursing home in England and Wales is in excess of £1,600 a week, or £83,000 a year. This figure can be higher still and our experience at Compass CHC is the figure is more often in the region of £2,500 a week, especially where specialist dementia care and EMI homes are concerned.
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. Due to the fact the average home in the UK is worth in excess of £250,000 the typical scenario is that 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 have to 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. When faced with this scenario it is crucial to contact a specialist such as the team at Compass Continuing health care to assist you. We are industry experts and have a high success rate in securing funding for our clients in the swiftest possible timeframe.
It is not necessary to wait for a negative funding decision; we can assist in influencing the assessment in your relative’s favour while they are still in hospital before any discharge to a nursing home. Contact us today to find out how we can assist. Our FREE, CONFIDENTIAL assessment is available for you to complete online or you can contact a member of our team directly on 0121 227 8940. Don’t delay, start the process in avoiding paying for care homes today.
Author: Tim Davies LLB