Will I have to Pay for Care? NHS Continuing Health Care Funding
When people turn their mind to future planning, they may well consider whether they have to pay for their care, and if there are ways of avoiding this. With an ageing population, and more people living longer, care costs have risen and many have become concerned that rather than being able to leave their estate to their loved ones in their will, or even their chosen charities, all they have worked for over their life will be swallowed by care costs.
While there are certain legitimate measures that can be taken to reduce one’s liability for care fees, often people requiring care can find themselves depleted of their lifetime savings in the space of just a few short years of needing care. With residential care fees now on average costing residents £1,160 per week (which is just over £60,000 per annum), it is very useful to understand whether you can obtain funding from other sources.
Am I eligible for funding?
There are two main circumstances in which funding can be available to you for social care costs.
If a person is subject to Deprivation of Liberty Safeguards (DOLS) and this leads to hospitalisation under Section 3 of the Mental Health Act 1983, the local authority will normally meet the cost of “after care” although the scope of this is limited.
Most people are aware that if your capital exceeds a certain amount, being £23,250 in England, or the more generous £50,000 in Wales, you are expected to fund the full costs of social care until such a time as your capital drops below these figures, following which you will receive a contribution towards your care or full subsidisation.
If you have more capital than this however, you are deemed to be “self-funding” and although local authorities are often prepared to foot the bill whilst your money becomes accessible (e.g. if your capital is tied up in a property or someone is applying for a deputyship order), you usually end up paying this back in full.
The key to the above is that this refers to “social care” and is not intended to refer to “healthcare”. Generally speaking, if a person’s healthcare needs outweigh their social care needs, it may be possible to obtain NHS Funded Continuing Healthcare (CHC) Funding, which involves your care being fully funded by the NHS, regardless of your personal means and you don’t have to contribute to it.
NHS Funded Continuing Healthcare Funding – Am I eligible?
CHC Funding is available to any individual whose health care needs meet a criteria (and this is revisited every year).
If an individual requires care and their specific needs are quite acute, they may be assessed for CHC Funding. If there is an urgent need, the process of assessment can be completed very quickly. A referral can be requested from any health or social care practitioner (usually the GP or social services) and depending on the person’s circumstances, what will generally follow the referral is a checklist assessment in relation to 12 specific domains of care needs which are:
- Breathing;
- Nutrition;
- Continence;
- Skin and tissue viability;
- Mobility;
- Communication;
- Psychological and emotional needs;
- Cognition;
- Behaviour;
- Drug therapies;
- Altered states of consciousness;
- Other significant care needs.
The assessment that takes place is multi-disciplinary, meaning that it should not just be carried out by one single practitioner whose experience is based in only one of the domains for care. The decision (recorded in a document known as a Decision Support Tool) will be recorded in writing. If funding is rejected, the complaints procedure should be provided to the person, alongside details of the decision.
Having a specific condition alone (e.g. Alzheimer’s or Parkinson’s disease) is not enough to qualify for CHC Funding but you can be eligible if you are deemed as having a “priority” need in one of the 12 domains, or “severe” needs in two or more domains. If this is not the case, full funding can still be granted if the patient’s overall level of need is very great.
What if funding is not granted?
There is something of a postcode lottery with CHC Funding and in certain areas of the country, there are more positive assessments than others. In England, there is a two-stage appeal process:
- The first stage of appeal is a local resolution meeting, which is chaired by a new assessor; and
- The second is a national level of appeal to NHS England. These appeals are heard by an Independent Review Panel.
While the appeals process can be quite time consuming, it is certainly worth considering as a fair number of appeals do succeed.
Recovery of funding that should have been given
It is sometimes possible to recover sums from the NHS when a deceased person might have been eligible for CHC Funding and this is something that estate administrators can explore.
When to speak with BRM
BRM can help you with the initial assessment, any necessary appeals or even retrospective assessments.
In particular, we can assist:
- Individuals themselves, or their attorney or deputy, when someone is receiving or about to receive care and will have to pay for it;
- Executors and administrators looking to recover care fees paid by a deceased individual who should have been eligible to receive funding;
- Individuals, or their attorney or deputy, with retrospective reviews for those who have been in care for some time and who should have received funding.
Please bear in mind however, that whilst in England it is possible to recover care fees going back to 2012, however in Wales, it is only possible to recover fees from the previous 12 months.
If you would like assistance with the above, or any other matter involving care, the Court of Protection or contentious probate cases, please contact BRM’s Joshua Proud or Lewis Hastie to discuss.
