Making the step to place a relative into a care home can be an extremely difficult time for families. What can make this even more difficult is not understanding how your relative’s care home fees will be funded, what help they may be entitled to and what assessments should be carried out to determine this.
Your local authority must assess your relative’s needs regardless of their personal financial position. If the local authority recommends a care home is the best option, it must specify the type of care home required, for example a nursing home rather than a care home and the potential costs. An assessment can be useful even if your relative will be paying the full amount of costs themselves. You have a right to information and advice from your local authority to enable you to make informed choices at an early stage in the process.
If your relative is in hospital and it is being recommended that they require long-term care on their discharge, an assessment for ‘NHS Continuing Healthcare Funding’ should be requested at the hospital. This will assess whether or not your relative’s needs are of a level to be eligible for this type of funding, which is where the NHS fully fund the care home fees (your relative is not expected to pay anything if eligible, regardless of their financial position). A person is deemed eligible for NHS continuing healthcare funding if the main reason they are receiving care is as a result of their health. Alternatively, an assessment for NHS Continuing Healthcare can be requested whilst the patient is residing at a care home. You should make it known that you want to attend all assessments for your relative and that you are aware of the process.
If an assessment for NHS Continuing Healthcare is negative and your relative is not deemed to be eligible, an assessment for ‘NHS Funded Nursing Care’ should be undertaken. This package of care is a lower level whereby the NHS funds the nursing care element of the patient’s care i.e. a contribution is given towards the care home costs.
If your relative is not considered eligible for NHS Continuing Healthcare Funding or NHS Funded Nursing Care, the NHS isn’t responsible for paying anything towards the care home fees. In this scenario, the local authority will carry out a financial assessment of your relative’s circumstances in order to establish their capital. If a person has savings/capital (this includes their home and any pensions) over £23,250, they will be responsible for funding their care home fees entirely independently. Where a person has savings/capital between £14,250 and £23,250, the local authority will be responsible for contributing to the care home fees. Where the person has savings/capital under £14,250, the local authority becomes fully responsible for paying the care home fees. If your relative is coming close to only having £23,250 of capital, it is important that you contact the local authority at least a few weeks before in order for a further financial assessment to be undertaken and financial support from the local authority to be put in place.
Challenging the NHS
It is quite often the case that your relative has been assessed for NHS Continuing Healthcare Funding and you do not agree with the outcome of that assessment. Often relatives are unaware of their right to challenge these assessments and so they simply go along with the decision of the NHS. Here at Devonalds, we offer a free consideration of any negative assessment for NHS Continuing Healthcare Funding in order to determine whether the assessment could be challenged. If we are willing to challenge the assessment on your behalf, we will discuss our funding arrangements with you at that time.
If you believe that your relative should have been eligible for NHS Continuing Healthcare Funding whilst they were in a care home and has since passed away, we can apply to the relevant health board for a retrospective review of your relative’s health needs on your behalf. If we believe the case has prospects of success we will take on your case on a “no win, no fee” agreement.
NB: Please note that due to the previous Welsh Government deadline, retrospective claims can now only be brought in relation to any period of care from 31st October 2015 onwards.
Why should I choose Devonalds?
At Devonalds, we have a team of specialised, experienced professionals with extensive knowledge in bringing claims of this nature, having successfully recovered over £450,000 for families across Wales. We can assure that you will deal with the same individuals during the whole process who are dedicated to your particular case and who are able to explain each stage of the process carefully to you.
Ultimately, we understand how important decisions concerning your loved one’s care are. We are passionate about understanding your individual circumstances and ensuring we achieve fair outcomes.
If you are interested in finding out more about the service Devonalds provide in relation to recovery of care home fees, please contact us. If you are interested, we can send you out one of our initial questionnaires in order to obtain some further information regarding your relative’s health needs. Following consideration of the completed questionnaire, one of our specialist lawyers within the care home fee recovery team will be in touch to discuss your case.
Call: 01443 755189