Care home fees

SHOULD YOU BE PAYING FOR CARE HOME FEES?;

If you or a loved one need long term care and support in a care home, your first consideration should be your health needs and quality of care, not what you can or cannot afford to pay.

People requiring care do not know their rights and entitlements and are failing to get the right advice. If you or someone you know is going into a care home or are already in a care home then it is important that advice is sought about available care and financial circumstances.

The NHS and funded care;

The NHS offer two different types of financial support for care;

1. NHS Continuing Healthcare
2. NHS – Funded Nursing Care

NHS Continuing Healthcare

This is a complete package of ongoing care arranged and funded solely by the NHS, where it has been assessed that the individual’s primary need is a health need.

This care can be provided in any setting.

In a person’s home, it means that the NHS funds all the care that is required to meet their assessed health needs. In care homes, this means that the NHS makes a contract with the care home and pays the full fees for the person’s accommodation as well as their care.

NHS Continuing Healthcare is often referred to as ‘fully funded care’.

 NHS – Funded Nursing Care

This is when the contribution is paid from the NHS to individuals for their registered nursing care when the individual is a resident in a care home with nursing care.

 Eligibility and Need in a Care Home;

Eligibility for NHS Continuing Care depends on an assessment of needs.

Needs may vary especially when this includes physical and mental conditions.

Physical conditions can include anything that inhibits are person’s ability and requires a level of constant care.

Mental conditions are more commonly dementia or Alzheimer’s disease but are not limited to such conditions alone.

It is often the case that a patient suffering with one condition often suffers from an overlap of the physical and mental conditions. A common example of this is stroke victims who are suffering from a physical impairment such as use of limbs or loss of speech and a mental overlap such as memory loss. When assessing a patient’s needs several areas of need are considered. These areas are then divided into categories and a patient is scored on their needs. This scoring is known as ‘the primary needs test’.

The overall scoring then determines what level of care a patient needs and this then goes on to determine what if any, financial assistance is available.

The primary needs test is available to everyone, regardless of their financial circumstances.

Eligibility and Need at Home;

The eligibility and need criterion of a patient being cared for at home is exactly the same as a patient who is being cared for in a care home.

The differences between home support and care in a care home is often the effects and views of family members and carers. This should be highly considered within any assessment process.

It is even more important when a patient is not in a care home, that the patient or their family members/carer notices changes in their condition and needs. The carers of a patient are the best people and people closest to a patient to notice significant changes. This is usually when a reassessment should be undertaken.

Carers should not minimise the needs of a patient and should be able to ask for an assessment with the comfort and confidence that the right assistance will be provided. Advice should be sought to assist if a relative or carer is unsure of their rights.

The Assessment Process

It is important that that a patient’s healthcare needs are accurately assessed as this will have a direct impact on the availability of financial support.

At the start of the assessment process the individuals healthcare needs will be assessed.

In some cases, usually cases whereby a patient is terminally ill, the assessment process is fast tracked and financial support is immediate.

However, in the majority of cases a patient will undergo a screening process.

When an assessment is carried out it should be;

• Completed in a timely and efficient manner;
• The patient’s family/carer should be involved in the assessment where appropriate;
• The assessment should consider a patient’s social and environmental factors as well as healthcare needs;
• The choices and views of a patient should be heard;
• The impact of a patient’s needs on their family, carers and dependant’s should  be considered;
• Mental capacity and physical conditions will be assessed;
• All medical professionals involved with a patient should be involved if possible and at very least should be consulted;
• A clear record should be kept of the assessment

It is vitally important that within any assessment process, a risk assessment should be considered.

A risk assessment would consider;

• Risk of physical deterioration;
• Risk of acute and/or prolonged psychological distress;
• Environmental risks and dangers;
• Risk of vulnerability to exploitation and/or abuse;
• Risk of harm to self and others;
• Risks to relationships with carers;
• Risk of social exclusion;
• Risk of autonomy

When assessing the above risks, the NHS are attempting to recognise the necessity of interventions by a third party when caring for a patient. This would include social services, occupational therapy or housing services.

Again, within the risk assessment process the knowledge of the patient and their condition would be considered. Their views and opinions and that of their families would be included along with their ability to manage any risks.

In terms of considering the assessment or challenging the assessment, the NHS have clear guidance on record keeping the assessments effectively.

Effective record keeping is an essential and integral part of the process of the assessment and the care planning of an individual and it is imperative a patient or their family ensure that an accurate record is kept.

Records can be used as evidence in both complaints processes and in any legal proceedings.

The Review Process

Peoples needs do change and regular reviews should take place to ensure that such needs are being met appropriately. In some cases, where there is sustained improvement a patient may no longer be entitled to NHS Continuing Health Care. If this is the case then a patient or their family must ensure that it is shown that the improvement is sustained and that the needs are not just being masked by treatment, medication or symptom control. If this is the case then funding may wrongly be stopped and could be challenged. Advice should be sought.

A review equally may show that a patient’s need has deteriorated. A decision can be challenged and if a patient or their family believe that the assessment is wrong then advice should be sought to ensure that costs are not being paid when a patient is entitled to funded care home fee support.

A patient’s needs should be reassessed when necessary. This is usually as a result of a change in the patient’s needs or condition.

A patient and/or families can request that a review is undertaken if they can demonstrate or reasonably believe that a patient’ needs have changed. A patient has a right to a review and if this is unreasonably refused then legal advice should be sought.

It is too often the case that reviews are not undertaken promptly and the result is a patient paying for care that should be funded.

The Consequences when an Assessment Fails;  

Remember, an assessment must be carried out and reviews should be carried out regularly.

If an assessment process appears to be wrong then it may be and a challenge should be considered. The process does have flaws and the assessment may be inaccurate, all factors may not have been considered properly.

A patient may not be able to challenge the process themselves and in this case it is left to family members to ensure that a patient is not paying for care fees when they do not have to do so.

Patients are entitled to regular reviews and a review can be requested at any reasonable time by a patient or their family. Advice should be sought if a review has been refused.

If an assessment is wrong or if a review has not been carried out, then a patient may be paying for care home fees and care when they do not have to. Care home fees are expensive and if a patient has sufficient needs then their care should be NHS funded.

How to get a Refund of Care Home fees?

Decisions can be challenged and reviews can be requested.

Patients with assets who are paying for their care are losing out and so are their family members. This is wrong and you may be entitled to a refund of past payments.

Our team ensure that the correct assessment has been carried out and a case would be reviewed to consider the merit of a claim.

A decision would be made to decide whether a claim could be made for a reassessment and a refund. It may be that overpayments have not yet been made but a decision finds that a patient no longer has to pay for their care and the NHS will fund care from a decided date.

What we can do to help;

We can review your case or that of a relative.We can help you and advise if an assessment is accurate or if a review should take place.

If a review is inaccurate then this may be challenged or if a review is refused this may be challenged.

Every case will be reviewed on its own merit and every patient will be considered on their own individual needs. We will discuss the patients needs carefully and consider the input of the patient, relatives and carers when considering how best to proceed with a case.

What are the costs?

We now operate a ‘no win – no fee’ system.

If successful, our costs will be paid out of the money refunded by the NHS.

Other costs are involved if money is not reclaimed but a decision is granted to prevent further charges for care home fees, this is when the NHS take over payment.

Full costs will be discussed and confirmed in writing prior to a case beginning.

Can we help you or your relatives review your case? Contact us today.