If your relative is receiving full time care in England and has been paying care fees, you may be able to claim some of those care fees back on their behalf.
You can make a claim whether or not your relative is still in care, and whether or not your relative has already passed away.
You can currently make a claim for period(s) of care from 1st April 2011 to 31st March 2012, and the deadline for registering this claim with the NHS is 31st March 2013.
This retrospective funding is call NHS Continuing Healthcare and it covers 100% of the costs of being in a care home or receiving full time care at home.
The assessment process for NHS Continuing Care is not always straightforward and many people report having obstacles put in their way by the NHS. Many people seem to be ‘overlooked’ for funding, many assessments are carried out incorrectly and many people are also often not told that there is a formal appeals process you can go through at the time.
Many people on first going into care are also simply told they ‘don’t qualify’ for funding and they have to pay, and yet their health needs will have been assessed without due regard to the guidelines.
All this has led to the current situation where so many families are now making retrospective claims.
Here’s what to do in the first instance:
- Write to the Continuing Care Dept at the NHS Primary Care Trust nearest to your relative’s care home.
- Be sure to include your relative’s full name, date of birth, address while in care, the dates of the period of care for which you’re claiming and a brief statement to say you believe they may have been wrongly charged for care and that you’d like a retrospective review of NHS Continuing Healthcare funding.
- If you hold (or held) a power of attorney for your relative, state this in the letter.
- Avoid including too many details about your relative’s health at this stage. All you’re doing at this point is making the NHS aware there is a potential claim to be made. If you include too much information at this stage without understanding how the form will be interpreted by the NHS, you could jeopardise your chance of success.
- Once you’ve done this, the NHS should acknowledge your letter in writing.
- The NHS may then send you an initial form to fill in. It’s important to complete this very carefully – and in line with the national eligibility criteria for NHS Continuing Care – because the NHS will often use this form to decide whether to actually review your claim at all.
For care fees paid between prior to 1st April 2011, the deadline for these claims passed in September 2012. However, you may find this article on retrospective care fees deadlines helpful in this respect:
After three and a half years we ae about to attend a meeting to discuss the Portrayal of Needs in a retrospective assesment.
It covers 01.04.2004- 15-02-2006, when my father died.
The covering material says
The total assessed period was prior to the implementation of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care in October 2007. It was therefore necessary to apply the existing criteria in place at that time which in the local area was “NHS Continuing Care Eligibility Criteria, assessment and application process across the Thames Valley – updated May and July 2006”.
Is this correct? My memory is that this set of criteria was a faulty interpretation of ther rules at the time.
Prior to the introduction of the National Framework, each health authority made up its own rules and the chaos and injustice that ensued was the reason the guidelines were streamlined nationally in 2007 – through the National Framework. In most of the retrospective cases I know of, the National Framework guidelines have been used. I can’t help wondering (as I’m sure you have too) if the pre-2007 guidelines in your area make it less likely for you to achieve a successful claim? Does the CCG actually have a written version of their pre-2007 guidelines?