These 7 top tips reflect some of the most common hurdles families are coming up against when navigating the care system for an elderly relative – and when applying for NHS Continuing Care funding. We’ve included some advice to help you through 2013…
1. Retrospective claims – get your claim registered
As you may know the NHS imposed a deadline of 30 September 2012 for people to reclaim care fees wrongly paid in the past for the period 01/04/04 to 31/03/11. Even if you missed this deadline, it may still be worth applying. Contact the NHS and state that you believe your relative was wrongly charged for care in the past, and that the NHS failed to inform you of funding options at the time.
Remember you can also apply for a retrospective refund of care fees for the period 01/04/11 to 31/03/12; the deadline for this is 31/03/13.
It’s our view that these deadlines are illegal, and we’re hoping they will be challenged in the courts at some point.
2. Retrospective claims – be VERY careful filling in the form
If you have lodged a retrospective claim with the NHS, they may send you an initial form to complete. Be VERY careful how you fill this in. The NHS will almost certainly use your answers on the form to determine whether or not to review your claim at all. It’s vital that you complete the form with full knowledge of the Continuing Healthcare eligibility criteria.
3. NHS reforms in England – question what you’re told
The much talked about and often controversial NHS reforms are going ahead in England. You may find that many of the health and social care bodies in your area are restructuring and changing their names, including Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs). Be careful when pursuing NHS funding applications. At least one family has recently been told that their regional SHA has already been dismantled, and for that reason there’s no longer a higher appeal process for Continuing Care funding. This is completely wrong!
SHAs may be being abolished, but there will still be an appeal process for Continuing Care. Any information you’re given to the contrary may be an attempt by the health and social care authorities to stop you securing NHS funding. We’ll be writing more about the NHS reforms in 2013.
4. Increasing maladministration – watch out in Continuing Care assessments and reviews
Be vigilant. Keep a notebook of all conversations and correspondence with health and social care staff, names, dates, actions taken (or not taken), promises made, your observations, etc. This will be invaluable if you have to appeal a funding decision that goes against you. Many people who currently receive Continuing Care funding are reporting that it is being taken away for no good reason. You can challenge this through a Continuing Care appeal.
5. Choosing a care home – will you get funding?
If you’re told you have to choose a particular care home to have any chance of NHS funding, take this with a pinch of salt. There’s a good chance you’ve been told this because it’s the cheapest care home for the authorities to fund, should they have to. When you find a care home you like, ask the manager how many people there receive NHS Continuing Care funding. The chances are at least one or two do, in which case the objection on the part of the authorities holds no water.
6. Care home location – the Equality Act 2010 may help
If you’re told your relative has to go to a care home a long way away from you, and if that makes visiting difficult for the spouse and/or close family, the authorities may be in breach of the Equality Act 2010. The Act talks about ‘associative discrimination’ – discrimination against an individual (e.g. a family member) because of an association with another person (e.g. your relative in care). It’s worth dropping the Equality Act into the conversation should you come up against this hurdle. Read more about choosing a care home.
7. Continuing Care funding at home – remember it covers full time care
Many people who qualify for Continuing Care funding and whose care is provided in their own homes are now frequently being told that this funding only covers part time care, e.g. 35 hours/week. NHS Continuing Care funding cover 100% of care needs, day and night, not part time care. Some families are also now being told that Continuing Care funding is only available in a nursing home, not at home. Again, this is completely wrong, and is almost certainly motivated by the fact that it’s often cheaper for the NHS to provide funding in a care home. Be vigilant. Continuing Healthcare funding is available to cover full time care in your own home.