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Discharged from hospital to a care home? Is your relative getting their entitlement to 6 weeks’ free care?

With the COVID pandemic on the rise again, there remains an urgent need for the NHS to discharge patients from hospital as quickly as possible in order to free up beds.

To incentivise quicker hospital discharge, the Government has put in place a COVID discharge funding scheme to help patients going into care.

Did you know that, from 1st September 2020,  if you (or your relative) are discharged from hospital into a care or nursing home, and require a new or additional package of care, you are entitled to receive free NHS funding for the first 6 weeks of your care, or until such later date as your long-term care needs have been assessed and the outcome is notified to you?

In the meantime, until the assessment has taken place and you have been informed of the outcome decision, your local Clinical Commissioning Group (or Local Authority) are obliged to continue paying for your care from their own resources and you should not be asked to pay a penny.

For more information, read our blogs:

Are you ready for 1st September 2020? CHC Funding Gets Back to Business

Read this if your relative is about to be discharged into a care or nursing home

Part 1. Explaining The Vital Difference Between Social Needs vs Healthcare Needs

This pot of available funding is not widely known nor volunteered, and unless you happen to chance upon it, there’s a real likelihood that you could be paying for your first 6 weeks in a care home, quite unnecessarily.

We applaud the BBC Radio 4 programme, ‘You and Yours’ dated 4th November 2020 for highlighting this specific issue on their excellent radio programme.

We also wanted to make special mention and thank ‘Caroline’ who called into the programme to share her story and for specifically mentioning Care To Be Different. She had no idea about the Government’s COVID discharge fund until she got in touch with us. We are pleased to hear that she found our services and information helpful.

Here’s our transcript of the interview slot in case you missed it. You can read about Caroline’s issue and the lack of transparency and public awareness of the COVID discharge fund. We have tried our best to portray the interview verbatim. You also can listen to it via this link (for as long as it is available): https://www.bbc.co.uk/sounds/play/m000p1gl

Presenter (Winifred Robinson): “The NHS is needlessly adding to families’ emotional and financial burden by refusing to fully fund the care of people who qualify for that funding. That is the key finding of a report published today by the official body that investigates complaints. If this story sounds familiar to you, it’s because it is. Wrongly denying very sick people discharged from hospital free, NHS Continuing Care has been going on now for years and years. Here at ‘You and Yours, listeners email us about it regularly. Caroline got in touch with us only last Thursday from Sussex, to tell us about her mum.

Caroline: “Well she’s got Dementia. She’s been in a residential home and she had a fall broke her leg and elbow and was taken to hospital. At the hospital, they said that she couldn’t go back to her residential home because she would need the care of two, and so we would have to be looking for a Dementia nursing home, and of course, the nursing care is almost double what a residential home is. To be honest, we’re right at the end of funding. Mum’s house has gone, the savings have gone, and I was panicking a lot to be honest. We found the home, paid them four weeks of respite which is £5,500, and then I thought I’m going to get in touch with Dementia UK and find out about continuing health care and whether she would, you know, qualify for it now. And they put me in contact with a company called Care To Be Different. They said, she’s entitled to what’s something called Covid discharge arrangement, and I said, sorry I don’t know what you’re talking about, and they said, basically it’s a national government directive and whereby, an elderly person, if they are discharged from hospital to a nursing home, they are entitled to up to the first six weeks of fees, and you know the CCG will pay them. And I haven’t been told this at all. None of the Department bodies that I dealt with at the hospital, you know the social services, the hospital discharge or any of them, had said anything about this.”

Presenter: “Rob Behrens is the Parliamentary and Health Service Ombudsman*, an independent arbitrator, he is the author of today’s report. Rob Behrens, our listener, Caroline, has been told by a care company [sic Care To Be Different] that her mum and anyone else discharged from hospital to a nursing home in England in the pandemic, is entitled to six weeks of NHS Continuing Care. Is that your understanding?”

RB: “Well, first of all I want to say how sorry I am to hear about the distress Caroline and her mother have been through – that’s not untypical. We’re talking about fundamental rights here, and the absence of them in this case. Yes, the government has put in place special arrangements during the pandemic, which at the moment means that, anyone discharged from hospital into a nursing home will have the first six weeks of their care paid for – to allow ongoing care arrangements and a full continuing health care assessment to take place. Now, one of the issues here is finding out what you can have access to, and I suggest that anyone listening goes onto a number of websites which spell it out very clearly… Beacon is one, Voiceability, Age UK, Parkinson’s UK  – spell it out. Now, I’m not defending the absence of Caroline being told this by the authorities, but you know, you have to do what you can in a crisis situation.”

Presenter: “Rob, well we spent ages this morning, our team, looking at government guidelines, pages and pages and pages of them, and I couldn’t find it clearly spelt out in any of those guidelines. I mean these rules are complex, and it feels as if officialdom, from top to toe, make them as a opaque as they can.”

RB: “Well, there is a big issue here. I mean continuing healthcare has been a challenge for a long time, as I think you know, and it is very complicated in order to meet needs, and it’s a complicated process. It involves a number of agencies, supposedly working together; it requires professionalism on the frontline, and if people are not communicated to during a time of personal crisis and told what their rights are, they’re not going to easily find out. So, I think you’re absolutely right, and the NHS needs to sit up and take notice of what you’ve just said and what is clear in in my full report.”

Presenter: “I can remember this story on ‘You and Yours’ when I first joined the team, and that was 20 years ago, and I can remember MPs calling NHS Continuing Care, and I’m quoting now, “The best kept secret in the NHS.”  What do you recommend should happen now?”

RB: “Well, I think first of all, I should pay tribute to what You and Yours have done to run with this issue and that’s unusual and very important. Secondly, we have laid this report, which I commend to your listeners to read, before Parliament and its Select Committees, to make sure that the NHS gives an account of what it’s doing and what changes it’s going to make as far as the recommendations, and the failures that that we’ve talked about. But, remember that the Ombudsman has no binding power to force a change under our current law, so we are dependent upon Parliament raising the issue in a way that forces the NHS to act.”

Presenter: “Do you think it’s really just a case of the NHS and the government rationing what funds there are?”

RB: “I think there are a lot of problems. On the basis of a very comprehensive study that we’ve done – we looked at over 300 decisions which we’ve made in the last two years – that’s a lot of cases – where we did 150 full investigations. I’m not able to say… I say a lot of things about failures, but I’m not able to say that it’s a result of financial rationing which has led to these issues. There are many other issues as well. Though, I accept, as I’m sure you’re aware, that the health service is going through unprecedented challenges at the moment and that doesn’t make it any easier.”

Presenter: “We asked NHS England if they’d like to come on the program but they said they couldn’t do that today, but they did say they look at the recommendations that you have set out, together with local health groups and the government who currently set the guidance on eligibility, and they also say, those who are concerned, can request an independent appeal review. How easy is that?”

RB: “Well, I mean it goes back to your point that these issues are not easily articulated. It’s difficult to find out about them. It’s quite hard to get from where the assessment is made to the Ombudsman’s office and increasingly smaller numbers of people go through the process. So, one of the key things, and I think there are two issues here – one of the key things is that the NHS needs to do a lot more to make this system understandable to users and to advocates who help the users. And secondly, Parliament has to call to account those who have responsibility for this through the Select Committee system to ensure that they give an account for what they’re doing. We have asked for the government to give a response within six months of what it’s doing in response to my report, and that is sensitively taking account of the current crisis. So, you know, there’s plenty of time for them to act on this and it’s up to Parliament to make sure that they do.”

Presenter: “I’m sure we will have you back, but people can complain to you, can’t they, when they feel they have been wrongly denied NHS Continuing Care? What proportion of cases do you uphold?”

RB: “Well, we get around between 500 and 800 complaints about this issue every year. We have a special team dealing with continuing healthcare because it’s complicated and it needs expert advice. Not everything that we receive is eligible, because you have to go through the frontline body first before you can make a complaint to us. But, we’re upholding around a third of the full investigations that we hold and there are significant failures which we’ve discovered, including two people losing £250,000 each as a result of the failures of the system.”

*Parliamentary and Health Service Ombudsman – “The Ombudsman’s role is to investigate complaints that individuals have been treated unfairly or have received poor service from government departments and other public organisations and the NHS in England.” Visit: https://www.ombudsman.org.uk/making-complaint

Summary:

Thanks to the BBC ‘You and Yours’ and to Caroline for featuring this issue and bringing it to the public’s attention.

If you want to make a complaint, you must first exhaust the CCG’s own complaint procedure. For more information, see: https://www.ombudsman.org.uk/about-us/who-we-are/the-ombudsman.

For more information, take a look at these blogs:

Rationing NHS Continuing Healthcare Funding – The ‘NHS’s Best Kept Secret’

Essential Preparation and Planning As CCGs Restart Assessments and Appeals From 01/09/2020

You, too, can spread the word and tell others about their entitlement to first 6 weeks’ free care upon discharge from hospital to a care facility. Let us know if, like Caroline, you were unaware of this available funding, and what you did about it when you did find out. Did you get reimbursed, and how long did it take?

Leave a comment below if you want to contribute to the debate…

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Things You Need To Check Before Your Relative Is Discharged From Hospital

Many families report that their spouse or older relatives are often forced out of hospital and into long term care – or back home – before proper health needs and funding assessments have been carried out, and before suitable care provision has been put in place.

If your relative is about to be discharged from hospital back to their care home, or else are going into a care home setting for the first time, then there are certain key things you must consider:

1) Is your relative eligible for NHS Continuing Healthcare Funding (CHC Funding)?

This is NHS funding and it covers 100% of the costs of ongoing full-time care if your relative needs it primarily for health reasons i.e. they have a ‘Primary Health Need’.

CHC Funding is not means-tested and is ‘free at the point of need’ and is paid irrespective of wealth.

However, many people are discharged from hospital into care without any assessment for CHC Funding having been arranged – effectively forcing them to pay for care before it has been properly established that they need to.

The revised National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (2018), provides that an assessment for CHC Funding should now take place outside the acute hospital setting. This is designed to allow time for a more accurate assessment of care needs away from the anxiety of hospital environment.

So, if you believe (or are told) that your relative has a primary health need, then let the hospital Discharge Team know so that they can make arrangements for your relative to be assessed for CHC Funding when they are in the care home.

In the meantime, the NHS should put in place an interim package of care until the preliminary screening Checklist has been carried out at the care home. This free care package usually lasts for around six weeks (but it can be longer if the NHS are slow to arrange the Checklist assessment). You shouldn’t have to pay any care home fees in the meantime.

For further information, read our blog: What’s new in 2018 NHS National Framework for CHC? Are you getting an interim care package?

Once in a care home setting, the NHS will carry out an initial screening Checklist assessment to see whether your relative has a ‘primary health need’ and is eligible for CHC Funding.  Read our blog: Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…

If your relative is successful at the Checklist stage and triggers for a Full Assessment by a Multi-Disciplinary Team (using the Decision Support Tool), then you they may be required to fund their care in the meantime whilst waiting for this assessment to take place. Read our blog: Am I eligible for NHS Continuing Healthcare? 5 questions.

If CHC Funding is awarded, then it will cover all your relative’s clinically assessed healthcare needs, including the cost of their care home accommodation.

2) Choosing a care home – some top tips

The transition of putting a relative into a care home is, for most families, an emotional and upsetting time. Your relative is about to be discharged from hospital but can no longer be cared for in their own home or live in yours. The hospital intends to discharge your relative to avoid ‘bed blocking’ and you are now forced to look for a suitable care (or nursing) home at short notice, to provide for their long-term care needs. You recognise that you need to find a roof to put over their head quickly to keep your relative safe and in a secure caring environment. With emotions running high and the turmoil of everything else going on, we recommend the following advice:

  1. Stay calm and don’t panic, however much pressure the hospital is exerting!
  2. Take your time. Don’t be rushed into choosing the first care home that comes available, however tempting that may be. This is your relative’s long-term care and well-being that is at stake. Choosing the wrong care home can be very distressing for you and unsettling for your relative.
  3. Ask your GP for recommendations. They are usually a good source of information and will have experience of visiting patients in many of the local care homes. They should know your relative’s care needs and therefore be able to suggest a suitable care home that is close by. Sometimes, living close to their own home or in a familiar local environment, can be an overriding feature when making your decision.
  4. Carry out due diligence. Are the care home’s facilities and amenities suitable for your relative’s care needs, and in line with their standard of living?
  5. Ask around. What reputation do they have for providing care? What is the standard of care/nursing care like?
  6. Speak to the care home manager and find out what is their set ratio of care/nursing staff to residents. And how will they meet your relative’s needs?
  7. What is the state of general hygiene, cleanliness and infection control?
  8. Will the standard of catering meet your relative’s nutritional needs and what is the hygiene rating?
  9. What relevant facilities and amenities does the care home offer that would be of benefit to your relative (eg beauty salon/spa type treatments such as hair dressing, chiropody and manicures).
  10. Whilst it may be important to your relative’s overall well-being to be in comfortable surroundings, don’t just look at the ‘fixtures and fittings’. Quite often an expensive care home in an affluent area, with extensive manicured gardens, does not reflect the quality of care! Look past the veneer and outer public appearance.
  11. Look at previous inspection reports on the care home provided by the Care Quality Commission (CQC) – an independent regulator of health and social care in England. Does the care home meet the standards expected? Are there any warning signs or matters that require improvement? Visit: https://www.cqc.org.uk/
  12. Try and speak to families or friends who have a relative in care or are familiar with this particular care home, to find out more. The bigger the picture you can build as to whether the care home will be suitable for your relative, the better.
  13. Don’t be embarrassed to ‘shop’ around, as rates, staffing level and amenities will differ with each care home.
  14. When visiting, ask to see available rooms. Will they be suitable for your relative’s care needs? For example, if your relative is immobile and needs several carers to assist with hoisting or transfers, can the room accommodate a wheelchair and/or a hoist?
  15. Critical: Don’t be pushed down the route of discussing payment and self-funding until your relative has first been assessed for NHS Continuing Healthcare Funding. Read our blog: “So will you be self-funding?”
  16. Check the care home contract carefully. Take time to look at it and don’t just sign it! You could be paying top-up fees unnecessarily! Read more about top-up fees below…

You will find these blogs useful, too:

BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare

What’s the difference between a care home and a nursing home?

3. Beware of unlawful ‘top-up’ fees!

 If your relative is being asked to make a financial ‘contribution’ towards the cost of their care fees, you need to be very clear why this is the case, as it could be an improper request. Some contributions, known as ‘top-up’ fees, are unlawful. Read our previous blog: Are You Paying Top-Up Fees Unnecessarily?

Some care homes may explain top-up contributions as being ‘voluntary’ payments – when they are anything but that and are mandatory! It is not uncommon for families to be told, quite bluntly, that unless their relative pays these extra ‘voluntary’ care fees, they won’t be accepted in the home (or else be allowed to continue residing there). Care home managers know that you are in a vulnerable position and need to place your relative in care quickly. Exerting such unfair pressure is emotional blackmail and tantamount to economic duress!

Top-up fees are unlawful and should not be charged according to the National Framework for NHS Healthcare and NHS-funded Nursing Care, if your relative has been assessed for having a ‘primary healthcare need’. In which case, all their healthcare needs, should be paid for in full by the NHS, regardless of whether the care home is located in an affluent area or set in beautiful grounds.

If there is a shortfall between the actual cost of care and what the NHS will contribute, then the care home should approach the NHS for more funds, and not seek to charge your relative a top-up fee just because private funding is available.

However, care homes can lawfully charge top-up fee contributions for extras, known as ‘hotel style services’ or the ‘luxuries of living’. Common examples include, having a ‘larger than standard or ‘premium’ room, perhaps with a better view or kitchen area, and for ‘spa’ type services.

So, if told that your relative has to pay a ‘voluntary’ contribution towards their care, you must find out exactly what it relates to before you sign anything! Query why this isn’t covered as part of the CHC Funded care package in place. If it relates to assessed healthcare needs, the NHS should pay the shortfall, not you!

Note: Some care home contracts are deliberately vague and may refer to such contributions in different guises to hide their true intent. For example, describing payments as a ‘third party contribution’. If you are not thinking clearly, or don’t understand the relevance, your relative could mistakenly be paying top-up fees unnecessarily.

Care homes should be completely transparent and not seek to disguise a top-up fee by calling them something other than what they really are!

For reading around the subject: TOP-UP FEES – Unfair Care Home Practices Now Face Government Sanctions

If you are paying top-up fees, visit our one-to-one page for specialist legal advice.

4. What happens if my relative’s healthcare needs change?

Remember, that an individual’s health can fluctuate over time.

If your relative is not entitled to NHS Continuing Healthcare funding at the outset, but their health deteriorates over time, then they are always at liberty to request that a reassessment be carried out for CHC Funding. If CHC is subsequently awarded, the NHS will take over funding the care home fees instead.

If your relative is not eligible for CHC Funding and is paying for their care privately (ie self-funding), but over time exhausts their savings, then they may well pass over into the realms of Local Authority funding if their capital or savings (including the value of their home) is less than £23,250.  In such circumstances, the Local Authority may be obliged to take over funding of the care home fees. However, if your relative is resident in one of their appointed care homes they will usually only pay an agreed fixed amount (or ‘bed rate’) towards the cost of care. Therefore, if your relative chooses a more expensive home, they be lawfully required to pay the shortfall (ie top-up) between the care home rate and the Local Authority bed rate.

If your relative’s assets are between £14,250 and £23,250, then they may be asked to pay an assessed contribution.

For more reading on the subject…

We highly recommend downloading our 39-page digital guide  “How to choose a care home” packed with over 130 tips and questions. The guide helps you:
– ask the vital questions most people don’t ask – but should
– get a better picture of what a care home will really be like
– gain peace of mind that you’ve made the best decision you can
– save time and avoid a lot of hassle

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Do Continuing Healthcare assessments in hospital still exist?

Continuing Healthcare assessments in hospitalShould Continuing Healthcare still be assessed prior to discharge from hospital?

One of our readers recently asked this question when his relative was about to be discharged from hospital.

So what’s the situation with Continuing Healthcare assessments in hospital?

On raising the issue of an NHS Continuing Healthcare assessment with the hospital discharge team, our reader was told that the government has now instructed hospitals to discharge patients first – before any Continuing Healthcare assessments are done.

The hospital team said that NHS Continuing Healthcare assessments should now take place ‘in the community’.

Is this correct?

NHS Continuing Healthcare assessments in hospital

In August 2017 NHS England sent a letter to CCGs saying that “less than 15% of all full NHS Continuing Healthcare assessments [should now] take place in an acute hospital setting”.

However, this does not mean that no Continuing Healthcare assessments should take place in hospital!

In addition, there are some vital things to remember if you’re told by a hospital discharge team that they ‘don’t do’ NHS Continuing Healthcare assessments.

We’ve outlined those here:

Typically, and in the experience of hundreds of families sharing their experiences on our website, a hospital will try to discharge a patient before an NHS Continuing Healthcare assessment is carried out. CCGs often call this ‘discharge to assess’.

However, many families call it ‘discharge to forget’, because people often have to wait months to be assessed outside hospital and some are never assessed at all once the hospital no longer has any responsibility.

Once a person has been discharged, families also lose the leverage of their relative occupying a hospital bed. It can be much more difficult to get an assessment done quickly as a result.

CCGs are responsible for paying for care in the interim

The Care Act stresses that people should be considered (i.e. assessed) for NHS Continuing Healthcare before they are are discharged from hospital, because that’s the only way to know who should pick up the care bill once they have actually been discharged.

If a person is discharged before being assessed for NHS Continuing Healthcare, the NHS must by default pick up the bill for ongoing care until the full NHS Continuing Healthcare process has been carried out.

What also often happens in practice is that many people are discharged and told that they’ll just have to start paying for care until the Continuing Healthcare assessment can be done.

This is completely flawed.

Why? Because it puts the responsibility for ongoing care onto the local authority – and local authorities means test people for care.

If a local authority does take on this responsibility before the Continuing Healthcare assessment process is complete, the local authority is in a potentially illegal position. It should never take on responsibility for care that is actually the responsibility of the NHS – or before a person has been assessed for Continuing Healthcare  At this point it has yet to be decided who should be paying.

Additional false information that people in hospital (and elsewhere) are also often given is that they must pay care fees anyway if they have savings or a house. As we know, that is completely flawed.

So let’s go back to the letter that NHS England sent to CCGs – the one that told CCGs to reduce the number of  NHS Continuing Healthcare assessments in hospital:

A letter from NHS England does not change the law. Nor does it change the principles of the Care Act.

In addition, the letter talked about ‘full’ NHS Continuing Healthcare assessments. Stage one of the process is the Checklist assessment; stage two is the full multidisciplinary team assessment.

Some families do allow their relatives to be discharged before the NHS Continuing Healthcare assessment process is complete. This is sometimes because being in hospital is proving detrimental to their relative’s health and wellbeing.

Others accept that their relative will be discharged, but (correctly) refuse to pay any care fees until the Continuing Healthcare assessment process has been carried out in the community (e.g. at home or in a care home).

Feedback and comments from many families also indicate that hospital discharge teams sometimes know very little about the proper NHS Continuing Healthcare process – and even less about the law. They are focused instead on managing and freeing up beds.

Stand firm when it comes to NHS Continuing Healthcare assessments in hospital

So if you’re told that an NHS Continuing Healthcare assessment can no longer be done in hospital, question this using the points outlined above. The person you are speaking to may be referring to the pressure from NHS England to free up beds or, alternatively, they may have been given incorrect information and may lack training in NHS Continuing Healthcare.

Ask them whether they have read and understood the Care Act, and if they tell you to start paying care fees, remind them that the NHS has a duty to cover the cost of ongoing care until the NHS Continuing Healthcare assessment process is complete.

Read more tips about NHS Continuing Healthcare assessments

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CCGs to cut NHS Continuing Healthcare assessments in hospital

CCGs to cut NHS Continuing Healthcare assessments in hospitalWatch out for more pressure on families to get relatives out of hospital

If you have a relative in hospital and they need ongoing care, you may soon come under even greater pressure to get them out before the proper NHS Continuing Healthcare assessments in hospital have taken place.

NHS England has issued new guidance to CCGs regarding hospital discharge and Continuing Healthcare assessments. It means that CCGs may now do whatever they can to avoid assessing people while they’re still in hospital.

The new guidance comes in the form of a letter sent by NHS England to CCGs. It’s dated 17th August 2017 and you can read it here.

We’ve pulled out a few points from the letter and added our comments and words of caution below. The focus of the letter is, on the surface, about making the NHS Continuing Healthcare assessment process more efficient. However, it may make things even more difficult for families.

Here’s what the letter says about NHS Continuing Healthcare assessments in hospital:

“1. CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting;”

and…

“These CCGs are required to submit a plan for improving this to less than 15% by March 2018…”

There are some crucial things to watch out for here:

  • You may come under enormous pressure to get your relative out of hospital. If you can stand firm and insist that the NHS Continuing Healthcare assessment process takes place while they are still in hospital, you will have more leverage to get it done quickly.
  • If/when your relative is discharged, they may be offered intermediate care (rehab) – if that’s appropriate for them. Your relative should not be charged for this. At the end of the period of rehab, and if your relative still has ongoing care needs, there should be an NHS Continuing Healthcare assessment. Again, your relative should not be charged a penny for any care until this process is complete – even if they have left rehab.

The NHS England letter also states:

“2. CCGs must ensure that in more than 80% of cases with a positive NHS CHC Checklist, the NHS CHC eligibility decision is made by the CCG within 28 days from receipt of the Checklist (or other notification of potential eligibility). CCGs are expected to ensure that full assessments are only undertaken when required, for example, assessments are not required for people who are going on to NHS rehabilitation services or do not have long-term care needs;”

The last few words here contradict existing guidance and are, frankly, alarming: NHS Continuing Healthcare funding is for any stage of life. It doesn’t have to be ongoing; instead, it can be provided during those times when a person’s care needs meet the criteria, and then cease if/when the person no longer needs it.

So, saying that people who don’t have long term care needs shouldn’t be assessed at all would seem to mean that anyone recovering from illness or accident (and who is actually recovering) would never get the funding. This must surely be in conflict with the whole legal basis on which the NHS operates, i.e. to provide healthcare.

Be alert also for the following:

  • The scores in Checklist assessments may be lower than they should be, essentially to avoid the need for the CCG to do full multidisciplinary team (MDT) assessments.

“NHS CHC assessments should only be undertaken when an individual has recovered after an acute period of care and when their long term care needs can be more clearly identified.”

This is essentially the same as before. However, remember that part of the purpose of the NHS Continuing Healthcare assessment process is to inform the kind of care that is required. If people are being shunted out of hospital without a clear ongoing care plan in place, this presents a huge risk to patients.

“CCGs must ensure that decisions can be made swiftly throughout the week, as soon as patients are ready for discharge. Verification of MDT recommendations should take no more than 2 working days.”

Whilst it’s good news that funding decisions will be made more quickly, be alert for the following potential scenarios:

  • NHS Continuing Healthcare full MDT assessments being arranged in haste without families being informed.
  • NHS Continuing Healthcare full MDT assessments being carried out so quickly that they do not reflect the true picture of need of the individual being assessed.

This may all sound cynical, but there is already a huge amount of impropriety in the way NHS Continuing Healthcare assessments take place (or don’t take place); these extra requirements placed on CCGs risk making this even worse.

Remember always 3 crucial things:

  1. Guidelines are just guidelines; they are not the law.
  2. Whether or not a person pays for care has nothing to do with their money, house or assets; it’s about their care needs only – and the decision about who does actually pay can ONLY be made once the NHS Continuing Healthcare assessment process is complete and a finding decision has been made, in writing, and with a full rationale.
  3. The local authority has a vital role to play in the NHS Continuing Healthcare assessment process.

So be vigilant, stand your ground and don’t be afraid to dig your heels in and get the Checklist carried out while your relative is still in hospital.

Read more about hospital discharge and NHS Continuing Healthcare assessments.

 

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Paying for care between hospital discharge and a funding decision

Woman saying no to paying for care between hospital discharge and a funding decisionDon’t let anyone means test you in hospital before a Continuing Healthcare assessment

If your relative is in hospital and you’re under pressure to have a financial assessment, this article will help you. It looks at who should be paying for care between hospital discharge and a funding decision.

Here’s a typical hospital scenario…

Your relative is in hospital and you’re under pressure from the discharge team to get them out. However, no one has done an NHS Continuing Healthcare funding assessment. You complain about this and you’re told the assessment will be done ‘later on’, after your relative has been discharged. Also implied is that your relative will pay for care in the meantime. You may also have come under pressure to have a financial assessment (a means test).

There’s a whole lot wrong with this scenario – and yet sadly it’s all too common. No one will have looked at who should legally be paying for care between hospital discharge and a funding decision for NHS Continuing Healthcare.

Let’s suppose you can’t fight the pressure from the discharge team and that your relative is discharged.

Who should be paying for care at that point?

The NHS Continuing Healthcare guidelines make it very clear who should be paying for care

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, page 25, paragraph 74:

“Where the Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.”

There are several points to note here about paying for care between hospital discharge and a funding decision:

First of all, a person in hospital who needs ongoing care should not be discharged from hospital without having been considered for NHS Continuing Healthcare funding.

Why?

The usual assessment process for NHS Continuing Healthcare has 2 stages. If a Checklist assessment for NHS Continuing Healthcare has been carried out (stage 1), and it indicates potential eligibility for Continuing Healthcare funding, there must then be a full multidisciplinary team assessment (stage 2). If a person’s ongoing needs are not yet clear, there may possibly be an argument to discharge the person and wait until their ongoing needs become more apparent before stage 2 is done.

However, this does not mean the NHS can simply hand the person over to the local authority for means testing,

The full NHS Continuing Healthcare assessment process could eventually indicate that the NHS does have a legal duty to fund all care; the NHS cannot offload this funding responsibility to anyone else in the meantime.

Upon discharge from hospital, if a person is means tested and told to start paying for their own care, the local authority may, as a result, be in an illegal position – because it may have taken responsibility for care that is beyond its legal remit.

No one should carry out any financial assessment (means test) until it’s clear who is responsible for paying. The health and social care authorities have no business asking about your relative’s finances during this time.

So it’s very clear who is responsible for paying for care between hospital discharge and a funding decision: the NHS is.

Why are elderly people so often wrongly charged for care?

What’s your experience?

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NHS Continuing Healthcare and hospital discharge – the assessment game: Part 1

NHS Continuing Healthcare funding assessments and discharge from hospitalNHS Continuing Healthcare funding and discharge from hospital

Here we feature a case study from Sarah, whose mum was being pressured to leave hospital – but without an NHS Continuing Healthcare assessment.

At the end of the article we also include a link to some vital tips you can follow if you also have an older relative in hospital.

Sarah wrote to us about her mum who had been in hospital and was seriously ill. She had been in hospital for seven weeks with a terminal liver diagnosis, and the hospital was struggling to stabilise her enough for her to go home.

Despite this, the hospital wanted to discharge her, but Sarah had grave concerns about this – understandably. In addition, no one had even mentioned an NHS Continuing Healthcare funding assessment.

Sarah explains…

“I hadn’t realised how horrific the physical elements of liver failure are. Mum was also permanently confused and had pneumonia. It was the toughest time of my life watching her deteriorate, The hospital was awful, and Mum was getting more and more distressed.

“The discharge team wanted to get her out, and I didn’t know what to say or do to stop them. I couldn’t believe how stressful this all was.

“We were gearing up to let them send her home, but then we found the information on Care To Be Different’s website, and our new knowledge stopped the hospital discharging Mum.

“We also realised we now had more power while Mum was still there, and had more chance of forcing the hospital to do the proper funding assessments. Everything felt like a quagmire, though – I’m so glad we at least had power of attorney.

“We played a strategic game (the hospital’s own game) where we led the NHS to their own conclusion that it was not safe to discharge Mum and that she should also have an assessment for NHS Continuing Healthcare funding. She could stay there for the time being while they completed several diaries of her behaviour and while they risk assessed her.

“It was a relief to have a little breathing space.

“Given Mum’s state of health, a Fast Track assessment for Continuing Healthcare was to be done – although we were warned that if Mum’s care was not at the level where she required specialist nursing provision she was likely to be turned down. From everything we’d read, this didn’t sound right at all.

“I am so grateful for the information we had from Care To Be Different. I used and cited a lot of it with the discharge team. It seemed to really annoy them that we knew so much! I can’t tell you what a help all the information has been.

“Despite assurances that a Fast Track would be carried out, Social Services then assessed Mum and said she part qualifies for NHS Continuing Healthcare funding. I knew this was rubbish. We had no knowledge of any such assessment, and we hadn’t even been invited. I insisted on the correct process.

“We were then told there was to be a Best Interests meeting, as they wanted Mum to go into a nursing home rather than back home, but they said the NHS wouldn’t pay for one-to-one care overnight.

“Having read so much by then, though, I was ready to fight.

NHS Continuing Healthcare and hospital discharge

“I suspected they would decline full Continuing Healthcare funding and that most of the ‘professionals’ involved would be pretty ignorant of the guidelines about Continuing Healthcare and the facts about funding. So my strategy was to educate the ward sister about NHS Continuing Healthcare funding – the NHS guidelines and the law – and to get her onside for the support we would need during the assessment process.

“I knew the assessors would tell me Mum’s care was all social care, and that they would means test her.

“The Continuing Healthcare assessment meeting was four hours long! The assessor kept making reference to the evidence in the diaries and medical notes, which was vague, incomplete and did not paint a true picture of need. When they asked the sister, she came up with everything we needed to pass the ‘nature, intensity, complexity and unpredictability’ element of the assessment.

“I’m relieved to say that, thanks to all the information from Care To Be Different, we have now got full Continuing Healthcare funding for Mum.

“The assessor that said without the description of Mum’s complex medical needs on a daily and ongoing basis we would not have qualified for funding. Sadly it would appear the old chestnut of who you know and not what you know is still alive and kicking. I completely see how flawed the system is.

“They need evidence in notes and yet they allow untrained people to make those notes – if indeed any are kept at all! They do not explain to you as relatives the importance of detailed diaries until the assessment meeting – when they tell you there is too little evidence to show ongoing care needs.

“I know they will do a review in three months’ time. I know Mum will be so much worse by then, if she is still with us.

“Without having read beforehand how underhand the assessors would be, I would not have had the pre-warning to play them at their own game – and a game, albeit and very unpleasant one, is exactly what it has been.

“My biggest learning over and above the information on Continuing Healthcare – and that I would pass on to others – is to make sure diaries are kept every day, and to make sure they are detailed and complete.”

Sarah’s experience is not unusual, unfortunately. When someone you love is dying, the last thing you want to be faced with is a battle with the care authorities. It seems those working in health and social care very often fail to follow procedure, don’t understand the assessment guidelines and/or fail to properly assess care needs. It often falls to the family to exert pressure to get things done properly.

Read part 2: If you’re in a similar situation with your relative, these tips will help you.

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Discharged from hospital into full time care – who pays?

Discharged from hospital into full time careWe often hear from families with an older relative in hospital. Very often that relative is being discharged from hospital into full time care – but no one has explained the process fore deciding who pays for that ongoing care?

A family will often be told that their relative no longer requires NHS care, because their relative’s care needs are social care needs. They are told their relative must vacate the hospital bed and pay for ongoing care themselves.

The family will also almost certainly be asked if their relative owns their own home.

This causes confusion and stress for many families – especially when it is obvious that their relative’s care needs are no different to when they were admitted – or have actually increased.

If a person is told they have only social care needs, they effectively become the responsibility of the local authority. When this happens they will be means tested.

However, a local authority should take responsibility only once it is clear who is actually responsible for paying for ongoing care. This is not based on a person’s money! Nor is it based on whether the person has a house.

If a person with health needs requires ongoing full time care, the only way to know who should pay is for an NHS Continuing Healthcare assessment process to be completed. This should happen before the person is charged a penny for their ongoing care.

If the discharge team (or anyone else for that matter) misleads a person into paying for care before an NHS Continuing Healthcare assessment has been done, they will be in breach of the court ruling in the landmark Coughlan case. They will also be breaching the NHS funding guidelines – the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

If a local authority takes responsibility for care before this NHS Continuing Healthcare assessment process has been properly carried out, it is at risk of acting illegally. Read more about the legal limit for local authority care.

The Coughlan case was vital in reinforcing this local authority legal limit.

If a person is discharged from hospital into full time while this assessment process is going on, the NHS is responsible for funding all care in the interim:

“Where the [NHS Continuing Healthcare] Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.”

(National Framework, page 25, paragraph 74)

Read more about the NHS Continuing Healthcare assessment process.

So, in a nutshell, when a person is being discharged from hospital into full time care, the local authority should only means test if:

  • the NHS Continuing Healthcare assessment process has been properly carried out
  • AND it has been properly shown that a person does not qualify for Continuing Healthcare

Otherwise the NHS should pay.

Read more about care fees and care funding.

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Should I sign hospital discharge forms for my relative?

If you’re under pressure to get a relative out of hospital, you may be asked to sign hospital discharge forms

Image of doctor and wheelchair - should you sign hospital discharge formsThere are all sorts of forms you may come under pressure to sign, such as hospital discharge forms, financial assessment forms, a care needs analysis, health needs assessment forms, a ‘needs portrayal’ form, a Continuing Healthcare assessment form – all sorts.

Our general advice is always to be careful.

Only sign hospital discharge forms if you understand what you’re signing (and not just accepting what hospital staff may tell you without further exploration), and if you’re aware of the implications of what you’re signing.

That’s easy to say, of course. When a crisis happens, you often don’t have time to find out what should and shouldn’t happen. Plus, as with most families, you’re unlikely to have faced such a situation before.

Every situation is different, but let’s look here at one typical hospital discharge scenario…

You have an older relative who is now frail, but still lives at home. However, things have been getting more difficult and dangerous for them at home. Then your relative has a fall and is taken to hospital as an emergency. After a few days, when it’s clear that there’s nothing from a medical point of view to keep them in hospital, the hospital declares them fit for discharge.

This raises alarm bells for you, because you know it’s not safe for your relative to go back home and they should not be discharged home. You raise this with the hospital.

At this point your relative may be offered a few weeks of rehab (local authority or NHS funded) in a separate location (often in a short-term care home). A member of social services or a ‘rapid response’ team may also start asking your relative questions about their care needs. Notes may be made and your relative may be asked to sign these notes.

There are several things to be aware of here:

  • If there is any doubt about your relative’s mental capacity to understand, retain and weigh up information on their care needs and risks – and communicate their decision about going back home – a Mental Capacity Assessment (MCA) should be undertaken before anything else is done.
  • If the MCA reveals that your relative does not have the mental capacity to make a decision about going home, a Best Interests Meeting may need to be held to ascertain what is best for your relative.
  • If the MCA shows that your relative does have capacity, and yet you disagree, you can challenge this. This is where having a Lasting Power of Attorney for Health and Welfare can be invaluable.
  • Your relative should not be asked to sign anything if they lack the capacity to understand what’s is going on and the implications of any decisions they make.
  • If you as their representative are asked to sign a form at this point, make sure you understand exactly what its purpose is. If it contains a few notes about your relative’s needs, be sure to add in writing on the form that this is not a full and comprehensive assessment of needs (if it’s not). Also, write down on the form what your understanding is of the actual purpose of the form.

Let’s go back to the point where you or your relative are being asked questions about care needs, and you’re asked to sign the notes/paperwork prior to your relative going into rehab…

If the sole aim of any suggested rehab care is to get your relative back home again, your signature on that paperwork could potentially be interpreted as your agreement that your relative should indeed go back home. And yet the option of rehab may have been the only option that was mentioned to you.

You may feel the hospital was backing you into a corner – just to allow them to discharge your relative.

There is, of course, another option, which is full time care. This could be either in a care home or through live-in care at home. This takes time to organise, though. In the meantime you may have to insist that there’s a delayed discharge from hospital, so your relative can stay in hospital until appropriate ongoing care has been put in place and all relevant assessments undertaken and care plans drawn up. This includes NHS Continuing Healthcare assessments.

Although this may all sound rather complicated, the golden rules in all of it are:

  • Get informed – and if you know a crisis is likely to occur, read up on the process as much as possible in advance.
  • Hold out for what you know to be right for your relative at every stage in the process.
  • No one should be asking you about money until the appropriate care needs assessments have been carried out – to ascertain who is responsible for providing the ongoing care. If it’s shown that the NHS is responsible, your relative should not have to pay for that care; it will be funding through NHS Continuing Healthcare.
  • Be careful what you sign – and if you feel things have not been explained or carried out properly, write this on the form.
  • Take one step at a time.

If ongoing full time care does seem the best option, start looking at care homes or live-in care providers as soon as you can. Don’t let the local authority push you into agreeing to their choice of care home – unless you’re happy with it. Choosing a care home needs careful thought.

If you’ve been through such a scenario, what tips and advice would you give to other families in the same boat?

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What to do if your relative is in hospital and needs full time care

Make sure your relative is safe and properly assessed in hospital

Elderly relative in hospital needing full time careThese tips are taken from our new and updated guide, How To Get The NHS To Pay For Care, and will help you if you’re facing pressure to get your relative out of hospital and into care…

Elderly people generally fare very badly in hospital in the UK and many are discharged too soon in an attempt by the hospital to free up the bed, yet without the proper NHS Continuing Healthcare assessments having been done and without proper ongoing care arrangements having been put in place.

Hospital social workers, as part of the discharge team, often seem very quick to tell someone they’ll have to pay for their ongoing care – even though they may know that no assessment has taken place to ascertain who is responsible for paying for that ongoing care. This is established through an assessment for NHS Continuing Healthcare.

Many families are also told that their relative will be assessed ‘once they get to a care home’. Again, this could seem to be an attempt to pass someone over to the local authority for means testing before the NHS has to assume financial responsibility.

When this happens, of course, the responsibility then falls to you to challenge this and track the maladministration back to when that mistake was made.

Insist on an assessment for NHS Continuing Healthcare

Do this while your relative is still in hospital – and don’t let anyone convince you your relative ‘won’t be eligible’ until the proper assessments have been done.

Families report that hospital staff are not always aware of Continuing Healthcare or the assessment process. However, this is no reason for assessments to be overlooked.

If your relative is going into intermediate care and their ongoing health and care needs are not yet clear, the assessment process may be delayed until things are clearer. They may, for example, improve with short-term rehabilitation. Equally, they may deteriorate. The NHS can wait to do an assessment to see how effective the rehabilitation is before they assess ongoing needs. However, your relative should not be charged for intermediate care, and your relative cannot just be told to pay for their ongoing care, whether at home or in a care home. It must be clearly shown, through assessment, whether their funding is a local authority or an NHS responsibility.

Make sure the hospital knows you want to attend all Continuing Healthcare assessments for your relative, and let them know you’re fully aware of the NHS Continuing Healthcare assessment process. Once the Discharge Team is aware of your knowledge, they may stop pressurising you so much.

Section 2 notice

At the point where the hospital decides your relative is no longer NHS responsibility, the hospital will issue a ‘Section 2 notice’. This is effectively a notice to Social Services that the hospital is handing over responsibility for your relative’s care to the local authority.

What this means in practice is that the NHS is shifting budget responsibility to Social Services, who will then means test your relative. However, if your relative needs ongoing care for health reasons, this handover should only be done after a proper assessment for NHS Continuing Healthcare funding has been carried out.

The NHS of course wants people to occupy hospital beds for as short a time as possible, because of the cost, which is understandable. However, many families report that the NHS will sometimes, incorrectly, try to hand over responsibility before proper procedures and guidelines have been followed. If the hospital tells you that they need the bed and that your relative is ‘bed blocking’, remind them that it’s their problem, not yours, and that their primary concern should be the proper care and wellbeing of your relative.

Make sure you know who the hospital discharge coordinator is for your relative and let that person know you’re aware of the discharge procedures that have to be followed.

If the hospital has already issued a Section 2 notification, ask to see a copy. You are entitled to see it as your relative’s representative. Make sure that everything on the form looks up to date and correct and based on a current assessment of health needs and that your relative has been assessed for NHS Continuing Healthcare. If the form is incorrect, raise this with the hospital. They will have to withdraw the Section 2 notification and do a new one.

Don’t be pressured into a quick discharge from hospital

No one who needs any kind of ongoing care should be discharged from hospital without a proper assessment for health needs and without a full package of care in place and available to them as soon as they are discharged. There should be no gap in care.

Don’t be pressured into a quick discharge from hospital. And beware – if you sign anything from Social Services you may be opening yourself up to paying for care, or giving them the opportunity to bill you for care. So check carefully anything you sign.

Once your relative is out of hospital, it’s much harder to fight for care funding because you have less leverage. All the while the hospital is anxious to get your relative out, the urgency of the bed situation can actually help you. It’s very sad that it should be like this, but many people report this to be the case.

Since Care To Be Different was set up, we have been approached by over 1,000 families, and this specific issue is one of the most common situations we hear about.

Delayed Discharges

A ‘delayed discharge’ period starts from the time your relative was originally meant to be discharged (the first Section 2 notice) until the time he/she actually is discharged – with appropriate ongoing care.

Once a new discharge date has been decided, a Section 5 Notification will be issued by the NHS to Social Services. All rules about carrying out proper assessments remain the same.

Once your relative is ready to be discharged from hospital, make sure that on the day of discharge they are still properly cared for – and not left in a Discharge Lounge without care and attention. Your relative should be properly dressed and fed, given enough drinks, and have any continence needs addressed throughout.

Your relative should only be sent home or elsewhere if ongoing care is in place and they will be safe at their destination, including if that’s likely to be a cold and empty house.

Find out more about NHS Continuing Care funding in our e-book, How To Get The NHS To Pay For Care.

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Why are elderly people wrongly charged for care?

NHS Continuing Care – and the story of Peter and Arthur…

Elderly man with breathing problemsEvery family is likely to be affected by long term care matters at some point, and it’s vital to be as informed as possible about what should (and shouldn’t) happen at the point where an elderly relative needs full time care – and what to do if things go wrong.

We’ve highlighted some of the issues using two fictional people as examples, and we’ve used a hospital setting as the context, because the same principles can be applied to someone still at home and needing full time care…

Peter, aged 52

…has just fallen off a ladder doing DIY at home, and he’s badly broken his leg. He’s taken to hospital where he’s admitted, and he undergoes surgery to pin his leg. He then remains in hospital until he is fit to leave. In the meantime he starts some rehab therapy and has ongoing treatment to heal the bones and the soft tissue damage.

Peter lives on his own, and it’s going to take some time for him to get mobile again and be safe at home. Once he’s out of hospital though, he can access the key healthcare services he needs such as his GP, a nurse at the surgery, a visiting district nurse and physiotherapy. Plus he can claim certain state benefits to help him through this time, as he cannot work.

Does he have to pay for any of this? Absolutely not. Healthcare and nursing care is free in the UK, and this is clearly set out in law.

Arthur, aged 79…

… is frail and has a bad fall at home and breaks his pelvis. He also has other chronic health problems that require access to medical/healthcare services. He’s taken to hospital where he’s admitted and he undergoes surgery, just like Peter. He then remains in hospital. His overall health needs are greater than Peter’s.

However, unlike Peter, Arthur quickly comes under considerable pressure to vacate the bed before he’s fit to leave, and in the meantime he is not offered any beneficial rehab therapy. Arthur lives on his own, and it’s going to take some time for him to get mobile again and be safe. The discharge team at the hospital continue their pressure to get him out, and they tell his daughter to find a care home for him. No one seems interested in the obvious signs that Arthur is deteriorating needlessly in hospital because of avoidable dehydration, malnutrition and lack of beneficial movement. Instead the hospital team ask how much money Arthur has, and whether he owns his own house. At no point was Peter asked these questions or put under such pressure to leave. The hospital does not seem interested in Arthur’s chronic disease.

Misinformation about paying for care

Arthur’s daughter (who is also his power of attorney) is understandably upset and stressed about what’s happening to her father. Her knowledge of the care system, based on what she hears on TV and in the press, and based on what other families say, is that when someone goes into a care home, they have to pay – and no one at the hospital has suggested anything to the contrary.

She knows her father can’t go home at this point and, because she wants him to be safe and can see he’s not being cared for appropriately in hospital, she agrees to find a care home. She succumbs to Social Service’s insistence on having evidence of Arthur’s financial situation, and she agrees to start paying for care in a care home.

Now that the hospital can effectively close their current files on Arthur, his daughter is even less likely to be given any accurate information about care fees and care funding. Arthur will simply continue to pay for what is, in his case, essentially healthcare and nursing care.

Access to NHS services in a care home

Once he’s in the care home, Arthur cannot easily access the key NHS healthcare services in the same way that Peter could – it’s harder to see a GP that actually knows him, he can no longer see a nurse at his local surgery and he will now also almost certainly be told to pay for physiotherapy. The care home will be in charge of this, deciding what he will have and when he might get to see a GP.

There may of course be nursing care provided in the care home. Is he charged for this? Yes.

For Arthur, healthcare and nursing care is no longer free (aside from a small weekly nursing benefit (Funded Nursing Care) that is paid directly to the care home, not to Arthur – but that doesn’t stretch nearly enough to cover the actual cost of his nursing care). Also, it seems increasingly likely that care home residents may have to pay to see a GP – and yet Peter doesn’t have to pay.

So what happened to the free healthcare that everyone else is entitled to?

Peter didn’t need full time care and yet Arthur does – so it perhaps it’s for this reason that Arthur’s finds himself in this situation. But Arthur has greater healthcare needs than Peter. And if care homes didn’t exist, Arthur would be in hospital receiving care provided free of charge by the NHS.

So what’s the difference between Peter and Arthur? One thing: their age.

When you get older and need care, one thing is absolutely guaranteed: You will be asked how much money you have before you’re asked anything else.

Arthur will now lose his savings, his home and everything he’s worked for to pay for care that should arguably be provided by the NHS. Indeed, in law, he should not be asked about his money before the NHS and local authority have looked properly at his care needs FIRST.

So on what basis should the NHS pay for care?

Let’s continue the story…

Arthur’s daughter continues to visit her father and manage the payments to the care home. She puts her father’s house up for sale, and gradually realises that very soon everything will be gone. She also knows that the proposed caps on care fees (due to come into effect in 2020) will actually make little difference to her father.

Then one day she happens to read something about NHS Continuing Healthcare funding for people in full time care – where those people have health needs. She looks into it and realises that, right at the outset, her father should have had an assessment for Continuing Healthcare in hospital before anyone did any kind of financial assessment for care.

And because Arthur is ‘self-funding’ (the ridiculous phrase used to describe someone forced to pay for care), no one in the local authority or the NHS is likely to be proactive in helping his daughter, because they have closed their files. She’s on her own trying to figure out what’s right and what’s not.

After doing some digging, she later finds out that an initial Checklist assessment for Continuing Care funding was in fact done at the hospital, but that she was kept out of the loop and the assessor simply rendered her father ‘ineligible’ for funding.

As her father’s power of attorney she should have been fully involved in the assessment and should have had the opportunity to give the assessor full information about her father’s health and care needs. In addition, the local authority’s (Social Services) primary focus should have been to assess care needs, not Arthur’s money. The local authority could now be in an illegal position.

Arthur’s daughter is now realising just how much incorrect information about care fees she’s been given by the various health and social care authorities, and that no one seems to be on her side.

Getting reassessed for NHS Continuing Healthcare

So now she also faces the battle of getting her father properly assessed for NHS Continuing Healthcare funding, making a retrospective claim to get back care fees he’s already paid and arguing at every turn with assessors – who are the same people who hold the purse strings.

This will be time-consuming, things will probably not be done correctly, the assessors may be unfamiliar with her father’s needs and with the legal framework in within which assessments must be carried out, and the care home may not be helpful as they will receive less money per week from the NHS should Arthur secure funding.

Plus, Arthur’s daughter will now incur her own significant time costs and expenses on her father’s behalf in a bid to get things done properly, and if she wants to get those costs back she will probably have to take legal action.

It’s an appalling situation.

And yet this is what happens every single day to families in the UK when an older relative needs full time care.

Social Services are usually the first point of contact that a family has with the health and care authorities. But Social Services are part of the local authority or local council… and local authority care is means tested. And so the problems start right at the outset.

And if the family asks about NHS funding, they will almost certainly be told they ‘won’t get it’ – and they’ll be given one of these 7 most outrageous reasons for not receiving a Continuing Care assessment.

So if you have an older relative needing full time care (or already in full time care and paying care fees), make sure they are properly (re)assessed for NHS Continuing Healthcare funding. This assessment should happen before they leave hospital, and it should happen before they start paying for care.

Case study: Getting assessed for NHS Continuing Healthcare before you leave hospital

Have you experienced the same situation?

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