What if your relative does have to move to a cheaper care home or switch care provider?
If your relative starts receiving NHS Continuing Healthcare funding you may be told that they have to move to a different care home or switch to a home care provider on the NHS’s list – not the one you have at present.
This can be an extremely distressing prospect.
In Part 1 of this article we looked at this problem and we highlighted some vital points from NHS guidelines you can use to make your case for staying where you are and/or retaining the same care provider.
But what if your relative does have to move or switch provider?
Let’s look at what the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care says about this. (The National Framework is the main set of guidelines for Continuing Healthcare assessments.)
National Framework pages 117-119…
“…any decisions on moves to other accommodation or changes in care provider should be…put in writing (by the CCG) with reasons given. Advocacy support should be provided where this is appropriate.”
“Where an individual become entitled to NHS continuing healthcare and has an existing high-cost care package, CCGs should consider funding the full cost of the existing higher-cost package until a decision is made on whether to meet the higher cost package on an ongoing basis or to arrange an alternative placement.”
In other words, the NHS must consider any such move carefully. It cannot just give you, for example, a few days verbal notice to find alternative care as soon as you’ve received the Continuing Healthcare eligibility decision – and then just leave you to it.
“The new accommodation and/or services should reflect the individual’s assessed needs…including taking into account personal needs such as proximity to family members.”
“Individuals should be provided with a reasonable choice of providers.”
“A transition care plan should be developed by the existing and new providers that identifies key needs and preferences, including how any specific needs and risks in the transition process should be addressed.”
“The CCG should keep in regular liaison… and to ensure that any issues that have arisen are being appropriately addressed.”
In other words…
Even if your relative does need to move to a new care home or switch care provider, the CCG must:
- consider very carefully whether your relative really does have to move
- still cover the cost of ALL the care needs that have been identified and assessed as part of the Continuing Healthcare process, even if that cost is more than it wants to pay
- make sure any new care provider is actually up to the job
- manage the transition carefully – for the benefit of your relative, not for the sake of NHS budgets
- offer you choice
None of this means that Continuing Healthcare funding can be capped and fail to cover all of your relative’s assessed care needs. If your relative needs a high level of care, and that care costs more that what the NHS wants to pay, those care needs must still be covered. The NHS cannot ask you to pay for NHS care.
If your current care home or care provider is the only one able to meet your needs, and it costs more than the NHS wants to pay, your relative’s care needs come first – and the NHS must nevertheless fund all their care needs with that care home or care provider.
Are you just starting out with all this – and looking for a care home or care provider?
Before choosing a care home or care provider it’s a good idea to ask the manager of the care home or care provider if they have – or have had – residents funded through NHS Continuing Healthcare. If they have, the NHS cannot really refuse to fund your relative there too.
It’s worth reading pages 117-119 of the National Framework in full – indeed, it’s worth reading the whole National Framework in full to be as informed and well-armed as possible in NHS Continuing Healthcare assessments and appeals.
Pages 107-110 also deal with the issue of receiving NHS Continuing Healthcare at home.
What’s your experience of having to change care provider or move to a different care home?