What to say when Social Services insist on a financial assessment

What to say when Social Services insist on a financial assessment

Everyone who receives full time care and who has health needs should be assessed for full NHS Continuing Healthcare funding.

However, most people who need full time care are told they have to pay for their own care, and many people find that they are assessed first by their local authority – to look at their financial means.

This is the wrong way round.

Despite what health and social care people may say, you don’t necessarily have to pay for care when you go into a care home – or when you have full-time care at home.

If you have health needs and your local authority does a means test before you’ve been assessed for NHS Continuing Healthcare funding, this puts this local authority in a potentially illegal position and any subsequent care fees charged could be illegal.

But how can you back this up when you’re speaking to Social Services?

Here are some suggestions:

Health law
The fundamental principle of healthcare in the UK is that, no matter how old you are, if you need health care or nursing care, you do not have to pay for it.

  • The National Health Service Act 1946 outlined this clearly.
  • The 2006 National Health Services Act did the same.
  • The new Health and Social Care Act 2012 also preserves it.
  • The new Care Act makes it very clear that people should be considered for NHS Continuing Healthcare funding before any financial assessments are carried out.

The fundamental principle has not changed.

It must be proven that a person does not have a ‘Primary Health Need’ before they are means tested or asked to pay for care – and to do this there must be an NHS Continuing Healthcare assessment first.

A social worker or local authority/council representative must be involved in the NHS Continuing Healthcare process if it appears that there is any chance a person may be eligible for funding.

The NHS Constitution
The NHS Constitution for England states that (amongst other things):

  • access to NHS services is based on clinical need, not ability to pay, and that NHS health services should be provided irrespective of the patient’s age. This applies just the same to an elderly person needing full time care.
  • the NHS must respect human rights. This includes not taking away a person’s entire personal assets in exchange for healthcare.
  • NHS services are free of charge except in limited circumstances sanction by Parliament – not when NHS Continuing Healthcare assessment teams decide to deny funding.
  • access to free health services should not be refused on unreasonable grounds. If health and social care workers have not been properly trained in the legal framework in which they operate, and as a result wrongly force you to undergo a financial assessment, these are certainly unreasonable grounds.
  • you have the right to receive care and treatment that is appropriate to you and meets your needs
  • you should not be unlawfully discriminated against on grounds of age.

What goes wrong?
Many people feel that the NHS Continuing Healthcare assessment process has little to do with the free healthcare we are entitled to in law and that it is instead financially-motivated. A complex web of assessment procedures and eligibility criteria has been fabricated to make accessing full NHS funding for people in full time care difficult.

Many care funding experts believe that the Continuing Healthcare assessment framework is not supported in law, and yet NHS ‘assessors’ and decision making panels seem to take on the role of judge and jury about who will receive NHS care, when in fact the principle of healthcare free at the point of use has never changed.

One of the most well-known court cases in NHS Continuing Healthcare is the Coughlan case. The outcome in this case is just as relevant now as when it was heard at the Court of Appeal in 1999.

Before a relative needs care, most people believe they can trust the health and social care authorities to give them accurate and truthful information about paying for care. Once families realise what really happens when applying for funding for a relative, this belief is sadly often shattered. What makes it even worse is that the people providing that information to families may not have been properly trained and may not even realise that they are acting outside the law.

It means that when an elderly person goes into care, many families don’t realise that the first priority is an NHS Continuing Healthcare funding assessment – not questions about money, property and savings.

This ‘oversight’ of the part of the health and social care authorities means that huge numbers of elderly people have been illegally railroaded into selling their homes and spending everything they have to pay for care that should have been provided by the NHS.

The only way to know who is actually responsible for paying for care is via the NHS Continuing Healthcare funding assessment process.

 

38 Comments

  1. Peter Knights 2 weeks ago

    My sister-in-law is in a care home, she has been self funded for 18-months, but her finances meant we had to get social services involved. In jan they did a financial assessment, the panel has just agreed to pay, it been backdated to 5 Feb 17, my sister-in-law contributes her pension, social the rest, everything seems to be fine, except social have now said they want to do another assessment on her health, less than 4 months after her initial assessment, how many times do they carry out these assessments?

  2. Lesley 3 weeks ago

    My Mother-in-law 97 years old has early stages of dementia, keeps falling and is walking the floor at all times of the night, she is also incontinent, she went in to a Nursing home 4 weeks ago (at the recommendation of the social services) and was constantly asking to go home, Father-in-law is 91 still at home has early stages of Alzheimer’s. The Home rang last week to say she is settling in fine 3 days later social services rang to say she wants to go home and its her human rights she be allowed to go home and they will put a package together , the Father-in-law is a very independent chap and doesn’t like the idea of people coming and going although he did everything for her before she went in to hospital on Christmas day, what exactly are his rights as he will be the one having to look after her in between carers visits?

  3. Tracey 4 weeks ago

    Hi can you tell me how far back a Local Council can request to see financial history? My mum has been funding Nursing Home fees for 4 years and is coming close to the £23k threshold where we will need to approach the council for support. Thanks Tracey

    • jules 4 weeks ago

      6 months if you have been self funding

  4. Ray Keighley 2 months ago

    Mum 86, Living alone since 1984 when my father died unexpectedly. Downsized to a small flat and has been very active till approx 4 years ago when she lost her hair with Alapi—- ! . Became more and more frail. Had two falls last year. 21/09/16 assessment y memory clinic, 18/10/16 diagnosed Alzheimers. I ordered her frozen meals and this was OK for a time but my Aunt then had to ring her every day to tell her to put meals in oven / take pills etc. We had to get carers in once a day. I visited for a week just after they started , I managed to get Social services to do a ( Care? ) assessment whilst I was there. The ”Social worker” who said straight away she was not a qualified social worker advised 3 visits a day and on my request she put the new care package in motion. THEN before this started Mum had a fall, taken to hospital two days later and kept overnight (Chest infection but nothing broken ) but when they were to discharge her she said she didn’t think she could manage with just the carers at home and didn’t want to go back, they found her a place in a residential home, she didn’t like it but at the same time a place became available at another home where we had her name on the waiting list.She moved in yesterday and I just spoke to her without getting much sense, just she likes the room. Can’t remember the place she’s been for the last week. We have ”Put” her there because it’s obvious she wouldn’t be able to care for herself even with carers coming in 3 times a day. We have been told she will have to pay, everyone tells me that unless she has to have ”Nursing care” she will continue to pay till she is below the 23000 AND will have to sell her flat .
    SO is Alzheimers a medical illness or not?? THE ONLY reason she is in the residential home is because she cannot look after herself anymore and that is because of the Alzheimers. AND as I have no other home in GB and lived with her whenever I am home can she be made to sell the flat? It would be taking away my ability to return when I am too old and can no longer continue doing what I do in France.
    SORRY it did become long but hope you can help .

  5. Lisa 3 months ago

    I have financial LPA for my great uncle who is provided with some help from our LA social services. I telephoned them recently to advise that I am now power of attorney for any financial matters along with my father who is also his next of kin. They advised that they needed to complete a financial assessment but my uncle is paying for the provision in full as he has substantial financial resource. When I asked why they needed to complete this financial assessment as he was paying in full for the charges I was advised that they needed to complete it as it hadn’t been assessed for a few years. I really don’t understand why I have to provide the information as we’re not disputing his eligibility to pay. Can you advise if I legally have to provide details of all of his financial resource as I feel it is none of their business considering he is paying in full and has the resource to continue to do so. I’ve read something about a light-touch assessment?

    Many thanks

    • Author
      Angela Sherman 3 months ago

      Lisa – no, your uncle does not have to be means tested. If he chooses to pay for his care, then his financial situation is no one else’s business. However, the question that arises from your comment is whether he has been assessed for Continuing Healthcare funding? http://caretobedifferent.co.uk/vital-information-about-paying-for-care/

  6. Alison 4 months ago

    I am so glad I have found this website – a social worker has already gained access to my fathers funds and opened an investigation on me – the social worker refused Best interest meetings despite countless emails – refused subject access FOI requests and refused a Continuing Healthcare (CHC) assessment. I was my father’s main carer and the social worker insisted my father went to live in a flat after having 24 hr care since 2012, he now is currently locked in his flat with no Deprivation of Liberty Safeguard (DoLS) in place. I went direct to his GP who sent a chronic disease nurse out who carried out the CHC – which triggered an A on the very first question on the revised 2012 checklist. Now the social worker is obviously looking for funding for more care because I have proved him wrong. Moreover he has also apparently sent a financial accusation on me regarding his LPA to which I am completely innocent. I have a meeting to attend next Tuesday with a CHC team and the social worker has been invited, I can see this is going to be a very interesting meeting 🙁

  7. Steven 5 months ago

    Great site and so helpful. I have recently attended a care assessment for my Mother who is resident in a nursing home, been there about 6 months and has now reached the £23,500 threshold, in fact inadvertently I have paid more than should have and assets are now below £18,000. we have been informed that we will need to complete a questionnaire regarding assets etc. I had spoken to an advisor regarding this as I discovered my Mum had invested a small sum with an investment company some years ago. I was informed that this particular plan does not come under the jurisdiction of ‘assets’ and that there are particular investments that the local authority can not claim against, by the way there is no property or other assets as she was in sheltered accommodation until her deterioration. Now I am worried that if a search is made this small policy will flag and it may look like I have withheld information, what information exactly will they be able to access once I have completed these forms and returned them?

    • Author
      Angela Sherman 5 months ago

      Thanks for your kind words about the website, Steven. Has your mother had an assessment for NHS Continuing Healthcare (CHC)? This should be the first thing that is done – before anyone asks any more questions about money. CHC is not dependent on your mother’s means; instead it is based on her care needs only. The local authority has no business asking about your mother’s financial situation until a CHC assessment has been carried out. If – and only if – your mother genuinely does have to pay for care will the issue of the investment bond be relevant. Investments with an element of life cover are disregarded. This may help: http://caretobedifferent.co.uk/care-fees-who-pays-for-care-when-your-money-is-in-an-investment-bond/

  8. sylvia leybourne 6 months ago

    I have had care for 15 years, now my carer is self employed and I get direct payments for her. Social services done a financial assesment about 4 weeks ago they wanted me to pay £42.20 a month. Now they have done another one and they want me to pay £73.60 a week. I am disabled – I get DLA which pays for my car and get the care componant for personal care. I get state pension and pension credit of £152.84 and £64.61. They are now wanting me to pay £73.60 a week. They haven’t took in consideration what bills I have to pay like gas & elec. of £110 a month and water £36 and I have insurance electricals on my white goods and death insurance. I am 69 and have a lot of health problems. Like I say, every thing but cancer. I have never been on holiday for 6 years. I can hardly buy food in. I am sorry but i am sick – been stuck in between four walls.

    • Author
      Angela Sherman 6 months ago

      Sylvia – that sounds really difficult for you. Because your question relates to your individual benefits, it may be advisable to contact the Citizen’s Advice Bureau and also your local AgeUK.

  9. Diane 6 months ago

    My mum is nearly 86. Even though she has some short term memory loss but she manages okay. After a fall she was in hospital for a week. She had care workers come in for 4 weeks after leaving hospital and then as I was away they extended their visits for a further 2 weeks until I returned. She was told a means test needed to be done and when she refused they said she needed to pay the extra 2 weeks out of her own money. Because of the hospital stay this has now sparked off an interference with a Ward matron visiting and now a social worker is scheduled to visit. They said she needed a memory test. An appointment was made but my mother cancelled it. I know they are going to insist care workers come into the home and because my mother has over £23000 in savings she is expected to pay. When I am away I am okay with someone coming in a couple of times a day to administer my mums pills and check on her, and I have a reliable person set up to do that. She has a prescription for Fortisip and I am able to arrange hot meals to be delivered. I just don’t like the way these people have come into my mothers life and are trying to dictate to her especially as they expect her to pay. If it was so important to them that she has carers come in why aren’t they funding it? I would like to know how much authority these people have? Can they insist she takes the memory test? Both my mother and I now feel very stressed and it’s making life miserable.

  10. Sharon 7 months ago

    Hi,
    Thank you for this web-site, very helpful. My 95 year old mother in law is currently in hospital following a fall. She has dementia, pressure sores Grade 3 and the hospital are currently doing the NHS assessment, I have to say they have been helpful and informative about the assessment but we have been asked to go along on Monday for a 2 hour meeting where a social worker will be present. They have scored Grad A on the pressure sore and B and C on other things. Is she likely to get funding? They have said she cannot return home so either way it is a nursing home.

  11. Mark 10 months ago

    Thank you for your informative site and advice. We have been asked to attend an imminent meeting at the hospital with the occupational therapy staff and local authority (LA) rep. The point is we have not been informed exactly what it is about – although, we assume it to be a possible means/financial assessment. Therefore, as we have not been informed of any CHC assessment, please could you clarify if a patient and/or their representative, are within their rights, to terminate a meeting if any mention of needs/financial queries are made. Basically, is the patient/rep within their rights to state (as they have not been offered or informed of any prospective CHC assessment), they do not want to discuss anything until this has been instigated via the CHC Checklist? Also, if they are informed a Checklist has already been done is this not correct procedure and are they legally entitled to not enter into any discussions, re discharge/needs/finances, etc, until a Checklist has been carried out with their presence and knowledge of it? In addition to this is it fine to discuss anything else as long as there is no mention of means or finances – i.e any possible transfer to a specialist NHS rehabilitation centre that is considered to be a valuable aid to further recovery, due to perceived stagnation in the present hospital situation? (There is also a concern that a request that’s been made for transfer to the specialist NHS rehab centre will be jeopardised, if a CHC checklist is done and is passed, due to the NHS rehab centre not accepting – due to the prospective CHC assessment). It is urgent, due to the late notification from authorities – basically, I need asap please. (Apologies for the length of the comment.) Thank you, kind regards Mark.

    • Author
      Angela Sherman 10 months ago

      Mark – yes, the first thing that should be done is a Continuing Healthcare assessment, and questions about finances have no place in that process. http://caretobedifferent.co.uk/paying-for-care-between-hospital-discharge-and-funding-decision/ The family and/or the person’s representative should be kept fully informed about any assessments and invited to attend and input into these. All aspects of a person’s care needs should be covered, as the Continuing Healthcare assessment also informs subsequent care plans.

  12. Michelle Fraser 11 months ago

    … To clarify: she has not been assessed for NHS funded CHC.

  13. Michelle Fraser 11 months ago

    Firstly, thank you for your fantastic site – the most useful information I’ve found. After falling and sustaining multiple hip fractures my mother was in rehabilitation for 6 and a half months and is still under Consultant care in terms of having further appointments to check her operation. I was told that she needed to pay for the rehabilitation home after the physiotherapy was signed off (in fact, they didn’t want to do the physiotherapy at all as they said she lacked the cognitive skills for it to be of value; but I forced the issue and she now transfers with a stand-aid rather than being hoisted. The consultant has recommended further physiotherapy. I asked the rehabilitation centre about NHS Continuing Care and they told me it was a waste of time and they would not recommend her to be assessed. Subsequently, I found a residential care home for her where she currently lives and I am being pursued by the borough council to complete and return the Assessment of Financial Resources along with bank statements etc. But she has not been assessed and the social services have said she doesn’t qualify. She suffers from extreme anxiety, is terrified of being left alone, has pressure sores, refuses to eat anything but cakes and puddings. So can I then legally stall the Financial Assessment and request that she first has to be assessed for CHC? Or will they then rule that she has to pay for all of her care? (Her savings are below £23,000).

    • Author
      Angela Sherman 11 months ago

      Thanks for your very kind feedback on the website, Michelle. First of all, well done for standing your ground over the physiotherapy. Sadly it’s not unusual for elderly people to be cast aside and told they’re not worth any therapy. Sad, sad, state of affairs. The statement by the rehab centre about Continuing Healthcare (CHC) is nonsense. Your mother must be assessed for CHC before anyone tries to means test her. This is the law. This article will help: http://caretobedifferent.co.uk/care-act-2014-helps-you-with-nhs-continuing-healthcare/ Social services are talking nonsense, too, when they say she doesn’t ‘qualify’ without even having done an assessment. Yes, refuse to participate in any attempt to means test your mother before the proper CHC assessment process has taken place. Social services (local authority) have a legal duty to be proactive in looking at the level of your mother’s care needs vis-a-vis CHC.

  14. Pam 12 months ago

    My mother aged 90 has dementia and is in hospital after a fall. She lives with me and has no apparent injuries but has had a few UTIs and chest infection. I have agreed to have care am and pm as mum can be v difficult and aggressive , lashing out swearing etc. Social worker (sw) has got ward to record triggers on behaviour chart.
    Mum passed stage 1 amd now awaiting stage 2 assessment for Continuing Healthcare (CHC). Do they have to complete stage 2 in 28 days from stage 1? Sw mentioned Mr pointon as a benchmark case regarding him being awarded CHC because of his behaviour. Just wondered if any advice you can give me, would be v grateful.
    Nurse, discharge planner at stage one said must tell you only 8% of people are awarded CHC – but don’t worry as social services will give you package of care…..
    Also she scored mum A for Behaviour but C for Emotional level. I said anger is an emotion and mum’s is damaged through dementia. Was told she would have to be bursting out crying or on antidepressants to get A. She then said if she marked mum A or B for emotional level then would have to mark her down on behaviour? I said system is seriously flawed and she agreed. I am worried mum isn’t going to get a fair assessment. Any advice welcome.

  15. Lisa sykes 1 year ago

    My parents put their property into a trust fund so they can live there rent free. We have financial assignment coming up – dreading what to say. My parents don’t own their property, the trust does. Could you advise me please.

    Lisa

    • Author
      Angela Sherman 1 year ago

      If your parents need care, the first thing that should happen before anyone starts talking about their property is an assessment for NHS Continuing Healthcare. If (and only if) they are not eligible for Continuing Healthcare, the local authority may potentially try to challenge the way the trust was set up – but that’s outside our field of expertise here at Care To Be Different. You may want to contact the financial or legal adviser who helped your parents set up the trust.

  16. Stephen Child 1 year ago

    Family took my 83 year old type 2 diabetic brother to his GP end of Sept 2015 due to behavioural worries. He had been erratic with his medications and suffers from memory problems. He had a memory test in December and a CT scan January 2016 for which we have to wait until March for a Consultants appointment.Social services have become involved and a continuous care assessment has been done for the last month. Now they want to do a full financial assessment but I am not aware of the care assessments result. He still does his own personal care and family do laundry and shopping etc. Carers visited twice daily to check he was taking his medication and recorded his food and drink intake. Are they jumping the gun before he’s had a definitive diagnosis and or change of medication regime?

    • Author
      Angela Sherman 1 year ago

      Social Services should not be doing a financial assessment until the results of the proper Continuing Healthcare (CHC) process are clear – and only then if your brother is NOT eligible for CHC. They should give you (or whoever is acting for your brother) a written copy of the decision making rationale. CHC does not depend on any specific diagnosis or medication – instead, it’s a whole picture of day-to-day care needs and risks that should be taken into account. It sounds as though they are jumping the gun.

  17. Margaret 2 years ago

    There is something to be said for keeping your spare money under a mattress. I did not know it was wrong for the social worker to arrive and ask outright “and what finances does your mother have”.? There was never any mention of a CHC assessment having been done or about to be done. Although my mum had been taken away already under the Mental Health Act due to confusion with wandering.

    I cannot thank you enough for your web site. My sincere thoughts go to the many families caught up in this care system and funding for next of kin.

    • Author
      Angela Sherman 2 years ago

      Thank you, Margaret. I’m glad it’s helpful.

  18. Kate 2 years ago

    I am looking after an elredly lady M who went inot the hospital SEP 2013, and came home in NOV 2013 after Continuous Health Assessement. She then had Reablement and then carers coming in from Local Authority. NOW – IN A YEAR’S TIME (!!!) – Local Authority contacted us to have a Financial Assessment done to see if M has to contribute towards her carers.

    We explained to them, that system with carers (twice a day) has been up and running for a long time now, why now they want to have an assessment done? They said it had to be done earlier but we still have to do it. They insist on assessment and we have it first week of November. What are our rights and responsibilities? What guidlines are they following?

  19. Carole 3 years ago

    Mam broke her knees shoulder and arm. In hospital she had a TIA. Mam’s wish Is to go home. She has been treated terribly in hospital and was sent to a care home where she had two falls and five strokes. Mam has been awarded Nhs continuing care and insists on mam going into a care home. Mam wants to come home. How can we stop Nhs putting mam in a care home miles away?

  20. Yvonne walker 3 years ago

    My friend who is 83 yrs old was refused any financial assistance from local authority to pay for her care at home because she is joint owner of a house that she is trying to sell but this is proving difficult due to family dispute . Case is currently with the solicitors . This lady does not have any money to pay for the care at present. Can you advise if the local authority decision is correct .

    • Angela 3 years ago

      To provide advice, I’d need to look in more detail at your situation, Yvonne – but if your friend jointly owns the house and the other owner(s) don’t want to sell, then your friend’s share is effectively worth zero, and so this cannot be taken into account in means testing. I would strongly recommend taking independent financial advice.

  21. John Frail 5 years ago

    True, it is financially motivated. When Mum was first taken ill in 2000, we were asked to answer questions about her in the hospital. The first question being if she owned her own home.
    I was summoned to Social Services, where again the first two questions were. again. if she owned her home, and how much she had in savings. It’s scandalous. Anyone who has not been thrifty or squandered their money does not have to put up with this, and also does not have to pay.

    • Angela 5 years ago

      Thanks for your comment John. You’re right, the pressure put on families to get elderly relative’s out of hospital – often without proper assessments having been done or even proper ongoing care in place – breaks so many guidelines. And of course forcing someone out of NHS care for financial reasons is wholly illegal.

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