NHS Continuing Healthcare: 3 mistakes you might not notice
In this week’s article, Angela Sherman, director of Care To Be Different, highlights 3 mistakes in NHS Continuing Healthcare assessments that you may not even notice…
These 3 mistakes come from my personal experience fighting for NHS Continuing Healthcare funding for my own relatives – but they are often repeated in funding assessments for many other people, too.
1. Subtle verbal intimidation
As I walked along the corridor at the nursing home, one of the assessors took me aside.
We were about to start a NHS Continuing Healthcare appeal meeting for my mother, to reassess her care needs and eligibility for NHS Continuing Healthcare funding.
The assessor was friendly and assured me we would look at all the relevant information. She also commented on how much work I’d done putting together my appeal.
And then came three simple words, each one slow and distinct:
“You won’t win.”
They were almost a whisper, and sympathetic in tone. Each word had a slight pause in between. For a moment I didn’t know what to think.
Was she on my side and willing to help me in what seemed like a monumental but ultimately futile battle?
Or was she trying to put me off, undermine my confidence and encourage me to give up?
It took me a few seconds to understand that it was the latter.
However, she had made a huge mistake: she could attempt to intimidate me all she liked, but to do that at the ultimate expense of my mother triggered in me an anger and a determination to fight this to the very end.
If I hadn’t been on my guard, and if I hadn’t already encountered other tactics to deny my mother Continuing Healthcare funding, I may have mistaken her words for sage advice.
The many blog and Facebook comments we receive from families indicate that verbal intimidation and misinformation about NHS Continuing Healthcare is sadly very common. So question everything you’re told by the health and social care authorities and by NHS Continuing Healthcare assessors, and be wary about assuming anyone is on your side.
2. The wrong care staff in funding assessments
At one of the first Continuing Healthcare multidisciplinary team (MDT) meetings I attended for a relative, there were several people in the room, including a nurse from the care home. I had seen the nurse around once or twice, but not very often.
At that time I was still learning about what happens in Continuing Healthcare assessments and so initially I didn’t question this. I assumed she knew my relative’s care needs and would contribute to the meeting accordingly.
The assessors seemed very keen to address all their questions to this particular nurse, and yet the nurse was really struggling to answer them. Not only that, I could tell that the assessors were placing greater store by the nurse’s answers than by my own – and yet it was becoming very obvious that the nurse barely knew my relative.
I had taken a friend with me to the assessment meeting, for support. My friend asked the nurse directly how much she had been involved in my relative’s care. When the nurse answered, my heart sank; the nurse did mainly night shifts – and only ever saw my relative asleep.
If this hadn’t been challenged, the assessment notes would have concluded that there were hardly any care needs at all!
At Care To Be Different we receive many messages from families who feel their assessment meetings have been sabotaged by having the wrong people present. So question everyone in an assessment meeting. Ask them what their role in the meeting is, how well they know your relative. Ask them what qualifies them to assess your relative’s care needs and make sure the right evidence of care needs is presented.
Don’t be afraid to do this. It’s your relative’s interests that should be at the centre of all this.
3. Casual questions about money
The multidisciplinary team (MDT) meeting was about to start for my aunt.
The NHS Continuing Healthcare nurse assessor and the local authority representative clearly new each other, and (it seemed) had decided that the local authority representative would ask the first question.
Her words were light and casual: “So will your aunt be self-funding?”
There is so much wrong with that question it’s hard to know where to start! And she had asked it right at the start of an NHS Continuing Healthcare funding assessment. I couldn’t really believe what I’d heard.
Needless to say I pointed out to her that a Continuing Healthcare assessment meeting had nothing whatsoever to do with my aunt’s money; it was about her care needs only.
As the meeting progressed it was clear that the local authority representative knew that all too well, yet she had asked the question anyway – presumably in an attempt to trip me up and lure me into divulging details about my aunt’s finances, which were none of her business.
Inappropriate questions about money are asked all the time. There are a huge number of comments on our blog and Facebook page to this effect.
Here are just some of the reasons why it’s not correct for assessors and social workers – or any other NHS or local authority staff to do this:
- No one should be means tested until they’ve been considered for NHS Continuing Healthcare funding.
- Means testing applies to social care ONLY. Healthcare/nursing care and social care are two completely different things. Healthcare/nursing care are not means tested.
- The Care Act requires people to be referred for Continuing Healthcare funding if there is even a small chance they may be eligible.
- Means testing is always strictly secondary to Continuing Healthcare assessments. It is only if a person is NOT eligible for NHS Continuing Healthcare funding that they should ever be means tested.
When a person needs care, very often their family is in a state of panic, wanting to find good care and not having time to read about what should and shouldn’t happen. Be alert for any questions about money; don’t answer them – instead, make sure an NHS Continuing Healthcare assessment is carried out first.
Key tips about NHS Continuing Healthcare and means testing…
- Don’t assume that what you’re being told by health and social care staff and assessors is correct – or that they’re on your side, no matter how friendly they may seem.
- Remember that it’s not unusual to find that people working in health and social care don’t always know the care funding rules or understand the legal framework within which they work. They may have had no appropriate training. For this reason they may sound very sure of their (incorrect) facts.
- Don’t assume that questions about money are just part of some pre-assessment Continuing Healthcare process. They’re not!
- Do your homework before an assessment, and make sure the correct evidence of care needs is considered.
- Read the NHS Continuing Healthcare and care funding assessment guidelines.
- Read articles and information about the Care Act.
- Ask everyone in an assessment meeting why they are there, what role they are playing and what qualifies them to be at your relative’s assessment in particular.
- Ask everyone in an assessment meeting how well they know your relative and your relative’s care needs.
- If your relative has a specific condition, for example, Parkinson’s disease, Lewy Body Dementia, multiple sclerosis, etc., ask the assessors what training they have had in the specific needs of someone with that/those condition(s).
- If any assessor says they have met your relative and understand their care needs, ask them how long they have known your relative for, how much time they have spent with them and how long they have spent actually looking into their care needs.
- Make sure the people present in an assessment meeting are the right people – including care staff from a care home or care provider.
- Refuse to answer any questions about your relative’s money until the NHS Continuing Healthcare assessment process has been carried out – and carried out properly – and a legitimate funding decision has been made by the Clinical Commissioning group (not by the assessors).
- If your relative is found not eligible for NHS Continuing Healthcare funding and you decide not to challenge that, you still don’t have to answer any questions about money or provide any financial information; you can simply start paying care fees.
- No one can tell you that your relative is not eligible until the Continuing Healthcare assessment process has taken place.
- Question everything and everyone – don’t be afraid to.
- If you’re not sure whether the information you’re being given is correct, ask the assessor (or whoever’s giving you the information) to show you the page and paragraph reference in the relevant Continuing Healthcare guidelines that supports what they’re saying.
Having a relative needing care is hard enough. Trying to figure out who pays for that care, and then trying to actually get hold of the funding you’re entitled to can make things even harder.
Many families are not told about NHS Continuing Healthcare, and you can find yourself seriously misled by the care authorities about how care fees work. It’s frustrating and distressing. This 183-page easy-to-read guide, How To Get The NHS To Pay For Care, will help you. It’s written by Angela Sherman, founder of Care To Be Different. She’s been in your position (several times), stood in your shoes, and she knows exactly what you need to do.