Blog updated 12/05/21: various links have been updated and the article has been fact checked for changes that have occurred in the CHC system.
If you’re involved with your relative’s care, you’ve almost certainly spoken to someone in health and social care about who pays. The chances are they won’t have explained these 10 tips about care fees…
Here are some very typical care scenarios that many families can relate to – and there are some very typical conversations about care fees that most families find themselves having. We’ve highlighted three such scenarios here:
Alice is in her 70s, she’s fit and well, plays golf, enjoys life, has a good circle of friends and all seems well. But then she has a major stroke.
She’s in hospital for many weeks until, eventually, the hospital discharge team tell Alice’s family that she will be discharged and that the family need to find her ongoing care.
The discharge coordinator at the hospital asks whether Alice owns her own home. The answer is yes, and the family are told that Alice will therefore have to sell it to pay for her care.
The family accept what they’ve been told because, well, everyone knows you have to pay, don’t you? Actually, no. You don’t.
George is in his 80s and still living at home. He also has a form of dementia. He has two care visits a day from the local authority, and his family also care for him on a daily basis.
However, George is becoming increasingly unsafe at home and and his social worker has suggested that his family find a care home for him. George is currently paying for his care visits, and the social worker tells the family that he’ll need to have a further financial assessment.
The family acknowledge that this should be done – because they’re none the wiser, and no one has said anything to the contrary. So it must be true, yes? Actually, no. It’s not.
Dorothy’s already in a care home and has been for two years. She has multiple health needs – as she did when she first went into the home.
When she arrived two years ago the care home told her that she’d have to pay if she had the money, and so began the usual means-testing and financial assessments.
The family have not challenged this, because they know (from what they read in the press and what people in health and social care have told them – and indeed from what friends have told them) that Dorothy has to use up her own money before any state help is available. That’s correct, isn’t it? Actually, no. It’s not.
The first thing that should have happened in every one of these cases is an assessment of health and care needs, NOT the person’s money. There should have been an assessment for NHS Continuing Healthcare funding (‘CHC’).
What does NHS Continuing Care cover?
It covers 100% of care fees for people who need full-time care primarily for health reasons, i.e. they have a Primary Health Need. It’s available whether you’re in a care home, in your own home, in a hospice or somewhere else.
- If you’re in a care home, NHS Continuing Healthcare covers all care fees, including the costs of accommodation.
- If you’re receiving full time care at home, Continuing Healthcare covers all nursing care plus personal care (bathing, dressing, etc.) plus any household costs directly related to care needs.
It doesn’t matter whether you’re in a residential home or a nursing home, the same rules apply: It’s about your health needs first, not where you live or how much money you have.
The landmark Coughlan case, reinforced the difference between health needs and social care needs.
10 Tips about care fees you may not know:
Here are 10 tips to help you respond when you’re in a conversation about care fees:
1) It doesn’t matter whether your relative is at home, in a care home or somewhere else, no one should ask them to pay for care until it’s been properly decided who is legally responsible.
2) NHS funding for care is called NHS Continuing Healthcare; it is available to people who meet certain criteria. Make sure you read the criteria in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2018).
3) If anyone in health and social care tells you your relative has to pay for care, ask them why and on what basis they’ve reached that conclusion. They can only reach that conclusion after NHS Continuing Healthcare funding has been considered.
4) You don’t have to complete ANY financial assessment forms – and certainly not before a Continuing Healthcare assessment. If you’ve had the Continuing Healthcare assessment and your relative is not eligible, you still don’t have to complete any financial assessment forms; you can simply choose to pay from private means (‘self-fund’). Also, be sure to also appeal any Continuing Healthcare funding decision you disagree with. The health and social care authorities have no business looking into your or your relative’s finances until the Continuing Healthcare process is complete. It is none of their business.
5) Some people working in health and social are have not had adequate training in the legal context in which they work. In other words, when they’re giving you incorrect information about care fees, they may not even realise that they may be in beach of their own code of conduct, and possible also the law.
6) Familiarise yourself with the Care Act and how it helps you with Continuing Healthcare funding.
7) It doesn’t matter what diagnosis a person may have; this does not affect their eligibility for Continuing Healthcare. It is their day-to-day healthcare needs that count.
8) If your relative receives NHS Continuing Healthcare funding, this covers ALL their social care needs, too. It also covers the costs of accommodation, food etc in a care home.
9) Make sure that your relative gets an assessment for CHC once they enter into a care facility or are discharged from hospital if they require a new or additional package of care.
10) Just because your relative may have been paying for care up until now doesn’t mean they should be – or that they should be in the future. Consider making a retrospective claim for CHC funding to get reimbursement for care fees that shouldn’t have been paid.
…and an extra tip:
11) Don’t let anyone put you off having a Continuing Healthcare funding assessment. People are likely to tell you it’s “not worth it” or that you’re “not eligible” or that they “don’t have time to do an assessment” or that you “have to start paying first” – and many other untruths. Get informed. Perseverance and stubbornness pays off, so don’t give up! Read as much as you can in advance. Read our blogs.
So if you find yourself having conversations about care fees with people in health and social care – and also care providers – be vigilant. Don’t let them steer you into paying for care before it has been properly ascertained who is actually legally responsible for paying. Never assume it is your relative.
If you need to help, call us on 0161 979 0430 or email your enquiry to firstname.lastname@example.org
If you want to speak to a specialist CHC nurse or just get some general advice about your case, visit our Advice Line Services or else get 1-2-1 expert legal support and advocacy help with your assessment or appeal.