Care fees means testing: 3 reasons to object to a financial assessment

Care fees means testing: 3 reasons to object to a financial assessment

Care fees means testing: 3 reasons to object to a financial assessmentWhen older people need care, there’s an incorrect focus on care fees means testing

…and yet care fees means testing should be done only after an NHS health needs assessment.

Over the past few years we’ve heard from hundreds of families who have an older relative needing full time care.

Almost all of them say that the first questions they are asked by the health and social care authorities are about their relative’s money.

The health and social care authorities seem to have made it a priority in many cases to do a financial assessment first and foremost. It means that anyone with savings or assets over the means test threshold will immediately be told to pay for care – when in fact the authorities should first assess people for their health and care needs.

There are 3 main reasons why care fees means testing should always come second:

  1. No one can possibly say whose responsibility it is to pay for your relative’s care until the full extent of your relative’s health and care needs has been assessed. This should be done by going through the NHS Continuing Healthcare assessment process. It is the outcome of this process that determines who pays for your relative’s care – not how much is in their bank account. Everyone who needs full time care and who has health issues should be assessed for NHS Continuing Healthcare.
  2. At the time of the Continuing Healthcare assessment, no one should ask your relative about their money. In the assessment, if the NHS assessor/decision-maker decides your relative is not a health service responsibility (i.e. ineligible for Continuing Healthcare funding) and if the local authority agrees with that, the local authority will by default be accepting responsibility for care. However, if this process has not been carried out properly, the local authority is in danger of breaking the law. Why? Because your relative’s care needs may be beyond that for which a local authority can legally take responsibility; it means the local authority will have failed to acknowledge the legal limit for local authority care that was reinforced in the Coughlan case.
  3. Plus, if the local authority does a financial assessment at the outset and starts asking your relative to pay for care, and yet it is later shown through assessment and appeal that your relative was eligible for NHS Continuing Healthcare funding all along, two things will have happened: the NHS will have failed to meet its legal duty to provide care, and the local authority will have acted illegally in charging care fees in the first place – including top-up fees.

How To Get The NHS To Pay For CareDo you need further help understanding how care fees and NHS funding work, and how to get through the NHS Continuing Healthcare assessment process? Our e-book, How To Get The NHS To Pay For Care, explains the whole process – with practical tips, advice and insights.

25 Comments

  1. niall Cunningham 2 months ago

    I just wondered if you could point us in the right direction or have any nuggets of information for us-our mother is in care and has recently had a Continuing Healthcare/Decision Support Tool with a one person Multidisciplinary Team as well as a financial assessment some time afterwards-she has no savings and my elder brother owns half the house (nothing could be found searching land registry according to the finance officer) so is the house in or out of the assessment?
    Have been guided by your writings and both used them to good effect and downloaded them, in particular being page 9 of Care fees and NHS Continuing Healthcare and Age UK factsheet 38 but stumped as Social worker said house not in financial assessment but finance officer says her percentage is included in the financial assessment ?

  2. Donna Pope 3 months ago

    Hi my mother has been in a nursing home since March. We were advised by the social worker that she would have to pay fees as she has savings and property. We are still waiting for the Decision Support Tool meeting and the local authority are requesting payment of fees. Am I right in thinking as it hasn’t been decided Who’s responsible for the fees, that mum doesn’t have to pay… But who does?

  3. Sue 11 months ago

    Hi my mum has dementia and is deteriorating. At present she self funds her own care (has managed with daily carers) however she appears to have deteriorated quite rapidly over the last 2 month. Mum is going into respite for 2 weeks soon whilst I’m away as concerned about her safety which she will self fund. Where do I go from here when she comes home she is going to need carers at least 3 times a day as she now is starting to struggle with basis activities like cooking . I feel if she continues to deteriorate at this speed she will no longer be safe at home she gets high rate attendance allowance as I sleep over at least nights a week however she is going to find it difficult to continue to self fund . Where do I go from here

  4. Ev 1 year ago

    My Dad was recently assessed for CHC funding as it appeared his level of needs had increased since he was assessed last April 2016
    He had been receiving funded nursing care up to this.
    When he was first assessed he had savings over the threshold and social did not make make any contribution, but his savings are now down to <£15,000, social are aware but have not offered any financial help.
    A recommendation was made for a joint package of care, social services contribution 66% and health 34%.
    Now social have told us he will needs to have a means test done and his home will be considered as assets.
    Why is this, if it is a joint package of care??

    • Author
      Angela Sherman 1 year ago

      Ev – in a joint package of care, part of the care is provided by the local authority and this part is means tested. However, the first question to ask is this: If your dad has sufficient healthcare needs to warrant 34% NHS funding, he clearly has care needs relevant to Continuing Healthcare eligibility, and so it’s worth challenging whether the decision not to provide 100% NHS funding is actually correct. Also, if his savings/assets are down to £15,000, though, the local authority should shortly be offering support. This page may help: http://caretobedifferent.co.uk/paying-care-home-fees/savings-thresholds/

  5. June 2 years ago

    My 93 year old father is currently in a care home he is very frail and has had a number of falls. He receives £112 pw from NHS funding and £451.91 from LA. Care home is £700 pw. He has no savings and lives in rented property. He got attendance allowance for looking after Mum (who now has dementia). He has a small private pension of about £50pw and then his state pension. We had to find a care home quickly has the Hospital could not keep him in any longer. My Mum cannot cope with him at home. I the daughter am only on a pension but having to find a top up of £285pw even after the home bought their fees down to £660pw plus my Mum will also need care soon. I have looked after them both for the last 5 years. I cannot manage it any longer. I just do not know what is going to happen as I cannot afford my Dad’s top up so there is no way I can afford both of them I am at my wits end.

  6. sarah 2 years ago

    My father in law 95 was in hospital because of a urine infection he was hallucinating etc and when well enough to leave it was at the same time all family members were away/holidays so for piece of mind instead of having carers in his home we found respite in a care home. When back we came to realise he would not be returning back home as he would be at risk of falls etc. We are meeting up with social worker, met whilst in hospital, at care home tomorrow. We have no idea what to expect, what to do, where to go. Should we be paying for care as we have during respite or should we expect them to do so now?

  7. molly 3 years ago

    My husband was discharged from hospital after 7 months back in 2004, we were told at a multi -disciplinary meeting in the hospital that he would receive continuing care, he did for 5 years, then we were told he had to pay, it was not a huge amount and in my ignorance I assumed it was some type of admin. cost. Then in last year we had a financial assessment and his weekly costs have rocketed by 7 times the amount. I appealed of course but got nowhere and when I mentioned CHC was told “ring the hospital, we have no record of CHC”, but nobody can tell me why we didn’t pay for 5 years, this information being swept aside as irrelevant.
    My husband has deteriorated considerably over the years as he has a progressive illness and has developed other health issues. We are paying the fees but feel strongly that this is wrong but how to put it right when nobody listens.

    • Author
      Angela Sherman 3 years ago

      The various people you’ve been dealing with sound thoroughly incompetent, Molly, and I imagine that is making things very difficult – in what is already a difficult situation. The Continuing Healthcare Dept at the local Clinical Commissioning Group (NHS) should definitely have records of the previous CHC payments – as it will have come out of their budget. And it’s only if your husband’s care needs have actually reduced that the funding should have been removed. I would write a very strong letter to the chief executive of the CCG, and copy it to everyone involved.

  8. Kerry 3 years ago

    My motherin law has had previously been receiving Continuing health care following several years of hospitalisation and relapse. This is due to behaviour and mental issues. Recently an assesment has been carried out with my husband present. As of yet neither my husband or I have actually had written or verbal confirmation of the outcome yet we are being asked to provide financial details by my local authority. This suggest that a decision has already been made and that her care has been switched to social services. Is this correct. We are asking for further assessment as my motherin laws health has deteriorated.

    • Angela 3 years ago

      This is the wrong way round, Kerry, as you suspect. If you’re still waiting for the outcome of a CHC review, then it has not yet been decided who is legally responsible for continuing to meet care costs. Also, if there is no paperwork to show that the review has been conducted properly, including scope for the family to input into that, then it would seem flawed. I would refuse to provide any financial information until the review has been conducted properly.

  9. Chris-G 3 years ago

    Follow up comment.

    The council has put a “special projects manager” on the case of my father in law.
    He’s the one that was denied CHC by a single assessor that formed a Multi Disciplinary Team….. all on his lonesome. The clue is surely in the words Multi and Team.

    In the spirit of means testing; I asked her what right the council had to means test him after the NHS had removed his funding without doing it properly as is actually recorded to be the case.

    She implied that it would appear that they had no right to, as obtaining and subsequently retaining the data would likely be Data Processing Act offences.

    Ergo, to demand money based upon the illegal acquisition and processing of data is likely false accounting. That is a criminal offence.

    Follow the logic……. Illegally obtained financial data is not permitted to be processed. Processing it to create financial accounts, is the same as just inventing the amounts charged on the invoices because the data does not in fact exist because it is illegal for them to possess it and use it to create accounts.

    The problem that all involved has with this process is that when they step outside of the rules within the National Framework they run squarely into the realms of the civil and sometimes the criminal law.

    Then they state that they don’t have to obey anything except the framework when it is in fact their often faulty internal training manual that they are actually operating in compliance of. They also add that they do not know anything about law.

    Instead they try to defend themselves by stating that they don’t know about it as if that is a defence.

    Try getting away with that defence the next time the cops stop you speeding.

    • Sara Perry 3 years ago

      This is exactly what happened to my mum – a Multi Disciplinary Team of one! They have eventually admitted to not abiding by the Framework and re-assessed finding my mum eligible. Just got to get the money out of them now!

      Next time they say they no nothing about the law, point out that ignorance is no defence. In British law, you cannot use the defence that you did not know something; you are still guilty and can be found guilty as though you knew it – that may make them sit up and think.

  10. Johanna O'Sullivan 3 years ago

    My mother-in-law is in hospital waiting for a place in a care home, she suffers from Alzheimers to such a degree she does not know how to do basic things i.e how to hold a fork, doesn’t always take medication, incontinent ect, needs help eating etc. she’s got little savings but owns her property, we’ve been told she does not meet the criteria for a full NHS continuous care assessment and has to pay in full for her care

  11. PaulineMac 3 years ago

    When my father was being financially assessed I advised them that I was in the process of applying for full CHC. I was told he would take as much info as we had and then ‘keep on file’ until decision made on CHC. As the process for CHC took so long Social Services started billing and demanding payment which we paid. CHC was finally agreed after almost six months and I am now in the position of trying to reclaim fees paid from NHS by appealing due to the delay in getting dad assessed and a repeat of the DST as paperwork used was out of date and panel wouldn’t look at it! Not his fault or ours. Wonder how long that will take, if they even agree to my claim?

  12. Sara Perry 3 years ago

    Did you see the article in The Times Magazine 14/6/14? Its clear this family have been led to believe that means testing comes first, then they appear to have been ‘allowed’ to get a CHC assessment once the individual’s funds fell below £23250. Its scandalous!

    • Chris Gallagher 3 years ago

      Hi Sarah, I missed the article but it sounds about right.

      My father in law has been funded after a serious accident and subsequent amputations, for 6 years and now found ineligible. He has not died quick enough for the system, or so it seems.

      His funds were a little below the 25K mark. Yet the council has invoiced the entire cost of the home every week since CHC was withdrawn.

      Needless to say we have not paid. We also told them that we would not pay and to go ahead and take us to court.

      They have not yet done so. Nor have they corrected the amount that they can lawfully try to take each week.

      The poor chap that is mentioned in the invoices has no idea of what it is all about and as such cannot even be sure that what he is accounting and invoicing is even correct…… He just does as he is told.

      Yes that is what he told me. So he regularly risks criminal fraud and false accounting charges because he just does what he is told to do. You couldn’t make it up.

      All the best.

    • Angela 3 years ago

      Hi Sara – yes, Gail Rolfe’s article highlighted so well just what goes on – and how confusing and bewildering it can be for families who are already going through such a very distressing and stressful time.

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