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Paying care fees: Be careful what you read

What you read about care fees may lead you to being wrongly charged

There are many websites and guides available about paying care fees, but they don’t all give you the full picture. Many are actually misleading – even if they don’t mean to be. So be careful when you’re researching on behalf of yourself or a relative.

Most information published on the web and elsewhere about care fees and care funding focuses first on means testing and local authority funding. However, this often leads families down the path of paying for care when it’s not appropriate.

Many families are also given misleading information by the health and social care authorities themselves. This is clear from the experiences of hundreds of families who contact us.

Whether or not you pay for care does not depend on your financial situation. It depends on your care needs. That’s something few families seem to be told.

It’s an assessment for NHS Continuing Healthcare that actually decides who is responsible for paying for care – not whether a person has savings or a house. This principle is reinforced in the National Framework for NHS Continuing Healthcare and is also supported in the new Care Act 2014, including when a person is being discharged from hospital.

In most guides and books about care and care matters, NHS Continuing Healthcare is usually given just a very small mention as an ‘aside’ – if indeed it gets any mention at all – and this exacerbates the problem. The undue focus on local authority funding, capital thresholds and means testing is exactly what has led to the tens of thousands of retrospective claims for NHS Continuing Healthcare in recent years – not to mention untold distress to families when they realise their relatives should not have been means tested in the first place.

By assessing for financial means first, instead of for NHS Continuing Healthcare eligibility, a local authority (and those working within it) are putting themselves in a potentially unlawful position, as the care needs they are potentially taking responsibility for may be beyond the legal limit for local authority care. This is clear in case law, including the Coughlan case, but sadly often seems to be ignored by both the NHS and local authorities.

So if you’re reading information online or elsewhere about care fees, or receiving advice about paying for care, remember that it first has to be properly established who is actually responsible for paying (i.e. the NHS or the local authority).

Another common thread in many guides to care fees is Funded Nursing Care (FNC). Very often families will read, or be told, that this payment may be available to help with care fees. What they should be told is that FNC is only awarded after an assessment for NHS Continuing Healthcare – and it is given to people with some nursing care needs who don’t qualify for full Continuing Healthcare funding. Families report that FNC is instead often given without any reference to full funding – and this means a person may be wrongly paying for the majority of their care themselves.

May 29, 2015/8 Comments/by Care To Be Different

Care fees

The Care Act and NHS Continuing Healthcare – what you need to know

There are certain points about the Care Act and NHS Continuing Healthcare that you need to be aware of.

Elements of the new Care Act come into effect in England on 1st April 2015. The remainder was due to come into effect in 2016*. (*See update at the end of this article.)

This article is not a detailed overview of the Care Act. Instead, it raises just a few of the points that families may need to be aware of in the first instance. We’ll look at other points in future articles.

The most important point to be aware of about the Care Act and NHS Continuing Healthcare is that:

the new Care Act does not change the rules about NHS Continuing Healthcare – or who it applies to.

The guidelines, Continuing Healthcare case law and eligibility criteria for NHS Continuing Healthcare remain the same.

(NHS Continuing Healthcare is NHS funding that covers all care fees for people in full time care who have healthcare and nursing care needs and who meet certain criteria.)

However, there are some points about the Care Act that it’s worth keeping in mind:

Social care vs. healthcare and nursing care

The Care Act is essentially a social care Act – applying for most part to local authority care, i.e. means tested care.

Generally speaking, there are two types of care:

social care: provided and funded by a local authority and means tested
healthcare and nursing care: provided by the NHS and not means tested.

This distinction is vital.

The Care Act deals primarily with social care, i.e. local authority means tested care.

Do not believe anyone who tells you any of the following:

That the new Care Act abolishes NHS Continuing Healthcare funding. It does not.
That all care will now be means tested, including NHS Continuing Healthcare. It is not. NHS Continuing Healthcare is not means tested.
That the new Care Act does away with the above distinction between social care and healthcare funding. It does not.
That people receiving NHS Continuing Healthcare now have to pay for their social care. They don’t.

Self-funders and the Care Act

If you don’t qualify for NHS Continuing Healthcare funding (or if you have Continuing Healthcare funding removed at some point) it means that your care needs are deemed to be social care needs. This means the Care Act becomes relevant to you at that point – because the Care Act is largely about social care.

‘Self-funders’ – the term used to describe people who pay for their own care – have had a pretty raw deal in the past. They’ve generally been invisible to the wider health and social care system and have been left to fend for themselves, paying the highest fees for care and having little – if any – access to advice or contact from the local authority.

With the Care Act, self-funders will at least now be on the radar of the local authority. The local authority must now calculate the cost of a person’s care – and keep a record of these calculations (a care account) – regardless of how much money a person has. This is because from April 2016* a new care fees ‘cap’ was due to come into effect. (*See the latest update on this at the end of this article.)

The ‘cap’ on care fees

Vital point:

The much publicised cap on care fees applies only to social care (means tested care).

It was due to start coming into effect from April 2016*. (*See the latest update on this at the end of this article.) The idea behind the cap is to limit the amount that any one individual over the age of 25 has to pay in total for their care to £72,000. In practice, however, few people (probably only one in eight people) will actually benefit because:

the cap only covers actual care costs, not living costs or accommodation costs in a care home
the average stay in a care home is between two and three years, many people will never reach the cap, but will instead have to pay for everything
the cost of actual care is calculated only at the rate the local authority is prepared to pay; very often this does not cover the actual cost of care.

For example, a self-funder could be paying £800/week in care fees, and yet if the local authority rate is only £500/week, it means only £500/week will be included in the care account – BUT living costs will also be deducted from this. These living costs are nominally calculated at £230 per week (approx. £12,000/year), and so in this example only £270 would actually count towards the cap (£500 less £230).

It’s easy to see that, by the time a person reaches the cap, they may have paid a great deal more than £72,000.

So, in essence, the lower the local authority rate, the less is included in any care account, and so the longer it will take a person’s total care costs to accumulate to reach the cap.

In the meantime they will have to pay the full cost of their care – and even when they reach the cap they will still have to continue to pay all living costs and all costs of accommodation in a care home. If a person can’t pay this, the local authority will help.

How will social care care needs be assessed under the new system?

There will be a new system of social care assessments, and this is a contentious point about the new Care Act. In many people’s views, the proposed system leaves scope for a high degree of both subjectivity and error on the part of the assessor.

But remember – and this is a vital point in relation to NHS Continuing Healthcare – if a person has care needs that are beyond the local authority’s legal remit for care provision, the NHS should still provide and pay for all care – with no means testing. NHS Continuing Healthcare funding is not affected.

If a person is receiving NHS Continuing Healthcare funding, the cap is not directly relevant to them while they are receiving that funding. There should also be no cap on NHS Continuing Healthcare funding, despite some Clinical Commissioning Groups incorrectly now trying to impose one.

A person who is awarded Continuing Healthcare funding may have previously been self-funding, and from April 2016* onwards (*see the note at the end of this article) any self-funded payments (for actual care) were due to be recorded and count towards the cap.

A person currently receiving Continuing Healthcare funding may, at some point, have that funding taken away and be deemed as needing only social care. If this happens, and if it’s justified in being removed, and the person becomes self-funding, their payments for care will of course count towards the cap.

Given the significant extra workload that will land at a local authority’s door with these new assessments, it’s important for self-funders to make contact with the local authority sooner rather than later, to be assessed from October 2015 onwards – in time for a ‘care account’ to be set up by April 2016*. (*See update at the end of this article.)

New social care assessments

Here’s the controversial bit:

The amount a person may need to pay for their social care will hinge on what scores or comments one sole assessor decides to put on an assessment form. The amount of care that will count towards the cap will be only those needs that the assessor actually records and decides are ‘eligible’ needs.

If care needs get overlooked or missed out, the person being assessed will end up with a lower ‘estimated budget’, there will be less recorded in their care account, they will pay more out of their own money and they will take longer to reach the cap.

Just like with NHS Continuing Healthcare, these new social care assessments are about care needs only; they should not be an assessment of a person’s money.

It is likely that local authorities will outsource the assessment of self-funders’ care needs to a third party. In this there is a risk that the companies doing such care assessments may not have the skills and knowledge to properly assess needs. (And remember this is an assessment of care needs, not money.)

Such assessments and/or reassessments could even be done over the phone, again allowing scope for grave error in determining a person’s actual level of need.

Also, in any new social care assessment, the assessor MUST take account of potential eligibility for Continuing Healthcare. However, many people fear that the people carrying out these tick-box social care assessments won’t have the knowledge or experience to understand what actually constitutes eligibility for NHS Continuing Healthcare.

It means a box could be ticked to say Continuing Healthcare has been considered and discounted, when in fact the assessor has not properly evaluated the criteria in the Continuing Healthcare Checklist at all.

There would seem huge scope for error here. And it would seem unlikely that any proper consideration of Continuing Healthcare eligibility could possibly be made if a self-funder is just asked a few questions over the phone by someone without professional knowledge of the person’s health and nursing care needs.

Before reaching the new social care cap

Before a person reaches the social care cap, and assuming they have money and/or assets above the means test threshold, they will pay for all of their care.

Again, this does not apply to NHS Continuing Healthcare – which is not means tested.

No care costs paid before April 2016* will count towards the cap. (*See the update at the end of this article.)

Top-up fees will not count towards the cap.

Any other services that are not in the original social care assessment of eligible needs will not count towards the cap.

Interest charged by local authorities on deferred payment arrangements (see below) will not count towards the cap.

Financial help provided by the local authority towards actual care costs will count towards the cap.

As with Continuing Healthcare, families will need to be vigilant to ensure that their relatives are being properly assessed and that all care needs are taken into account. The number of appeals is expected to be high.

New means test thresholds from April 2016

Once a person has reached the cap, i.e. they have paid £72,000 for their actual care (excluding living costs), the local authority will provide funding based on a means test. The individual will still be responsible for paying for accommodation, general living costs, etc. – and, if applicable, care fees top up payments will still need to be paid by someone other than the local authority.

Separately from the care fees cap, new thresholds for means tested care were due to come into effect in April 2016*. (*See update at the end of this article.) Essentially:

if property is included in the value of a person’s money and assets, the new upper means test threshold will be £118,000 (currently £23,250), i.e. anyone will money above this level will pay for all of their care
if property is disregarded (for example if a spouse still lives there), the upper threshold will be £27,000, and means tested support will be available from the local authority
the new lower threshold (below which a person contributes only from their income, not their capital) will be £17,000 (currently £14,250).

…and this one: Further Dept. of Health factsheet

Your care costs will be recorded in your care account regardless of how much money you have and regardless of any means test threshold. This care account is the amount you’re paying for your actual care that counts towards the cap.

Universal deferred payment schemes

These deferred payment arrangements are designed to give people a choice about whether or not to sell their home to pay for care. A person can put off the sale and the local authority will cover care costs in the meantime and then recoup costs from the sale of the property later on.

These arrangements will continue but now a local authority will charge interest (at 2.65% p.a.) and the agreements will only apply to people who have already used up their other money and savings down to the upper means test limit (currently £23,250, from April 2016 £27,000).

The local authority will also be able to levy an admin charge for such arrangements. A local authority must offer a deferred payment arrangement if a person has no other funds with which to pay for care.

Deliberate deprivation of assets

The restrictions on deliberately giving away or hiding money to avoid care fees will still apply, and it’s vital to take good independent financial advice before doing anything. People will still be able to make certain gifts under inheritance tax rules.

Hospital discharge and NHS Continuing Healthcare

One of the most common problems people encounter when being discharged from hospital and needing ongoing care is that members of hospital discharge team often seem very keen to find out about a patient’s money – and yet the focus should be on the patient’s ongoing care needs – not their money.

No one should be asking about a patient’s money until it has been clearly shown who is responsible for paying for any ongoing care – based on care needs only.

The Care Act requires the NHS to notify a local authority if a person being discharged from hospital is likely to require ongoing care and support. This is called a ‘notice’ or ‘assessment notice’, i.e. a hospital is giving the local authority notice that there are ongoing care needs for which provision needs to be made.

Also, the Dept. of Health’s “Care and Support Statutory Guidance” issued under the Care Act makes it clear that a person should be assessed for NHS Continuing Healthcare funding prior to their discharge from hospital. Annex G of this guidance states:

“Before issuing an assessment notice, the NHS body must have also completed any assessment of the potential Continuing Health Care needs of the patient and if applicable made a decision on what services the NHS will be providing.”

Annex H5 of this same guidance covers more about NHS Continuing Healthcare funding.

The Care Act and NHS Continuing Healthcare

Remember…

Given that many people in the care sector – both within local authorities and the NHS and also professional advisers – and focused heavily on the Care Act at the moment, NHS Continuing Healthcare could get forgotten when families are told about care funding.

Remember these three points:

the Care Act does not change NHS Continuing Healthcare
a person needing full time care who has health needs should still be assessed for Continuing Healthcare before they pay a penny in care fees
on discharge from hospital a person should be assessed for Continuing Healthcare funding

All the current talk about the Care Act in the press and by people in health and social care could mislead people into thinking that all care is social care – and that all care is means tested. This is not the case.

NHS Continuing Healthcare is still provided by the NHS and it is not means tested – and it has nothing to do with a person’s savings or property. It is provided and funded by the NHS regardless of a person’s means. The Care Act does not change this.

Remember also that if a person is eligible for NHS Continuing Healthcare, the NHS funding that follows should not only cover their healthcare and nursing care needs, but also that person’s social care needs.

*UPDATE: Important note – the Conservative government announced in July 2015 that it is shelving both the new cap on care fees and the new means test threshold until 2020. This will come as a blow to those paying for their own care. Read more about the care fees cap postponement here – and what it means for self-funders.

March 30, 2015/39 Comments/by Care To Be Different

Care fees

Do we have to sell the house to pay for care?

Here’s a very common story we hear from many families who are trying to make sense of the care funding maze. Most are told to sell the house to pay for care – and yet they may not need to.

Here’s a typical story:

“My father is currently in hospital awaiting discharge. He’s been ‘assessed’ by Social Services who have decreed that he can go back to his house with a care package in place.

As yet, we don’t know what that care package is likely to be, or exactly what kind of assessment he’s had. No one told us it was even being done.

My father is frail with various health issues and he’s cognitively very confused and therefore vulnerable on many fronts. His family feels he needs full time care. In my view he should go through the NHS Continuing Healthcare funding assessment process.

He does not want to go back to his house, and has told us this. Historically, he has had a care package at home, but it has generally lasted only 48 hours before he’s been back in hospital.

We’ve been told that if he goes into a care home we’ll have to sell his house and self-fund. Is that correct?”

So do we have to sell the house to pay for care?

This is the kind of misleading information that families are given every day by people within health and social care.

Always remember – you do not necessarily have to sell your house to pay for care!

If you have a relative needing full time care, read this vital information on care fees and care funding – now. It will help you to:

understand that you don’t necessarily have to sell the house
see that an NHS Continuing Healthcare assessment should be carried out before anyone tells you to pay for care – and before you pay a penny in care fees
understand why a Mental Capacity Assessment may be needed

Sadly it’s not unusual for ‘assessments’ to be carried out without the family’s proper involvement – and indeed the wrong assessments at that. Read more about care assessments.

Keep in mind the key point that it is not a person’s money or assets that determine whether they pay for care; it is their health and care needs ONLY.

So don’t be put off by anyone who tells you have to sell the house to pay for care – or that you always have to pay for care if you have savings. The only way to know if you have to pay for care is for your health needs to be assessed – not your money. Be sure to read this vital information about care fees before you agree to pay anything.

February 1, 2015/13 Comments/by Care To Be Different

Care fees

Paying for care if you have a partner

Does your spouse or partner have to pay for your care?

If you’re wondering whether one partner in a couple is liable for the other’s care costs, generally speaking the answer is no.

Age UK have produced an excellent factsheet to help answer questions about paying for care if you have a partner, and it’s worth reading: Paying for care in a care home if you have a partner.

Keep in mind at all times, though, that:

The only time anyone should be asked to pay for care is once it has been clearly shown that they are not eligible for NHS funding. So, if a person with health needs requires full time care, no one should carry out a financial assessment or ask about their money until an assessment for NHS Continuing Healthcare has been carried out – and a proper decsion has been reached about who is actually responsible for care costs.

Paying for care if you have a partner

If you do have to undergo a means test, always remember that:

this should only look at the assets/savings of the person needing care – not the partner
the partner who does not require care should not be left in fiancial hardship after their spouse’s/partner’s assets have been means tested
if the partner who does not need care is still living in the house, and this is jointly owned, it must be disregarded while the remaining partner is living there
generally speaking you should each be treated as separate individuals as far as your money is concerned, even if you both need care at the same time
it’s important to consider ongoing house maintenance costs (insurance, heating, etc) when being means tested, so that there are enough funds to maintain the property, especially if the stay in care is temporary

But remember, this only applies if you’re not eligible for NHS Continuing Healthcare funding – and that should be assessed first.

Regardless of your current health, and regardless of who actually has to pay for care, be sure also to have a Power of Attorney in place, so that someone you trust can act on your behalf if needed. This is such an important point. Trying to deal with health and social care authorities without one can be extremely difficult.

Also, always take independent financial advice before you make decisions about your money, especially when it comes to care fees. There are many potential pitfalls. Be sure that any adviser you speak to understands the CRAG rules inside out (Charging for Residential Accommodation Guide).

Read the AgeUK report here: Paying for care in a care home if you have a partner.

October 31, 2014/20 Comments/by Care To Be Different

Care fees

New means test guidelines for property – your home could now be safe

The Dept. of Health has issued new Relative’s Property Disregard guidelines.

This is in response to a recent court case about means test guidelines for property: A daughter successfully stopped the value of her mother’s house being included in care fees means testing.

It means other people may now be able to stop their own family home having to be sold to pay for care.

Let’s assume for the moment that your mother or your father needs full time care in a care home and also owns a property.

Let’s also assume for the moment that your parent is not eligible for NHS Continuing Healthcare funding and that they have to pay for their own care.

Ordinarily, there are certain circumstances in which your parent’s property could be disregarded from means testing.

(By ‘disregarded’ we mean protected from being taken to pay care fees and disregarded under Para 2(b)(ii) of Schedule 4 to the National Assistance (Assessment of Resources) Regulations 1992. )

These circumstances include a situation where:

your parent’s spouse or partner still lives at the property
another relative over 60 lives there
a younger relative still lives there who is incapacitated
your parent’s former partner (divorced or estranged) still lives there and is a lone parent with a child under 18
another of your parent’s children lives there and is under 18
a relative over 60 lives there (or in some circumstances a friend who has been caring for your parent for some time and for whom the property has become their home)
another person owns a share of the property and does not want to sell

However, there is now a new circumstance in which the property can be disregarded from means testing…

New means test guidelines for property – Relative’s Property Disregard guidelines

In February 2014, Glen Walford brought a case against Worcestershire County Council. She successfully argued that her family home should not be included in any means testing for her mother’s care costs.

The key issue was whether the property was Miss Walford’s main or only home. The High Court judgement concluded that a ‘home’ is a place to which a person has a degree of attachment both physical and emotional.

However, emotional attachment may not be enough on its own; the degree of occupation of the property by a relative is crucial, and yet this occupation does not have to be all the time.

For example, someone who travels a lot, or who is posted overseas as part of their job, but considers the property still their main home, and returns regularly where possible, could now claim the property is their main home, even if they rent other properties in the meantime.

Similarly, someone with a nomadic lifestyle who does not have their own home elsewhere and who considers the property somewhere they will eventually come back to, could also potentially argue that the property should be disregarded in means testing.

Essentially this means that ‘occupation’ is not the same as physical presence, i.e. you don’t have to actually physically live at the property all the time to ‘occupy’ the property.

These new Relative’s Property Disregard guidelines – new means test guidelines for property – also highlight that local authorities should take account of a family member’s changing circumstances in this respect.

Also, there is no need for a relative to have been occupying the property before the person needed care; the purpose of the move will be considered, and also to ensure that a family member does not become homeless if the property is included in means testing.

However, in all this there is of course one vital point to remember:

Issues of mean testing and property disregard are secondary to assessments for NHS Continuing Healthcare; where a person needs full time care on account of health needs, a Continuing Healthcare assessment should be carried out first, before the health and social care authorities ask any questions about a person’s money or property assets.

Read the new Relative’s Property Disregard guidelines here.

UPDATE:

Since this article was originally published, Worcestershire County Council appealed the decision and, unfortunately for the family, the Council won. It means that the property can now be taken into account in means testing. The Court of Appeal decided that a relative must actually be resident at a property at the time a person goes into care in order for the property to be disregarded in the means test. This will come as a blow to many families in a similar position.

August 7, 2014/14 Comments/by Care To Be Different

Care fees

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

When 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:

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.
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.
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.

Do 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.

June 15, 2014/26 Comments/by Care To Be Different

Care fees

Care home top-up fees: Do you really have to pay?

In 2013 the charity Independent Age published an excellent report into third party care home top-up fees. It’s worth promoting the report again here, as it contains vital information for all families faced with paying care home top-up fees. (See below for a link to more recent findings, too.)

The report revealed that many care home top-up fees should not be charged at all. It also shows that in many casers local authorities should be meeting the full costs of care.

Care home top-up fees – some key points from the Independent Age report:

Top-up fees are required only when the person needing care or their family have specifically requested more expensive accommodation. They should not be charged just because a care home costs more than the local authority/council is willing to pay.
Care home top-up fees should only be paid by relatives who are able and willing to pay them.
Local authorities are responsible for top-up arrangements. However, many such arrangements are made between a care home and a relative – with the local authority out of the picture.
Often local authorities fail to direct people towards independent advice; they also fail to explain a person’s right before top-up contracts are signed.
Many local authorities are in breach of the Choice of Accommodation Directions (LAC(2004)20. These Directions prevent local authorities/councils from asking for top-up fees as a blanket policy.
If a relative cannot pay third party top-up fees, the local authority is responsible in full for the full cost of care.

These are just some of the many important points that come out of the report. It also names specific councils/local authorities and highlights the degree to which they are ignoring their responsibility towards relatives – and breaking national guidance on third party top-up fees.

So remember these 5 points about top-up fees – regardless of where the care is being provided:

They should only be charged if a person is receiving a genuine upgrade in the services they’re receiving.
The family must give informed consent before any top-up fees are charged.
Top-up fees are voluntary.
They are the exception – not the general rule.
They should not be requested from families to plug the gap in local authority funding.

One final point – many families are told to pay top up fees before their relative has been assessed for full NHS Continuing Healthcare funding. This is completely the wrong way round. Read more about care fees and NHS Continuing Healthcare.

Remember that if you do receive NHS Continuing Healthcare funding, this cannot be topped up – and no one should ask you to. Top up payments are for social care (local authority care) only. It is unlawful for NHS Continuing Healthcare funding to be topped up. The NHS Choices website reinforces this point:

“Is it possible to pay top-up fees for NHS continuing healthcare? No, it is not possible to top up NHS continuing healthcare packages, like you can with local authority care packages. The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you get from the NHS. These private services should be provided by different staff and preferably in a different setting.”

You’ll find more here about Independent Age’s findings on top up fees

What’s your experience with top-up fees?

April 27, 2014/207 Comments/by Care To Be Different

Care fees

5 biggest myths about care fees

Does your relative need full time care?

Beware the 5 biggest myths about care fees…

The whole subject of care fees can be a minefield. Much of the information on the internet, in the press – and from the health and social care authorities themselves – is misleading, and often just plain wrong! It simply reinforces the 5 biggest myths about care fees.

Maybe you’ve been told your relative has to pay for care. Or perhaps you’ve heard about NHS funding for care and you’re wondering if you can apply for NHS Continuing Healthcare.

Mistakes about paying for care are made right at the start. People are told that if you have a certain level of savings and assets you have to pay. Not true. What should happen at the very beginning is an assessment of your health needs, not your money.

Most people are led to believe that care is just ‘care’. However, there is social care and, separately, there is healthcare/nursing care. Healthcare and nursing care are free in the UK, in law. Social care is means tested.

When someone goes into care the very first thing that should happen is an assessment for their health needs and their nursing needs. And it’s only if they’re not eligible for NHS funding that money should even been discussed. This almost always happens the other way round, though. People are asked straight away whether they have a house and/or how much money they’ve got. This is one of the reasons care funding mistakes are made.

If this happens to you, simply say: ‘At this point in time this is not about money, this is about health needs.’ Then ask for an NHS Continuing Healthcare assessment. This is the funding that covers 100% of care costs for someone in care who has a certain level of health or nursing care needs. You can also ask for an assessment if your relative has been in care for some time.

Very often the first point of contact anyone has with the care authorities is with a local authority or local council. However, local authorities and councils provide (means tested) social care, and very often nobody mentions that there is also NHS funding for full time care.

People just don’t know about NHS funding and they’re not told about it; it’s one of the biggest scandals in our care system

As a result, many thousands of people are paying for healthcare and nursing care – care that should be provided and paid for by the NHS – regardless of a person’s age. If care homes didn’t exist those people would be in hospital and paid for 100% by the NHS.

Let’s look at the 5 biggest myths about care fees. They are myths that may have been told to you as fact…

5 biggest myth about care fees

“All care is means tested and so, if you have a house, you always have to pay.” Not true. The decision as to whether you have to pay for care does not depend on whether you have a house; it depends on your health and care needs.
“If you have savings over £23,350 you always have to pay for care.” Not true. See point 1 above.
“If you have health/nursing needs – but you also have savings and/or a house – you have to pay.” Not true. Healthcare needs come before money – and it doesn’t matter how much money you have, if you need healthcare or nursing care it is these things that determine who pays, not what’s in your wallet.
“It’s not worth applying for NHS Continuing Healthcare funding because it only covers specialist needs – and it doesn’t apply to people with dementia.” Absolutely not true! So many people are told this – by people in all parts of the care industry. NHS Continuing Healthcare funding does not depend on any specific diagnosis or any particular specialist needs. It’s about your day-to-day health and care needs – whatever the underlying diagnoses or problems are, and regardless of whether or not you have dementia.
“If your spouse needs care and you own a house together, you will have to move and sell the property to pay for their care.” Not true. No one should be asked to pay for anyone else’s care (aside from top-ups, which are linked to social care) – and you don’t have to sell your house to fund someone else’s care.

There are also many other myths flying around about care fees.

The health and social care authorities often seem to be complicit in perpetuating these myths, and it leaves families exasperated, exhausted and seriously out of pocket trying to uncover the truth.

Always remember, it is only social care that is means tested, not nursing care.

What’s the difference between a healthcare need and a social care need?

Why long term care fees are a con

February 27, 2014/11 Comments/by Care To Be Different

Care fees

Why long term care fees are a con

How do care fees fit with our duty to care?

A friend of mine, during an unexpected visit to hospital in another EU country, had a conversation with one of the nurses about the care system in the UK.

My friend explained to the nurse that older people in the UK are forced to sell their homes to pay for the essential healthcare and nursing care they need. Not only that, they are forced to hand over their life savings and everything they may have wanted to leave to their children.

The nurse asked, “But how does that fit with our duty to care for those people?”

Good question. And it’s one that many UK families ask every day – and especially those who have come face to face with the ageist and budget-motivated funding approach that is being used by many health and social ‘care’ authorities. Healthcare, it would seem, has often lost the desire to actually care.

Since when did the NHS Constitution limit free healthcare to younger people only?

Deceit and ageism is sadly all too apparent when it comes to NHS care for the oldest generation, people who are often the most vulnerable and ill. For those needing full time care, healthcare (just like for other people) should be provided free of charge. The NHS Constitution clearly outlines this, confirming that NHS care should meet the needs of everyone, that it be free at the point of delivery and that it should NOT be based on ability to pay.

One of the care funding mechanisms for full time care is NHS Continuing Healthcare. But even if a family is aware of this funding, assessments are often carried out incorrectly and health needs are ignored, resulting in NHS care funding being declined. Obstacles and delays are often put in a family’s way by the NHS and by local authorities, many families are simply told by all and sundry their relative ‘won’t qualify’ – or they are simply ‘overlooked’.

The stark reality when an older person needs care is that it’s no longer their health needs that dictate what the state should provide; instead, it is what’s in their wallet.

It will come as no surprise to those locked in battle with the NHS on behalf of an older relative that the free healthcare available to most people in the UK – the same free healthcare the law specifically provides for – is often illegally withdrawn when the authorities know it’s for an older person, and especially when the authorities know that person has a house. As a result, those older people are made to pay for healthcare and nursing care.

People need to know why long term care fees are a con – before it affects their own family

The principle of free healthcare explains why long term care fees are a con. Care providers need to be paid, no question. But by whom?

Nursing care is free in the UK. Logic therefore dictates that any fees charged to an individual by a nursing home for nursing care are inappropriate. Indeed, logic also concludes that there should be no difference between residential fees and nursing fees – at least not to the person needing care.

Few other, if any, sections of the population are asked about money when they access healthcare, and yet older people are almost always asked to pay for care – before their health needs have even been assessed.

We need a tsunami of media coverage to expose what goes on in NHS Continuing Healthcare

NHS Continuing Healthcare funding has been in the press a fair bit over the last year or so, primarily in account of the questionable care fees reclaim deadlines set by the Dept. of Health in 2012.

But a bit of press coverage here and there is a far cry from what’s really needed to help the wider population understand what is likely to lie ahead for their own older relatives.

Many charities are now promoting the issue more widely, which is great, but still most people in the UK believe you always have to pay for care when you get old. That is, after all, what the state tells us.

The issue of care fees are likely to affect most families at some point, and people need to be aware and informed – now. Instead, we have Government ministers attempting to distract people from the real issues in ‘photo opportunities’, rolling up their sleeves and being filmed visiting or ‘helping out’ in a hospital, proclaiming of course what a wonderful institution our NHS is.

It doesn’t fool the exhausted families who, every day, are fighting the fierce protectionism of NHS assessors and budget holders on behalf of those they love – vulnerable older people who have already paid for their healthcare and nursing care their whole lives through taxation, and yet this cowardly healthcare system sees them as easy prey.

By ordinary people spreading the word about Continuing Healthcare funding at every opportunity, we can help ensure that more people realise what’s going on. It’s important that people know their older relatives don’t necessarily have to lose their homes to pay for care.

If you’re fighting a battle for NHS Continuing Care funding, you’ll find lots of useful information on our website and blog, and if you need step-by-step guidance through the Continuing Healthcare assessment process, take a look at our e-guide, How To Get The NHS To Pay For Care. It shows you what to do – and what not to do.

January 9, 2014/5 Comments/by Care To Be Different

Care fees

Who can provide support during a care funding battle?

Having support during a care funding battle can make a big difference

…but who can help – and how? Many people feel they have little support during a care funding battle – and yet acting on behalf of a relative who is in care can be exhausting.

When it comes to funding matters, not only do you continually have to find out what should and shouldn’t be happening, but you’re probably also chasing replies from health and social care authorities, writing numerous letters and emails, attempting to hold the authorities to account and perhaps also trying to hold down a full time job and maintain your own finances – not to mention having a life of your own in between.

So who can provide support during a care funding battle?

Family and friends

One of the obvious people is a close relation – a partner, sibling or your son/daughter. Although they may not understand exactly what things are like from your point of view, having emotional support really helps. Friends can play a vital role in this respect too, of course.

Your relative’s GP

You may or may not have good communications with the GP. Some GPs are more aware than others of the ins and outs of long term care funding. You could make an appointment to see the GP yourself and highlight the difficult situation you face. Some GPs are also happy to write/sign a summary of needs to help support your case for funding.

Care home manager, care provider or care workers

If you have a care worker on your side, or a manager from the care provider or care home who supports your application for funding, it can make a big difference. Many people report a tendency by care staff paint an overly rosy picture when asked questions about someone’s care needs; this is of course very frustrating when you’re trying to show how extensive your relative’s needs are! It can be beneficial to speak to the carers and the manager to explain that this is not about the quality of care provided; instead it’s about showing the extent of the underlying needs that require care.

Specialist nurses and therapists

If your relative has some kind of cognitive impairment, Alzheimer’s or dementia, there may be a Community Psychiatric Nurse (CPN) or a Mental Health Team involved in their care. Similarly, if your relative has a degenerative disease such as Parkinson’s or Multiple Sclerosis, etc, there may be a specialist nurse who can provide helpful input into a funding application or appeal. You may also been able to make contact with a physiotherapist or other kind of therapist who has been involved.

Consultants/clinicians/physicians

In the same way as above, other medical professionals may be prepared to summarise your relative’s specialist needs, for example if your relative sees a neurologist, the neurologist may be prepared to write a letter highlighting the serious issues. Make sure any summary does actually support the specific level of needs you know your relative has, and doesn’t inadvertently dilute it by using language that makes the needs seem less.

Specialist solicitor or other legal adviser

If you need to offload your case and have someone else take it on for you, a specialist solicitor can be invaluable. Equally, if you need advice on specialist matters such as mental capacity, deprivation of liberty or other safeguarding issues (just as examples), a relevant specialist can help hugely.

Specialist funding advisers

If you’re dealing with specific sources of funding, such as NHS Continuing Healthcare, you may need to seek specialist advice. Some former Continuing Care nurses now provide such a service, as do other specialists, who have been through the funding process themselves and now show other families how to do the same.

Coach or counsellor

If you’re finding things difficult emotionally, it may be worth seeking out a professional coach or counsellor to help you. Sometimes it’s easier talking to an independent person than it is to close family. Everyone’s different, of course.

Forums and blogs

There are an increasing number of blogs and online forums about care fees and care funding, including NHS Continuing Healthcare. Some of the big national charities also have forums you can participate in and comment on.

Above all, it’s important to look after you, given how stressful funding matters can be. Get enough sleep, drink lots of water, eat healthily and take one step at a time. At times you may also have to choose your battles and decide how much you can actually take on.

Just having support here and there from people you know are on your side, even if for a short while, can help you stay focused and provide you with the impetus to keep going.

What kinds of people have been able to support you during a care funding battle?

November 25, 2013/3 Comments/by Care To Be Different