Care fees Archives - Page 3 of 8 - Care to be Different

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, 2014/206 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

Care fees

How keeping a diary helps in a care funding application and appeal

Your care funding application and appeal is much easier with the right notes to hand.

When you’re acting on behalf of a relative who needs care – whether that care is full time or otherwise – there are so many things to think about.

You’re probably visiting your relative regularly, making sure their care seems appropriate, resolving any problems, making sure they have the things they need, managing their finances, keeping an eye on their house – all sorts of things.

If you’re also applying for NHS funding to cover care fees, this can add another thick layer of responsibilities and time commitments.

One of the things that can help, particularly in an NHS Continuing Care funding application and appeal, is to keep a journal or diary. When the NHS makes decisions you disagree with, and you decide to challenge those decisions or launch a Continuing Care appeal, the details you record in your journal now will save you a lot of time later on.

The more information you jot down each time you speak to or receive communications from people in the health or social care authorities, or from the care home or care agency, the quicker you’ll be able to put a response together when you need to.

If you are your relative’s formal representative, for example you hold a power of attorney, be sure to ask for copies of assessment notes plus the rationale for any funding decisions already made.

Keep general notes about:

your relative’s specific diagnoses and their general progression over time
dates and details of any previous assessments for NHS Continuing Healthcare – when they took place, who was present, any available ‘scores’ and what the outcome was
any NHS or local authority maladministration that you’re aware of – and/or things that just don’t seem to have been done right, including things that NHS or local authority staff may have said (or not said) to you.
delays and obstruction in the assessment process
misstatements of fact in the assessment notes
any intimidation or inappropriate pressure put on you to give up your battle for funding
dates and times of any relevant medical or healthcare appointments and other meetings to do with your relative’s health needs, health decline, care provision or funding
any relevant conversations with staff and/or therapists from different bodies/departments (NHS, local authority or private), including physiotherapy, occupational therapy, speech therapy, nutrition, etc. – and what was discussed
other appointments, conversations and phone calls
notes on anything that doesn’t seem right to you about a lack of statutory funding and/or care provision
any other information or notes from relevant clinicians, doctors, nurses or therapists that you think will strengthen your case.

If you’re asking for daily care notes, care records or charts, or other information you need for a care funding application or appeal, and you’re told the information is not available, ask why this is not available and be sure to note down what you were asking for, who you spoke to, when you spoke to them and the reason you’re given for the information being ‘unavailable’.

Be sure to also keep copies of any hospital/GP/care home correspondence and/or letters or health reports from relevant consultants, doctors, clinicians or therapists.

When you’re going through a funding battle, especially an NHS Continuing Healthcare application and appeal, all these notes and details will be invaluable, especially if you keep them up to date and record them at the time things happen.

If you’re not sure what should – and shouldn’t – happen in a Continuing Healthcare funding assessment, you may find our step-by-step e-book helpful: How To Get The NHS To Pay For Care.

How has keeping a diary helped you in a battle for funding?

June 27, 2013/6 Comments/by Care To Be Different

Care fees

Why information about care fees fails people who need full time care

There’s a lot of information available on the web and also from various professional advisers about care fees and who pays what when you need full time care.

However, much of this care fees advice is misleading

Why? Because it usually starts from the basis that, if you have savings or assets over £23,250 (in England), you have to pay for all of your care. End of story.

This is not true!

Whether or not you pay for care does NOT depend on your money or whether you have a house; it depends on your care needs only.

If you find yourself reading that you always have to pay for care if you have savings or a house – or if someone tells you that’s how it is – be aware that they are only giving you half the picture.

Here’s what you should actually be told right at the start:

If you have health needs and you need full time care, health care and nursing care is free of charge – in law – no matter whether you’re in a care home or in your own home. (It can be any type of care home – residential, nursing or other.)

Full NHS nursing care funding is called NHS Continuing Healthcare and it covers 100% of your care costs. In a care home this includes accommodation, food, heat, all care, everything – and you don’t have to pay anything, no matter how much money you have.

The only way to know whether you’ll be eligible for this full NHS funding is to have an assessment for NHS Continuing Healthcare – first – before anyone starts talking about means testing or tries to take away your pension or your home.

However, what almost always happens at the start is that you’re simply told you have to pay for your care. It’s the wrong way round.

The Dept of Health defines NHS Continuing Healthcare as follows:

“NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’… Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness.”

If you’re told you ‘won’t be eligible’ for this free NHS care funding, question the source of that information. If you’re ‘not eligible’ for NHS funding, it means by default that you simply require ‘social’ care instead.

You can read pages and pages of information about care fees, and speak to a lot of different people, and still be unaware that the first thing that should happen when you need full time care is an assessment for full NHS funding.

The people who have absolutely no excuse for failing to inform you about this are, of course, health and social care employees themselves, and yet they may well tell you that you don’t need nursing care (when in fact you do!), or that you don’t need ‘enough’ nursing care to qualify for Continuing Care funding.

Any attempt to get you to pay for care under false pretences or without you having had the proper NHS assessments can be considered an attempt to defraud.

So, remember these key things at all times when you’re exploring the subject of care fees:

Generally speaking, nursing care is free, in law, in the UK.

The landmark Coughlan case (where Pamela Coughlan succeeded in securing full NHS funding through the Court of Appeal) clarified the law about NHS Continuing Care funding, and your own health needs should be measured against those of Pamela Coughlan.

Be alert for people trying to put you off having an assessment: 7 most outrageous reasons for not receiving an NHS Continuing Care assessment

Be sure to learn as much as you can about nursing care funding and how to get assessed for NHS Continuing Healthcare – before you start paying any care fees.

Why a social worker MUST be involved in the assessment process for NHS Continuing Healthcare funding.

Older relative in hospital and needing ongoing care. Here’s what must happen before discharge.

Getting the NHS Continuing Healthcare assessment process started.

May 25, 2013/0 Comments/by Care To Be Different

Care fees, NHS Continuing Healthcare

How to prepare for a NHS Continuing Care assessment – 15 top tips

Full assessment for Continuing Healthcare – 15 top tips

These tips and insights are taken from our ebook, How To Get The NHS To Pay For Care, which helps you through the whole Continuing Healthcare assessment process…

NHS Continuing Healthcare funding covers 100% of care fees for people who need full time care and whose needs are primarily health needs. This article focuses on some of the things you need to keep in mind when preparing for a full multidisciplinary team (MDT) assessment (sometimes referred to as a Decision Support Tool assessment)…

There are clear guidelines about how NHS Continuing Healthcare assessments should be carried out. Assessors are obliged to use a strict set of assessment ‘tools’ and to assess your relative’s health needs against national minimum eligibility criteria. They are also obliged to follow case law.

The NHS also has a responsibility to ensure that assessments of eligibility for NHS Continuing Healthcare – and its provision – take place in a timely and consistent manner. In practice, however, there are often frustrating delays and appalling maladministration in the process.

Even if you’re not sure if your relative will be found eligible for NHS Continuing Healthcare it’s nevertheless important to get the ball rolling. It’s also a specific duty of the NHS to assess your relative, in the sense that if your relative has primarily health needs, the NHS should be paying.

How to prepare for a NHS Continuing Care assessment:

15 top tips for the multidisciplinary team assessment

1. You should be given a date and enough time to prepare for an assessment. If you can’t attend on the date given, you can ask for an alternative. It’s vital that you attend if your relative is to have any real chance of securing NHS funding.

2. If a relative or friend can attend the assessment with you, it’s a very good idea. You’ll have a second pair of ears and eyes – and you are entitled to take someone with you.

3. You need determination – because health and social care bodies will defend their budgets aggressively and many families report that the NHS and local authority may do this regardless of whether their actions comply with the guidelines and the law.

4. The more money that’s at stake, the more likely the NHS is likely to dig its heels in. So, be very clear about what you expect to achieve. Be bold, be vocal and be persistent – and don’t take no for an answer.

5. No health or social care professional is likely to know your relative as well as you do. That’s why you play such a vital role in any assessment. Start pulling together as much information about your relative’s health and care needs as possible.

6. As you may quickly discover, when you’re dealing with the NHS and the local authority, you may find yourself having to provide facts and information about your relative’s health that you would normally expect to be in their general medical or care notes. Never assume that people already know this information. The reality is that you will often have much more accurate information than the people who are involved in your relative’s care and in their assessment.

7. A full assessment for NHS Continuing Healthcare should be carried out by a multidisciplinary team. It may be largely up to you to make sure that the right people are actually going to attend. because, sadly, there’s no guarantee otherwise that it will be done.

8. Keep a record of what happens at every stage of an assessment – including before and after. What should happen in theory and what actually happens in practice are not always the same thing. Keep a note of any maladministration, as it can count in your favour in further appeals down the line. Procedure is key – and if an assessment is not done correctly, the NHS will have to do it again.

9. Keep a dedicated diary from day one. You may not realise how much you’ll rely on it at the start, but it will be extremely useful when you come to appeal any denial of NHS funding.

10. Record of all dates and times of appointments, meetings, phone calls, copies of letters and reports, conversations with staff from different organisations – and what was discussed – plus views from any therapists – everything. It will be invaluable.

11. Keep notes about your relative’s state of health: how they are and how their health is changing; things your relative says and does and any changes in character, behaviour or mood; any specific needs; things you notice about their overall health and disabilities; information on their skin, pressure sores, weight, mental clarity, speech and communication skills, hearing, sight, sleep, personal hygiene, oral hygiene, mobility and hoisting needs, ease of eating and drinking, nutritional and water intake, swallowing problems, appetite, risk of infections, continence, flexibility of joints breathing, hallucinations, medication (and its unwanted effects and impact on other things); anything unpredictable or complex, plus any general and specific risks – everything. Also, note how well they understand things and can make decisions. This might sounds daunting – but just approach it bit by bit, for example each time you visit them just jot down some notes, including about conversations with care staff that you might have had.

12. Ask questions – as many as you need to ask. If you don’t get a reply, ask why not. Don’t agree to anything if you haven’t had answers to your questions. If someone is reluctant to give you an answer it could be because the information you’re asking for will help you in a way the NHS or local authority doesn’t particularly relish.

13. If you ask for any information and you’re told it’s ‘not available’, make a note of that – what you were asking for, who you spoke to, when you spoke to them and what their reason was for it being ‘unavailable’.

14. Where possible, go along to your relative’s general medical appointments and take notes. Without attending these it’s more difficult to gather the evidence you need to fight your corner. Ask the physician or whoever you’re seeing to summarise his/her view/findings in a letter and send a copy to you. Be careful with this though – it’s vital that the physician understands why you’re asking and that the words they write support your relative in terms of the eligibility criteria for Continuing Care. A GP, for example, might write a summary, and yet what they’ve written doesn’t highlight the kinds of things the Continuing Healthcare assessors will actually be looking for. In such a case the summary could do more harm than good. Once you’ve read more about the Continuing Healthcare eligibility criteria, you could offer to draft something for your GP to simply sign, assuming they’re happy to.

15. Get hold of your relative’s care home care plan and the daily care notes. This also applies to care from a home care provider. Check the care plan and care notes regularly for accuracy and scope. Many people find the notes don’t give an accurate picture of health needs, and you may need to take this up with the care provider. Bear in mind that the NHS will use these notes as part of their funding decision making process.

You’ll find lots more helpful tips on preparing for an assessment – what to do and say, what not to do or say and how to avoid the pitfalls – in our ebook, How To Get The NHS To Pay For Care.

March 29, 2013/15 Comments/by Care To Be Different

Care fees, NHS Continuing Healthcare

Just started applying for NHS Continuing Care?

17 top tips to help you with NHS Continuing Care funding…

In the UK, as a general rule of thumb, nursing care is free – in law – and should never be means tested. And yet there are currently tens of thousands of elderly people in care homes or receiving full time care at home, in the UK, who are being wrongly charged for nursing care.

Why are they paying for nursing care? Three key reasons:

They may have been told they have to pay for care without anyone having done – or even mentioned – an assessment for full NHS funding.

They may have simply been told they ‘don’t qualify’ for NHS care fees funding – or that it’s not relevant for them – because they only have ‘social’ care needs (when in fact they have nursing needs).

They may have had an NHS Continuing Care assessment, but it’s been carried out incorrectly and their family has faced so much obstruction by the health and care authorities (as frequently reported by families commenting on our blog articles) in trying to challenge the outcome, that the person just ends up wrongly paying for care.

It’s one of the biggest scandals in health and social care today. With all the maladministration and misinformation surrounding NHS Continuing Care assessments and funding, it means in effect that the state is stripping people of their personal assets to fund care that should be paid for by the NHS.

If you have a relative with health needs who requires full time care – or who is already in full time care and paying care fees – these top tips will help:

If you receive NHS Continuing Care funding, it covers 100% of the costs of your care. It is for people primarily health needs. There is a Continuing Care assessment process to go through to ascertain whether you will be eligible, and there is a set of Continuing Care eligibility criteria against which your health needs should be measured.
Mainstream news reporting often overlooks the fundamental difference between ‘social’ care and ‘health’ care. They are not the same thing.
Social care is provided by a local authority (Social Services) and is means-tested. (Social care generally covers things like help getting washed and dressed, help getting to the toilet, etc.)
Healthcare and nursing care on the other hand are provided by the NHS and should never be means tested. Discussions on radio and TV and reports about care fees in the press generally fail to make this distinction and, instead, lump everything together as social care – and so it’s no wonder that many families believe that everyone has to be means tested.
The recent discussions about a future cap on care fees is all about social care (means tested care), not healthcare or nursing care. There should never be a financial cap applied to nursing care – because NHS Continuing Healthcare funding must cover all assessed care needs, whatever they are. And it doesn’t matter how old you are or whether or not you’re in a care home. (UPDATE: The proposed cap on care fees is now unlikely to happen.)
Most families’ first point of contact with the various care authorities is with Social Services. Social Services are part of the local authority – and so straight away you are probably dealing with someone whose focus is on means testing and on care provided by the local authority. They might not even tell you that NHS Continuing Healthcare funding is available.
The first questions you’ll be asked will probably be about money. They should be about health needs, not money. No one who needs full time care and who has health needs should have a financial assessment until they’ve first been assessed for NHS Continuing Care funding. If someone asks you about your property or savings and yet no one has assessed you for Continuing Care, ask that person why. This almost always happens in hospital, where the discharge team (often headed by someone from Social Services) will frequently ask about money before health needs have been properly assessed, and you will probably come under pressure to leave hospital before the proper assessment process is complete.
Forcing someone with health needs to pay care fees without a proper NHS Continuing Care assessment is not only a breach of Dept of Health guidelines, but it can also be considered financial abuse and an attempt by the authorities to defraud.
To get the ball rolling with NHS Continuing Care, ask the local NHS for a ‘Checklist assessment for Continuing Healthcare’; you can also ask a social worker, district nurse, your care provider or another health or social care professional. The Checklist is the first stage. If you get through that, you then have a full assessment.
The full assessment must be carried out by a multidisciplinary team of people, not just one. The person/people who actually carry out Continuing Care assessments should understand both the process and the eligibility criteria – and should be properly trained in this. They must also understand the care needs being assessed.
NHS Continuing Care is available whether you’re in a residential care home, a nursing care home, in your own home or somewhere else. The setting in which the care is provided does not matter.
It also does not matter who is delivering the care, i.e. it does not have to be a nurse; instead, it’s the nature of the care that matters. If it is effectively nursing care, you should not have to pay for that care.
Getting the person who needs care to set up a Power of Attorney is absolutely vital – whether you think you’ll need to use it or not. The family member holding a Power of Attorney should be involved in all assessments for NHS Continuing Care.
If you’re waiting for a Continuing Care assessment – or if you’ve had one and you don’t agree with the outcome – read up about it as much as possible, and at the assessment itself, and afterwards, challenge anything you don’t agree with. If you have an assessment and are told you don’t qualify, there is a Continuing Care appeal process.
Continuing Care is NOT the same as the weekly nursing care contribution that some people receive in nursing care homes (known as Registered Nursing Care Contribution or Funded Nursing Care).
If you do agree to be means tested, the value of your property should not be included during the first 12 weeks of you being in a care home.
If you don’t want to sell your home to pay for care, you may be able to negotiate a Deferred Payment Arrangement with your local authority.

Always remember the golden rule: In the UK, as a general rule of thumb, you don’t have to pay for nursing care.

March 10, 2013/0 Comments/by Care To Be Different

Care fees, Care system in the UK

Why downsizing in later life costs you more than you think

Is it really a good idea to downsize when you get older?

Once again the government is ‘encouraging’ elderly people to downsize and to move out of their homes – to free up housing stock for other people.

Once again the elderly are an easy target, and the word ‘encouraging’ does not sound terribly encouraging.

Elderly people and their families already come under significant pressure to comply with the health and social care authorities when it comes to care provision and care funding, and there is nothing to indicate that this kind of pressure would be any less with this new suggestion.

But why is the government instead not encouraging younger and/or wealthy people with large houses to do this? MPs perhaps? Younger people are far more physical able to tolerate moving house. It would hardly be a vote-winner though.

And so, once again the state makes a grab for elderly people’s assets, just as it does when elderly people are wrongly charged for care and are effectively forced to sell their homes.

In later life, moving to a property that is more suitable for your physical abilities is one thing, but downsizing in later life can have significant financial risks, should you subsequently need care. Here’s why:

If you need full time care, you don’t necessarily have to go into a care home; you can choose to receive full time care at home instead. However, if you’ve already moved into smaller accommodation, there may no longer be any space for a live-in carer or nurse.

If you find yourself being means tested for care, remember this: Your home is currently protected against being taken to pay for care if:

your partner still lives there

a younger relative still lives there who is incapacitated

your former partner (divorced or estranged) still lives there and is a lone parent

a dependant under 16 lives there

a relative over 60 lives there (or in some circumstances a friend who has been caring for you for some time and for whom the property has become their home)

However, if you’ve already moved into smaller accommodation, it may not be possible for these people to live in your home and, when that happens, you may no longer be able to protect it.

If you move to a smaller property and this new one is of lower value, you’re likely to free up cash in the process. If the local authority subsequently means tests you for care, that money may be up for grabs by the care authorities.

Your son or daughter may choose to move in with you when you become frail – to provide care and to stop you having to go into a care home. Will this be feasible in a smaller property?

So consider carefully whether downsizing in later life really is a good idea. Take financial advice before you make any big decisions about your property or other assets, and make sure the adviser you speak to clearly understands how care funding works, including NHS funding.

And, remember, if you need full time care for health needs, you should be assessed for NHS Continuing Healthcare before anyone means tests you or asks you to pay for care.

February 27, 2013/0 Comments/by Care To Be Different