We often hear from families with an older relative in hospital. Very often that relative is being discharged from hospital into full time care – but no one has explained the process fore deciding who pays for that ongoing care?
A family will often be told that their relative no longer requires NHS care, because their relative’s care needs are social care needs. They are told their relative must vacate the hospital bed and pay for ongoing care themselves.
The family will also almost certainly be asked if their relative owns their own home.
This causes confusion and stress for many families – especially when it is obvious that their relative’s care needs are no different to when they were admitted – or have actually increased.
If a person is told they have only social care needs, they effectively become the responsibility of the local authority. When this happens they will be means tested.
However, a local authority should take responsibility only once it is clear who is actually responsible for paying for ongoing care. This is not based on a person’s money! Nor is it based on whether the person has a house.
If a person with health needs requires ongoing full time care, the only way to know who should pay is for an NHS Continuing Healthcare assessment process to be completed. This should happen before the person is charged a penny for their ongoing care.
If the discharge team (or anyone else for that matter) misleads a person into paying for care before an NHS Continuing Healthcare assessment has been done, they will be in breach of the court ruling in the landmark Coughlan case. They will also be breaching the NHS funding guidelines – the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
If a local authority takes responsibility for care before this NHS Continuing Healthcare assessment process has been properly carried out, it is at risk of acting illegally. Read more about the legal limit for local authority care.
The Coughlan case was vital in reinforcing this local authority legal limit.
If a person is discharged from hospital into full time while this assessment process is going on, the NHS is responsible for funding all care in the interim:
“Where the [NHS Continuing Healthcare] Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.”
(National Framework, page 25, paragraph 74)
So, in a nutshell, when a person is being discharged from hospital into full time care, the local authority should only means test if:
- the NHS Continuing Healthcare assessment process has been properly carried out
- AND it has been properly shown that a person does not qualify for Continuing Healthcare
Otherwise the NHS should pay.