Funded Nursing Care refunds: should a nursing home reduce your fees when it’s already paid by the CCG for providing nursing care?
The Local Government and Social Care Ombudsman has published new guidance about Funded Nursing Care refunds. (Funded Nursing Care is also known as FNC.)
Funded Nursing Care is paid directly to a nursing home when a person is found ineligible for full NHS Continuing Healthcare funding, and yet the person still has nursing needs.
That sounds like a contradiction it itself – and it certainly can be. Many families believe their relatives have been wrongly denied full NHS Continuing Healthcare funding and ‘given’ Funded Nursing Care instead – which is a lower cost for the Clinical Commissioning Group (CCG).
(Note: Funded Nursing Care payments are not made to ordinary residential homes nor to providers of care at home.)
Another problem families report is CCGs failing to assess people properly for full NHS Continuing Healthcare funding before decisions are made about Funded Nursing Care. It’s vital that the assessment process for full Continuing Healthcare take place first – always.
What’s more, where Funded Nursing Care payments are made to a nursing home for a specific person’s nursing care, there are many complaints from families that the person in care does not see any reduction in their fees. Let’s remember that nursing care in the UK (generally speaking) is free of charge. So why are some people in nursing homes paying for their nursing care?
Funded Nursing Care refunds – should your relative receive one?
The new guidance from the Ombudsman highlights some of the things that go wrong when a nursing home receives a Funded Nursing Care payment to cover the cost of nursing care for a resident.
It looks at these 4 scenarios involving potential Funded Nursing Care refunds:
1. where the total care fees include nursing care
2. where nursing care fees had previously been reduced for a resident, but then the level of Funded Nursing Care payment available to the home increased
3. where there was no contract to start with between the home and the resident
4. where there was a contract, but it failed to address the subject of Funded Nursing Care
If your relative receives Funded Nursing Care, they may or may not have seen a reduction in their care fees.
Funded Nursing Care payments are currently £155.05 per week in England. Read more here about the rates. It’s hard to see how that amount could cover the actual cost of nursing care in some instances, but that’s another debate.
Although the new Ombudsman guidance is aimed at nursing care providers, there are some vital points that families can draw from it:
- Make sure you always have a written contract with the nursing home, and that you know on what basis they are charging you fees.
- Make sure you have a written breakdown of those care fees and that it’s very clear what (if anything) is being charged for nursing care – and on what basis this might happen in the future.
- If the total care fees include nursing care, then it’s logical to expect the total care fees to reduce once the nursing home starts receiving Funded Nursing Care payments from the CCG. If not, the home is effectively being paid twice.
- If you feel you are being wrongly charged nursing care, address it with the nursing home first. You might also want to copy your letter to the CCG and also the Head of Adult Care at the local authority.
Read the Ombudsman guidance here: Funded Nursing Care payments – guidance for care providers – on the right hand side of that page click the link under ‘Downloads’.
Read more about how FNC is ‘assessed’
What’s your experience with Funded Nursing Care?
I had the same problem and eventually complained to the social Care ombudsman. I had read on Care to be different Website that the social Care ombudsman had put out information about this to care homes saying they were wrongly keeping the money unless the terms of the contract stated how the funded nursing payments were addressed. Could Care to be Different highlight this booklet again to help people understand their rights. After about a year of arguing the Care finally refunded the money along with a payment for my trouble after the social Care ombudsman found in my favour.
However I don’t understand why the Quality Care commission still allow this to happen. It is clearly fraudulent. Diane Andrews
My father was a care home resident prior to his death and we did have a signed contract confirming a gross weekly fee which included the FNC. The care home applied for and received the FNC and so, according the terms of the contract, we expected the weekly fee to be reduced by the FNC amount. However, the care home simply refused to reduce the weekly fee.
We contacted the citizens advice bureau and they agreed that the care home was in breach of the contract. A number of letters were exchanged with the care home explaining our position and that they were in breach of the contract but they still refused to refund the FNC, which amounted to thousands of pounds. We contacted a solicitor who also confirmed that the care home was in breach of the contract. The solicitor also sent the care home a letter threatening legal action if the FNC was not refunded – the care home just ignored this letter completely.
This all took several months and we finally decided that the only course of action left was to take our case to the Small Claims Court. A final letter (a ‘Letter before Claim’) was sent to the care home, which is necessary step in the process. We also raised a complaint about the care home with the Local Government and Social Care Ombudsman. At this point the care home finally did agree to repay he total FNC – we’re not sure whether it was the threat of court action or the complaint to the Ombudsman which did the trick.
I think perseverance paid off – we were not prepared to meekly give in when the care home refused to pay and, as we were sure we were correct, we just stuck at it!
My father was recently given FNC and as many others thought this would be coming off the amount that he pays weekly, being told no this is extra to the home on top. The confusion I have this is the care he receives has not changed, he already as part of his payment received nursing care when needed. So it feels like a fraudulent act that they get this extra £600 a month for what exactly, surely something can be done about this I am so angry. Also, surely people should know that this is happening as well. Where there has been increased care I would understand but in my fathers case there is nothing so seems that we are just lining their pockets.
My mum is 94, completely bed bound since May 2019. I had been caring for her in our home for 8 years She went into a nursing home in July after a spell in hospital and after a long meeting with an NHS representative we were told she would get Funded nursing care. I was quite pleased as I thought it would reduce the fees. I was initially told the fees would be £850 per week and it was not made clear that the nursing home would further benefit from the NHS funded nursing care if awarded and in fact I believe we were misled over this. I have visited mum every day and no attempt has been made to get her out of bed or give her any stimulation whatsoever and she has deteriorated mentally. She just stares at a wall and her basic needs are dealt with, washing, food, and nappy changes. Mum crys all the time and begs to come home. I have now given notice to the care home and she will come back home. We will use carers and look after her ourselves 24/7 This is not ideal as I am 72 and very poorly and it was acknowledged by the hospital that I was too unwell to look after her. I would advise anyone looking for a nursing home, do your homework and get clarification on funding
My father has been in a nursing home since October 2018. When the nursing home fees went up in April, in brackets was a fee for FNC on the April invoice. Last week my father had a CHC checklist meeting for which he qualified for a full CHC assessment to be carried out next week. At the CHC checklist meeting the nurse said that FNC was not being paid to the nursing home. Does anyone know what is going on here? I am totally confused.
I too have just come across this. Ive been to numerous meetings hoping that we would get some form of help and was slightly relieved to hear we will get Funded Nursing Care (FNC) for my mother (currently self funding also). Well apart from today that is, when I was told that the nursing home will be getting it and my father will not get any reduced monthly invoices……pretty cross to say the least. I didn’t realise all this chasing and meetings was for their benefit and not actually helping us. I will get my father to hook out the contract.
I am very confused about the Funded Nursing Care. The care home looking after my father says that the funding is paid direct to them and this is not then taken off the total fees. In the contract it does not offer an explanation in the contract just a fee. Now my father has had to move to the nursing part of the nursing home his fees have increased from £1,100 per week to £1,400 per week. They have not offered to trigger an NHS Continuing Healthcare check so we initiated this ourselves and are still waiting to hear from the Ccg. However nothing seems to work in the way the Ccg leaflet suggests. Why is it that it seems people are taking advantage of someone is is very poorly with Parkinsons Dementia and has lots of other health issues and is probably near to end of life. Why are families being put through this at such a difficult time. It is only because of this website that I have come to realise that people are being very deceitful and unhelpful. This amount of money a week is totally unrealistic. It’s just miserable when us women have enough going on, working , looking after grandchildren and trying to manage elderly and seriously ill parents. Please help we really need it fighting all these authorities. The nursing home says it is not their policy to reduce the fees by the funded nursing care payments.
Social services refuse to co-operate.
My mother moved in to a care home in Aug. 2015. During our initial search for a suitable care home we visited about 12 premises & when discussing terms some advised that Funded Nursing Care (FNC) funding was in addition to the fees quoted, others as in the case of our chosen place, advised that FNC funding was deducted from the fees quoted.
At this stage, we had no idea if mother would receive any funding, however she did receive a level of FNC funding & back dated payments were return to her by the care provider & future monthly invoices were reduced by the funding received. The fact that the FNC funding was deducted from the gross room rate is a very clear indication that her gross room rate had been calculated to include her nursing care.
On 23 Nov. 2015 we were advised that with effect from 1 Jan. 2016 the gross room rate would be increased by 8.55% & the letter continued to state “If you are in receipt of FNC then your gross fee will continue to be reduced by this amount”
On 3 August 2016 we were informed that the NHS had carried out a comprehensive review of FNC contribution & was therefore to be increased by £44.25 per week.
We were then informed that the increased FNC funding had increased the operating costs of the care provider & in accordance with their terms & conditions [ an additional clause that allows for increased operating costs such as taxation or statuary changes] have no option other than to increase the gross room rate by £44.25 per week.
I first wrote to the care provider & then to two MP’s without any joy so tried the Local Government Ombudsman (LGO). Imagine my disappointment when the investigator at the LGO deliberately misunderstood my complaint & quoted “Your second complaint is that the care provider increased its care costs by 8.55%. It gave notice it was going to do this & explained why this is the case. The LGO could not say this is fault”. My answer is that there was NO second complaint made by myself to the LGO. I feel that the care provider has breached consumer law by altering & manipulating their terms & conditions and welcome this latest development.
My husband has been in a nursing home since Nov 2014 and is self funding. I have tried to get NHS Continuing Healthcare but the assessors say he is not eligible. He has Alzheimer’s is doubly incontinent, cannot feed himself and sits in a chair all day. I provided a pressure relieving cushion so he doesn’t have sores. He gets hoisted in and out of bed. I will ask to see the contract. Thank you for your information.