Learning lessons as “Four Seasons Healthcare goes into administration”

The demise of Four Seasons Healthcare, one of Britain’s largest care home groups, which went into administration recently, should be a warning sign to anyone seeking to make a claim for NHS Continuing Healthcare Funding.

The Four Seasons Group reportedly serves about 17,000 residents and patients and employ some 20,000 staff.  It is reported to be the biggest care home that has gone into liquidation since Seven Cross in 2011. It has 322 residential and nursing care homes.

Whilst the administrators are undoubtedly trying to keep things up and running, and find a buyer for their care homes, in the interim, one can generally expect such a demise of this huge scale to create administrative chaos, staff absences, and may inevitably result in a declining level of care for all residents.

Don’t delay. Take action now –

1. If you are in the process of seeking an assessment for your relative’s eligibility for NHS Continuing Healthcare Funding (a free funded package of care provided by the NHS which is not means-tested) get hold of all relevant care home records and assessments (eg care plans/risk assessments, falls risk assessments, health needs assessments, nursing assessments, physiotherapy assessments and behavioural assessments, etc.) as soon as possible. Ensure you have a comprehensive full set or records. Look for any gaps, check for any missing records, and get copies as soon as possible; or
2. If making a retrospective claim to recover care home fees that were wrongly charged, check your own records for any missing evidence as to proof of payment of care home fees, such as old invoices and statements of account from the care home. If you don’t have these documents, then request copies immediately. It is better to have them at the outset. Keep them safe.

Why are the care home records so important?

The care home records form an integral part of the assessment process. Without access to these records, any full assessment carried out by a Multi-Disciplinary Team (MDT) could be delayed, and the outcome would be meaningless – amounting to an abuse of process and immediate grounds for appeal. In the meantime, your relative might be paying thousands of pounds for their care.

For more information about the MDT assessment process read our blogs below.

Alternatively, in respect of any retrospective claim for care home fees that have wrongly been paid, you must review the care home records as they are a vital part of the evidence when carrying out a retrospective assessment.

You need to carry out an in-depth line by line analysis of the records including care plans, and risk assessments etc, in order to present your relative’s submissions for a refund of care home fees that should have been avoided, had a proper, fair and robust assessment been carried out by the Clinical Commissioning Group in the first place.

A thorough and careful review of the care records are the key to success and can be supported by your personal knowledge of your relative’s daily healthcare needs.

Furthermore, if successful in your retrospective claim, the burden is on you to prove what amount of care fees should be reimbursed.  The Clinical Commissioning Group (CCG) won’t do this for you, nor should you expect them to assist you.

Therefore, it’s essential that you keep all correspondence from the care home, invoices and statements of account for fees that have been paid. 

However, for some CCGs, invoices alone may not be sufficient proof, and over time CCGs have become noticeably more difficult (obstructive) for obvious financial gatekeeping reasons, as to the quantity and quality of evidence they want to you to provide before they will make reimbursement.

Some CCGs may insist on having a statement on account as well from the care home, on letter-headed stationery, to check when and whether the amount invoiced matches the sums purportedly paid.  This can prove very difficult especially if the care home has gone into administration (as with Four Seasons Healthcare), or closed down and no longer exists. A statement of account (and your bank statements) will give a truer reflection as to actual sums and dates monies were paid into the care home’s account.  That’s why it’s vital you get the relevant proof of your relative’s claim at the outset and keep the documents safe and accessible. Take care, as it’s surprisingly quite easy to forget years later where you’ve hidden them, or else throw them away by mistake.

Note: There’s no point making a retrospective claim (which can invariably take years of painstaking slog through the NHS review process!) and finding that the CCG won’t reimburse your care home fees because you can’t prove your loss.

Remember some banks (e.g. Barclays) only keep bank statements for up to a 6 year period.  Therefore, it is important you do not throw away this vital evidence.

For further information read our blog: What Evidence Do I Need To Prove My Claim For Past Care Fees Paid?

Here’s a quick summary:

1. Get hold of all care home records and an up-to-date statement of account from the care home as soon as you intend to make a claim for CHC.
2. Keep all invoices and bank statements covering the whole period of your relative’s stay at the care home.

Read our suggested blogs below for more information around the subject:

Need help getting copies of your relative’s care home records?

Applying for Healthcare Records. Dealing with delays

What Happens At The Multi-Disciplinary Team Meeting?

Attending the Multi-Disciplinary Team meeting – some useful guidance

How do I claim back care fees that have been paid?

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