Get your care fees claim in quickly
The Department of Health has issued new deadlines for people in England wanting to claim back care home fees they believe were wrongly charged.
These new deadlines seem designed purely to make life easier for the new Clinical Commissioning Groups (part of the NHS reforms) – but certainly not to help elderly people or their families access the funding they’re entitled to in law.
If your elderly relative was paying care fees for full-time care between 2004 and 2011, the new deadline for retrospective claims for NHS Continuing Healthcare funding is now 30th September 2012.
In more detail…
If your relative was receiving full-time care (at home or in a care home) and they needed care primarily for health reasons, they should have been assessed for NHS Continuing Healthcare. This is NHS funding and it covers 100% of the costs of being in a care home or receiving full-time care at home.
You can claim retrospectively for a refund of those care fees if you believe they were wrongly charged. This applies whether or not your relative is still alive.
- For periods of care between 1st April 2004 and 31st March 2011, the deadline for claims is now 30th September 2012.
- For periods of care between 1st April 2011 and 31st March 2012, the deadline for claims is 31st March 2013.
Read more about NHS Continuing Care.
Read why we believe these new deadlines are illegal.
New review timescales for Continuing Care applications after 1st April 2012.
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How long should it take my CCG to deal with and make a decision on my appeal for nursing care funding I’m now in week 43 since I sent in my appeal and have been stalled and was only asked for my Mum’s notes from the care home in November they have now had the 5 weeks and only after my email today was I contacted by the person reviewing them. I’ve also asked for the 12 week disregard that Mum should have got in 2011 although I realise I’m probably past the deadline now.
Well…we have been turned down. After all these years, that’s the end of that. She most certainly did qualify, but guess what. The ‘home’ had destroyed all her records !! ? At that particular home she was totally unable to walk because of the broken pubic bone that I knew nothing about. Because she could walk at the previous home, which had records, that was what they went by. She went drastically downhill .At one visit she refused to respond to me and lay in bed facing the wall. Often she was spaced out and was black and blue. The staff said she was always flinging her arms at the carers to stop whatever they were doing. …. After the refusal by whoever of the retrospective element I was told I could appeal .
I said ” No fear, and wait years ? ” This has all been a farce. My mum had a nightmare death. I have to carry guilt for life.
Perhaps I have same to look forward to. Serve me right. 2017.
So sorry to hear you are carrying this guilt. It sounds as though you were there for your mother and could do no more to help her so you shouldn’t feel guilty. Our family has been badly affected by our mothers time in care too and the fact that we feel most of her savings were unlawfully taken away. If we thought that legally she should have paid for her care then we would let this drop. We feel that her health needs were deliberately dumbed down and as a result she didn’t receive the help that she could have got had the assessments been done correctly. We spent hours every day with her in the eight years she was in care in an effort to support and protect her as she couldn’t do anything for herself and could not communicate but the CCG just try to belittle us and make us feel like money grabbers.
I used a template to submit an appeal against the decision of my mother’s continuing care assessment which had to be submitted to the CCG by September 2012 deadline. Because it was in respect of assessments carried out from 2008 to 2011. They acknowledged receipt and also told us we had to submit copies of our POA so that they could continue with the appeal which we did. We heard very little until recently when we were told that they have now decided they would not carry out a respective review because assessments had been done. We took this to the ombudsman who have upheld the CCGs decision. We do not feel that our appeal has been given full consideration – surely it should not have taken from September 2012 to 2017 to just brush us off like this. The ombudsmans letter refers to the fact that assessments had been carried out – this isn’t what we had appealed against. We had appealed against the decisions made. Can we do anything else?
What a nightmare – My Father in Law was assessed in Hospital for Continuing Healthcare – and on the assessment it was agreed that he would qualify – however this area has a weird way of progressing this – they say he has to be assessed again after he has been in the Care Home 6 weeks – unfortunately he passed away last Friday – having paid 6000 for his Care Home – 4 weeks in advance which seems to me free money. Does anyone know if we can make a retrospective claim ?
Martin – what you’ve been told sounds like nonsense. If your father in law qualified for CHC, then first review would have been after three months, not six weeks. Make a strong complaint to the CCG. The CHC funding should have started 29 days after the date the Checklist was received by the CCG. (There should be minimal delay between the Checklist being carried out and it being received by the CCG.)
Angela and Lynne, thank you so much for sharing a thought or two with me. I had kept an original e mail from a person 3 offices ago. I sent an e last week to her saying what a scandal. She got on to my present office who then sent an e to me a couple of days ago. They said ‘We confirm your mothers case has been to panel. However due to the many thousands of cases, we can give you no time scale whatsoever. ‘ So there we are . Keep trying everybody. Regards D
How so true. We also have been moved from pillar to post and have just been told that we will have a decision by the end of March 2017. We have contacted the media as they highlighted the case several years ago, but it seems they have moved onto other things. Is there no one out there who will take the reins and sort out this issue?
My mother has been deceased ten years now. I saw the retrospective claim feature in the news four years ago. I applied in time. I have had to chase. The case was moved to different offices. I heard early this year that it was going to Nurse !. They said you will hear in October. 2016. I did not. I have just got on to the last office and that was no longer in use. I was told to e mail AGCU. RetroReview@nhs.net which I have done today. I have seen my mothers Care Home notes which were a shock. As next of kin I was never informed of some injuries including a broken pubic bone !!! I have no idea if anything at all will happen now. It feels dead in the water to me. At this rate its not only my mother that will be late, but me too !
It’s shocking that you were never informed of your mother’s injuries, Diana – I imagine it’s been very difficult to read about them. Keep fighting if you can.
Can anyone advise me on how retrospective a ‘retrospective claim’ can be?
At the time of my Mother’s illness, transfer into a Care Home and eventual death, my sister and I knew nothing of the NHS continuance of care responsibilities. Neither were we advised of those.
Her case is over a period between November 2002 – January 2004.
The deadlines referred to above were for periods of care after 1st April 2004 – and you wouldn’t not have been able to claim for care fees prior to that date. However, as is the case with many, many families, you were not informed about Continuing Healthcare at the time – and I doubt very much if you were contacted by the NHS when they announced the above deadlines either. In theory, you could argue these points as a way to pursue a claim, but I think it would be very hard.
My husband had a checklist done 8/7 2014. He was found eligible for NHS continuing care funding one year later on 3/7/15 by the local CCG. I have now been sent a letter to the effect that the whole case has to be reviewed with full paperwork and evidence from me, before the money I have paid for care up to 3 July 2015 can be refunded. The money may or may not be refunded back to the checklist +28 days. I have had a long telephone conversation with the retro team who claim that they are obliged to do the retro review. I claim that due process has not been followed, they are making up new rules, it gets me nowhere. Please can anyone tell me what my rights are and what to do next.
Karin – this should be a straightforward case of the the NHS paying for all care from day 29 after the date of the Checklist onwards. There should be no need for a retrospective review for this – it’s all part of the current assessment process.
I am with specialist solicitors in a no win no fee retrospective claim for my deceased Fathers care. My claim is within the published timeframes and has been with the solicitors for three years. We are now half way through the fourth year. The solicitors keep me well informed and they have now been told by The Clinical Commissioning Group that my case will be be awarded a ‘Nurse Assessor’ but this will take a further year! I cannot believe this is right and how can one person assess the terrible anomalies in the assessment of my Fathers needs. We used every penny of his money from his home and his savings as his needs were too great to be handled at home by untrained people. I don’t know who to turn to to resolve this as the solicitors seem to have their hands tied to.
Unfortunately, such delays are ‘normal’ – although of course quite unacceptable. Also, it’s not unusual for a single nurse assessor to look at a case and then provide a funding recommendation. The time it’s taking in your case, Renee, certainly is long. When you eventually receive any paperwork from the CCG via the solicitors, be sure to read it all very carefully yourself. You’re likely to be sent a Needs Portrayal Document (NPD). In my experience these are often littered with mistakes and omissions, so make sure the whole period of your claim is covered and that the information is accurate. If the NPD is simply a few notes copied and pasted from the care notes, be sure to complain. This is supposed to be a full and proper review of your late father’s healthand care needs.
Does anyone know what happens when you receive the draft copy and it goes to the first panel meeting. Not sure what to expect.
The NHS is supposed to have the whole assessment process completed within 28 days, unless they can give you very good reasons why they can’t. Keep chasing them. This may help: http://caretobedifferent.co.uk/nhs-not-responding-to-your-continuing-healthcare-correspondence/
Does anyone know if there are deadlines for the NHS to respond to applications already submitted for a full assessment? Our application has been with the NHS since last September and we still have not received notification as to whether we will be granted a full assessment and no timescales as to when this will happen.
It is now Aug 2016 and we still have not got a decision almost four years later.