Don’t let anyone means test you in hospital before a Continuing Healthcare assessment
If your relative is in hospital and you’re under pressure to have a financial assessment, this article will help you. It looks at who should be paying for care between hospital discharge and a funding decision.
Here’s a typical hospital scenario…
Your relative is in hospital and you’re under pressure from the discharge team to get them out. However, no one has done an NHS Continuing Healthcare funding assessment. You complain about this and you’re told the assessment will be done ‘later on’, after your relative has been discharged. Also implied is that your relative will pay for care in the meantime. You may also have come under pressure to have a financial assessment (a means test).
There’s a whole lot wrong with this scenario – and yet sadly it’s all too common. No one will have looked at who should legally be paying for care between hospital discharge and a funding decision for NHS Continuing Healthcare.
Let’s suppose you can’t fight the pressure from the discharge team and that your relative is discharged.
Who should be paying for care at that point?
The NHS Continuing Healthcare guidelines make it very clear who should be paying for care
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, page 25, paragraph 74:
“Where the 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.”
There are several points to note here about paying for care between hospital discharge and a funding decision:
First of all, a person in hospital who needs ongoing care should not be discharged from hospital without having been considered for NHS Continuing Healthcare funding.
- because the requirement for this is set out clearly in the Care Act
- because until a person has been assessed for NHS Continuing Healthcare funding, it’s not possible for anyone to say who is legally responsible for paying their care fees
The usual assessment process for NHS Continuing Healthcare has 2 stages. If a Checklist assessment for NHS Continuing Healthcare has been carried out (stage 1), and it indicates potential eligibility for Continuing Healthcare funding, there must then be a full multidisciplinary team assessment (stage 2). If a person’s ongoing needs are not yet clear, there may possibly be an argument to discharge the person and wait until their ongoing needs become more apparent before stage 2 is done.
However, this does not mean the NHS can simply hand the person over to the local authority for means testing,
The full NHS Continuing Healthcare assessment process could eventually indicate that the NHS does have a legal duty to fund all care; the NHS cannot offload this funding responsibility to anyone else in the meantime.
Upon discharge from hospital, if a person is means tested and told to start paying for their own care, the local authority may, as a result, be in an illegal position – because it may have taken responsibility for care that is beyond its legal remit.
No one should carry out any financial assessment (means test) until it’s clear who is responsible for paying. The health and social care authorities have no business asking about your relative’s finances during this time.
So it’s very clear who is responsible for paying for care between hospital discharge and a funding decision: the NHS is.
What’s your experience?