“Funding for care homes is ‘wrongly denied’ to thousands…
AT LEAST 15,000 sick and elderly Britons have been wrongly denied state funding for care home places in the past decade, a nationwide analysis has found – forcing their families to needlessly fork out a total of £30 million.
It is also revealed that most of those initially told by local NHS bosses they were ineligible for residential care funding were suffering life-limiting illnesses such as dementia.
In many cases, residents or their family members have been forced to sell their homes to foot the eye-watering bills, which can reach £6000 a month…”
– The Mail on Sunday (8/11/20)
Although this article was written a few months ago, it is just as relevant today and will resonate with the experience of many Care To Be Different readers whose spouse or relative may have missed out on their entitlement to a package of FREE-funded healthcare from the NHS – otherwise known as NHS Continuing Healthcare Funding (or ‘CHC’). The core essence of CHC is that NHS healthcare is “free at the point of delivery” – i.e when you need it, and this principle is enshrined in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2018).
NHS Clinical Commissioning Groups (CCGs) carry out assessments to determine whether an individual may be eligible for CHC – a tax-free package of funded care provided by the NHS to people aged 18 and over, that is not means-tested and which pays for all of a resident’s care package (i.e. 100%), including their accommodation, whatever the care setting or care facility they are living in.
However, many thousands of people in England and Wales just don’t know that CHC even exists, or how to go about getting assessed to see if they, or their relative, meet the eligibility criteria for funding.
We hear from families who have been given incorrect or misleading information at the outset which has dissuaded them from making an application for CHC; whilst others who have been turned down by CCGs for CHC Funding, have been subjected to incorrect or flawed decision-making, misinterpretation or misapplication of National Framework’s prescribed assessment process. These negative outcomes have resulted in many thousands of families needlessly paying for care which could and should have been funded in full by their CCG.
Families who manage to successfully secure CHC often tell us of the huge relief and stress lifted off their shoulders, knowing that their relative’s care (home) fees will be met by the NHS and that their life-time savings will not be eroded to pay for monthly care fees.
However, commonly, the realisation comes too late, usually after their relative’s home has already been sold to pay for their care, or sadly after they have passed away. Whilst a retrospective claim can, of course, be made (within certain time limits), wouldn’t it have been far more expedient if their local CCG or care home had offered to arrange an assessment for CHC at the outset or as the individual’s needs became more complex or challenging? Such proactive steps could have saved the family a fortune in care fees. Remember CHC is free at the point of delivery.
Part of the problem is general ignorance amongst the public who have no idea that CHC Funding even exists!
After all, CCGs don’t volunteer that CHC Funding is potentially available because funding for care comes out of their budget. Care homes don’t often let on about it either, as they can usually charge a self-funding, private paying patient far more than the fixed ‘bed’ rate the CCG will pay them for an individual’s care. So, many thousands of families are blissfully unaware of this pot of free NHS funded care, and needlessly sell their home believing that this is their only option. And, even those who do know or happen to chance upon CHC, struggle to navigate the complex assessment and appeal process or really understand the eligibility criteria set out in the NHS National Framework For Continuing Healthcare Funding.
Make no mistake, the bar to obtaining CHC Funding is set very high, and families often tell us how they felt daunted, out of their depth and overawed by the whole CHC assessment process. Assessments are anxious times for families as the outcome will determine who pays for their relative’s care. Matters are compounded by inherent inconsistencies in interpretation and application of the CHC assessment criteria in the National Framework guidance. Such inconsistency and variance between CCGs throughout the country can result in a wide disparity of outcomes as to who gets CHC and who doesn’t.
Most medical practitioners we have spoken to, including GPs and eminent Consultants across multiple areas of specialty, haven’t heard of NHS Continuing Healthcare Funding, or if they have (or pretend they have), can’t actually explain what it is. Yet all have been trained in the NHS, and/or continue to work within the NHS, or else still have some connection to it. So, if those closely associated with the NHS don’t understand what CHC is, what chance does the average family with a relative in need of long-term healthcare have? Just think how many hundreds of thousands of people could have been recommended to get an assessment for CHC by their GP, before paying a penny for their care.
Similarly, some financial advisors we have spoken to don’t know what NHS Continuing Healthcare Funding is either. The risk is that families could unwittingly be sold an expensive policy to pay for their relative’s care, which might have been free all along, had they had an assessment and been found eligible for CHC Funding.
Certainly, most of the media attention in recent years has focused on the need to improve social care funding as a means of stopping people from selling their homes to pay for care. But, so often, that misses the crucial point entirely! CHC is FREE! It is not means-tested (unlike social care), and therefore, is not dependent on wealth or your ability to pay. If you meet the eligibility criteria – you get CHC.
There was a letter published recently in the Daily Telegraph, where a woman had written in stating that her husband had been in residential care for 4 years with Dementia and had been self-funding his own care, using up his life savings which would have paid for the couple’s retirement. The cost of care was a huge financial drain on their savings and just heaped even more stress onto an already unbearable situation. She writes, “Where did we go wrong? Should we not have saved during our working lives, or spent our spare cash on cruises. Those without savings have their care paid for or subsidised by those funding themselves. Dementia sufferers are ill, and, as such, should be funded by the NHS.”
Like so many thousands of others throughout the country, we suspect that she hasn’t heard of NHS Continuing Healthcare Funding – which might have paid for all of her husband’s care and accommodation in full, without the need to part with his hard-earned savings. It remains a national scandal that people who work hard all their lives and pay their taxes, don’t receive CHC at the point of need.
A full assessment of your relative’s eligibility for CHC is carried out by a Multi-Disciplinary Team (MDT) appointed by their local CCG. The MDT assessors will arrange to meet your relative in their current care setting (e.g. whether in their own home, care/nursing home or other care facility) and review their healthcare needs in conjunction with any available care home and medical records. The assessors will complete a Decision Support Tool, taking an overall view of the your relative’s healthcare needs, before making a ‘recommendation’ to the CCG as to their eligibility for CHC Funding. According to paragraph 153 of the National Framework, “Only in exceptional circumstances, and for clearly articulated reasons, should the multidisciplinary team’s recommendation not be followed”. So, by all accounts, if the MDT assessors positively recommend CHC, the CCG should ordinarily follow that recommendation and grant a fully-funded CHC package.
However, it can happen that the CCG’s panel choose to override their own assessors’ positive recommendation for CHC Funding and supplant their own contrary outcome (i.e rejecting CHC Funding), despite not having had the benefit of actually seeing the assessed individual in person. Why? Some sceptics may say it’s all to do with money and rationing care – in other words practicing ‘financial gatekeeping’ or imposing financial controls, contrary to paragraph 64 of the National Framework and Practice Guidance Note 37.3.
But, if the MDT’s outcome decision is flawed or incorrect and you don’t know how to challenge it, most families will just accept the CCG’s outcome at face value, and needlessly end up using their savings to pay for care or even being forced to sell their home.
You should always be provided with the CCG’s outcome letter setting out the rationale for their decision. If dissatisfied, and you believe that there has been an abuse of process, misapplication of the National Framework or the CCG’s decision is simply wrong, you must challenge it. Beware: strict time limits apply and CCGs will not give you any leeway.
Critical: Before you pay a penny for your relative’s care, make sure that they are first assessed for CHC Funding!
Here’s a selection of articles for further reading:
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Browse our website for a whole range of free information and resources to help your understanding of the CHC assessment or appeal process.
Quite understandably, many families going through the assessment or review process, find it overwhelming and emotionally fraught. There is professional expert legal help available to take the weight off your shoulders at every stage of the CHC process. Visit our 1-2-1 Support page for more details.