Many families report that their spouse or older relatives are often forced out of hospital and into long term care – or back home – before proper health needs and funding assessments have been carried out, and before suitable care provision has been put in place.
If your relative is about to be discharged from hospital back to their care home, or else are going into a care home setting for the first time, then there are certain key things you must consider:
1) Is your relative eligible for NHS Continuing Healthcare Funding (CHC Funding)?
This is NHS funding and it covers 100% of the costs of ongoing full-time care if your relative needs it primarily for health reasons i.e. they have a ‘Primary Health Need’.
CHC Funding is not means-tested and is ‘free at the point of need’ and is paid irrespective of wealth.
However, many people are discharged from hospital into care without any assessment for CHC Funding having been arranged – effectively forcing them to pay for care before it has been properly established that they need to.
The revised National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (2018), provides that an assessment for CHC Funding should now take place outside the acute hospital setting. This is designed to allow time for a more accurate assessment of care needs away from the anxiety of hospital environment.
So, if you believe (or are told) that your relative has a primary health need, then let the hospital Discharge Team know so that they can make arrangements for your relative to be assessed for CHC Funding when they are in the care home.
In the meantime, the NHS should put in place an interim package of care until the preliminary screening Checklist has been carried out at the care home. This free care package usually lasts for around six weeks (but it can be longer if the NHS are slow to arrange the Checklist assessment). You shouldn’t have to pay any care home fees in the meantime.
For further information, read our blog: What’s new in 2018 NHS National Framework for CHC? Are you getting an interim care package?
Once in a care home setting, the NHS will carry out an initial screening Checklist assessment to see whether your relative has a ‘primary health need’ and is eligible for CHC Funding. Read our blog: Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…
If your relative is successful at the Checklist stage and triggers for a Full Assessment by a Multi-Disciplinary Team (using the Decision Support Tool), then you they may be required to fund their care in the meantime whilst waiting for this assessment to take place. Read our blog: Am I eligible for NHS Continuing Healthcare? 5 questions.
If CHC Funding is awarded, then it will cover all your relative’s clinically assessed healthcare needs, including the cost of their care home accommodation.
2) Choosing a care home – some top tips
The transition of putting a relative into a care home is, for most families, an emotional and upsetting time. Your relative is about to be discharged from hospital but can no longer be cared for in their own home or live in yours. The hospital intends to discharge your relative to avoid ‘bed blocking’ and you are now forced to look for a suitable care (or nursing) home at short notice, to provide for their long-term care needs. You recognise that you need to find a roof to put over their head quickly to keep your relative safe and in a secure caring environment. With emotions running high and the turmoil of everything else going on, we recommend the following advice:
- Stay calm and don’t panic, however much pressure the hospital is exerting!
- Take your time. Don’t be rushed into choosing the first care home that comes available, however tempting that may be. This is your relative’s long-term care and well-being that is at stake. Choosing the wrong care home can be very distressing for you and unsettling for your relative.
- Ask your GP for recommendations. They are usually a good source of information and will have experience of visiting patients in many of the local care homes. They should know your relative’s care needs and therefore be able to suggest a suitable care home that is close by. Sometimes, living close to their own home or in a familiar local environment, can be an overriding feature when making your decision.
- Carry out due diligence. Are the care home’s facilities and amenities suitable for your relative’s care needs, and in line with their standard of living?
- Ask around. What reputation do they have for providing care? What is the standard of care/nursing care like?
- Speak to the care home manager and find out what is their set ratio of care/nursing staff to residents. And how will they meet your relative’s needs?
- What is the state of general hygiene, cleanliness and infection control?
- Will the standard of catering meet your relative’s nutritional needs and what is the hygiene rating?
- What relevant facilities and amenities does the care home offer that would be of benefit to your relative (eg beauty salon/spa type treatments such as hair dressing, chiropody and manicures).
- Whilst it may be important to your relative’s overall well-being to be in comfortable surroundings, don’t just look at the ‘fixtures and fittings’. Quite often an expensive care home in an affluent area, with extensive manicured gardens, does not reflect the quality of care! Look past the veneer and outer public appearance.
- Look at previous inspection reports on the care home provided by the Care Quality Commission (CQC) – an independent regulator of health and social care in England. Does the care home meet the standards expected? Are there any warning signs or matters that require improvement? Visit: https://www.cqc.org.uk/
- Try and speak to families or friends who have a relative in care or are familiar with this particular care home, to find out more. The bigger the picture you can build as to whether the care home will be suitable for your relative, the better.
- Don’t be embarrassed to ‘shop’ around, as rates, staffing level and amenities will differ with each care home.
- When visiting, ask to see available rooms. Will they be suitable for your relative’s care needs? For example, if your relative is immobile and needs several carers to assist with hoisting or transfers, can the room accommodate a wheelchair and/or a hoist?
- Critical: Don’t be pushed down the route of discussing payment and self-funding until your relative has first been assessed for NHS Continuing Healthcare Funding. Read our blog: “So will you be self-funding?”
- Check the care home contract carefully. Take time to look at it and don’t just sign it! You could be paying top-up fees unnecessarily! Read more about top-up fees below…
You will find these blogs useful, too:
BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare
What’s the difference between a care home and a nursing home?
3. Beware of unlawful ‘top-up’ fees!
If your relative is being asked to make a financial ‘contribution’ towards the cost of their care fees, you need to be very clear why this is the case, as it could be an improper request. Some contributions, known as ‘top-up’ fees, are unlawful. Read our previous blog: Are You Paying Top-Up Fees Unnecessarily?
Some care homes may explain top-up contributions as being ‘voluntary’ payments – when they are anything but that and are mandatory! It is not uncommon for families to be told, quite bluntly, that unless their relative pays these extra ‘voluntary’ care fees, they won’t be accepted in the home (or else be allowed to continue residing there). Care home managers know that you are in a vulnerable position and need to place your relative in care quickly. Exerting such unfair pressure is emotional blackmail and tantamount to economic duress!
Top-up fees are unlawful and should not be charged according to the National Framework for NHS Healthcare and NHS-funded Nursing Care, if your relative has been assessed for having a ‘primary healthcare need’. In which case, all their healthcare needs, should be paid for in full by the NHS, regardless of whether the care home is located in an affluent area or set in beautiful grounds.
If there is a shortfall between the actual cost of care and what the NHS will contribute, then the care home should approach the NHS for more funds, and not seek to charge your relative a top-up fee just because private funding is available.
However, care homes can lawfully charge top-up fee contributions for extras, known as ‘hotel style services’ or the ‘luxuries of living’. Common examples include, having a ‘larger than standard or ‘premium’ room, perhaps with a better view or kitchen area, and for ‘spa’ type services.
So, if told that your relative has to pay a ‘voluntary’ contribution towards their care, you must find out exactly what it relates to before you sign anything! Query why this isn’t covered as part of the CHC Funded care package in place. If it relates to assessed healthcare needs, the NHS should pay the shortfall, not you!
Note: Some care home contracts are deliberately vague and may refer to such contributions in different guises to hide their true intent. For example, describing payments as a ‘third party contribution’. If you are not thinking clearly, or don’t understand the relevance, your relative could mistakenly be paying top-up fees unnecessarily.
Care homes should be completely transparent and not seek to disguise a top-up fee by calling them something other than what they really are!
For reading around the subject: TOP-UP FEES – Unfair Care Home Practices Now Face Government Sanctions
If you are paying top-up fees, visit our one-to-one page for specialist legal advice.
4. What happens if my relative’s healthcare needs change?
Remember, that an individual’s health can fluctuate over time.
If your relative is not entitled to NHS Continuing Healthcare funding at the outset, but their health deteriorates over time, then they are always at liberty to request that a reassessment be carried out for CHC Funding. If CHC is subsequently awarded, the NHS will take over funding the care home fees instead.
If your relative is not eligible for CHC Funding and is paying for their care privately (ie self-funding), but over time exhausts their savings, then they may well pass over into the realms of Local Authority funding if their capital or savings (including the value of their home) is less than £23,250. In such circumstances, the Local Authority may be obliged to take over funding of the care home fees. However, if your relative is resident in one of their appointed care homes they will usually only pay an agreed fixed amount (or ‘bed rate’) towards the cost of care. Therefore, if your relative chooses a more expensive home, they be lawfully required to pay the shortfall (ie top-up) between the care home rate and the Local Authority bed rate.
If your relative’s assets are between £14,250 and £23,250, then they may be asked to pay an assessed contribution.
For more reading on the subject…
We highly recommend downloading our 39-page digital guide “How to choose a care home” packed with over 130 tips and questions. The guide helps you:
– ask the vital questions most people don’t ask – but should
– get a better picture of what a care home will really be like
– gain peace of mind that you’ve made the best decision you can
– save time and avoid a lot of hassle
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I have a relative that has Alzheimer’s & general mobility problems,her medication was changed by her doctor,I was told that the medication in liquid form was no longer available & she was given tablets.after a few days she was not sleeping & was doing strange things..the manager at her sheltered housing got involved & the hospital social worker arrived.i explained that her odd behaviour was due to change of medication & asked if she could go into respite..the answer was yes if I paid £300+ per week.i now have read that Alzheimer’s patients care home fees are paid by the local authority,even if the person has savings..is this correct ?
Paul you may have a number of strands confused here.
If your relative has not yet received a CHC assessment insist on one. You can do this via her housing provider, her social worker, GP or better still follow the instructions in the ebook available from this site. You need to know what her health and care needs are. If she’s had a care assessment it sounds like this needs updating to take account of any change in behaviour, needs etc.
Do you have Powers of Attorney for her finances and Health and Welfare? Without these you’ll face more of a struggle to represent her interests.
Are you her carer, and is that the reason for the respite request? Have you had a carer’s assessment? Carers are entitled to time off. Look at this https://www.ageuk.org.uk/information-advice/care/helping-a-loved-one/ and other fact sheets regarding payment for care.
Local Authority used to allow approx 10 weeks for assessment of condition and needs whilst in care homes, but I’m guessing that’s now gone along with the discharge to assess changes. It’s really worth going through The National Framework to check.
The bottom line is that if you think your relative has a primary health need, she should be assessed for CHC and if eligible all her care should be paid for by the NHS regardless of her means. Health must be assessed before her (or your) means.
My 82 year old dad had a fall at home. He is not very mobile and only has one leg and also has Alzheimers. He was taken into hospital as he was unable to get up after the fall. He had an X-ray and CT scan and was diagnosed with lung cancer that has spread to his bones and he now only has weeks to live. The day after we learnt this news a physio rang me up and was asking how he gets on at home and asked if I was power of attorney and that they were looking at getting him mobile enough to go home and we could look at funding for this. I am horrified that they are even contemplating sending him home. I complained to the nurse that I thought it was inappropriate to be asked this a day after diagnosis and asked if they were just going to send him home. She tried to make me feel guilty by saying we wouldn’t want him to lose his independence and that a lung team would have a meeting and maybe fast tracking him home! I’m scared. Isn’t he allowed Macmillan nurses for terminal cancer. Angie
Contact MacMillan, and also read up on this site about fast tracking for CHC. AgeUk fact sheets and website may also be useful. If you do have POA take charge, and insist on attending all meetings concerning his care. Remember CHC can be awarded even if the recipient is at home, the location of the care is irrelevant once a health need has been established. It doesn’t sound like they’ve assessed him in any lawful way.
My dad is 96 and has dementia, prostate cancer that has spread to his bones, doubly incontinent, cannot stand, has to be washed, dressed, and fed. He has had asperational pneumonia 3 times and we have been assessed twice on the checklist for continuing healthcare and told he does not qualify. No one wants to seem to help, social services only seem to want to prevent him from scoring sufficiently or being presented in a way to qualify for CHC funding.
On the third time of applying for a checklist, we have now got through to stage two. However, the CCG have assigned a case worker to pull all the information together for the MDT, which will not include his specialist, only their reports (if the care home provide the name and details of them to them). The MDT will be the social worker, CCG and care home staff. What chance do we have of being successful, ZERO i think at present. Does anyone have any advice ti successfully get through this next stage?
Paul – thanks for your post. Please call us if you wish and we will be happy to discuss with you how we might assist with these issues. 0161 979 0430 Kind regards
My Husband has just passed away aged 98,dementia, doubly incontinent, couldn’t stand, had to be hoisted, had to be washed, dressed, fed. Hospitalised many times from nursing home with chest infections. I had same problem with social services who assesssed him but kept telling me he didn’t qualify for CHC funding. Staff didn’t compare notes before meetings so stories never matched.
Hi Berry – please call us if you would like to chat this through. We may be able to assist you 0161 979 0430. Kind regards
Dad was rejected for CHC but awarded FNC, which the care home took as additional payments on top of the £1,175 a week charge. This vindicated our position that he needed nursing care on discharge from hospital as it was backdated to the date of discharge. They (hospital, social worker, district nurse) had said dad only needed residential care which we refused to allow to happen, as it had resulted in aspirational pneumonia through lack of care. The care home had provided a breakdown of the cost of dads placement £1,175 in which £500 a week was for nursing care. As the care home were paid FNC directly, they said it was extra money for them and not FNC taken off the £500. The local authority were not interested as they just pass the cost outside his personal budget on in top up fees. I feel this practice is just robbing the NHS of much needed funding, the NHS would have been better off if we had never applied for CHC/FNC
As far as hospital discharge is concerned, in the majority of cases, it is preferable for eligibility for NHS Continuing Healthcare to be considered after discharge from hospital when the person’s ongoing needs should be clearer. Page 34, Para 109 of the revised national framework (2018) refers.
My husband is 98 and has dementia, doubly incontinent, cannot stand, has to be washed, dressed, and fed . We have been assessed twice for continuing healthcare . He was discharged from hospital to a nursing home 6months ago.
Why are we not entitled to funding when the person in the next room doesn’t pay anything because they had the foresight to spend .
Hi Pauline – Have you considered appealing? Please do get in touch if you would like to chat this through. 0161 979 0430 Kind regards
Excellent and comprehensive advice for anyone finding themselves faced with this issue.
There are no shortcuts; just get very well informed (through this site and Age UK fact sheets).
Keep thorough notes of any conversations you have or calls you make, and with whom.
Send letters by Signed For and check when they were delivered.
Ensure you have Powers of Attorney made and registered in good time.
Ensure any GP, nurse or care home understands The Mental Capacity Act as it relates to your relative and the decisions they are able to make.
Seek help if you feel out of your depth, but keep informed and keep going. Your relative deserves no less.