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:
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