A key role not always emphasised is the care of our elderly. Care funding, whether it is in the home or in a residential/nursing home environment, is very expensive no matter which way you look at it. All of a sudden, you can find that either you or your relative is in a situation where they need extra help and support. All that anyone is concerned about is who is going to pay for it?
Below we will answer your questions about NHS continuing healthcare:
- What is continuing healthcare funding?
- Who is eligible for continuing healthcare funding?
- What is a primary health need?
- Is continuing healthcare means-tested?
- The continuing healthcare assessment
- What if I need urgent care?
- I am not eligible for continuing healthcare funding – what are my options?
- Will I have to pay care home top-up fees?
- I need help and advice with continuing healthcare funding
What is continuing healthcare funding?
Continuing healthcare (CHC) funding is a valuable service provided for by the NHS that far too many families are unaware of. It is available for those who have care needs that are primarily related to their physical or mental health and are above and beyond that which the local authority is expected to provide. Essentially it is funding for people who have a primary health need.
If you qualify, the NHS is responsible for the entire cost of your healthcare package.
Who is eligible for continuing healthcare funding?
Anyone over 18 years old who the NHS has assessed as having a ‘primary health need’ is eligible for CHC funding. Eligibility is the same for everyone whether their needs are being met in their own home or in a care home.
What is a primary health need?
The National Framework explains that there are four main characteristics of needs that “may help determine” whether the care required is beyond that which the local authority should provide. If the health issues you are dealing with are more important than your social care needs, you may have a ‘primary health need’ and would be eligible for NHS continuing healthcare.
The quality and quantity of care that is required to meet the individual's needs, the totality of the overall needs and the effect of their interaction will be considered carefully when carrying out the assessment process.
To determine whether there is a primary health need, the assessors will be looking at the following aspects of the person’s health needs:
- nature
- intensity
- complexity
- unpredictability
Is continuing healthcare means-tested?
CHC funding is not means-tested and depends entirely on whether a person has a primary health need and is eligible. Do not be fooled that because you have savings you will never be eligible for funding. It does not matter whether you have savings and/or a high income; you do not need to disclose your finances to Social Services if you are being assessed for CHC funding.
Therefore, from the outset it is important to get an early checklist assessment. Do not talk about finances before this. Be aware that you may not have to sell your home to pay for care. No decision should be taken about using assets to pay for care until the correct care assessment procedure has been followed.
The continuing healthcare assessment
The continuing healthcare assessment process has two stages:
- Checklist assessment - initial screening tool to determine whether a person may have eligible needs
- If the checklist assessment is positive, the next stage is a more detailed assessment called a decision support tool (DST)
Circumstances where assessments may take place include:
- In hospital prior to discharge to a care home or even to your own home with a package of care
- In your own home if you are no longer coping and need support and assistance
- While in a care home if your needs change and more assistance and support is required
Assessors will often start talking about funding before you have been assessed. It is important that you do not get drawn into a discussion about assets and income from the outset. The first criteria is whether there is a healthcare need, not what you can afford.
What if I need urgent care?
If urgent care is required, the CHC fast track pathway tool can be used.
This is very different process from that used to determine eligibility for CHC. There is no checklist and no decision support tool. It can only be used by an ‘appropriate clinician’, such as a consultant, GP and registered nurse.
I am not eligible for continuing healthcare funding – what are my options?
Even if you have been assessed and eligibility for funding has been rejected, it is still possible to challenge this decision and appeal if you think the decision is wrong. This is particularly important if care needs have increased due to a deterioration in your health.
If you do not qualify for CHC funding, you will have the following options:
Be aware that there is no such thing as avoiding care home fees. If you are not eligible for care home funding, you should expect to fund your own care if you have the means to do so. Gifting or transferring assets and income could result in a deliberate deprivation of assets and the consequences are grave.
Will I have to pay care home top-up fees?
Top-up fees are usually associated with the additional costs of accommodation that the local authority will not fund and instead will ask you or a relative to pay. It is very important to understand whether you should be paying top-up fees. Legal advice should be sought if a person is unsure as to whether a top up should be applied.
Relatives must be very careful when entering such an arrangement. They will have to be willing to meet the additional cost for the likely duration of the arrangement, recognising that this may be for some time into the future.
If a person is already receiving CHC funding, the care home should not charge top up fees. CHC funding is supposed to be provided free at the point of when you need it. All of the costs required to meet care needs should be met by the NHS where a person has primary health needs.
I need help and advice with continuing healthcare funding
Thousands of people are paying care home fees when they are entitled to have these costs covered by the NHS. With the cost of these fees being an average of £750-£1,000 per week, this can quickly escalate into many thousands of pounds. The entire savings of an individual can disappear within a very short space of time.
You may be in hospital waiting for discharge with a care package. You may already be paying for care and are not sure if you should be. Or you may have a loved one who has passed away and you think they may have been wrongly paying for their care. Using a lawyer for continuing healthcare funding can help you solve your financial worries and remove some of the emotional stress you will be experiencing.
To find out more about NHS continuing healthcare funding, contact our Funding Care Team who will be happy to help.
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