How Compass CHC helped my family secure £100,000 in retrospective CHC Funding

When Michael reached out to Compass CHC, his mother in law had already spent two years in full time care. Despite significant cognitive and physical impairments, including immobility, double incontinence, dementia related anxiety, recurrent infections, and arthritis, the family had repeatedly been told by their local Integrated Care Board (ICB) that NHS Continuing Healthcare (CHC) funding was unlikely. They had also been given incorrect information, including claims that the care home placement would need to change if funding was ever granted.

Recognising the strain this placed on the family, Compass CHC guided them step by step through the process, ultimately helping them secure almost £100,000 to fully reimburse more than two years of care fees.

• Expert guidance through a difficult process – Compass CHC initially supported the family with our Investigation service. Sadly Michael’s mother-in-law passed away during the investigation, so our team continued with a Retrospective assessment and then full representation at the Retrospective Appeal. Throughout, we ensured the family understood the correct procedure, helping them feel informed and reassured.
• Correcting the ICB’s misinterpretation of needs – Originally, the ICB had wrongly awarded a Low level of need in one domain, a score that did not reflect the extent and complexity of the individual’s needs. At the Appeal meeting, our advocate presented detailed evidence showing why this domain should have been categorised as Severe. The panel agreed and revised their scoring accordingly. This demonstrates how important it can be to pursue an appeal, a different assessment panel can review the same information and score differently, in this case from Low to Severe
• Demonstrating the complexity of needs – we also successfully argued that the individual’s dementia significantly impacted other areas of health, including continence, behaviour, and psychological well being. This recognition of complexity played a crucial role in establishing eligibility.
• Ensuring correct application of the National Framework – our advocate highlighted further instances where the ICB had not applied national CHC guidance correctly. Addressing these errors ensured an accurate and fair reassessment and directly contributed to the positive outcome.

Following our attendance at the Appeal meeting, the ICB awarded full NHS Continuing Healthcare funding for the entire review period – more than two years of care.

This resulted in a £100,000 reimbursement to Michael’s family, providing:

• Financial relief after years of self funding care
• Recognition that their loved one’s needs were far more complex than initially assessed
• Confidence that the correct process had finally been followed.

This case highlights the difference experienced advocacy can make. Without Compass CHC’s intervention, the ICB’s incorrect scoring, downplaying of health needs and procedural errors would likely have gone unchallenged, leaving the family without the significant reimbursement they were entitled to.

Michael said:

“Due to dementia we had to place my late mother-in-law in a local care home. The care home and the staff were absolutely brilliant, and we couldn’t have asked for more. We were self-funding and in total the cost of care was just under £100,000.

After researching care home fees I found Compass CHC online and from the first introductory call I felt I was in good hands. After completing a web form, within hours I was contacted by an advisor and an initial assessment was made of our case. The next day we were informed that they believed we had a fairly strong case to pursue.

From the beginning to the end I have been in contact with several members of the Compass CHC team and all were absolutely brilliant. Very understanding, professional, knowledgeable and above all not pushy.

Collecting the necessary medical evidence was painstaking and time consuming, something that the average person would never be able to undertake. Compass CHC successfully represented us at the numerous reviews, meetings and obstacles that the NHS put in our way.”

Learn more: How Helen won an appeal to secure continuing healthcare funding.