Thousands of properties are sold each year to fund the ever rising cost of care fees. However, many of these family homes should not have been sold, as the individuals concerned may be eligible for NHS Continuing Healthcare, a package of funding where the NHS covers all costs, including care home fees.
Unfortunately, applying for NHS Continuing Healthcare funding is an extremely complex process and establishing eligibility is not as simple as it should be. Showing that an individual is being cared for by nurses or medical practitioners; or has a disability or been diagnosed with a long-term illness or condition, doesn’t automatically mean that they’ll be eligible for NHS Continuing Healthcare.
To help decide which services the NHS should provide and pay for, and which services local authorities will provide, and charge individuals for, the patient will be assessed against the National Framework for Continuing Healthcare to determine if they have a ‘primary health need’.
The process for determining if an individual has a primary health need can be protracted and challenging. It involves an initial checklist followed by a full assessment which is carried out by an NHS multidisciplinary team comprising two or more health or social care professionals familiar with the patient’s needs. The information gleaned from the full assessment is used by the multidisciplinary team to complete a ‘Decision Support Tool’ (DST). The DST is split into twelve domains. Each domain is divided into levels of need from: ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’. The levels reflect the nature, intensity, complexity and unpredictability of a need.
The multidisciplinary team will allocate a level of need to each care domain to determine if the individual has a primary health need, and then make a recommendation to the ICB whether the individual should be entitled to NHS Continuing Healthcare.
If the recommendation is positive, the individual qualifies for NHS Continuing Healthcare, which covers up to 100% of care costs and can be received in any setting outside of hospital including care homes, hospices or even within your own home.
There is a lack of information and signposting about NHS Continuing Healthcare within hospitals or GP surgeries. Individuals sell their homes and start paying hundreds of pounds in care fees each week without knowing that they may be eligible for free care. Many people do not realise how expensive care costs can be until they encounter first-hand the need to secure 24-hour care for a relative. The average cost of a nursing home in England and Wales is now in excess of £1,800 a week, or £93,600 a year. This figure can be higher still, in the region of £2,500 a week, for specialist dementia care and EMI homes.
If you are refused NHS Continuing Healthcare, or if you are unaware of its existence and start to pay for your relative’s care, the value of the family home will be taken into consideration by your local council when calculating if an individual is entitled to support with care costs. Due to the fact the average home in the UK is worth in excess of £250,000, a large proportion of people who own their home will be liable for the full cost of their care as their assets will be over the threshold of £23,250.
Additionally, once the individual’s assets fall below £23,250 they have to continue to contribute towards their care costs from their assets until they fall to the lower level of £14,000. Once the capital assets are below £14,000 the individual will continue to pay towards their care from any income they receive, normally from any pension they may have.
If an individual has significant ongoing health needs, it’s crucial to secure their entitlement to continuing healthcare to avoid the liability of paying for care homes and the need to sell the family home. The issue is that the NHS is increasingly restricting access to the funding and individuals who ought to be eligible are denied continuing healthcare.
It is not necessary to wait for a negative funding decision; we can provide support while your loved one is still in hospital before any discharge to a nursing home.
Unsure if you or a loved one qualifies?
If you think you, or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
Submit an enquiry to get started.
