The costs of NHS Continuing Healthcare

Posted by Val Prosser

Senior Associate

Paul Lewis, in his recent Radio Times article, urged individuals to obtain advice from a specialist solicitor when approaching the matter of whether a loved one may be entitled to full payment of their care fees by the NHS.

Paul stated that the rule book of how a primary health need is established, the existence of which makes an individual eligible for NHS Continuing Healthcare, is “long and complex”.  He commented that it can be “a long road and there is a backlog of appeals”.  Understandably, this can put relatives off considering the matter further.  However, the prospect of significant financial support can outweigh the procedural difficulties which exist in the short term.  The Elderly and Vulnerable Client Team here at Furley Page can assist by taking forward a claim for NHS Continuing Healthcare for your loved one and easing the burden on you.

Furley Page’s Elderly and Vulnerable Client Team has extensive experience in lodging and progressing claims for NHS continuing care on behalf of those individuals with a primary health need.   They are aware of the intricate procedure involved, the arguments which can be put forward in order to draw attention to an individual’s eligibility for this funding, and the impact of care needs upon one another, all of which should be carefully borne in mind when taking forward a claim.

In the event that a claim for NHS Continuing Healthcare has been refused in the first instance, and a person’s care needs are such that this should be challenged, the Team also has a great deal of experience in launching appeals and taking these to a conclusion.  Appeals can be progressed even when the person concerned has passed away, and lodged on behalf of their estate.

Do contact a member of the Furley Page’s Vulnerable Client Team to discuss your relative’s care needs and obtain specialist advice on whether they may be successful in a claim for NHS Continuing Healthcare.

NHS CONTINUING CARE

NHS Continuing Healthcare (sometimes known as NHS Continuing Care and NHS fully funded care) is a package of care which the NHS may arrange and fund entirely, where it is understood that an individual's needs are primarily for healthcare rather than, for example, social care or accommodation.

Where someone is found eligible to receive this type of funding it can be provided in any setting, for example a residential care or nursing home, or in a person's own home.  Many families are unaware that this form of funding exists or may be challenging the NHS where they feel that this type of funding has been incorrectly denied to their elderly relatives.

If you act as deputy or attorney for an individual who receives care, their eligibility for NHS Continuing Healthcare should also be something that is considered by you on their behalf.

Families are occasionally under the false impression that in the event that someone suffers with dementia then they should automatically qualify for NHS Continuing Care.

Whilst dementia sufferers may certainly be found eligible, it is important to remember that it is the extent and nature of a person's needs which are paramount.  People with all types of illnesses and conditions may benefit from this type of funding where their needs are severe.

At Furley Page we are experienced in taking forward claims for NHS Continuing Healthcare and appealing decisions where someone has been found not eligible to receive this funding.

We can assist you in advising upon the likelihood of a successful claim for NHS Continuing Care and navigating the intricacies of the process involved in securing this type of funding.

Families or representatives can also lodge a retrospective appeal if an individual has been paying for their own care to date, or were doing so right up until when they died, that person had never been assessed for NHS continuing care and you believe the NHS should have been meeting this cost.

Deadlines for retrospective claims were introduced more recently and it is now possible to look back only to April 2012 in terms of a retrospective claim.  Of course, care home fees are very expensive and so seeking specialist advice on this subject can be extremely worthwhile.

So how does someone receiving care qualify for NHS Continuing Care?

First of an all an assessment will take place to ascertain the level of care they require.  A member of Social Services and an NHS continuing care nurse should be present at that assessment; it may take place take place in two stages with, initially, consideration being given to whether someone may qualify for NHS continuing care.

In the event that someone's needs are understood to pass that threshold, then a full assessment takes place.

There are 12 areas that will be considered as part of the assessment and these are:

  1. behaviour;
  2. cognition;
  3. psychological and emotional needs;
  4. communication;
  5. mobility;
  6. nutrition (food and drink);
  7. continence;
  8. skin (including tissue viability);
  9. breathing;
  10. altered states of consciousness;
  11. drug therapy and medication;
  12. other significant care needs.

It is important to remember that even if the carers are successfully managing a need, this may still qualify a person for NHS Continuing Care, because the need still exists - well-managed needs are still needs. Only where successful management of a need has permanently reduced that health care need will it affect eligibility.

If you believe that a person close to you has been or is paying for care which perhaps should have been the responsibility of the NHS, and would like help navigating the processes involved in trying to secure NHS Continuing Care, please contact a member of the Elderly and Vulnerable Client team.

 

 


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