Avoiding care fees: NHS Continuing Healthcare/NHS Continuing Care

NHS continuing healthcare funding

If you or a relative close to you suffers from a disability or a complex medical problem, you may be entitled to get the full cost of your care funded by the NHS – regardless of your assets. The scheme is called NHS Continuing Healthcare (CHC) for adults, or NHS Continuing Care for children – and many people who could claim are unaware of it. For those eligible, the scheme can save thousands of pounds a year on care costs.

The NHS Continuing Healthcare scheme is available in England, Wales and Northern Ireland. In Scotland, an alternative scheme exists, called Hospital Based Complex Clinical Care. This scheme is only available to people in hospital.

What is NHS Continuing Healthcare/NHS Continuing Care?

NHS Continuing Healthcare/NHS Continuing Care is a scheme run by the NHS which funds the full cost of care for certain people. Funding may be available if you have:

  • a complex medical condition that requires additional care and support
  • a long-term medical condition
  • a physical or mental disability
  • a terminal illness
  • rapidly deteriorating health
  • mobility problems
  • behavioural or cognitive disorders

and you need a lot of nursing support. If you are entitled under the scheme, the NHS will pay for the full cost of your care, even if you have substantial assets. The funding can pay for you to be cared for in your own home, in a nursing home or in a hospice.

Wrong information

Many people are not told about NHS Continuing Healthcare/NHS Continuing Care, or they are given incorrect information by health and social care professionals. Consequently, many people end up paying for care when they don’t have to. Assessments are also often carried out incorrectly and health needs are ignored.

When a person has care needs, the first thing that should happen is an assessment for NHS funding. Instead, many people will be given a means test by the Local Authority which looks into the assets that they have, to see if they can pay for their own care. What they don’t understand is that under the NHS Continuing Healthcare/NHS Continuing Care scheme, a financial assessment or means test is not necessary. People with a ‘Primary Health Need’ get 100% funding, even if they own their own home or have assets. The first question that professionals should be asking is about the person’s health and care needs and not their means.

Am I eligible?

Many people who have long term health conditions are not available for NHS Continuing Healthcare or NHS Continuing Care. The assessment criteria is quite strict and it is certainly not something you should count on getting with any certainty. On the other hand, many people who are eligible don’t ask for an assessment and end up having to fund the cost of care themselves.

There’s no fixed list of the conditions which are eligible for funding. Anybody who suffers from a condition that comes under the above list should have an assessment. It costs nothing to get an assessment and it could save you thousands of pounds.

However, the above list is not final. If you have a condition that means you need long term care and support, it is worth getting an assessment, even if it is not listed above.

Do not be put off by others’ stories that their claims have been refused. It is always worth having an assessment yourself as every assessment is individual.

How do I claim?

To claim under the scheme, you’ll need to ask your social worker or GP to arrange an assessment.

How the process works

The first stage of the process is the initial screening. This will typically be carried out either at home or at a hospital. A doctor, nurse, social worker or another healthcare professional will carry out the screening. However, if your health (or the health of the person you’re trying to secure funding for) is rapidly deteriorating, you should ask for a fast track assessment. This bypasses the initial screening stage.

The initial screening is just as simple checklist that looks at various factors relating to your care needs. These include:

  • behaviour
  • breathing
  • cognition (your understanding of what’s happening around you)
  • communication
  • continence
  • mobility
  • nutrition (food and drink)
  • psychological and emotional needs
  • skin (including wounds and ulcers)
  • symptom control through drug therapies and medication
  • altered states of consciousness
  • and other significant care needs.

The second stage is the full assessment stage. Although this can be complex, try to keep in mind that if successful, the funding you’ll secure will be well worth the effort.

The full assessment is carried out by two or more healthcare and social care professionals who are involved with your care. They will use the same checklist as for the initial screening but they will go into more depth. Each of your care needs will be marked as:

  • priority
  • severe
  • high
  • moderate
  • low

Those who have at least one priority need or two severe needs will qualify for the funding.

However, if you have one severe need and several other moderate or high needs, you may also qualify for the funding.

How much will I get?

If you’re eligible, you’ll get funding for personal care and healthcare costs which might include help with bathing and dressing, or specialist therapy required by your condition. If you need to live in a care home, the funding may cover the cost of your accommodation. If you need support in your own home, the funding may cover the cost of carers providing that support.

Options

If you reside in England, the NHS will give you two options: they can arrange and pay for care on your behalf, or you can receive a direct payment, called a ‘Personal Health Budget’. This allows you more control over how you are cared for. In Wales, Scotland and Northern Ireland, Personal Health Budgets aren’t available.

If you don’t qualify

If after the full assessment you are told that you (or the person you are seeking funding for) cannot get funding and you don’t agree with this decision, you can ask for your situation to be reviewed again periodically. This is particularly important if your health is deteriorating.

You can also ask your local Health Board, Social Care Trust or Clinical Commissioning Group to review the decision. If the decision was made on the initial screening alone, you should ask for a full assessment.

Note that you should have the opportunity to contribute to the review of your case and you should be shown all of the evidence that was used in making the decision.

If you’re already paying for care

If you or a relative of yours is already paying for care, you can ask for funding retrospectively. Ask your GP or social worker for a retrospective assessment. Even if you don’t qualify for NHS Continuing Healthcare/NHS Continuing Care, you might be able to get help from the Local Authority with meeting some of your care needs.

More help

You may find the book ‘How to get the NHS to pay for care‘ helpful. This book was written by Angela Sherman, a lady who went through a four year battle to secure Continuing Healthcare funding for both of her parents. The book explains how to prepare for the assessment and sets out both what to do, and what not to do.

You may also find these sites useful:

Other ways to avoid care fees

If you (or your relative) need care in the future and you are not eligible for help with care fees, you could lose a substantial portion of your hard earned assets paying for the care yourself.

Couples can take action to protect their share of assets by changing the way they own their property from joint tenants to tenant in common. They can then leave their share to their partner for life, after which the property goes to their choice of beneficiary – the children for example.

The benefit of this is that if your partner needs care after your death, the Local Authority cannot take your share into account when assessing how much they are able to pay.

If you don’t put your share of the property in trust, the Local Authority can take everything your partner owns (including your share), leaving them with just £14,250. This means your children and grandchildren will inherit little, if any, of your estate.

See our page on Care Fee Trust Wills for more information.

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