Reclaim Care Home Fees
Elsewhere I have set-out the technical aspects in relation to the issue of reclaiming care fees, but below I have provided a practical guide to care fees funding, covering the following key areas:
- What is the time-scale?
- Under what circumstances can care home fees be reclaimed?
- How do I reclaim care home fees?
- What can I expect during the process of reclaiming care fees?
- How long does the process of reclaiming care home fees take?
What is the time-scale?
The Government recently introduced a rolling moratorium on reclaiming care fees so that for backdated claims there is a strict time limit. For example, for care fees incorrectly paid between 01 April 2014 and 31 March 2015, the claim must be submitted before 31 March 2016 or it becomes time-barred.
Under what circumstances can I reclaim care home fees?
The full cost of funding nursing, care and accommodation fees falls on the NHS, as opposed to you or the Local Authority, if your need for care is a “Primary Health Need” rather than a “Social Care Need”.
A Social Care Need is defined by the Department of Health as:
“In general terms (not a legal definition) a social care need is one that is focused on providing assistance with activities of daily living, maintaining independence, social interaction, enabling the individual to play a fuller part in society, protecting them in vulnerable situations, helping them to manage complex relationships and (in some circumstances) accessing a care home or other supported accommodation.”
A Primary Health Need is defined by the Department of Health as:
“Whilst there is not a legal definition of a healthcare need (in the context of NHS continuing healthcare), such a need is related to the treatment, control or prevention of a disease, illness, injury or disability, and the care or aftercare of a person with these needs (whether or not the tasks involved have to be carried out by a health professional).”
So, if you’re assessed as having a Primary Health Need, and care and accommodation costs have already been funded personally, then there is a prima facie (before closer inspection) case for those care/nursing home fees to be reclaimed from the NHS. This can either be done during your lifetime or even at post mortem. However, the dice seems to be loaded very firmly in favour of the NHS. The following example, taken from an internet forum, gives an insight into how difficult it is to establish a Primary Health Need – this lady was declined!
“My late mother was an insulin dependent diabetic, who was visually impaired (diabetic retinopathy) and could no longer manage blood testing and injections (she also had neuropathy in her fingers) which then had to be done by Registered Nursing Staff. She needed 24hr monitoring (agreed by the authorities) and 5 injections per day – one late at night – these could not be provided by district nurses at her own home nor at the original residential home where my Mum spent 4 very uncomfortable and distressing weeks”.
How do I reclaim the care home fees?
At the core of the process for reclaiming care fees is a full Continuing Healthcare Assessment, which is undertaken by the relevant Clinical Commissioning Group (CCG). If you had been in hospital before going into care, then a full assessment should have been carried out before being discharged. If an assessment hasn’t been carried out, or if there is a change in your care requirements, then you should seek the help of a GP, Care Home staff or Adult Social Services at the relevant Local Authority.
If you qualify for NHS Continuing Healthcare, then the NHS will fund the cost of care from that point forwards. They will also assess when your need started, so you may even qualify for some funding being backdated.
If the outcome is that you do not qualify; there is an appeals process. This process can be started at any time particularly if your health deteriorates.
What can I expect during the process of reclaiming care fees?
First and foremost, it is your right to have a Continuing Healthcare Assessment, so there should be no obstacles put in the way of proceeding, at least to the Checklist stage, if not beyond.
Your consent will need to be obtained before the process starts; that would be delegated to a Health & Welfare Attorney, if you’re unable to make your own decision. It is also your right to be represented throughout the process and your medical needs should be considered thoroughly.
How long does the process of reclaiming care home fees take?
In the event of an emergency, a full Continuing Healthcare Assessment will be carried out as quickly as possible, particularly if an admission to hospital is likely to be required.
In a non-emergency situation, following the request to the CCG for a full assessment, the process is required to be completed within 28 days.
Is professional help available?
Dealing with this entire process can be a daunting task, especially if you have never been involved in a similar exercise previously, so if you want professional help I am pleased to be able to introduce you to Compass CHC. Whilst Compass CHC charges fees for its services, obtaining an initial evaluation is at their expense, using their straightforward on-line questionnaire.
If I can help with any aspect of care fees planning, please contact me via the form below.