With the UK’s average life expectancy steadily increasing, more of us are likely to require full-time care at some point in our lives. Consequently, an increasing number of older people are being forced to sell their homes, or part with their lifetime savings, to enable them to meet the cost of their care fees.
However, for individuals found eligible for NHS Continuing Healthcare, the NHS is required to meet the full cost of their care. NHS Continuing Healthcare is a non-means-tested package of care, and is awarded to individuals whose needs are deemed to be primarily for healthcare. Our previous blog, NHS Continuing Healthcare: What Makes Someone Eligible, explores the eligibility criteria in detail.
On the face of it, the system may appear deceptively simple - an individual’s needs are measured and, if their needs are primarily for healthcare, the NHS is required to meet the full cost of their care. Unfortunately, the system is seldom this straightforward, and families are often perplexed by the long and intricate assessment process.
At Hugh James Nursing Care, we regularly provide assurance to concerned clients who have been supplied false information from third-parties, including NHS-bodies, nursing homes, and even misinformed friends or relatives. In this blog, we will attempt to add clarity to the process by tackling some of the most prominent myths regarding NHS Continuing Healthcare.
1. “You have to be diagnosed with dementia to be eligible for funding.” - This statement is false!
One of the most common misconceptions regarding NHS Continuing Healthcare is that funding is automatically awarded on the existence of a specific medical diagnosis. However, decisions regarding eligibility are based primarily on the individual’s day-to-day health and care needs, and not their diagnosis.
For example, a diagnosis of dementia will not trigger automatic eligibility. However, day-to-day memory loss, disorientation and confusion (as a result of the diagnosis), are factors that will be taken into consideration when determining whether or not an individual meets the criteria for funding.
2. “My relative owned a house, and was/is able to afford his/her care fees. Does that mean we can’t apply for an assessment?” - This is not true!
NHS Continuing Healthcare is not means-tested. Therefore, the value of the individual’s estate should have no bearing on whether or not they meet/met the eligibility criteria.
If there is evidence to suggest that an assessment did consider the value of the individual’s estate in reaching a determination, the decision may be unsound, and therefore you have the right to appeal the decision.
3. “My relative has passed away. I’ve been told that it’s too late to request a review.” - This is also false.
Whilst it is advisable to commence the review process as soon as possible, and preferably while an individual is alive, you are still able to request a retrospective review after they have passed away. The review will be completed using their care and medical records.
However, it is important to be mindful that the Department of Health has imposed time limits on how far back you can claim for, which is based on where your relative lived. You should also be aware that from time to time, the Government will announce a new deadline on requesting reviews that encompass certain periods, limiting some claims. Therefore, it’s best to start the application process as soon as possible.
4. “My care home has told me that my relative wouldn't be eligible for NHS Continuing Healthcare. Is it worth applying for an assessment?” - This is not true!
Care homes are not qualified to undertake Continuing Healthcare assessments. The only way to ascertain whether or not an individual meets the eligibility criteria is by requesting a formal assessment from your local health authority.
5. “I’ve been told that you have to be terminally ill, or be suffering from the final stages of a disease, to qualify for funding. Is this true?” - This is false!
Funding is not awarded based on the existence of a specific medical diagnosis and/or the length of time an individual is expected to live. Instead, the assessment is based on an individual’s day-to-day health and care needs.
However, as an individual’s condition may rapidly deteriorate towards the end of their life, it may be easier to secure funding at this stage. In this scenario, you are able to request an urgent assessment and funding may be fast-tracked and provided almost immediately.
6. “Social services contributed to my mother's care fees. I've been told that I can't recover any fees paid.” - Once again, this is false!
Any personal monies paid towards care (including any relinquished state or private pensions, and some state benefits) are recoverable, if you are found eligible for Continuing Healthcare. This is true even if care fee contributions were paid directly to social services, and not to a care home.
7. “You have to be in a nursing home to be considered for funding.” - This is simply not true!
National guidelines specifically prevent nurse assessors from considering the setting of an individual’s care when considering whether or not they meet/met the eligibility criteria for funding.
Despite this, it is not uncommon to discover that this guideline has not been adhered when formal assessments are undertaken. If there is evidence to suggest that the assessors have factored in the setting of an individual’s care, the decision may be clinically unsound and can be appealed.
8. “I’ve been told that my relative is eligible for Funded Nursing Care Contributions (FNCC), is this the same as Continuing Healthcare?” - No!
Funded Nursing Care Contributions (FNCC) are not the same as Continuing Healthcare. NHS FNCC is a contribution for individuals where aspects of their care need to be provided by a registered nurse. The NHS will therefore pay a contribution towards the cost of the registered nursing care input.
Conversely, NHS Continuing Healthcare is a full package of care that is arranged and funded solely by the NHS. In short, the NHS pays for the entirety of your care fees.
It is also important to note that the NHS is required to assess an individual’s eligibility for Continuing Healthcare prior to assessing them for FNCC. If it is established that this did not occur, it may be possible to request that the NHS re-review the individual’s eligibility for Continuing Healthcare.
If you believe that you or your relative may be eligible for Continuing Healthcare funding, or if you have been adversely affected by any of the misconceptions outlined in this article, contact our specialist Nursing Care team on 0800 652 5523, or complete our online enquiry form.
We are the leading national experts in recovery of wrongly paid nursing care fees, successfully recovering over £100 million to date for families in England and Wales. We will help you find out if you have a valid claim and advise you on how to proceed.