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26 May 2017 | Comment | Article by Lisa Morgan

My relative is in hospital and requires long-term care – what should happen now?

Witnessing a loved one’s health deteriorate is difficult. If your family member is admitted to hospital as a result of poor health, they may require long-term care following their discharge. At such times, it can be unclear as to what steps should be taken prior to your loved one’s discharge from hospital to determine who is responsible for the cost of their ongoing care. Please be assured that there is a process that should be followed, which I will set out below.

If ongoing care is required, then your relative should be assessed for NHS Continuing Healthcare first. This is a package of care arranged and funded by the NHS, regardless of the individual’s personal wealth. To start the process to see if your relative is eligible for this funding, a checklist should be completed before your relative is discharged from hospital.

The checklist assessment is a basic screening tool, which is used by the health authority to determine whether a full assessment for NHS Continuing Healthcare funding is required.

If your family member passes the checklist assessment, the next step is a Decision Support Tool (DST). This is an assessment tool which considers a patient’s needs within 12 specified care domains. A patient’s needs are assessed within each care domain and a level of need is awarded. You can read more about the DST and what makes someone eligible for Continuing Healthcare in our previous blog post NHS Continuing Healthcare: What makes someone eligible.

In the event that there are delays in assessing eligibility for NHS Continuing Healthcare, the relevant health authority will be responsible for funding the individual’s care in the interim period. Therefore, even if your family member is discharged from the hospital into care, they should not be responsible for the cost of their care until they have been fully assessed.

Once the assessment has been completed and a decision has been reached, your family member should receive a letter clearly explaining the decision. If required, this can also be sent to a representative, i.e. a family member, to ensure everyone is fully aware of what assessments and decisions have been taken. If the assessment is positive, your family member’s care will be fully funded by the NHS.

Your relative should only be means tested (i.e. assessing an individual’s savings and assets to determine whether they can cover the cost of their own care) if they are not found eligible for NHS Continuing Healthcare. For more information regarding the means test, please visit the Age UK website.

NHS Continuing Healthcare funding should be the first consideration when long-term care is required. However, in our experience families are not always made aware of this funding scheme and are instead means tested first. By not automatically completing an NHS Continuing Healthcare assessment, the health authority is not following guidelines. In this event, we would recommend that you contact the relevant health authority (a Clinical Commissioning Group in England or Health Board in Wales) directly in order to request that an assessment be undertaken.

You should be aware that eligibility for NHS Continuing Healthcare funding will be reviewed from time to time. This is dependent on where the individual receives their care. For example, if someone receives care in a residential home, the health authority must review their eligibility for funding if their care needs change. However, if care is received in a nursing home, a review should be completed annually as well as if there’s a change in care needs.

If you believe your relative has been unfairly denied NHS Continuing Healthcare funding, please do not hesitate to contact our specialist Nursing Care department who will conduct a free assessment of your case and potentially help you reclaim wrongly paid care fees. Find out more about our Nursing Care team here.

Author bio

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 40 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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