Worried about care home fees? The assessment process for NHS continuing healthcare made clear

25 Oct 2017 | Comment

It is a common misconception that when a person needs to go into a nursing home, that person is automatically liable for the cost of their care home fees. However, this is not the case. If someone requires care as a result of their health as opposed to their social care needs, they should be eligible for NHS continuing healthcare, a scheme in which that person’s care is funded entirely by the NHS, regardless of their ability to pay.

Having a relative who needs go into a care home can be a daunting experience, especially as there are a number of assessments that may be undertaken by various professionals. This blog aims to explain the assessment process for NHS continuing healthcare. For more information on the criteria for NHS continuing healthcare, please see our previous blog, NHS continuing healthcare: What makes someone eligible.

The assessment process for NHS continuing healthcare

The first step of the assessment process is to undertake a Checklist assessment. This is a screening tool undertaken by a health professional to establish whether a person has sufficient needs to warrant a full NHS continuing healthcare assessment. The individual or their representative should be involved in the completion of the Checklist.

If the outcome of the Checklist is positive, a full NHS continuing healthcare assessment should be undertaken. The tool used to assess a person’s eligibility for NHS continuing healthcare is known as the Decision Support Tool. Please see our previous blog titled My relative is being assessed for continuing healthcare using a Decision Support Tool (DST). But what is a DST? for more information on this. This assessment should be undertaken by a multidisciplinary team of at least two professionals, usually from both a health background and social care background.

If you’re concerned about a family member with a rapidly deteriorating condition that may be entering a terminal phase, an assessment using the Fast Track Tool could be completed. The Fast Track Tool is designed to ensure those with a rapidly deteriorating condition receive the required care in their preferred setting as soon as possible.

When should my relative’s needs be reviewed?

When a person is residing in long-term care, their needs should be periodically reviewed. The frequency of reviews will depend on whether they already receive NHS continuing healthcare, are residing in a nursing home or a residential home:

  • When a person has been awarded NHS continuing healthcare, their needs should be reviewed after an initial period of three months and annually thereafter;
  • All residents of a nursing home should have their needs reviewed annually, regardless of whether they are receiving NHS continuing healthcare. If a person’s condition is expected to deteriorate, a professional judgment may be made to review their needs sooner; or
  • If a person is residing in a residential home, their needs should be reviewed if there are any significant changes in needs.

Assessments that are not relevant for NHS continuing healthcare

There are assessments relating to a person’s mental capacity which may be undertaken around the time of entry into a care home, such as Best Interests assessments or Deprivation of Liberty Safeguard assessments. These assessments are not NHS continuing healthcare assessments, but they may be used as evidence of a person’s needs.

A local authority will assess a person’s finances prior to entry into a care home to assess their contribution towards the cost of their care. Eligibility for NHS continuing healthcare is not dependent on a person’s wealth, therefore a financial assessment is not relevant for the purposes of NHS continuing healthcare. A person should be assessed for NHS continuing healthcare before any financial assessment is undertaken.

How our nursing care department can help

If you feel that you or your relative should be assessed for NHS continuing healthcare, or you feel that the correct procedures have not been followed by the NHS, please contact our nursing care department who may be able to request an assessment on your behalf. Our Nursing Care department will undertake a free no obligation assessment of your case. We are the leading national experts in recovery of wrongly paid nursing fees and have recovered over £100 million in wrongly paid care homes fees. You can contact the team on 0800 988 2373 or complete an enquiry form here.

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