NHS Continuing Healthcare: What Money Can I Recover?

28 Jun 2018 | Comment


Claims for continuing healthcare can be made both in real time (when a patient is living) and retrospectively (after the patient has passed away). However, people are often confused as to exactly what money is recoverable. Many people are led to believe that continuing healthcare is means-tested, cannot be claimed retrospectively, or that continuing healthcare is only a ‘top up’ or partial payment of fees. In this post, we look at what money is potentially recoverable in a claim for NHS continuing healthcare.

What can I recover if my relative is deceased?

Broadly speaking, a retrospective claim for continuing healthcare is when the individual has paid care fees in the past. Families are often led to believe that the full amount of the cost of care is not recoverable and that if a patient is found eligible, only a percentage of the care fees paid will be reimbursed, however this is not the case. Potentially, all care fees are recoverable. This will usually mean the cost paid by the patient and/or their family to the care home at a weekly or monthly rate. The cost of care is rising and becoming harder for families to meet. Over time, the amount paid for care can add up, but all of this is money that is potentially recoverable.  Expenses incurred in the care home for things such as haircuts or toiletries are not recoverable.

This is not the only money that would be reimbursed. Also payable by the health authority, if someone is found eligible for continuing healthcare, would be the interest on the wrongly paid care fees. Interest begins to accrue from the date that eligibility for continuing healthcare would have been awarded until the date that calculations are provided by the health authority. Interest is calculated at Retail Price Index (RPI) rate, which fluctuates year to year.

By way of example, let’s consider Mr Smith. Mr Smith resided in a care home for one year in 2012 and the cost of his care was £4000 per month, which he paid himself out of savings. If Mr Smith was found eligible for the whole period of his 2012 care he would be reimbursed £48,000, excluding interest. Interest would be calculated as though it had accrued from 2012 to 2018.

Who is the money paid to?

In a case where a claim is being brought for someone deceased, any monies recovered are paid to the executor of the deceased’s estate. It is then the duty of the executor to distribute the money in accordance with the will of the deceased. If eligibility is found in a claim where the patient is living and is currently paying care fees, money will be paid directly to the care home to meet the cost of care going forward.

How is the reimbursement calculated?

Reimbursement is calculated based on the financial evidence that is provided to the health authority. This can be, for example, statements of account from the care home, invoices or bank statements. If you are considering making a claim for NHS continuing healthcare, it is recommended that you keep hold of any documents or statements relating to care fees that have been paid.

What if there was a charge on the property?

Sometimes, if an individual doesn’t have enough savings to pay for care, but they do own their own home, the council may put a charge on the property. This would mean that the council would pay for the care fees, and therefore your family member is in debt to the council, and their home is used as the security. This means that you or your relative did not directly pay care home fees to the care home. However, when the property is then sold, payment is made to the council to pay off the debt. This does not mean that you cannot claim for continuing healthcare. Simply, the health authority would require proof that the debt has been paid off. This sum is potentially recoverable in a claim for continuing healthcare.

Isn’t it means-tested?

No. Continuing healthcare does not take into consideration the value of an individual’s estate and the value of the estate will have no bearing on whether an individual meets the eligibility criteria. Clients often think that if their relative has savings, then this must be used to pay for their care. If an individual is found eligible for continuing healthcare, then their savings or assets are not taken into consideration.

The cost of care is rising, and in some parts of the UK, care can cost upwards of £1000 per week. These fees are becoming harder for families to meet and often consume all of an individual’s assets, leaving little or no inheritance for their family. However, these fees (plus interest) are potentially recoverable in a claim for continuing healthcare. If you think you or someone you know may be owed money for care fees, please contact our specialist nursing care department on 02920 391 129.

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