In the UK, you can recover nursing care fees through a current assessment or retrospective claim. Furthermore, eligibility for NHS continuing healthcare and NHS funded nursing care is based on an individual’s care needs and not on a specific diagnosis or disease.
Do you know that over £287 million in redress and £25 million in interest has been awarded to families who were wrongly denied care funding by the NHS?
Any individual admitted to a nursing or care home (or even residing in their own home) due to their physical and/or mental needs should have the care costs covered by NHS nursing home funding, irrespective of that individual’s current wealth or bank account balance.
Unfortunately, with approximately 40% of Britain’s 440,000 care home residents funding care themselves, thousands of families across both England and Wales have been wrongly paying care fees out of their own pockets.
If you or a loved one from your family or social circle has been paying home care fees themselves, they may be eligible for a fee recovery.
What is Nursing Care Fee Recovery?
Nursing care fee recovery for continuing healthcare and nursing care is the process of recovering money which has been wrongly ‘self-paid’ as care or nursing home fees. This fee recovery can be initiated through a solicitor if you believe that you have been paying for care yourself all this time, whereas it should have been through the NHS CHC .
Once you meet the eligibility criteria, your solicitor will work on your case, and when successful, get you the due amount reimbursed to you.
Understanding Continuing Healthcare and Its Benefits
NHS fully fundedcare, also commonly referred to as Continuing Healthcare (CHC), is a fully NHS-funded care package for people in England and Wales who have been identified to have significant ongoing healthcare needs:
- It is available to individuals who are 18 years or older
- It is for individuals who have been identified to have a ‘primary health need’
- CHC covers the complete cost of care, including residential accommodation
- It is not a means-tested method of providing funding
- It is provided outside of hospitals, so that means in a nursing care home or the individual’s own place of residence
It’s important to understand how continuing healthcare through NHS funding for nursing could change the life of your loved one, not to mention the financial relief they receive. Here are some benefits to consider:
- The affected individual receives the funding they need for day-to-day care as a PHB (personal health budget) which is given in the form of a direct payment. This is often managed by the individual’s family member or relative.
- If the individual is being provided care in a nursing or care home, then the NHS will pay the care home provider directly. However, in both cases, neither the provider nor the family member can legally ‘top up’ the NHS funding.
- There is no charge from the NHS whatsoever – all costs are taken care of by them.
Eligibility for Nursing Care Fee Recovery
Eligibility for NHS continuing nursing care which can often lead to nursing care fee recovery is based on the affected individual’s primary care needs. As mentioned earlier, these are healthcare-focused rather than disease or diagnosis-focused.
The eligibility assessment for NHS continuing healthcare and NHS funded nursing care involves two things:
- A checklist – This is a screening tool to determine if the individual’s needs will require a DST.
- DST – A Decision Support Tool is an assessment tool which examines 12 care domains, including behaviour, nutrition, cognitive abilities, and mobility.
Just to quickly reiterate as it is an important point of consideration: eligibility is not in any way determined by the person’s ongoing disease or diagnosis, as people with the very same health condition, diagnosis, or disease may have different care needs.
If you or a loved one has been previously funding themselves with no financial assistance at all, then you should speak to a solicitor to determine if you are eligible for nursing care fee recovery and that you get the full amount reimbursed to you without delay.
How to Apply for Continuing Healthcare Funding
As per the current NHS guidance available, the process of applying for CHC funding depends, for the most part, on the location where the individual requires assessment. This could be in the hospital as the individual awaits discharge, at home where he/she is being given full-time care, or a nursing/residential care home.
The application process works slightly differently in each of the three cases above, and may get a bit tricky at times. This is why it is best to consult a solicitor who can dramatically help speed up the process for you.
At Hugh James, we make it really easy for families and their loved ones to begin the NHS CHC funding or fee recovery process. All you need to do is complete a questionnaire and our solicitor will guide you from that point on.
Even though working with a solicitor is not required to complete the application process for NHS Continuing Healthcare (CHC) or NHS fullyfunded care (as it’s sometimes called), it can be quite complex when people attempt it on their own. However, working with an expert in the areameans you can significantly increase your chances of being eligible for CHC, ensuring that the complete stream of funding is opened up to you without any unnecessary delays or legal red tape.
Steps to Recover Nursing Care Fees
To recover nursing care fees in England, here’s what you can do:
- Write a letter of complaint to the CCG (Clinical Commissioning Group) to get CCG funding for nursing care.
- Request a retrospective review so that the CCG reviews the relevant care home along with the person’s medical records.
- Complete a DST, an assessment tool which determines if the person’s needs actually qualify him/her for NHS continuing healthcare and/or NHS funded nursing care.
- Attend an LRM – a Local Resolution Panel Meeting – where the CCG will schedule the meeting on your behalf.
- Make an appeal in case you disagree with the decision to release funding or reimburse the wrongly paid fees.
- Request a hard copy of all previous assessments and outcome letters.
- Consult a solicitor well-versed in the area of CHC funding to understand what the next steps are and how to get the quickest resolution.
- Challenge eligibility for CHC if you were deemed ineligible.
- You can also claim a refund in case the ICB (Integrated Care Board) takes more than 28 days to decide your eligibility; from the 29th day, you can claim a refund, asking them to refund any care costs until the date of the decision.
Common Challenges in Nursing Care Fee Recovery
- In order to be eligible for CCG funding for nursing care or CHC funded nursing care, you must have a primary health need which significantly impacts your daily life. Important to note here is the fact that a primary health need cannot be defined by the health condition or diagnose itself.
- The CHC eligibility assessment is conducted by a certified healthcare professional who will assess your care needs in 12 domains, which include: cognition, behaviour, emotional and psychological needs, nutrition, continence, mobility, skin integrity, communication, breathing, and drug therapies & medication. This can be uncomfortable for most people, where some people have also felt nervous and anxious as they have to answer difficult questions.
- All in all, the CHC assessment and nursing care fee recovery process can be lengthy, cumbersome, and even tortuous. There are typically long waiting gaps where you must wait for the outcome or decision to be sent to you, and then wait even for an appeal to reach the Panel, should you decide to go down that route.
- The process from start to finish, while ideally shouldn’t take more than just a few months, can often take years, as the affected person awaits a final outcome.
With professional legal support by your side every step of the way, you can be rest assured that each stage of the assessment, fee recovery, and appeals process (if required) is made easy, taking a huge emotional and financial burden off your shoulders. Don’t hesitate to contact our friendly and highly experienced solicitor today for a free initial consultation.
