Should I be paying for my care?

When a relative moves into residential care, the local authority will assess the individual’s means to pay for their care. At present anyone with assets or savings over £23,500 will be required to pay for their own social care and accommodation. Those with assets below this threshold will still be required to contribute from their income.

However, someone needing nursing care, whether in a care home or their own home, is entitled to this free of charge as it is provided by the NHS so an assessment to determine which needs are social and which nursing should be requested.

Eligibility

A continuing healthcare assessment results in the NHS meeting the entire cost of care, social and nursing, without any means testing or contribution. To be eligible for continuing healthcare, the main or primary needs will relate to health. There is likely to be a complex medical condition which requires highly specialised, constant, nursing support.

Even if not eligible for continuing healthcare, the NHS should fund, free of charge, that part of a package consisting of nursing care. The remainder is means tested as it is social care provided by the local authority. An accurate assessment of needs is therefore essential and any decision scrutinised carefully to ensure the Local Authority are not trying to charge for what is really nursing care.

Assessment

An initial checklist is completed by a nurse, doctor or social worker. If appropriate, a full assessment is carried out by a multidisciplinary team who will look at areas such as mobility, nutrition and behaviour. Anyone can ask for the initial checklist to be completed. With care fees averaging over £2000 per month it is always worth requesting an assessment.

Decision

A decision should be communicated within 28 days. Where someone is eligible for continuing healthcare, discussions will take place with the Primary Care Trust and the multidisciplinary team to determine an appropriate package. Since continuing healthcare can be provided at someone’s own home, consideration should be given to whether this is possible.

Appeal

A review of the decision must be lodged within 6 months of the notification. The PCT then has three months to deal with this request. If not satisfied with this outcome an independent review can be sought through the strategic health authority.

Retrospective assessment

It is possible for there to be a retrospective assessment of eligibility, even after the cared for person has died. There are cut off dates for seeking an assessment.

Complaining about a care home

Given the cost of care homes, one would be entitled to receive the highest standards of both care and accommodation. Sadly this is not always the case.

If you are not happy with the care or accommodation, for yourself or a relative, complaints should be addressed in the first instance to the care home. By law every home should have their own complaints procedure and a good home will make sure that this is followed quickly and fairly. If care is being funded by the local authority, their complaints procedure can also be used to resolve any problems. Since October 2010, anyone, including those who are self-funding, who is dissatisfied with the outcome of their complaint can refer the matter to the local government ombudsman.

The Care Quality Commission (CQC) is responsible for regulating care homes and their role is to ensure that a home complies with regulations and national minimum standards, rather than handle complaints about a care provider. However, where a complaint is about areas such as the standard of accommodation, this can be referred to the CQC.

If you have any queries feel free to contact us.