How care homes fees are are allocated

You may have read articles in the media recently about families claiming back care home fees worth thousands of pounds from the NHS, in situations where they have been charged for the cost of care for loved ones who were wrongly assessed.

We find that clients are often concerned about this issue, after having been told horror stories by friends and family about other people having to sell their homes to meet the cost of care.

The state will provide funding to those who cannot afford to pay for care themselves, but this is based on a ‘means test.’

People with assets worth more than £23,250 will be expected to pay for their own care, which can be up to £700 a week. Those with between £14,250 and £23,250 will have to pay a contribution towards their upkeep, whilst those with less than £14,250 will have their care funded entirely by the local authority.

A house will not be taken into account for means testing if a spouse still lives there and the local authority can extend this exemption to other dependent relatives at its discretion. However, if a person lives alone, their house will be included in the means test after the first 12 weeks of care.

For those who require the assistance of a nurse, their care may be either fully or partially funded by the NHS. Continuing healthcare is the full funding provided by the NHS. NHS-funded Nursing Care provides partial funding for the nursing element.

People often struggle to qualify for NHS funding and there are frequent disputes about responsibility between the various authorities. When assessing whether a person qualifies for NHS funding, there are national guidelines that Primary Care Trusts must follow. However, the criteria are not applied consistently and assessments take a long time. The whole process can be very frustrating and quite often families simply give up.

Family members should ensure that they attend the NHS assessment meeting and obtain a copy of the report. If the family does not agree with the outcome, they are entitled to request a further assessment and a second medical opinion. Should funding still be denied, an appeal can be submitted to the Strategic Health Authority, followed by the Health Service Ombudsman. The final stage of this process is to issue Judicial Review Proceedings, but this must be done within three months of the Ombudsman’s decision.

The assessment and appeals process can take a long time – years in some cases. Our aging population means more people than ever are requiring care and this means Primary Care Trusts often have excessive numbers of cases.

If you are dissatisfied with the outcome of an assessment, don’t give up. Speak to a professional who will be able to offer more detailed advice about your rights and the appeals process.