Care home fee challenges are becoming increasingly common as people are refused help with their care home fees. Most people will end paying for care at some point in their lives and it can come as a surprise that care home fees are not always covered by the NHS. Continuing Healthcare Funding, also known as CHC Funding is provided by the NHS and can cover up to 100% of the cost of care. Pilgrim Hope can help if you feel that you or a relative qualifies for CHC Funding.

The average cost of care for a nursing home can exceed £800 per week (£41,600 a year).

This means entire life savings can very easily be spent on care.

I thought the NHS paid for all of my care. Why am I being asked to pay care fees?

Many people are shocked to find out that the NHS does not automatically cover care home fees, or care at home fees, even when they have a serious medical condition such as Dementia or Parkinson’s, or after a stroke. The NHS only has a legal duty to fully fund care costs if the individual has a primary healthcare need. It can be difficult to persuade the NHS that you or your relative has a primary healthcare need and should qualify for Continuing Healthcare Funding (also known as CHC Funding).

What is CHC funding?

If the primary need for care is a health need the full cost of care should be paid by the NHS. The funding is called Continuing Healthcare Funding also known as CHC funding. NHS CHC funding is not means-tested and it can cover up to 100% of care costs.

How do NHS England assess a primary healthcare need?

The NHS continuing care Framework is intended to provide a method of considering the evidence of need. There are four characteristics of need:

  •  Nature
  •  Intensity
  •  Complexity
  •  Unpredictability

Each of these characteristics may, on their own or in combination, demonstrate a primary healthcare need. The Framework requires that health needs are considered in 12 domains (behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin and tissue viability, breathing, drug therapies, altered states of consciousness, and other significant care needs).

There is a lack of consistency in terms of interpretation of the Framework by Clinical Commissioning Groups across England, and decisions can be challenged. The usual time limit for requesting a review of a decision of ineligibility is 6 months following notification of the decision.

Do not to delay in contacting our expert team.

I am eligible for NHS Continuing Healthcare and want to stay in my own home. Can I?

Care at home costs can be paid by NHS Continuing Healthcare but the funding rates offered may not cover the true cost of the care at home package. The NHS may say it is too risky to have care at home and try to persuade you to agree to a Nursing or Care Home. An NHS Personal Health Budget could help.

If your local Clinical Commissioning Group has a resource allocation policy that limits the amount that they will pay for your care at home to about the amount they would pay for you in a care home, contact us.

What is a “self funder”?

In simple terms, if your assessable savings and capital are more than £23,250 you’re expected to fund your care costs in full until your savings fall below that level. The thing to note is that your assessable savings could include your home. If you own a property, the value of your home may be disregarded for up to 12 weeks but if your assessable capital (apart from your home) is more than £23,250, you’ll normally have to self-fund as soon as you move into the care home.

Deferred Payment Agreements (DPA) mean you won’t necessarily have to sell your home whilst you’re in care. A DPA is a loan agreement with Social Services which allows you to “borrow” against the value of your home instead of selling it. Social Services will contribute towards your care home fees and apply a Legal Charge against the property. The loan will have to be paid back when the person in care dies, or when the property is sold, whichever is the sooner.

Giving away savings or your home to avoid the risk of having to sell it at a later date to pay for care fees doesn’t get rid of the problem. This is because the care rules make it clear that giving away money or signing over your house to someone else might be considered an intentional deprivation of assets. This means that the Local Authority could treat you as if you still owned your house even after you’ve given it away and you could still be liable for all of your care fees and not have the money to pay them as you don’t own your house anymore!

I’m going into care and my home is occupied by another relative. Do I have to sell?

It depends who lives in the property, how old they are, whether they have a disability, whether they are dependent on you, whether they have been caring for you and possibly also how long they have been living there.

I have been in hospital and want to go home but need to recuperate in a convalescent home for up to 6 months. Do I need to sell my home?

The value of the home MUST be ignored if the stay in care is “temporary” and the resident intends to return to it or to sell it and buy a more appropriate property. Temporary stays can be up to 52 weeks or longer. You may need legal advice if Social Services regard the care placement as permanent when you still have a realistic opportunity of leaving the care home and returning home.

I have been told I am going into interim care for 6 weeks. Do I have to pay?

It depends upon the nature and purpose of the short-term care package being arranged. Health & Social Services should confirm whether this is “temporary care” or “Intermediate Care” as the funding rules differ. No charge should be made for a package of Intermediate Care, but you may not qualify for this particular source of help because there are other criteria. If in doubt, seek advice. The value of your home should be disregarded in any short term or temporary residential care package.

Social Services told me to cash in my Life Assurance Policy to pay for my care, but my Financial Adviser said it was protected. Who is right?

The surrender value of a life insurance policy, endowment policies and some Investment Bonds should be normally be disregarded (ignored) by Social Services. This may depend upon when and why you bought the policy. Social Services may dispute whether a policy is a life policy so get specialist legal advice before you cash in the investments.

The rules regarding eligibility for care funding can be complicated but we can help guide you through this maze and help you get back money you or a loved one has paid for care.

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