How To Get Care Home Funding

When a close relative has a health crisis and can no longer live at home, many of us face the prospect of securing nursing home care while hoping there are funds to foot the bill. Funding does exist for some types of nursing care need in England, Wales and Northern Ireland, however, the criteria are complex and the process frustrating. A different approach applies in Scotland where nursing and social care costs are currently funded in full.

Cate Searle, a solicitor specialising in continuing care funding at Martin Searle Solicitors, offers some straightforward advice to take the strain out of securing NHS continuing care funding, in the light of rules introduced in October 2007.

The Basics

The National Framework and Decision Support Tool introduced in England on October 1st, 2007 aim to establish a fairer and more consistent system for determining whether an individual's care should be funded by the NHS.

However, the same basic qualification principles apply; the individual must require healthcare services that are not merely incidental to the provision of accommodation or which are not of a nature that social services could be expected to provide, such as help with washing, cooking and so on.

How Need Is Assessed

Central to the National Framework is the primary health need test. Unfortunately, the phrase is not defined. The concepts of nature, intensity, unpredictability and complexity of nursing care need are still relevant, but the Primary Care Trust (PCT) will use the Decision Support Tool to assess the level of an individual's needs in 11 care domains.

This is used alongside other evidence to determine whether an individual has a primary health need - as opposed to a social care need alone, where costs are not covered by the NHS.

So what can and should you do to ensure the right decision is made in your own or a relative's case?

Request A Healthcare Needs Assessment

Make sure the PCT assesses healthcare needs at an early stage - preferably at the time of, or before, Social Services assesses finances.

PCTs now have to take reasonable steps to ensure an assessment is carried out in all cases where there may be a healthcare need.

However, this may not happen automatically and you should ask. If this is refused, ask for a needs checklist to determine if a full assessment is necessary and consider seeking advice if the PCT refuses this request or if it rejects a full assessment.

Check The Assessment

Ask for the Decision Support Tool document usually completed by the PCT's nurse assessor after consulting with the multidisciplinary team involved in your relative's care - you may need Enduring or Lasting Power of Attorney for this. You or your relative may be asked to comment.

Check the document and any supporting evidence to ensure it is an accurate picture of your relative's healthcare needs taking all relevant factors into account. For instance:

• Does it take into account supervision or specialist mental health nursing requirements as a result of dementia or Alzheimer's?
• Is a need defined as moderate when it should be high, severe or priority?

Have Your Say

Put your comments in writing and ask for them to be presented to the PCT alongside the Decision Support Tool and the multidisciplinary team's recommendations. The decision on NHS continuing healthcare funding will normally be made by the PCT panel at a closed meeting.

Get Specialist Advice

If the correct assessment procedure has not been followed or the assessment or the funding decision is wrong ask the PCT to register a review - it costs nothing and you can withdraw if a solicitor or specialist local charity suggests you have no prospect of success. Act quickly as PCTs set deadlines for registering appeals.

Request Reassessments

If your relative does not qualify for NHS continuing healthcare funding ask the PCT to re-assess their eligibility if their health declines and their healthcare needs increase.

Investigate All Possibilities

If the PCT decides your relative does not qualify for fully funded care and Social Services suggest you should sell your relative's home to pay fees, ask a specialist if there is any way the value of the family home should be ignored by the financial assessment. Social Services has discretion to ignore the value of a home in assessing an individual's ability to pay for care, but they will not exercise it unless asked to do so.

Remember to check your relative is getting all of the benefits to which they are entitled as a self-funding resident.

A Deferred Payment Agreement with Social Services can allow you to delay the sale of a home by putting a charge - similar to a mortgage - against the property. When you sell the property, Social Services recover care fees from the sale proceeds.

Please note, the above applies to continuing healthcare funding in England. Different guidance operates in Wales (www.wales.nhs.uk) and Northern Ireland (www.dhsspsni.gov.uk). Anyone seeking funding might want to consider seeking specialist advice. A different approach applies in Scotland (www.show.scot.nhs.uk) where nursing and personal care costs (but not accommodation costs) are funded at set levels.

Cate Searle is a community care law solicitor in the area of continuing healthcare law. Find out more at www.ms-solicitors.co.uk.

Read the next article, How To Challenge A Nursing Care Funding Decision

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