A Deficit In Care Home Costs

Posted on: 13 October 2008 by Gareth Hargreaves

Anne asks solicitor Cate Searle whether the Primary Care Trust should pay her father's nursing care.

Cate Searle from Martin Searle Solicitors answers your questions on the intricacies of obtaining care home funding and the avenues you can take if your case has been refused.

Anne asks:

My father for the past two years has been funding his care in a nursing home. The PCT during this time paid the middle band fee for the nursing care. He contracted MRSA whilst recovering from a mionr operation which has resulted in him not being able to walk as the muscles in his leg have been eaten away by the MRSA.

The cost of the nursing home was £565 per week and my father paid this. Now, due to his funds reaching £21,000 he has recently been financially assessed by Social Services.

They have agreed to pay only £261 per week towards his care leaving a deficit of £89 per week. No mention of nursing PCT Funds. The rest of the funds are to be taken out of my father’s private and state pension.

Should the PCT still pay his nursing care which would assist us with the deficit?

Cate says:

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Cate Searle is from Martin Searle Solicitors: www.ms-solicitors.co.uk

Thank you for your query. It is difficult to answer this point comprehensively without seeing the financial assessment that social services undertook. If they have not given you a copy of the assessment, you should request the same. This may show that the “middle band” Registered Nursing Care Contribution paid by the PCT has been taken into account in the breakdown.

Many of my clients find that the amount of the fee that they are told to pay to the nursing care facility is expressed as a figure after the RNCC contribution has been taken in to account - for example, the actual cost is £652 per week, but the PCT have agreed to pay the middle band of £87, so the fee is presented as being £565 per week. Again, looking at the written financial assessment should show whether this is what has been done in your father’s case.

It could be the case that the PCT have reviewed the rate at which your father qualifies for the RNCC at the same time that Social Services took on responsibility for making a funding contricution. You should ask the PCT to clarify this. If they have decide that he now has no nursing care needs, or they have substituted only a lower band contributon, you may well want to appeal against this decision (seek a review). Have you considered whether your father may qualify for fully funded Continuing NHS Healthcare?

Again, it is difficult for me to do more than speculate without seeing the relevant paperwork, but I am concerned about what you describe as a “deficit” of £89 pedr week. By this, do you mean that your father’s private and state pension income come to £215 per week; and that he has a further £89 per week to fund his care? Have Social Services discussed “third party top up” payments with you? Have they left your father with a “personal expenses allowance” of £20.45 per week?

Part of this “deficit” may relate to what is called “tariff income” - they treat your father as if he erecevies an income of £1 each week for every £250 he has in savings (capital) between £21,500 and £13,000. These figures apply if your father is in England. So if your father has now got £20,000 in savings, he is treated as having a tariff income of £28 per week. This would not account for the whole “deficit” you refer to, however.

The above are general points that hopefully explain what might be going on, but you certainly need clarification. I do urge you to ask Social Services to give you a written breakdown, and if things are still unclear, seek specialist advice.

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