Points of Law: Care home fees

The NHS is under a duty to meet the entire cost of care, should it be demonstrated that an individual has a primary health need in comparison to a social need

The NHS is under a duty to meet the entire cost of care, should it be demonstrated that an individual has a primary health need in comparison to a social need

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Lawyer Amy O’Sullivan from Seatons Solicitors in Corby writes for the Telegraph.

“I have been challenging NHS decisions in relation to care fee funding for several years.

If a relative enters care, and you are informed that they have to self-fund their care, you take that as a given.

Many people are not informed about the concept of NHS Continuing Healthcare or where to go about finding out about it.

The NHS is under a duty to meet the entire cost of care, should it be demonstrated that an individual has a primary health need in comparison to a social need.

It should be noted that the eligibility criteria is extremely complex and it is not based on the diagnosis of a particular illness.

In order to establish whether an individual has a primary health need, 11 domains are assessed including factors such as behaviour, cognition and mobility.

These are scored based on the level of need within that domain.

Following this the nature, intensity, complexity and unpredictability of the overall care needs are assessed.
At that point, a decision on eligibility for NHS Continuing Healthcare is made.

Even if your relative has already been assessed for NHS Continuing Healthcare and the decision was negative, you still have the right to appeal against the decision.

We understand that appealing against a decision can be emotionally draining.

From experience, the NHS does not follow its duties set out in the National Framework Guidance, so frequently individuals are unfairly assessed.

Had the NHS fulfilled its statutory duties, that individual may have been found eligible for NHS Continuing Healthcare.

The consequence of this is significant.

With the average care home fees amounting to £555 per week, and nursing fees at £687 per week in the East Midlands, challenging an incorrect decision can save the individual thousands of pounds.

If an individual has assets totalling less than £23,250 then the local authority will meet the majority, if not entire, cost of care.

If the individual has their own property, or vast savings, then these will be depleted at a steady rate if they are self-funding care.

If you believe your relative should be eligible for NHS Continuing Healthcare, please do get in touch.

If your relative has been in care for several years then it is possible to commence a retrospective review for NHS Continuing Healthcare.