If your relative enters care, you should insist on an NHS Checklist being undertaken which would establish whether they have a primary health need in which case the NHS will fund the entire cost of care.
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If your loved one enters care, you may be worried about how you will pay the care fees. Before any discussions about the financial situation, the NHS is under a duty to undertake an assessment to ascertain whether your relative has a health need. If this is the case, then the NHS are obliged to meet the entire care of cost.
Throughout the entire process you (as your relative’s representative) have a right to be notified of any assessment dates, to attend the assessment, give your input as to your thoughts of the care needs and to appeal any decisions you are unhappy with.
This is the initial assessment and it’s purpose is to determine whether or not a full assessment for NHS Continuing Healthcare is required. The NHS Checklist has a low threshold to ensure that all those who require a full consideration of their needs do get this opportunity.
A nurse assessor will meet your relative to assess their care needs. This will look at care needs in the following domains; behaviour, cognition, communication, psychological need, mobility, nutrition, skin integrity, breathing, continence, medication and altered states of consciousness.
The threshold for this assessment is set intentionally low, as a there are two further assessments in the process as outlined below. Should the NHS Continuing Healthcare Checklist result in a determination for full eligibility, then the assessments detailed below will be carried out. If it is decided that your relative does not meet the threshold for the full assessment, then they will be liable to self-fund their care costs (means tested).
If eligible at the NHS Checklist stage, then a full assessment to determine eligibility for NHS Continuing Healthcare is completed using the NHS Decision Support Tool.
Both assessments look at different care domains but the NHS Decision Support Tool also takes into account the primary health needs test which looks at the complexity, intensity and unpredictability of the care needs as a whole.
Eligibility for NHS Continuing Healthcare should be awarded if a person scores highly in the Decision Support Tool.
When you receive the decision from the NHS they are under a duty to provide details and the process in relation to disputing a decision. Usually there is a 6 month time limit so be aware of this. If the concluding letter does not include this information, request it in writing and inform them of their legal duty.
If your relative has been found eligible, then the next dispute is backdating a reimbursement of care fees already paid. The NHS usually avoid this and just fund from the date of the outcome but it should be backdated (and reimbursed) to at least the date of the NHS Checklist. You can commence a retrospective review prior to the NHS Checklist and in this instance we can usually work on a no win no fee basis.
It may be the case that the Decision Support Tool does not make a recommendation for NHS continuing healthcare, instead offering eligibility for NHS funded nursing care. This is to cover the cost of any nursing fees and is usually paid directly to the nursing home.
However, even if your relative has been assessed as eligible for NHS funded nursing care and you believe their primary need for entering care is a health need, then you should still dispute the decision.
Unfortunately, if the NHS assessments demonstrate that your relative does not have a health need, then they are liable to self-fund their care. It is not until the NHS have completed the above assessments, can discussions take place about your relative’s assets.
Self-funding is means tested and the higher threshold is £23,250. Anything below that, the local authority will contribute part or all of the care fees. You do not have to disclose any financial information (if so, the Local Authority will presume you have the assets) but it is advised to have these financial assessments undertaken when your relative’s assets fall around £23,000