It can be confusing to understand who qualifies for a refund of care fees. We’ve broken down the five reasons why you may be entitled to a refund.
Here are five reasons why you may be entitled to a refund of care fees.
1. Do you have intense, complex or unpredictable care needs arising from a primary health need?
This does not have to be from a specific diagnosis. It may be the result of, for example:
• a severe illness such as Alzheimer’s, multiple sclerosis, chronic obstructive pulmonary disease, or Parkinson’s;
• a physical or learning disability;
• the effects of stroke or diabetes;
• an accident that caused injury;
• a severe mental illness.
If so, you may be eligible for NHS Continuing Healthcare funding. This is personal health and social care arranged and funded by NHS Clinical Commissioning Groups (CCGs). It can be received whether in a residential or nursing facility or at home. It is not means-tested and must cover all assessed care needs. If you have been paying care fees, you may be able to claim these back for assessed periods of care.
2. Have you been told you were not eligible for NHS Continuing Healthcare funding without being assessed?
Your CCG should assess you for NHS Continuing Healthcare if it seems you may need care. Usually there is an initial checklist assessment, which helps decide quickly if you need a full assessment. The exception is for urgent care needs – usually as a result of terminal illness – in which case the assessment should be fast-tracked. If the checklist suggests the need for a full assessment, this should be carried out by a team of trained health and social care professionals. If you think you should have been entitled to an assessment, you can ask for one retrospectively.
3. Has the NHS has carried out an NHS Continuing Healthcare assessment but downplayed or ignored your care needs?
The NHS should not carry out an NHS CHC assessment behind closed doors – it should involve the person needing care and their family and carers and consider their input where appropriate. If you believe the assessment did not give a complete or accurate picture of needs, you may be able to challenge this with evidence of your own.
4. Have you had NHS Continuing Healthcare funding withdrawn following a review, on the grounds of a reduction in care needs?
Were you told your care needs have reduced, even though this is purely down to good management of your condition – rather than any underlying improvement? Do you believe your needs are as intense, complex and unpredictable as ever? Again, you may be able to challenge a review with evidence.
5. Have you been asked to “top up” your NHS Continuing Healthcare to meet the needs set out in the care plan?
While the legislation governing local authority social care expressly provides for “topping up” care fees (though only in specific circumstances) the NHS are not permitted to ask for NHS Continuing Healthcare top-ups. (You can, however, pay for additional private services over and above those you need from the NHS – in certain circumstances.) Yet we know many recipients of NHS Continuing Healthcare are paying “top-ups”. You may be able to claim these back.
Because of Government rules you cannot now claim for a refund of care fees paid before 31st March 2012 unless there are exceptional circumstances as a strict deadline applies. You can claim a refund of care fees on behalf of someone who has since died as long as you have the authority to do so.
If you fill in our initial online questionnaire, Just Caring Legal can advise you further on whether you may have a claim.