Last night, The One Show aired a segment, led by Iain Lee, on the cost of social care. However, while the focus was on social care, there was little discussion about when social care tips to a primary health need. In such a case, care should be funded. However, it is still largely unknown (and little promoted) that NHS Continuing Healthcare Funding is not means-tested, and is actually based upon a person’s ‘primary health need’.
The greatest battle that families seem to regularly face is misinformation. Families are coming to Just Caring Legal believing that all of their options have been exhausted. In some cases, having already paid out thousands of pounds for care fees. The average cost of care fees is £44,000 per annum. Yet, the law is clear. If someone has a ‘primary health need’, they should not pay for their care. This means that the resources of a person (or family) should not be considered as a factor that could limit financial support. A lot of my clients don’t seem to know this.
Financial thresholds calculated for social care do not apply in the case where a person has a ‘primary health need’. Yet, families still come to Just Caring Legal asking if they must sell their home or use their savings to pay for care that they are entitled to by law.
All too often the same situation is repeated. A person may exhibit a healthcare need that meets the criteria to be eligible for NHS Continuing Healthcare Funding. Yet, various sources will state that they do not qualify. They may hear “you are not entitled”, “you have too much money/too many savings” or “family are not included in the process”. They are then told, or left to assume, this is the end of the process. Client’s are left believing they can’t receive funding, and that they do not have a right of appeal.
In other cases, clients are simply not told that they should be considered for NHS Continuing Healthcare Funding at all. These issues are also highlighted by recent NAO reports and Continuing Care Alliance reports. If people, typically (but not limited to) older people and vulnerable people, exhibit a ‘primary health need’ then there is a statutory duty from the relevant authorities to consider the individual for Continuing Healthcare Funding.
For example, one client asked how Just Caring Legal could help her husband, who had a recent stroke, pay for care. The effects of the stroke were serious and he could no longer move, feed himself speak or ask for help. All his daily needs had to be anticipated, particularly as he could no longer physically move or verbally communicate his needs. They did not know that they could possibly be entitled to funding. They thought they would have to pay for care as they had savings. Firstly, Just Caring Legal establishes the nature, intensity, complexity and/or the unpredictability of healthcare needs and if they meet the criteria. If the standard of eligibility is met, then Just Caring Legal will make the application. At no point should finances be discussed. NHS Continuing Healthcare funding is not means-tested.
Another client contacted Just Caring Legal who had a relative with profound disabilities and cognitive impairment. She had “extreme” issues with dealing with the administration for accessing NHS Continuing Funding, but through a lengthy process, was able to receive support from my firm.
Another client – Jane* – approached Just Caring Legal for advice on behalf of her mother. Jane’s mother had Alzheimer’s Disease. After worsening behavioural problems that were becoming more challenging and a series of falls, Jane’s mother was admitted to hospital in early 2017. During her stay in hospital, Jane’s mother was assessed as unable to return home as her needs were too great. She was assessed over two months. Jane was then informed by NHS staff that her mother did not qualify for NHS Continuing Funding.
However, the ‘checklist’ process to assess whether Jane’s mother did qualify was filled with irregularities. Inaccurate and incomplete information was included. The severity of her mother’s condition was also downplayed. Just Caring Legal was able to advocate for Jane’s mother and the decision was overturned. The process was carried out again, done properly and she received full funding for care. However, Jane and her family said they were left with little faith in the system or the hospital.
Often clients have no idea what rights – or what funding – they are entitled to. Just Caring Legal ensures they are assisted throughout the whole process. With full advice and support, they end up saving (on average) £3,000 per month / £44,000 per year when they secure full NHS Continuing Healthcare funding to pay for care costs. As a result of support and relentless advocacy, families can receive the support that they are entitled to. With the right information, families can ensure that they are looked after. This means that, ultimately, they experience far less stress once the process has been successfully navigated.
Clients often say that ‘we couldn’t have done it without you’. With accurate information and guidance, families don’t have to feel isolated by the process. Families can be put at ease over their future, and secure the healthcare funding that should, in many cases, already be theirs.
Watching The One Show, I was a little frustrated at the lack of information regarding NHS Continuing Healthcare Funding. On such a prominent platform, the message that the funding is not means-tested was, sadly, absent. Whether your needs are healthcare needs or social care needs is still a grey area, but the distinction between the two is vital in determining who pays for care. It’s an area in need of greater attention so that people can know that they may qualify for funding. Yet, the fundamental misunderstanding around the funding seems entrenched across the UK. With greater information, many more people will be able to access the funding they are entitled to.
*Names have been changed to protect client confidentiality.