By Rosalind Hughes, founder, Just Caring Legal
It happens to around 5% of us, according to official figures. Well enough to leave hospital, but not well enough to return home. So what happens when that moment comes to someone close to you? Who pays for care after they leave hospital? In these Covid times, discharge is likely to be swift. Once they are clinically ready to go, community health, social care and acute staff should work together to ensure they are discharged in a “safe and timely manner”.
For people going from hospital into a care home for the first time, their care fees will be covered in full for six weeks. (Only until the end of June, though. After that it will fall to four weeks of post-discharge funding until September. And after that? Watch this space.)
Six weeks to decide who pays for care
Within that six weeks, all the necessary care needs assessments will have to be carried out. This will decide what care and support your relative needs and where it will take place. It will also decide who pays for care going forward. There are basically three options.
- The NHS will continue to fund their care because they have a “primary health need” and qualify for NHS Continuing Healthcare. This is not means-tested and covers all health and social care costs whether they are in a care or nursing home or in their own home.
- They will have mainly social care needs, in which case they will undergo a needs assessment by the local authority and also a financial assessment. If they have more than £23,250 in cash or assets, they will have to pay their own care fees in full.
- If they have less than this amount the local authority will fund part of their care.
If I have one piece of advice, it is this. Don’t be lured into answering any questions about your relative’s financial situation until they have been assessed for option 1. You may be told that your relative has already been assessed for NHS Continuing Healthcare and “doesn’t qualify”. But that’s not how it works.
Assessments for NHS Continuing Healthcare
The law requires the local Clinical Commissioning Group (CCG) to “take reasonable steps” to assess people for NHS Continuing Healthcare “in all cases where it appears that there may be a need for such care”. This should usually start with a “checklist”. This is a screening tool to see if a full, detailed assessment is appropriate. The checklist should not happen behind closed doors: you have a right to be involved in your relative’s assessment.
If your relative “screens in” for a full eligibility assessment, this should also be carried out within the six weeks. If it isn’t, the CCG will carry on footing the bill until it is. A multi-disciplinary team of healthcare and social care professionals will meet to complete a “decision support tool”. This is meant to help them assess your relative’s care needs using a range of inputs from health and care professionals. If they find evidence of a “primary health need”, they will recommend that the CCG pay for all of their care, including accommodation.
What is a primary health need?
This is where it gets interesting. There is no legal definition of “primary health need” – and it doesn’t rely on a medical diagnosis. To decide if someone has a primary health need, the assessors follow the decision support tool, which sets out different levels of needs in relation to 12 care ‘domains’. It includes looking at behaviour, cognition, mobility, nutrition and more. For each domain the assessors should identify which description most closely matches the individual’s needs. These range from “no needs” to “high”, “severe” or even “priority”. They then use this as the basis for a comprehensive assessment of the nature, severity, complexity and unpredictability of their overall care needs. You can find out more here.
Are you worried about your family member’s future after the six weeks post-discharge funding?
If your six-week clock is ticking and you are panicking, don’t! Instead, get in touch for a free initial assessment of your case. We can point you in the direction of further information and/or help you present the best possible case to those assessing your relative’s needs. If we think there is a good case for NHS Continuing Healthcare funding, we will tell you. If we don’t, we will tell you that too. So don’t fret in silence. Call us today and use the time you have to your best advantage.