WHAT IS NHS CONTINUING CARE FUNDING?

NHS Continuing care describes the care which people need over an extended period of time, as a result of disability, accident or illness to address both physical and mental health needs. It can be provided in a range of settings, from an NHS hospital, to a nursing home, and people’s own homes.

If someone is assessed as needing NHS Continuing care the NHS arranges the care package and pays the whole cost.

ELIGIBILITY FOR NHS CONTINUING CARE FUNDING

To be eligible for continuing NHS health care, it must be shown that the person’s needs are primarily health needs as opposed to personal care/social care needs.

The following are examples of some of the needs/conditions which should be taken into consideration:- (This list is not exhaustive)

1. Mobility problems


2. Inability to self medicate


3. Levels of medication used.


4. Breathing difficulties


5. Poor sleep pattern


6. Fragile skin tissue


7. Inability to eat without assistance, swallowing difficulties


8. Nutritional problems


9. Inability to communicate and express needs


10. Incontinence


11. Cognitive impairment, inability to understand, manage affairs


12. Sensory impairment.


13. Levels of confusion, disorientation


14. Challenging behaviour, aggression or anxiety


15. Risk of harm to self or others


16. Prone to infections

These needs, particularly when combined with each other, may indicate that the person should be eligible for NHS Continuing Care.

APPLYING FOR NHS CONTINUING CARE FUNDING

In Wales, the Local Health Board is responsible for undertaking assessments for NHS Continuing care. If you are unsure whether an assessment has been made or of you want to ask for one contact your Local Health Board.

Nursing home

Anyone living in a nursing home should have been assessed for NHS continuing care funding before going into the home. However, it is always worth checking this as, in some cases, assessments for NHS Continuing care funding have not been carried out. Annual assessments by the Local Health Board should take place whilst someone is resident in a care home.

If a person in a nursing home has not been assessed as eligible for NHS continuing care, they will often still be eligible for a contribution from the NHS towards the costs of their registered nursing care. This is known as the registered nursing care contribution and is currently £119.66 per week in Wales.

Residential home

People living in residential homes have not usually been assessed for NHS Continuing care but as their health deteriorates it may become appropriate for them to be assessed. Please note that if an assessment is undertaken and the resident is considered eligible for NHS Continuing care, the NHS may decide that the resident should be cared for in a nursing home setting instead.

Your own home

The government’s guidance on NHS Continuing care states that it can be provided in someone’s own home and you believe that you or your loved one is eligible you should request an assessment.

CHALLENGING AN ASSESSMENT

If you believe that your loved one has been wrongly assessed you can request a review of their eligibility. If a review takes place and is successful your loved one should receive reimbursement of the care home fees paid. Even if your loved one has now passed away, you can still request a review of their eligibility for NHS Continuing care. If successful, your loved one’s estate should receive reimbursement of the care charges they have paid.

If your loved one was paying for their care between 1 April 1996 and 31 March 2003 but you believe they should have received NHS Continuing care funding you must submit your claim before 4 December 2009. However, at present, there is no deadline fro claims relating to a period which began prior to 1 April 2003 but continue after that date.

We can assist you to bring a claim. We have successfully represented many individuals to claim back monies wrongly paid in care home fees. For instance, one of our clients went into a care home on 23 May 2003 and was not assessed as eligible for NHS Continuing care funding despite being doubly incontinent, being diabetic, refusing to eat and having swallowing difficulties, having fragile skin, displaying inappropriate behaviour, being unable to communicate properly and suffering with severe pain in her legs. However, after attending a Review in September 2008 our client justly received over £99,000.00 from the Local Health Board. This lady continues to receive NHS Continuing care funding to date.

Please contact Laura Selby on 01633 867000 or email laura@rlob.co.uk for further information.

This article deals in general with a complex subject. No responsibility for any loss by any person as a result of acting in reliance on this article can be accepted by this firm. The article is written on the basis of the law and procedure in Wales as at 15 October 2009.