Lisa Morgan heads up the nursing care fee recovery team at Hugh James law firm. In the following analysis, Lisa explains what makes a person eligible for Continuing Health Care (CHC) and why so many people are being turned down for it. Crucially, she also lays out the recourse available to people’s families (even after the patient has passed away) in challenging the decision made by the NHS. Lisa has helped recoup millions of pounds for families across the UK and she can provide helpful advice to IFA Magazine readers on how you can provide even greater support for clients’ finances where care costs are concerned.
Arranging care for a loved one can be an emotionally challenging experience – not least due to the financial burden it entails. Sadly, it is not unusual for the cost of care homes to reach up to £10,000 a month.
With an ageing population, the cost of care is a real concern for over 50s, not only for their own future care costs, but the number of people in their 50s, 60s and 70s caring for elderly parents is increasing. The cost of care in the UK has risen by almost 10% in the past year to an average of £41,600 per annum for a residential care placement and an average of £56,056 for a nursing home placement, according to Healthcare analysts LaingBuisson. Many wealthy individuals will be at care homes that cost significantly more, and as the population ages, affording one’s own care might not be as straight forward as it once was. In many cases, as the cost of care increases, family members are being asked to pay a top-up payment on behalf of their loved one.
40% of people aged over 65 have a limiting long-term illness or disability, which is expected to rise to over 6 million by 2030. Yearly six figure care fees demonstrate the importance for those with healthy financial portfolios to be taking long-term care into consideration when managing their finances.
However, there is a fully funded option available to many people that does not have any bearing on the wealth of the individual or their family. For those who have significant ongoing healthcare needs, the NHS has a legal duty to pay the full cost of their care. If a patient’s needs primarily fall under health, rather than social care, they are entitled to a free package of care paid for by the NHS called NHS Continuing Healthcare (CHC).
This funding scheme is not very well known, and it can be difficult to get around the guidelines which are often applied too restrictively. With this in mind, many more people could be eligible for funding than it seems. Despite an ageing population, NHS England figures show the number of people successfully receiving funding after an assessment has dropped by a third in the last decade. There is also a clear postcode lottery with people in the North of England more likely to receive funding than those in the South.
Advisers must ensure that they have thoroughly checked whether their client in care is eligible for NHS Continuing Healthcare by making sure that they have been properly assessed by way of a multi-disciplinary team assessment. Every person needing long term care because they are ill should be assessed by their Integrated Care Board (ICBs) in England or Health Board in Wales.
Continuing Healthcare is often referred to as ‘fully funded care’ and is a package of care arranged and funded solely by the NHS. It can be received both in a private care home or at the home of the individual. If the individual demonstrates primarily health needs (be they physical or mental), then the NHS must pay for their care in full, regardless of personal wealth.
Eligibility for NHS Continuing Healthcare is not based on a diagnosis of an illness, rather on the type and amount of care that a person requires in order to meet their needs. A person can make retrospective claims for unassessed periods of care if a person has been in care for some time or has since died, which is important to take this into consideration.
For those approaching retirement and fearing the cost of care, this package could be a viable solution and eliminate the need to sell the family home. Unfortunately, it is often the case that individuals are wrongly assessed. 30% of those who should be eligible for fully funded nursing care are turned away. Families unhappy with a decision that has been made can challenge it via the NHS appeals process. This is a two-stage process, culminating in an Independent Review Panel. Statistics from the Department of Health reveal that 18% of challenges are successful at Integrated Care Board (ICB) level, and a further 30% on a national level.
Irrespective of a person’s financial portfolio, advisers should be aware that their clients may be legally entitled to NHS Continuing Healthcare so as to ease potential burdens such as liquidating assets or turning to family members for support.
Lisa Morgan is partner and head of the Nursing Care Fee Recovery team at Hugh James
