Wealthy families turned down by NHS to pay for loved one’s care home fees – CHC analysis from legal expert, Lisa Morgan.

by | Dec 8, 2022

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Despite the NHS’ legal obligation to fund 100% of care home costs for those deemed eligible, many advisers’ clients are turned down for Continuing Healthcare (CHC). According to Hugh James Solicitors’ Head of care home fee recovery team, Lisa Morgan, this is because many have been incorrectly assessed.  

CHC is a service offered by the NHS where they pay 100% of a person’s care, irrespective of how wealthy a person or their family is.

In this article, Lisa lifts the lid on CHC as she explains how advisers can help their clients to understand where their rights lie with regards to expenditures that they do not have to pay, like care home fees, as detailed below:

November’s budget was disappointing in many ways for high-net-worth individuals (HNWIs), who are expected to foot the bill in aid of economic recovery. While there may be little way around certain measures the government are putting in place, such as the tax hike for those earning over £125,000, there are ways in which HNWIs can put their foot down on expenditures that need not be paid by them.

Which brings us to care home costs – a topic that is constantly making headlines owing to an unfavourable combination of factors, including the downward spiral of the UK economy, fewer people in the care profession and an aging population.

The latest blow has come in the form of the Government’s announcement to delay (and potentially scrap altogether) the introduction of a social care cap. The cap (which was supposed to be introduced in October 2023 until November’s budget said otherwise) would place a £86,000 cap on the cost of a person’s social care fees. Beyond this amount, the government would subsidise the funding.

 

What people are not made aware of is the existence of Continuing Healthcare (CHC). This is a service offered by the NHS in which they have a legal obligation to meet the full cost of a person’s care home fees, should they be eligible. Eligibility is entirely unrelated to a person (or their family’s) wealth. So while HNWIs may be able to comfortably meet the £6 – 7,000 a month that care homes charge, they should look at whether it is in fact the NHS’s responsibility for meeting this cost.

If a person requires long term care, the first consideration must be the health needs of this person as opposed to  their ability to pay. For individuals whose primary need for care is because of their health (as opposed to for ‘social’ reasons), then it is the NHS’ responsibility to fully fund their care.

Unfortunately, many individuals who should be deemed eligible are turned down for this funding having been incorrectly assessed by the NHS. A lack of awareness of the funding scheme coupled with guidelines that are often forgotten or applied to restrictively, means more people could be eligible for CHC.

 

What should happen?

So, how should this process be carried out?  The first step is to check whether an individual has been properly assessed for CHC by way of a multi-disciplinary team assessment. For any person requiring long term care because they are ill should be assessed by their Integrated Care Board (ICBs) in England or Health Board in Wales.

Those who are not the responsibility of the NHS, they are the responsibility for the local authority. However, unlike the NHS, the local authority can assess the individuals’ ability to pay. Currently in England, if a person has capital over £23,250 (£50,000 in Wales), they will have to meet the full cost of care.

 

In the event of being dissatisfied with the outcome of a CHC assessment, a person can challenge the decision through a review procedure. Many cases are turned down initially, but with persistence, a successful outcome can be reached.

It is also worth noting that fees can be recovered retrospectively. So far, at Hugh James, we have recovered over £200 million on behalf of individuals and families in wrongly paid care home fees.

What is the process for recovering wrongly paid fees?

 

ICBs in England will review unassessed periods of care back to April 2012. In Wales, it is extremely restrictive being that they will only review one year back from the date of request. The authority will look back at someone’s care needs int eh past to decide whether they should have received CHC care at the time. This is the case even if the person has since died.

Challenging CHC can be a difficult and time-consuming process. However, the department of Health Statistics show that 24% who challenge at ICB level are successful, with a further 30% at national level. If one is persistent and cases are argued in a thorough way, they will be won.

There is a thin line between healthcare and social care, however the impact on the individual is the difference between free care and care which is means tested. It is not because an individual is wealthy that they should be dismissed by a service that has a legal duty to fund their or their loved one’s care home fees.

 

Lisa Morgan is a partner and head of the care home fee recovery team at Hugh James Solicitors

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