subject: Getting back the costs of nursing and care home fees [print this page] Getting back the costs of nursing and care home fees
Families that have a close relative inside a residential care home because of physical or mental medical problems could be entitled to have their care home fees settled with the NHS and may be also allowed to get back those fees which have previously been paid for.
The scheme, called NHS Continuing Healthcare is provided for free for anyone eligible to it and can be provided in a patient's house or care home. If that person's primary need is one of health then they may meet the criteria, though the NHS also assesses persons by technique of four signals:
Nature - the kind of condition or treatment necessary.
Complexity - symptoms that interact, causing them to be difficult to manage or control.
Intensity - a mixture of needs that require routine interventions.
Unpredictability - unexpected changes in that person's affliction.
The ongoing medical care in the form of medical costs and residential care requirements ought to be given to those who have medical needs which are seen as being "complex and unstable" and they include sufferers from ailments like Alzheimer's and senile dementia. Nevertheless, it seems that there are variations in the way in which health authorities classify such illnesses. Some see them as "social factors" with others arguing they're health conditions. Therefore, those health authorities tending to prefer the former would be more likely to refuse to set aside funding for individuals with Alzheimer's and dementia throughout their area.
Several still see healthcare being a means-based issue and in some scenarios it is. For the people in a care home who do not qualify for NHS continuing healthcare, if they have over 23,000 in funds, which includes the value of that person's home then they would be assessed as being capable of meeting the full costs of their care. For the people with capital in between 14,000 and 23,000 then they will need to contribute part of their care fees, while those whose capital falls below 14,000 will get their healthcare costs paid for, although earnings from pensions and benefits needs to be paid towards those care fees.
Those of you that qualify under the NHS continuing healthcare the above numbers are irrelevant as they would be entitled to 100 % financing. Though, as has been encountered by many through the country, the hardest task is usually to persuade the local PCT or health authority that the individual concerned is really qualified.
Cases
The case of Hilda Atkinson is usually brought up when viewing NHS Continuing Healthcare. She was afflicted with dementia and her friends and family fought a lengthy battle in an attempt to encourage her local primary care trust, Plymouth Teaching PCT, that she was in need of 24-hour nursing care instead of "social care" for which she'd be charged.
The case was decided in 2007 within the High Court in London and so the PCT agreed to pay for 43,000 to cover the costs of her nursing treatment between January 2004 and July 2007 as well as agreeing to cover her fees from that point on. Her lawyers criticised the stance of the PCT as "unlawful and wholly unreasonable".
In 2009 the family of Judith Roe, who had been identified as having Alzheimer's, won a legal fight to claim back 100,000 in care home fees after NHS Worcestershire had refused to pay for her case, declaring that her condition was social rather than medical. Their final decision meant that Mrs Roe needs to sell her house to pay for the 600-a-week nursing home fees and brought about a five-year fight between her family as well as the NHS.
Mrs Roe's son highly criticised the local PCT and said: "I want anyone else going through a similar experience to know they may be entitled to care. Even if they're being told they're not entitled, they should fight for it. With us, they made a mistake. They did not carry out their duties properly."
In a similar case last year, the family of Leslie Terry retrieved nursing home fees which should have always been paid for through the NHS as part of continuing healthcare. The family of Mr Terry, who is affected by Alzheimer's disease, initially had to pay the 3,500 per month for his long-term nursing care and had not been told of the continuous healthcare system. His family also highlighted the importance to families in a comparable circumstance, of asking for all available information to avert being placed into much the same situation.
Help at hand
For individuals who believe that a family member has actually been incorrectly evaluated, and that this assessment occurred before October 2007, then their first act is usually to speak to a social worker, health practitioner and even somebody at the primary care trust to ask for a continuing care review or perhaps a retrospective assessment dating back to when the relative was first admitted to the nursing home.
The family member involved can reclaim charges retrospectively even if the individual involved no longer lives inside the house. In England claims can be made for care home fees from April 2004 onwards.
For those unsatisfied with a decision which has been made, the initial course of action should be to seek an assessment the decision by the original decision making body, via a written appeal. Additional facts to support their claim may be gathered and also the case submitted to the panel to evaluate once more.
In case a relative continues to be unsatisfied after that point they can seek an independent evaluation by the local strategic health authority.
