0370 1500 100

Later Life – challenging care funding decisions

The government’s delay in publishing its long-awaited green paper on social care has prompted council leaders to take action.

The Local Government Association (LGA) has launched its own consultation on how to deal with what it calls a funding crisis.

Individuals may face their own crisis when confronted with the costs of funding care, so fully understanding the options is a crucial first step. It is also important to remember that funding decisions can be challenged with the right advice.

NHS funding

For anyone in residential care or needing care in their own home, one option may be direct support known as  NHS Continuing Healthcare Funding (CHC).

Eligibility hinges on a tightly-controlled assessment process. A referral for a CHC assessment can be made by a GP, care home manager, or treating doctors as well as by the person with care needs or an advocate or family member.

An initial screening will filter out people who clearly will not qualify for the funding, using a checklist. Those who ‘pass’, move on to a full assessment carried out by a multi-disciplinary team. These professionals should build a profile of someone’s needs, looking at their needs in different areas and will also consider the complexity, severity and unpredictability of their needs.

They have a 10-point framework covering everything from behaviour and understanding to mobility and continence, and then a five-level choice of priority, from severe to no need. A CHC assessment can be provided in a variety of settings, including someone’s home or care home.

If someone has at least one priority need, or severe needs in at least two areas, they should be eligible for CHC. They may also be eligible if they have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.

In all cases, the overall need, and interactions between needs, will be taken into account in deciding whether an NHS continuing healthcare should be offered.

The assessment should take into account the views of everyone involved, and documents outlining the decision and the reasons for it must be made available.

If someone’s health is deteriorating quickly and end of life is approaching, an NHS continuing healthcare fast track pathway can be put in place as soon as possible, usually within 48 hours.

CHC is non means tested and so if a person is eligible, they will not be required to contribute to the cost of their care. For those who succeed in securing CHC funding, their eligibility will be monitored regularly – it’s funding for needs, not for life.

The options after assessment

In some cases, the NHS will contribute a portion of funding (“funded nursing care”) for people living in registered care homes who have been assessed as ineligible for CHC.

Those who are not eligible for CHC, may be eligible for support to meet their social care needs from the local authority. The person in need of support can request a needs assessment directly from the local authority, or a third person can request one on someone’s behalf. The request can be made using a template letter (available on our website) and the only criterion is that someone “appears” to need support, which means most adults with disabilities should receive a needs assessment when requested.

A social worker or trained assessor will usually visit the adult at home to discuss their needs, and take into account the views and wishes of the individual, their carer, and the whole family. The person’s finances, eligibility for support, or whether a carer is already providing support, should all be irrelevant at this stage.

The local authority has a duty to carry out an assessment, but just because they assess someone as requiring care does not mean they are obliged to foot the bill.

The authority will decide whether a person meets national eligibility criteria for its support and whether a person is financially eligible. The NHS may still make a contribution to a ‘joint package’ of care. A person will only be financially eligible for local authority support if they have less than £23,250 in capital. If they have less than £23,250 they may still be required to contribute to the cost of their care package.

Anyone turned down for CHC after a full assessment has a right to appeal against the decision. Irwin Mitchell can advise on whether there are grounds to challenge the decision and act as a guide throughout the appeals process.

Legal aid may be available for these cases, subject to meeting the Legal Aid Agency’s means tested eligibility criteria. We also offer fee arrangements for affordable advice.

Published: 18 September 2018

A monthly briefing from Irwin Mitchell Private Wealth

Sign up to receive a moment of clarity

September 2018

Key Contact

Kelly Greig