Are you paying for a relative’s long-term care? In many cases the NHS has an obligation to fund it…

Do you remember when Arthur Dent’s house was demolished at the beginning of Douglas Adam’s Hitchhiker’s Guide to the Galaxy? 

Arthur didn’t find out that his home was doomed until too late in the day.

The reason? It was because the plans were ‘on display’ in a cellar with no stairs or lighting, at the “bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.’”

If you’ve ever tried to find out whether an elderly relative or a person with long-term health needs qualifies for NHS Continuing Healthcare funding, you’ll sympathise with Arthur Dent.

Finding the right information can be a Herculean task in itself. Understanding it when you actually find it is equally difficult.

You may very well think that it was designed to be this way? Funding very hard to obtain?

Indeed, you may very well think that but I couldn’t possibly comment!

Healthcare funding – regardless of savings or income

So, it’s worth knowing that, in certain cases, people who ‘need ongoing care and support from health and social care professionals as a result of disability, accident or illness’ will qualify for a fully NHS-funded package of care that is not linked to savings or income levels.  In other words it is NOT “means tested”.

Exactly who is eligible for NHS Continuing Healthcare (CHC) is open to interpretation. Examples of people who have been awarded CHC include elderly people with dementia or Parkinson’s Disease, those with advanced cancer or adults with spinal injuries or conditions such as Multiple Sclerosis. Normally, eligible people will be in a community setting, such as in their own home or in a care home.

The decision to fund CHC is based first on a screening process and then on a full assessment. The nature, intensity, complexity and unpredictability of a person’s condition and needs are examined. Factors that are considered in detail include a person’s ability to breathe, communicate or feed themselves properly, plus their psychological needs, behaviour, continence, mobility issues and more.

Appeals and backdated claims

It’s a highly complex process and each case is decided individually. The better you understand how to apply, the higher your chance of success – so be sure to get advice from people who understand the process. If a case is turned down, it’s possible to ask the Clinical Commissioning Group to reconsider the decision and – if this doesn’t succeed – you can apply to NHS England for an independent review.

Importantly, if a person has been paying for their own care when the cost should have been borne by the NHS, it is possible (in some circumstances) to receive backdated funding. If that person has since died, the reimbursement can be made to whoever is entitled to it (normally a relative).

You can find out more about applying for NHS Continuing Healthcare here. This page contains a detailed video about eligibility and assessment, plus a link to a leaflet on the subject (PDF file).

The complexity of understanding and applying for CHC means that there will be many people out there paying for their care unnecessarily. Little wonder that there are a number of specialist legal firms that offer to pursue cases to reclaim care home fees and other costs.

So, if you are responsible for someone in need of complex, long-term care, don’t simply assume that there isn’t financial support out there. There is – and if you can make a strong, evidence-based case for NHS CHC funding, you can get the support that person needs while making sure they don’t lose their assets paying for it.

It’s time that locked filing cabinet was opened!

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