Nursing home fees and NHS care

Money Talk By Susan Midha Adams and Remers solicitors

Various guidelines are in place regarding free care

A typical scenario: your father is admitted to hospital, perhaps following a fall or a stroke at his home.

His doctor has said that he cannot return home because he would not be able to cope.

The nursing staff want his bed, and the local authority, after checking that your father owns his own home and therefore is "self-funding", gives you a list of care homes.

They imply that it is now up to you to find a care home for your father to move to, and quickly.

If your father lives in England, despite government guidelines and numerous cases in the courts and investigations, your father will still not necessarily receive the free care he is entitled to, unless a relative or friend knows the options available and has the confidence, and the time, to push for it.

'Self-funders'

So what should be happening in these circumstances?

Eligibility is not an objective test based on diagnosis, but an assessment of the needs of the patient 'Free personal care' for elderly Q&A: Social care plans

The various parts of the United Kingdom have similar but not identical systems in place.

In England the local authority has a responsibility for the frail elderly, whether they are "self funders" - going to pay for care themselves - or not.

While you can assist if you wish to, it is not your responsibility.

So, the hospital should not discharge your father without:

• a multi-disciplinary assessment of his needs, including the observations not only of your father's doctors, but his immediate family or carers, occupational therapists, and any specialists dealing with his particular condition

• a written care plan. Could he return home with assistance provided by carers? Does he need residential or nursing care? Or does he need a home with special facilities e.g. for dementia care?

• confirmation that he has been assessed for fully-funded NHS continuing care, and the criteria used in the assessment.

Fully-funded care

But what is fully-funded continuing care from the NHS, and who is entitled to it?

Susan Midha, Adams and Remers solicitors

It is care provided in hospital, a care home or in one's own home, which is funded by the NHS and is not means-tested.

Eligibility guidelines are set down by the government, but interpretation of those guidelines in England is up to the local NHS Trust.

Continuing care is not the same as something called the nursing care contribution - a flat rate of £101 per week paid to care homes on behalf of residents.

Eligibility is not an objective test based on diagnosis, but an assessment of the needs of the patient.

Two tales

As an example, take two patients, both with Parkinson's, both of whom are due to be discharged to the same nursing home.

It is important that the patient awaiting discharge has an advocate to make sure that appropriate care is provided

One of them has breathing difficulties, double incontinence, an unstable medical condition and needs regular supervision from, say, palliative care specialists.

His nursing home fees will be paid for by the NHS regardless of his means.

The other patient's needs do not, in the opinion of the medical staff making the assessment, meet the eligibility criteria.

He will pay for his own care until his capital falls to below the limit at which the local authority will contribute to his funding.

It is the NHS who will have to find the funding if they conclude that continuing care applies, and they make the assessment.

Which is why it is important that the patient awaiting discharge has an advocate to make sure that appropriate care is provided and appropriately funded.

Entitlement to assessment

But what can be done if, say, your mother is already in a nursing home, paying for her own care?

If she has never had a needs assessment, or if her health has deteriorated since her last assessment, she may be paying for care which should be paid for by the NHS.

In her case she is entitled to be assessed, although there is no mechanism in place to make sure that this is done automatically and the family may have to insist on one being carried out.

Following such assessments, the NHS has had to repay millions of pounds to elderly residents or their estates in respect of care which they should have received free.

This has sometimes come only after following the NHS Complaints procedures and eventually taking the case to the Ombudsman.

If you think a friend or relative may be paying for his or care inappropriately, a solicitor with experience of such cases will be able to guide you through the process.

This would start with obtaining an assessment, and looking in detail at it to check that it is factually accurate, and that the eligibility criteria have been correctly applied.

Sometimes it is necessary to challenge the criteria themselves as there are still health authorities whose criteria do not conform fully with the law as laid down by the courts and the Department of Health guidelines.

An understanding of how the system works can greatly contribute to ensuring that your friend or relative receives the care which is right for him or her - and that any charges levied are legal.

The opinions expressed are those of the author and are not held by the BBC unless specifically stated. The material is for general information only and does not constitute investment, tax, legal or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.

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