One of the biggest scandals in elderly care is the number of people wrongly charged care fees. Tens of thousands of elderly people in the UK have been illegally forced to sell their homes and everything they own to pay for care that should be provided by the NHS – through NHS Continuing Healthcare funding.

This funding is provided for people who need full-time care primarily for health reasons. If this applies to your relative, and yet you’re being told to pay care fees, ask for an NHS Continuing Healthcare assessment.

NHS Continuing Healthcare is also known as Continuing Care. It’s available no matter what accommodation your relative lives in: It could be their own home, it could be a residential home or it could be a nursing home – or somewhere else. The assessment process is the same.

There are two stages to the initial assessment process:

Stage 1: This is called a ‘Checklist’ assessment. It’s a short ‘screening’ assessment that looks at 11 different types of health needs. The combined scores across all needs determine whether someone warrants going through to the second stage full assessment.

Stage 2: The full assessment uses a form called the Decision Support Tool (DST). In this full assessment, as well as giving scores as before, the assessors also look at how stable or unpredictable your relative’s health needs are, and how complex and intense their needs are. This is the point at which many families find the assessment process gets very subjective – especially for people with any degree of dementia. That’s why it’s vital that a family member is present at all assessments, to make sure that all aspects of health are considered and that nothing gets overlooked.

If your relative is still at home but needs full-time care…
Ask their GP to refer them for a Checklist assessment for Continuing Care. This assessment can be done by a GP, a district nurse, a social worker or other health or social care professional. Unfortunately many GPs are not familiar with Continuing Care. This is not only frustrating for families but it means many elderly people slip through the funding net. Don’t be put off by someone telling you that your relative ‘won’t qualify’. No one can possibly know that until an assessment has been done. If your GP won’t help, ask your contact from Social Services – and remember that no one should do any financial assessment until a Continuing Care assessment has been done.

If your relative is in a care home and is being asked to pay care fees…
Ask the manager of the care home if your relative has already been assessed for Continuing Care. If so, ask to see the notes. As your relative’s power of attorney or formal representative you can also contact the NHS directly and ask for a copy of the notes. If no assessment has been done to date, ask the care home manager to arrange for a Checklist assessment to be done. As before, no one should do any financial assessment until a Continuing Care assessment has been done.

In either situation, if you’re told your relative will not go through to a full assessment (Stage 2), and yet you believe their health needs warrant NHS funding, you can ask for this full assessment to be done. If you’re still turned down at that stage, you can appeal.

Read more about NHS Continuing Healthcare assessments. It could save your relative losing their home to pay for care.

As you may have also heard in the news, the government has recently imposed new deadlines for retrospective claims for Continuing Care. Don’t miss out! Read more here
 
 

If a hospital decides someone no longer has ‘acute’ health needs, it will want to hand the person over to Social Services as quickly as possible – and will often put immense pressure on Social Services (and on you as the next of kin) to get the person discharged.

If you have an elderly relative in hospital and you’re being pressured into finding a care home for them – or Social Services are threatening to find one for you – follow these tips:

1. Your relative should be assessed for NHS Continuing Healthcare funding before they’re discharged. This is NHS funding and it covers 100% of the costs of ongoing full-time care if you need it primarily for health reasons. Many people are discharged without this assessment having been done – effectively forcing them to pay for care.
2. Make sure the hospital knows you want to attend all assessments. If you have power of attorney for your relative, this should be straightforward. If you don’t, but your relative still has mental capacity to give consent to you being their representative, this should also be reasonably straightforward. If you don’t have power of attorney or consent, it can be more difficult to get to see assessment notes – but always ask. You don’t have to tell the hospital that you don’t have power of attorney. It’s up to them to ask you.
3. Make the Discharge Team aware that you know about NHS Continuing Healthcare funding. Also, make sure you have been given the opportunity to attend these assessments and appeal any decisions about funding that you don’t agree with – before your relative is discharged. Once the Discharge Team is aware of your knowledge, they may stop pressurising you so much.
4. At the point where the hospital decides your relative is no longer their responsibility, the hospital will issue a ‘Section 2 notice’; this is effectively a notice to Social Services that the hospital is handing over responsibility for your relative’s care to the local authority. However, if your relative needs ongoing care for health reasons, this handover should only be done after a proper assessment for NHS Continuing Healthcare funding has been carried out.
5. Once your relative is ready to be discharged from hospital, make sure that on the day of discharge they are still properly cared for – and not left in a Discharge Lounge for hours. Your relative should be properly dressed and fed, given enough drinks, and have any continence needs addressed throughout. Just because the hospital may want to free up their bed in the morning, doesn’t mean the NHS can wash its hands of responsibility for care while your relative is still on the premises.

Read more about NHS Continuing Healthcare funding.
 
 

Acute hospitals are supposed to have an older people’s mental health liaison team in place to ensure that people with dementia – arguably the most vulnerable people in our society – are discharged into the most appropriate care.

What’s alarming, however, is that most people with dementia, whether receiving day-to-day care in their own homes or in a care home, end up in the hands of carers who may just have an NVQ but no other relevant qualifications or skills relating to the needs of people in their care. They often have no specific experience of dementia and no specialist training.

A recent Care Quality Commission report highlights that in 25% of care homes surveyed, staff were unsure about the health needs and care requirements of the people in their care. If a sick child were placed in the care of someone who was unqualified to look after it, there would be uproar. And yet it seems ‘OK’ for this to happen to elderly people with a serious brain disease.

If you’re currently looking for a care home place for a relative with dementia, do your homework. Obtaining a list of care homes in your area providing EMI (Elderly Mentally Infirm) care is fairly straightforward, but actually choosing the home can be harder.

If the care home you’re visiting has a special Elderly Mentally Infirm Unit (EMI), always ask to see it. It may be a separate EMI unit that is kept locked. Although keeping people safe is important, EMI residents still need fresh air, sunlight, access to the garden and other stimuli. In some homes EMI residents never go outside that locked unit.

There are some good care homes though, and it’s vital to ask the manager specific questions to get a good idea of their approach to people with dementia. These 3 critical questions will get you off to a good start:

1. How much knowledge do the carers and nurses have about dementia and its associated challenges?
The home may say that it has other residents with dementia, but this doesn’t necessarily mean the residents’ needs are well understood. Ask open questions such as, “What specific training do you give your carers in looking after someone with dementia?” or “What do carers do differently when they’re with someone with dementia?” The answers will indicate more fully how much they really understand the disease. If the answer is simply that the staff are ‘fully trained’, keep asking questions. How exactly does the care home educate its staff about dementia? It’s also worth asking whether the home invites any specialist dementia nurses in to help train staff in dementia.

2. What patterns and designs are on the carpets and curtains?
This might sound like an odd question, but people with dementia or mental confusion can find some bold patterns or certain prints disorientating and sometimes frightening. It can also worsen the severity of hallucinations. The same applies to lighting where certain shadows are cast. A good care home will be aware of this. The Alzheimer’s Society has an interesting web page about patterns and lighting for people with dementia.

3. How much do residents get involved in the day-to-day operation of the home?
For example, if your relative likes gardening, what opportunities are there for them to make important decisions about maintaining the garden? Generally speaking, the more involved residents are, the greater their sense of purpose and value will be, the more they will engage with activities (instead of being passive recipients). This often manifests itself in stronger mental health and wellbeing.

Be persistent with your questions about dementia at any care home, and don’t be pressured into making a quick decision. Then, once you’re satisfied that the home can provide proper care, ask for a trial period to start with.

Find out more about going into a care home.
 
 

NHS funding is available to cover 100% of care fees for elderly people with predominantly health needs. This is called NHS Continuing Healthcare. (It’s also called ‘Continuing Care’ or ‘fully-funded nursing care’.)

However, many people are not told about this funding, and many families who ask about it on behalf of an elderly relative are simply told they won’t get it – and that there’s no point in doing an assessment.

This is not only completely wrong (because everyone with health needs going into full-time care should be assessed for Continuing Care), but it also puts families off pursuing things further. It means elderly people often wrongly lose their homes and everything they own to pay for care that should be paid for by the NHS.

It is one of the biggest scandals in elderly care in the UK.

At Care To Be Different we hear from many families who’ve been given incorrect information about Continuing Care by the health and social care authorities. That’s why we’re sharing with you the 7 most outrageous reasons we’ve heard to date for elderly people not being assessed. We’ve also included some useful tips about what to say in response…

1. “You won’t get funding because not many people do.”
No one can possibly make a decision about funding until an assessment has been done! If your relative needs to go into a care home, or needs full-time care at home, they should be assessed for NHS Continuing Healthcare ideally at the start, but certainly within three months of starting to receive care. If your relative is in hospital, they should be assessed BEFORE they’re discharged.

2. “We’re not doing an assessment because you won’t qualify.”
Again, no assessor (or care home nurse) can make a judgment about this without doing an assessment. The first assessment is a screening assessment called the Checklist.This determines whether your relative will receive a second full assessment using the Decision Support Tool. Make sure you’re present at every assessment.

3. “To get Continuing Care you have to be about to die.”
The eligibility criteria for Continuing Care look at your ongoing health needs, not how long you have left to live. There’s no limit to the length of time you can receive Continuing Care, and it has nothing to do with how close you are to the end of your life.

4.“There’s no Continuing Care contact here.”
There may not be a Continuing Care contact where your relative is based, but that’s irrelevant. The NHS must arrange for someone to be available to do the assessment.

5. “The care you need is too expensive.”
If your relative’s care needs are primarily health needs, it doesn’t matter what their full-time care costs; the NHS has a legal duty to pay for it, including the costs of accommodation in a care home.

6. “We’re too busy to assess you.”
It doesn’t matter how busy the local NHS Continuing Care Department is – or how busy any other assessor is – your relative should be properly assessed. As your relative’s representative, you also have the right to appeal any decisions you don’t agree with.

And the most outrageous reason we’ve heard so far:

7. “Continuing Care is only for people who can’t swallow.”
A family called us to say that their relative was desperately ill and had significant healthcare needs, but had been told none of that mattered because the elderly person could still swallow. The Continuing Care assessment looks at a range of health needs, from mobility to symptom control, and from cognition to breathing, including those needs arising from dementia. It is not, and never has been, solely about the ability to swallow.

If you need advice about Continuing Care, we can help. Complete our online enquiry form and tell us what help you need.
 
 

NHS Continuing Care is NHS funding and it covers 100% of the costs of full-time care in a care home or at home.

It’s available to people who need full-time care primarily for health reasons. Sadly, many elderly people are wrongly charged care fees when they should have been receiving this NHS funding all along.

You can reclaim care fees that have been wrongly charged. HOWEVER… the Department of Health has imposed new deadlines for retrospective care fees claims in England – and it has also introduced new timescales for reviews of current Continuing Care eligibility decisions.

Current Continuing Care reviews

If you’re applying for NHS Continuing Care funding for a period of care from 1st April 2012 onwards, and you’re found to be ineligible for funding, you can ask for a review.

Follow the steps below…

If you disagree with a decision made by the local PCT to deny Continuing Care funding:

• You have 6 months* to notify the local PCT that you disagree with their decision and that you’re requesting a review
• The PCT has 5 days to acknowledge in writing that it has received your request – and it must also provide you with information on the Continuing Care review process
• The local PCT must deal with your request, complete a review and make a further eligibility decision within 3 months of receiving your initial request for review. If there’s a delay, the PCT must inform you in writing explaining why. It could be because they can’t access the relevant care records in time or they can’t pull together an appropriate multi-disciplinary team to carry out the review.

If you miss the initial 6 month deadline, but you have a good reason, you may still be able to get your case reviewed, as long as it’s still possible for the PCT to access all the relevant care records, etc.

If the PCT still denies funding and you still disagree:

• You can request an Independent Review by the regional Strategic Health Authority; you should do this within 6 months* of the PCT’s earlier decision
• The Independent Review should be conducted within 3 months – unless it’s found that the PCT’s previous assessment for Continuing Care was not done properly OR the members of the Review Panel are not available OR the Review Panel can’t get hold of the care records in time OR you request a delay yourself due to unforeseen circumstances
• The Strategic Health Authority should let you know of its decision within 6 weeks – and it must give you information on how to contact the Parliamentary Health Service Ombudsman if you’re still not happy

If the Strategic Health Authority denies you funding:

• You have 12 months* to contact the Parliamentary Health Service Ombudsman to take your case further.

* from the date you were notified of the decision

The PCT is responsible for informing you about the review/appeal process for Continuing Care – and it must do this at the same time as it informs you of its Continuing Care eligibility decision.

From 1st April 2013:

• Responsibility for local Continuing Care assessments and reviews will pass from PCTs to the new GP-led Clinical Commissioning Groups
• Responsibility for Independent Reviews will pass from Strategic Health Authorities to the new NHS Commissioning Board.

Retrospective Continuing Care reviews

The Dept of Health has also issued new deadlines for retrospective Continuing Care claims in England – for periods of care from 1st April 2004 to 31st March 2012. Don’t miss out! Find out more.

Read more about NHS Continuing Care funding – it can save you losing your home to pay for care.
 
 

The Department of Health has issued new deadlines for people in England wanting to claim back care home fees they believe were wrongly charged.

These new deadlines seem designed purely to make life easier for the new Clinical Commissioning Groups (part of the NHS reforms) – but certainly not to help elderly people or their families access the funding they’re entitled to in law.

If your elderly relative was paying care fees for full-time care between 2004 and 2011, the new deadline for retrospective claims for NHS Continuing Healthcare funding is now 30th September 2012.

In more detail…

If your relative was receiving full-time care (at home or in a care home) and they needed care primarily for health reasons, they should have been assessed for NHS Continuing Healthcare. This is NHS funding and it covers 100% of the costs of being in a care home or receiving full-time care at home.

You can claim retrospectively for a refund of those care fees if you believe they were wrongly charged. This applies whether or not your relative is still alive.

• For periods of care between 1st April 2004 and 31st March 2011, the deadline for claims is now 30th September 2012.
• For periods of care between 1st April 2011 and 31st March 2012, the deadline for claims is 31st March 2013.

If you need to make a claim, act quickly. We can help. Complete our Care Fees Enquiry Form in the first instance.

New review timescales for Continuing Care applications after 1st April 2012.

Read more about NHS Continuing Care.

Today’s article is by Chris Broome from Broome Financial Planning, based in Milton Keynes. Chris helps his client manage their personal finances and build wealth.

Protecting your assets and making sure your loved ones aren’t hit with an Inheritance Tax bill is vital when planning your future.

If you’re employed, and as part of your package receive Death in Service and Pension Benefits, it’s important to seek out advice on how to protect those assets if you were to die.

How to maximise the tax efficiency of death payments

The problem:

Employers’ Death in Service and Pension Benefits provide financial security for employees and their families. On death before retirement, the benefits are paid to your chosen beneficiary(s) free of Inheritance Tax (IHT).

The Pension Fund Trustee’s will normally honour your choice(s) (unless for example, if a beneficiary has themselves died it would not be possible).

BUT… If the benefits are paid to a spouse or civil partner with children, the IHT exemption is wasted. Why? Because unless the money is spent completely in the survivor’s lifetime, it will be fully taxable upon their death.

AND… by passing the benefits directly to the survivor, not only is the money exposed to IHT, but it is also open to means testing by local authorities (in England and Wales) for long term care – which means it could all be taken to pay care fees.

Read the full article here. Chris explains how to avoid this situation…

Care To Be Different does not recommend or endorse any one specific provider, and we do not give financial advice. There are other providers available.
 
 

The subject of care fees is never far from the headlines, and it can cause great confusion and distress for families.

Who has to pay for care? And do you really have to sell your home in the process?

The rules are really quite simple: The NHS pays for healthcare and the local authority (Social Services/local council) pays for what’s called ‘social’ care, e.g. help getting dressed and washed, etc.

However, it’s the subjective interpretation of these rules by various health and social care authorities that causes problems. And you could of course argue that the reason someone needs social care is because they have health needs – and it’s their health needs that prevent them looking after themselves!

There’s a lot of conflicting information – and misinformation – flying around. So, if you have an elderly relative needing full-time care, read on…  (Click the link and then scroll to the end.)
 
 

Few of us like to think about long-term care – and the subject of care fees is rarely an appealing one. Compounding this is the fact that, every year in the UK, tens of thousands of elderly people are wrongly charged for care.

These 3 tips will help make sure you’re not one of them…

1  Don’t assume you have to pay for care

If you need care primarily for health reasons, your care home fees should be funded 100% by the NHS. Get assessed for NHS Continuing Healthcare before you start paying care fees…

2  Reclaim care fees retrospectively

If you’re already paying care fees, and yet you need care primarily for health reasons, you can claim those care fees back. You can also reclaim care fees on behalf of someone who has died. Keep hold of as much paperwork as possible…

3  Take good financial advice

You can’t predict whether you’ll need residential care in later life. Just one year’s care can cost you over £25,000 – as a minimum. Before making any decisions about how to fund care, take financial advice from someone well-qualified in care matters…

Read the full article here.
 
 

We previously posted a starter guide to getting assessed by your local authority if you need care at home.

We also mentioned that many local authorities (councils) are cutting the care that they will provide – and limiting it to people assessed as having ‘substantial’ and ‘critical’ needs only.

Some councils have now been taken to court over this. In this post you’ll find the results of those court judgements…

Isle of Wight Council – illegal changes to funding criteria

The Isle of Wight council was taken to the High Court by two severely disabled adults over the council’s plans to reduce adult social care. The Court has now ruled that the council’s actions in cutting its care budget were illegal. It ruled that the council had changed its eligibility criteria without following its own eligibility guidelines and without the proper process of consultation.

This ruling now also applies to ALL councils in England and Wales.

What it means for you?

A council cannot cut services if it affects overall quality of care. If you’re an elderly person receiving care at home and you’ve been told you’re no longer eligible for local authority care (because the thresholds have changed), you can now challenge your local council about this:

1. Ask your local council to explain exactly how the review of your care needs has been carried out – and according to what specific guidelines.
2. Ask for everything in writing
3. If the council’s assessment criteria have changed, ask for a copy of their previous criteria.
4. If your local council cannot justify why they have cut your care, they may be acting illegally and they will have to revert to the previous eligibility thresholds.
5. Your council must be able to provide you with sufficient information and for you to be satisfied that they have acted in a way that is not discriminatory.
6. They must also show that any change to their eligibility criteria is NOT simply on account of ‘budget cuts’.

In essence, councils must always go through a thorough process of consultation before changing at care provision. It would seem that many have not done this.

Sefton Council – illegal freezing of care fees

In a separate judicial review, Sefton Council on Merseyside has been found to have acted illegally in freezing its payments to residential care homes for local authority placements. It had not gone through proper consultation with those care providers.

The Sefton ruling means that 120 local authorities in England will now also be forced to review their funding policies.

With Sefton there had been no proper negotiation with the care homes and no regard for the subsequent risk to care home residents.

Care homes on the one hand are saying that the punitive cuts to or freeze in fees received from local authorities are making it difficult for them to provide adequate care.

Councils, on the other hand, are saying that government budget cuts mean they no longer have the funds to provide care.

Pembrokeshire Council – illegal freezing of care fees

In a similar case to Sefton, in Dec 2010 the High Court told Pembrokeshire Council to review its fees after local care homes complained that they weren’t receiving enough to cover the costs of care.

What are our priorities?

Balancing a tight budget is difficult. But is care for vulnerable elderly people really secondary to things like council firework displays, Christmas lights and celebrations and less life-critical areas of spending?

Vulnerable elderly people often don’t have a strong voice to make their case heard – and so any cuts to care under the guise of ‘budget restraints’ would seem cowardly and cynical.

According to Age UK, 75% of councils have frozen the rates they pay residential homes in 2011, and 80% have frozen what they pay for specialist dementia care and for local authority care in nursing homes.

Landmark care fees judgements

These recent court rulings are landmark judgements and indicate that in many instances people should not have lost their council-funded social care packages.

According to the Association of Directors of Adult Social Services in April 2011 only 26 out of 148 councils were funding people with ‘moderate’ or ‘low’ needs. It means that even if you qualify for local authority care after means testing, the council can still simply say that because your needs are not ‘substantial’ or ‘critical’, they still won’t provide care.

It’s like literally moving the goalpost just as the ball’s about to go into the back of the net.

You can now challenge this.

The whole care system is short-sighted and based on budgets and profit for today – regardless of the additional cost this approach brings for tomorrow. Providing better care for people while they are still at home means that more people will be able to stay in their own homes for longer.

Should you be receiving NHS-funded care instead?

If your local authority has assessed you as having ‘substantial ‘or ‘critical’ care needs, you may in fact be eligible for free NHS Continuing Care. Find out more.

Read Part 1 – Local authority assessments: How to get started