‘Reclaiming’ Care Home Fees

A deathly silence has descended upon us!  Call me sceptical but I couldn’t help noticing that it started around the 30th September 2012.  Claims companies that were once assisting the good people of this fair land to ‘claim back’ (almost as if they were referring to a benefit that had not been claimed by the masses) care home fees that they had incurred for themselves or a family member fell silent.

So why has it all gone quiet?

Until recently, individuals and family members have been able to make retrospective claims (backdate their claim) if it was identified that they or a family member were paying for all or some of their care when in fact they should have been receiving full funding to pay for it.   There then was a decision to place a deadline on retrospective claims which is why there has recently been an influx of ‘helpful’ organisations desperate to assist you.  In return for their kind assistance they would take a percentage of your successful claim.  However, one of the deadlines for making retrospective claims that could date back several years has now passed and there remains a less modest time-frame within which claims can be back-dated.

For cases during the period 1st April 2011 – 31st March 2012 the deadline for individuals or their families and representatives to notify the relevant Primary Care Trust will be 31st March 2013.

The truth of the matter is, not everyone who has paid care home fees is entitled to claim a refund.  They were of course referring to Continuing Healthcare funding which is the NHS funding stream that enables some people to have their care home fees refunded or not pay them in the first place if that person meets the eligibility criteria for Continuing Healthcare funding.  Throughout this article I am using the example of a care home but the same information applies to all care such as nursing homes, live-in carers and care agencies visiting someone in their own home.

Why do some have to pay for care home fees and others not?

Care homes charge a weekly fee to cover the cost of such expenses as accommodation and care.  This can range from a few hundred pounds to several thousands of pounds depending upon the care provider and the necessary skills required by the home and carers.  Anyone who is in need of such care is entitled to a community care assessment from the local adult social service department.  If, following this assessment the individual is eligible for help from social services they will then receive a financial assessment.  This has been common practice for a number of years and beyond the scope of this article to discuss in any depth. If an individual has assets (such as savings or a property not being lived in) just over £23000 then they will be required to pay 100% of their care (in this case the care home fees).  If they have less than this amount, they pay variable contributions towards the care home fees and the local authority pay the remainder.  Local authorities usually have funding thresholds which are a maximum they will pay for a care home so won’t automatically pay thousands of pounds each week if the same care is available within their funding limits.

Can I avoid paying care home fees?

This is where Continuing Healthcare funding comes into the equation: Continuing Healthcare or CHC as it is usually referred to is the NHS funding stream used to pay for care fees is someone’s needs are predominantly health related.  Because it is the NHS, unlike social service funding (see section above) CHC funding isn’t means tested and you don’t pay a contribution towards your care home fees.  In practical terms, receiving CHC funding rather than social services funding could be the difference between having to sell your home to pay for care home fees and keeping it!  It is worth reiterating though that not everyone in a care home is entitled for CHC funding.

How do I see if I’m eligible for CHC funding?

The CHC assessment process is detailed within 2 documents; they are national documents so it shouldn’t matter where in the country you live.  I say that with slight apprehension because in reality any assessment that involves human intervention is not always 100% objective all of the time.  If you would like more information, the documents are:

Eligibility for CHC funding starts with the completion of a checklist.  This will be considered when an individual is discharged from hospital for instance or can be requested at any time.  Professional including G.P.’s, social workers, district nurses & occupational therapists might also complete a checklist.  Individuals or family members can also ask for a checklist to be completed.  The threshold for the checklist is set lower than the eligibility threshold to ensure that everyone who may be eligible for CHC funding is considered.

If the checklist has a positive outcome (high enough scores) the full consideration for CHC funding is undertaken in the form of a decision support tool (DST).  A DST isn’t an assessment itself but a tool to help professionals collect all the relevant information such as assessments in order to reach a conclusion as to whether someone is eligible for CHC funding.

How is a decision about CHC funding made?

If someone has a rapidly deteriorating health condition, a G.P. or health professional can ‘fast-track’ a CHC application and avoid an unnecessary assessment; the funding should be agreed by the local Primary Care Trust without question and immediately. Your local Primary Care Trust or PCT is the agency responsible for administering NHS services such as CHC funding at a local level.

If a DST has been completed, the professionals involved will look at the tool and make a decision based on the following characteristics:

Nature –   This describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. It also describes the quality of care required to meet those needs.

Intensity – This relates both to the quality and severity of the need and the support required to meet them, including the need for ongoing care.

Complexity – This is concerned with how the needs present and interact to increase the skills required of the carers.

Unpredictability – This describes the degree to which needs fluctuate and thereby create challenges in managing them.

As you can see, the process isn’t an exact science and can’t be determined by a series of tick boxes.  The determining factor is whether the care required is predominantly health related than social care.  A local authority is not permitted to provide or pay for health care which is why health funding such as CHC exists.

Care White Paper – pre-publication thoughts and hopes

Cash

Finally the Adult Social Care White Paper will be published today. There have been a number of ‘leaks’ and there is a fair bit of information we know already. I wanted to collate what I know is coming with some hopes about what is contained.

Funding

We’ve known since the weekend and suspected for far longer that the bulk of the Dilnot recommendations will be shelved. The government while supporting the idea of a cap have been unable to find the money ‘in the pot’ for it and so any significant changes to the funding systems are going to be put on hold until the next Spending Review which conveniently will make it too late for anything to be done in the Parliament.

Care Home Fees

Oh look. The Government have worked out this REALLY CLEVER plan to allow people to pay for their care home fees after their death. Oh, so that would be completely different from the system already in place that allow people to pay.. um.. care home fees after their death.

Well done, clever little government, you’ve managed to bring out as a headline something that is already fairly standard practice across local authorities in England. Oh wait, you are now allowing the local authorities to charge interest.

I don’t understand how selling a home after death is better than selling it during a lifetime if it is still being ‘lost’ to potential inheritors. Remember, the value and asset of the home is discounted if there is a spouse or dependent still living in it. Making the process all about the inheritance is disingenuous at best.

Reducing ‘adult social care’ to ‘residential care’ is also enormously deceptive. There’s a lot happening to and with people who don’t own properties.

Carers

There is expected to be a broadening and firming up of rights of carers and duties of local authorities to provide support. I will be very glad to see this. There are enormous complexities in the systems that we are often not very good at explaining to people who are unfamiliar with the jargon. While ‘powers’ to provide support are all well and good, ‘duties’ are better and can be challenged.

Personalisation

We’ve heard Burstow make noises about increasing choice and moving away from minute by minute commissioning. I am really excited to see what will be proposed to avoid this and particularly seeing the focus more heavily fall on the commissioning by local authorities which favours block contracts with large companies. In fact, oddly for me, this is the area which I hold out the most hope for in terms of the content of the White Paper – with a look at the way the processes of commissioning can bring in more local organisations to provide more interesting/creative and most importantly – individually tailored support.  I expect a lot in this and I hope for a lot too.

Safeguarding

This is another area I think will be shored up. The current processes of adult safeguarding can be frustratingly flimsy at times and it is very hard to bring some prosecutions or to take speedy action as would be the case if the age of those who are being abused were under 18. I think we need to look at streamline the procedures and pathways in terms of safeguarding so it doesn’t become meaningless in terms of a process – and we need teeth that can bite in terms of protection of adults who may potentially be abused.

It’s can be a difficult balance often but it’s really important to be able to get this right and can be improved considerably.

Access to Support

I don’t expect many significant changes to the eligibility frameworks although I can’t help hoping for it. I do expect to see more entitlements to support/information/advice to those who fund their own care and are not reliant on local authority to pay some or all of the costs. I will be very glad to see this. It is an enormously complex system to navigate and everyone is entitled to help to access and understand it, regardless of income/assets.

Legislative Frameworks

We know the legislative framework is going to be ‘tidied up’ so we aren’t needing to hark back to legislation from the 40s (National Assistance Act (1948) I’m looking at YOU). I expect the new composite Adult Social Care Bill will encompass previous legislation. It will be interesting to see the specified roles around assessment/entitlements to services and how they are updated in the context of ‘self-assessments’ and ‘call centre assessments’. I hope they are.

Final Thoughts

While reading and thinking about the White Paper,. I’m going to conclude with five key points to remember.

Adult Social Care is not just about older people.

Adult Social Care is not just for ‘other people’

Adult Social Care is not just about funding possible residential care.

Anywhere ‘choice’ is mentioned I want to see how it will be extended to all, even those who may not be able to engage with decision-making processes individually.

Adult Social Care isn’t free. You don’t get it paid for if you ‘pay into the system all your life’. The funding stream doesn’t work like that. The funding stream needs to change and the governments and parties (all of them) need to bang their heads together in order to improve the quality of life for some of the citizens who rely most on the state to provide support/guidance/assistance and quality of care.

I’ve said it before but I want to work in a system which offers quality and excellence in terms of support – not the minimum amount at the minimum cost.

I’ll read the White Paper with interest and am sure I’ll be back tomorrow to comment on it.

picture by Bashed at Flickr

CareAdvisor

Yesterday, it was announced that the government was going to set up a website, the details of which would be unveiled  in the Spring White Paper on Adult Social Care which could bring a kind of ‘Trip Advisor’ model of rating and commenting to providers of care homes and nursing homes.

Sounds good so far. I certainly welcome more open and accessible information for those who are choosing care homes but there are some real and obvious differences that need to be highlighted between the choices that are available to those who are picking hotels in New York City and those who are choosing care homes for Granny in Wallsend.

On a positive note, Burstow claims that these plans came from user-led discussion groups which shows that he is listening but there are some important points that have to be taken into consideration, lest this is seen as a way of trying to provide regulation on-the-cheap because the actual regulatory body – the CQC – is unable to carry out its function.
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