30% lose out on care funding

A third of those eligible for fully funded care are losing out because of overly strict assessments, according to law firm Hugh James.

Health and social care is known for being expensive; care home fees have risen by 10% in the last 12 months alone with some charging as much as £8,000 a month.

With average yearly fees of over £41k a year for residential care – and more than £56,000 for a nursing home – you’d be forgiven for thinking that you have to stump up the costs.

But under the continuing healthcare (CHC) package, the NHS is legally obliged to cover the fees for some people who live in England, Wales or Northern Ireland.

Strict assessments and postcode lotteries

Unfortunately – due to a lack of knowledge and increasingly strict assessment criteria – 30% of eligible individuals are being turned down for CHC funding.

Funding guidelines have also been compared to a postcode lottery.

NHS England says that, despite an ageing population, the number of people eligible for CHC funding has actually fallen by 20% since 2015.

Lisa Morgan, head of the nursing care fee recovery team and partner at Hugh James, explains:

“Many more people could be eligible for it if the guidelines were applied less restrictively.”

Qualifying for funding

Unlike other sources of funding, you only need to meet a single condition to have your care costs fully covered.

If your primary needs are health-based, you’ll be eligible for aid. But if they’re deemed to be social, you won’t qualify.

While that sounds straightforward, it can get a little complicated as you’ll need an assessment to decide whether your needs count as being health or social.

In most cases, your medical needs will be assessed by an NHS integrated care board to see how complex your requirements are, what support would benefit you and any risks to your health without the right help.

If you’re under the care of your local council, they’ll assess you instead.

Your ability to pay will only be taken into consideration if you’re assessed by the local authority, not the NHS.

If you have more than £23,250 (£50,000 in Wales), you’ll have to foot the bill yourself.

Appealing a decision

If you’re unhappy with the outcome of an initial CHC assessment, you can challenge the decision and ask for a review.

Figures from the Department of Health show that 24% of those who appeal to the ICB are successful, rising to 30% at a national level, so it’s worth speaking up if you disagree with the outcome, as it could save you thousands.