If you have on-going healthcare needs outside of hospital, the NHS offers a free, non-means tested service called Continuing Healthcare which provides care in your own home or in a nursing home setting.
In order to qualify for NHS Continuing Healthcare, you must demonstrate that your main needs are related to healthcare, such as the treatment or prevention of an injury, disease or disability, rather than social care needs such as personal care.
The distinction between health and social care is very blurred, and is often the cause of disputes in determining eligibility for NHS Continuing Healthcare.
In some cases even if you have a diagnosed illness, your needs may not be considered ‘primary’ health needs and you may not therefore be considered eligible.
NHS Continuing Healthcare Guidance – How Nelsons can help
The assessment process for NHS Continuing Healthcare is complex. Our experienced team of solicitors can help you negotiate the process, whether for care in your own home or in a residential home.
We can provide all necessary guidance and advice to steer you through the maze of information you receive, and can help you put your case forward in the most precise and succinct way to secure any funding which you are entitled to.
Our team can also assist with appeals if you are refused funding, and with retrospective applications for care funding.
The Assessment Process
Eligibility for NHS Continuing Healthcare is decided by a checklist assessment to determine your needs. If a certain level of need is highlighted, a full assessment using a Decision Support Tool is undertaken, which covers a wide range of areas of need and consults professionals concerned with your care.
After the assessment process, you should be told what the assessors’ recommendation is. Their recommendation is not the final decision but it carries a great deal of weight. Ultimately, the outcome of the assessments is submitted to a panel which makes the final decision based on the evidence provided.
If funding is agreed, it is initially for a short period and should be reviewed within three months. If ongoing funding is agreed after this review, it is normally subject to annual review thereafter.
Nursing Home Care Assessments
Anyone entering a registered nursing home is entitled to have an initial checklist assessment. Adequate notice of the assessment should be given, however residents and their families are often not consulted about the assessment and may be unaware that it has taken place.
This can lead to information being missed which could have triggered either the awarding of funding, or a fuller assessment. If this has happened to you or a loved one, then you should contact Nelsons for further advice.
Care Fee Disputes and Appeals
If your application for NHS Continuing Healthcare funding is declined, you have the right to appeal the decision and Nelsons can help you navigate the appeal process.
Even if you are ultimately deemed ineligible for NHS Continuing Healthcare funding, Nelsons’ team of expert lawyers can still offer advice and assistance in preparing and dealing with long-term care costs.
Retrospective Care Funding
We can also help with undertaking retrospective reviews of care to check whether you may have met the criteria for NHS Continuing Healthcare, and can submit an appeal on your behalf.
Claims for care between 1st April 2004 and 31st March 2012 were subject to deadlines imposed by the Department of Health in September 2012 and March 2013, and if you have missed these deadlines you can only make a backdated claim in exceptional circumstances.
However these deadlines only apply to unassessed periods of care, and you may still be able to appeal against a refusal to grant funding.
For more information or for assistance with care fee applications or disputes, please contact us or call 0800 024 1976 and a member of our specialist team will be happy to discuss your situation with you.