A recent TV documentary has revealed that many vulnerable, elderly people are being wrongly charged care fees which should in fact be covered by the NHS.
The Channel 4 Dispatches programme featured a number of families who successfully challenged funding decisions.
During the documentary a retired businessman described how he overturned an NHS decision not to pay his mother’s £1,000-a-week care home bill by producing an audio recording of health professionals who had said the fees would be funded by the state.
His story highlighted the extreme measures some families have been forced to take, in order to challenge the NHS Continuing Health Care (CHC) rules which are complex and have been described by a number of charities as “not fit for purpose”.
In another case, a pensioner was turned down for funding on behalf of her 78-year-old husband, who has Alzheimer’s and lives in a specialist care home.
Initially, the couple were told they were ineligible for help with funding but after challenging the decision, their local Clinical Commissioning Group (CCG) not only granted funding but agreed to refund almost £10,000 in fees they had wrongly been forced to pay.
Tim Steele, a Partner with Palmers who specialises in legal matters relating to Older Client Care, said: “The programme highlighted the significant difficulties that many people face when trying to apply for care funding.
“The system draws an unclear distinction between health care needs and social care needs and the complex assessment process is intended to weigh up the balance between these two different types of need in order to determine whether or not a person has a primary need for health care services (‘a primary health need’). If you do not have a primary health need then NHS will not meet the cost of your care (although, in some instances, they may make a modest contribution towards the cost of your care where it is clear that you have a regular need for nursing services) and, subject to a financial assessment undertaken by the Local Authority, you may need to meet the cost of that care in full.
“If, following an assessment for NHS funding, it is concluded that you have a primary health need, then you will not pay any fees for your care at all. This is the case, regardless of what wealth you may have and is referred to as Continuing Healthcare (CHC) funding.
“However, to be frank, it is not in the interests of the CCG for anyone to be awarded CHC funding. CCGs have budgets and their resources are constantly under pressure.
“As a result, entitlement to CHC is not actively promoted and many people do not know that their relatives might in fact be entitled to CHC.
“To further complicate matters, there are a number of companies who are taking advantage of the current situation by mis-selling expensive trusts as a ‘guaranteed’ method of avoiding having to pay for care, with people often being persuaded into signing up to such schemes without understanding all the implications.
“Care funding can be a minefield but as this programme demonstrated, CHC funding decisions can be successfully challenged. Specialist advice from a qualified solicitor can be of significant assistance and is best sought at the earliest stage possible.”