Given that the cost of funding an individual’s care in a residential or nursing home may run to tens of thousands of pounds per year, it is perhaps surprising that comparatively few people seek legal advice on their rights in this area.
The potentially huge financial cost to a family may, in certain circumstances, be dramatically reduced, but skilled advice is essential.
NHS fully-funded care
Depending upon the level of care required, an individual’s care may be fully funded by the NHS.
There have been a number of cases where individuals have successfully challenged decisions to deny them NHS fully-funded care, including the landmark case of R v North and East Devon Health Authority, ex parte Pamela Coughlan (‘the Coughlan case’).
These cases have established that if your primary need is for health care, as opposed to ‘personal’ or ‘social’ care then you should be entitled to NHS fully funded care. However, many individuals who should be entitled are being refused NHS fully funded care, notwithstanding the Courts decisions in the Coughlan case and other cases.
In October 2007 the government introduced the National Framework for NHS Continuing Healthcare which was intended to introduce greater transparency and consistency when deciding who qualifies to have their care fully funded by the NHS.
However, in their annual report for 2008/9 the Parliamentary and Health Service Ombudsman confirmed that they had partially or fully upheld 75% of the challenges to decisions refusing NHS continuing care funding which they had reported on during the year.
NHS Funded Nursing Care
If a person’s needs involve an element of nursing care, but that person does not qualify for NHS fully-funded care, he or she may still be entitled to receive from the NHS a weekly contribution towards the cost of care.
However, there are currently those who should be entitled to NHS fully-funded care, but who have been assessed as only being entitled to RNCC.
Those who are not entitled to NHS fully-funded care are obliged, partially or fully, to fund their own care from income or even, depending upon the value of assets, from capital. The local authority will usually meet any remaining cost of care, if the individual’s assessed contribution is insufficient to meet the cost in full.
There are complicated and confusing rules as to what income and capital the local authority may take into account, when calculating what an individual must pay towards the costs of care. Unless there is a clear and informed understanding of the rules, there is a risk that an individual will end up paying more than necessary.
For detailed and specialist advice on the above issues please contact us at the Basildon office in order to make an appointment to meet with one of our solicitors.