Do you worry whether your views on the question of whether you should self-fund care fees are good enough? You are not alone. Every attorney has doubts about managing financial and health needs of their loved one. The good thing is being involved in self funding issues leads to becoming an expert by experience with our skilled support. Every view you input in all of the decisions made by the various assessors is a step along the road and makes you more skilled in usual pitfalls.

We describe how we routinely tackle common pitfalls in NHS continuing care processes. Each client tells us the processes are complicated and time consuming. Many people are ‘overlooked’ for continuing care awards because the assessments are carried out incorrectly and day to day care needs are ignored by a social worker, NHS Assessor or care home staff. Many people are also not assessed at all reporting obstacles in their way. Whilst travelling along this road, you can either travel the long road – or use shortcuts of our skilled support. Using shortcuts means  spotting and fixing mistakes in order to avoid the usual pitfalls of delay in assessment or unfair decisions being made.  At Dementia Partners, we’re here to support you from beginning to end with these issues. You’ll be able to select as much or as little advice from initial advice to guidance with a continuing care complaint or appeal.

NHS Continuing Care Assessments

We explain in this page what is involved when you get our support with your NHS continuing care assessments. 

  • What is an NHS continuing care award for care home fees?
  • What is the eligibility criteria for getting an award of continuing care?
  • What are common pitfalls in NHS continuing care processes?
  • Dementia Partners’ 8 quick support fixes to your continuing care assessment
  • Discounts of up to TWO FREE HOURS support are just a quote away. There are 2 easy ways to get started now
  1.  Call us anytime to arrange a FREE review on 0800 023 8422 or 07956 833659
  2.  Simply provide us with your contact information by emailing Reeta on reeta@dementiapartners.com with your name, telephone number, email address and when you prefer to be contacted by email.

What is an NHS continuing care award for care home fees?

NHS continuing healthcare is a package of care funded solely by the NHS. It is also known as NHS continuing care or fully funded NHS care. Individuals who meet the eligibility test will receive the full cost of their care and accommodation funded by the NHS. It is awarded based on whether a person’s primary need for care is a health need. It can be provided in a range of settings, including an NHS hospital, a care home or someone’s own home. This package of care is funded solely by the NHS and is not means tested, unlike LA funding. NHS continuing healthcare is available to any UK resident over the age of 18 assessed as having primary health needs which are intense, complex and/or unpredictable. The impact of fluctuation in health needs arising from dementia syndrome must also be considered.

What is the eligibility criteria for getting an award of NHS continuing care?

In practical terms, the central question in each case is whether care should be provided by the LA or by the NHS. The answer to this question is crucial. If care is to be provided by Local Authority (LA) it is mean tested. This means that who pays depends on what your needs are, how much money you have, and what level and type of care and support you require. The cost of nursing homes in London are substantial from £900 to £1500 per week. If care is to be provided by the NHS, however, it is ‘free at the point of delivery’.

Despite the introduction of the National Framework, the criteria used to determine eligibility remain challenged by NHS assessors, and can therefore be difficult for you understand. A combination of toolkits, indicators and legal tests based upon case law are used to establish the presence of a primary health need. The Health Ombudsman in the Pointon complaint in 2004 confirmed primary health needs extends to emotional and challenging behaviour needs caused by dementia and requiring skilled carers.:

What are common pitfalls in NHS continuing care assessment processes. Have you ever sat in a continuing care assessment and thought they were talking about someone else?

Where you are self funding care home fees in London, we have seen weekly care home fees range from £900 to £1500 per week.  Although the care home manages day to day health or care needs, it is not within their remit to manage financial or legal matters. Although the CQC is the regulator for care homes and the NMC is the regulator for nurses, they do not regulate continuing care nurse assessors or nurse coordinators at all.  The options available for an attorney are to provide comments in in the processes and if there is dissatisfaction with service levels, to pursue formal complaints through your local NHS complaints procedure and/or appeal. We have more than 10 years’ legal background in medico legal matters, pushing through gaps in this system and bringing about change up to the Independent Review Panel stage of the appeal process.

Dementia Partners’ 8 quick support fixes to your continuing care assessment

We describe next how with the support of our family representative, you’ll not waste lengthy time on a NHS Continuing Healthcare assessment. What is a ‘good’ attorney’s view in NHS continuing care assessments? How does the attorney know when to comment on significant flaws in the assessment process? Inexperienced attorneys think that giving their views on the assessment is too complex. It can be if you are not familiar with the processes and the NHS coordinator and assessor are the ones actually creating the significant flaws through their approach.  No, providing your views is an essential part of you being involved in the assessment being familiar with needs and wishes of a person with dementia. With skilled support of our family representative, it does not need to be such a difficult process.

With our support, you’ll be well prepared for a NHS Continuing Healthcare assessment in our 8 quick support fixes:

1. Know the NHS Guidelines

Be well prepared before an assessment by understanding the NHS Guidelines and assessment tools with service user guidance notes Click here http://goo.gl/5ZOzwo The guidelines are the National framework for NHS continuing healthcare and NHS funded nursing care. Assessment tools are a Checklist screening tool (stage 1) and a Decision Support Tool (DST).  Another unpublished assessment tool is a health needs assessment or needs portrayal tool.  Assessors look at health and care needs in 12 different need ‘domains’. These are common needs caused by progressive dementia, such as resistance to care, nutrition, mobility, medication, etc. You can find out more about these domains in the assessment tools Click http://goo.gl/5ZOzwo.

2: The art of being most familiar with needs and wishes

We help summarise clinical evidence of  all health and care needs, risks and consequences before the assessment because the dementia care plan may not have all of the information.   This may be found in GP or hospital records.  Many families discover with the unpredictable progression of dementia that the dementia care plans are either not kept up to date or they do not include information on all health needs, new incidents, all interventions needed to better manage needs and care provision. Checking the daily care home plans and available medical notes are up to date is vital to the continuing care assessment because they are categorised as “relevant clinical evidence”.

3. Get the care home used to your supervision role

From the outset, read the dementia care plan updates each month and inject your views on timely updates needed. Some care home records we helped families update have never been seen by the family in a few years.  The Care Quality Commission and adult social workers nationwide recommend care records should be updated monthly and that the attorney should always be invited to be involved in commenting on those updates. Ensure you are involved in updating and progressing the dementia care plans. You can be sure the assessors are looking at all the evidence relevant to your NHS Continuing Healthcare case.

4. Make the Assessors aware of their legal obligations when making best interest decisions to fully include your relevant views 

Understand your best interest role as family member in every financial or health decision made. Many families are unaware NHS Assessor decision makers ‘must’ take into account views of the family when selecting the least restrictive decision under the Mental Capacity Act 2005 and its Code of Practice Click here http://goo.gl/h72INd   Inject your best interest views in a lengthy continuing care assessment meeting involving the two assessment tools.

If there is too much delay or you are dissatisfied with service user levels, preparing a formal NHS complaint may minimise delay and result in quick solutions provided by a review of your complaint. The complaints team do have a time limit to respond whilst continuing care teams have no fixed time limits to respond to your concerns. The complaints team will have a written complaints policy you can request directly.

5. After the meeting, are the failures in the process and facts obvious?

After the assessment meeting, the next step is for a panel or NHS representative to ratify the recommendation made to award or not award continuing care funding. If you disagree you have had a fair assessment, we can help you to prepare your written comments on every failure by continuing care assessors to follow the correct process in the national framework and Mental Capacity Act 2005 Guidelines.

6. What action points are needed after notification of successful award

Where you get notification of successful funding, the care home may not accept a lower block contract rate offered by the NHS. Legally you are not allowed to ‘top up’ the care home fees when you receive NHS continuing care funding. You may need to discuss further with the NHS Assessor and LA the suitability of moving to a new care home or moving back to the family home.

7. What action points are needed after notification of unsuccessful award

Where you get notification of unsuccessful continuing care funding, you may get a Funded Nursing Care award which is around £110 per week.

You may soon reach the capital threshold of £23,250 and need to request a financial assessment from the LA to identify how much contribution you must self-fund out of your income and savings.

You may wish to appeal against the decision because you believe there are significant flaws. You’ll comment on everything that has been done incorrectly in the assessment process and in the way the eligibility criteria have been applied in order to get a re-assessment. You’ll need to follow the NHS’ local appeal process and with significant delay or loss in confidence in the local appeal process, you may successfully ask the Independent Review Panel to consider the appeal and provide you with a fresh recommendation on eligibility. See video of Pamela Coughlan on her successful appeal to the Court of Appeal which is relevant Court of Appeal law since 1999 http://goo.gl/UHN2W3 After the IRP stage, you may ask the Health Services Ombudsman to review the decision made.  If you then disagree with the Health Ombudsman, you can proceed to make a claim for Judicial Review in the civil courts.

8. Warning: in all of this lies more care related processes. You’ll also be helped by our family representatives from start to end of other usual LA and NHS processes

  • There’s been a LA financial assessment. We help you to prepare the forms so that it is a fair financial assessment. Questions include do you need to self-fund out of all of your income? What capital is disregarded when the LA calculate the capital threshold of £23,250k? Will the LA consider gifts made many years go to be a deliberate deprivation of assets? The nursing home do not accept block contract LA payments, can you personally sign up a top up agreement?
  • You have been receiving continuing healthcare funding, but now the NHS is threatening to remove it. What you do? If your needs are the same or greater than when funding was first provided, you can question clinical rationale for removing the funding.
  • Without a financial power of attorney (or equivalent) the NHS may not allow you to consider the evidence in the assessment. We prepare the documentation you need to get the power of attorney or equivalent.  Although it can take some time to get, this could save you more problems in the future because your attorney or deputy will have legal authority to manage your affairs.
  • Without a health power of attorney or equivalent the LA will make all the decisions about care. We help you inject your views in the best interest decision making process to getting a specialist clinical report on your needs. The LA assessor must consider the specialist clinical opinion in making their best interest decision about your care.

If you experience great resistance from a care home, NHS Assessor or LA social care assessor to even listen to or consider your views in NHS continuing care Assessments, do ask us to help you with pushing onwards for the rights of the person with dementia to be actioned by them.