Are you paying for care unnecessarily?
An enquirer recently referred us to an article in the Daily Mail headed, “Injustice for care home self-funders” dated 17.04.24.
The article questions why self-funders are charged more than local authority-funded residents for the same care in the same care home.
A Local Authority (LA) will pay towards your care if you have run down savings and assets below the current threshold of £23,500. But if you have more than this amount in savings (e.g. money in the bank or investments) and/or assets (e.g. own a property), then you will have to self-fund your own care – i.e. pay for it out of private means. Your hard-earned savings will quickly vanish and be swallowed up paying for your care.
But isn’t that one of the reasons you pay your taxes – so that the Government can pay for your care in a time of need? Not necessarily – is the answer!
If you are in a care home and have over the £23,500 threshold, you will have to self-fund your own care. Unfortunately, for most residents, that inevitably means selling their home to pay for care or else entering into a Deferred Payment Scheme with the LA (or care home). When care is no longer needed, or more usually upon death, the LA (or care home) will recoup the cost of care out of the sale proceeds of your home. Your treasured asset, preserved with the intention of passing on to future generations, will eventually be sold to repay the care fees owed; and depending on the care costs incurred, you may be lucky if there is any equity left over to hand down.
For further reading from the archives:
How To Avoid Selling Your Home To Pay For Care…
The Daily Mail article refers to the Competition and Markets Authority (CMA) and a finding of ‘cross-subsidisation’ i.e., where self-funding residents are (willingly) paying higher premium prices – on average, a whopping 41% more than LA funded residents – for the same care, and for the same type of room and in the same care home. Worse, some sectors were reportedly charging self-funders double the rate that the LA pay.1
The practice of self-funders subsidising the shortfall in care home costs (which are mixed with LA-funded residents), is apparently nothing new and has been widely practised for many years. Of course, the extent of cross-subsidisation i.e., the differential in care fees paid across the country by LA-funded residents compared to self-funders, will vary depending on the area you live and the profits that the care home want to make! For example, the South East, East of England and London were shown to charge self-funders the highest rates and had the biggest differential compared to LA funded residents; with the north of England charging less and having a far lesser differential.1
Self-funders are essentially underpinning the LA’s financial obligations and propping up many ailing and underfunded LA care homes for a place in the same care home.
However, many people don’t realise that there is an alternative potential pot of available funding from the NHS to pay for their care – it’s called NHS Continuing Healthcare Funding ( or ‘CHC’).
What you need to know about CHC in a nutshell
CHC is free at the point of need.
It’s available for adults aged 18 and over, with complex, intense or unpredictable healthcare needs.
Unlike LA funding, CHC is NOT means-tested. So, your wealth should never be a consideration.
CHC is all about healthcare needs, not your wealth. So, the poorest and wealthiest in society should equally all be able to access FREE CHC funded care if they are assessed as meeting the eligibility criteria- i.e. the ‘primary health need’ test.
For more reading on the subject here’s a blog from our archives:
Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…
CHC Funding is intended to cover the cost of ALL your social AND healthcare needs, including the cost of your accommodation at a care home or other care facility. In theory therefore, you shouldn’t even have to contribute £1 to the cost of your assessed healthcare needs. It’s free under the NHS! Obviously, extras such as chiropody, manicures and hairdressing which are not part of an assessed need, will have to be paid for privately if you choose to have these and similar ‘luxuries’.
However, accessing CHC is not as simple as it sounds.
CHC is not a term you hear often in the public domain or being widely promoted by the NHS. Nor does the NHS signpost you to this available area of funding for the simple reasons that (1) they are not obliged to; and (2) each positive award of CHC will deplete their budgets.
Read: What? You’re enquiring about care funding AND you’ve never heard of CHC!
Furthermore, care homes are not renowned for volunteering the wherewithal of CHC either. They can offset the cost of their overheads by getting higher care fees from a self-funding resident for the same bed, than one funded by the NHS (or LA) – again practising ‘cross-subsidisation’. Care homes are run as a business, so we can understand why they, too, are inclined to stay shtum and not push residents to apply for CHC – until they are running out of private funds and an urgent conversation about CHC Funding suddenly becomes a relevant topic of conversation.
Do Care Homes Play A Part In Preventing Successful Outcomes For CHC Funding?
A CHC assessment should ALWAYS be the FIRST port of call for an individual with complex, intense or unpredictable healthcare needs to determine eligibility before getting shunted down the path of LA means-testing and possibly self-funding (if your means are above the £23,500 threshold).
The NHS CHC’s process is administratively cumbersome at times, and the assessment criteria are applied subjectively, leading to a disparity of outcomes and uncertainty. That creates unnecessary stress for applicants as the decision-making is in the hands of the NHS gatekeepers – effectively acting as judge and jury.
Customers often tell us how they feel the CHC process is designed to conspire against them and frustrate their attempts to access this pot of free care funding, regardless of their indisputable high level of complex needs.
The NHS assessment process can be a challenging minefield in itself! The NHS National Framework – their CHC one-stop guide book – says the assessment process is intended to be ‘person centric’ – i.e., to put the individual at the forefront of the process. Unfortunately, when the process is applied it doesn’t always match what it “says” on the tin, leaving the individual, or more usually, their (family) representative to battle the NHS alone.
So many families come to us quite astounded and even annoyed, when they find out that CHC exists, and quickly come to realise that their relative (usually a spouse or parent) might not have needed to self-fund expensive care costs at all from the outset, or indeed, sell their home to pay for their own care and seen their life-savings eroded or worse, wiped out!
Fortunately, there is help out there and we recommend you read our best-selling book, How To Get The NHS To Pay For Care. Why not slso seek professional help and have a free initial chat with our partner organisation, Farley Dwek Solicitors renowned experts in the field of CHC.
Don’t forget, you can, of course, also apply retrospectively for a CHC review in circumstances where there is an unassessed period of care. At the time of publishing, you can go as far back as 1st April 2012. However, understanding the retrospective review process, collating and presenting the right evidence is far from straightforward, so don’t be under any illusions. The NHS aren’t going to make life easy for you, and you can expect them to mount a firm challenge when defending such claims – which, on occasion, can cost them an eye-watering 6-figure sum when interest is added.
How to recover care fees paid for unassessed periods of care going back to 2012
Don’t pay care fees until you’ve read this!
Here’s how we can help you!
Read our free blogs
Book an appointment with our Nurse Advice Helpline for specialist advice.
Join our Facebook community and get help from others with similar experiences.
Don’t miss our helpful book: “How To Get The NHS To Pay For Care” available as a paperback or PDF download.
If there is a particular topic you would like us to cover, we’d love to hear from you! Just send an email via our “Contact Us” page with the subject “blog request” and we’ll do our best to cover your suggested topic.
________________________________________________________________________________________________________________________________
1.Competition and Markets Authority, Care homes market study – Final report, 30 November 2017
My father in law has been in a care home for over 2 years now. He was transferred direct to the home from hospital by the local authority and my wife and I were told about this after it had taken place. We had no objection to this and in any event had no Power of Attorney for health and welfare. My father in law has a modest property and money in the bank which exceeds by some distance the £23,500 threshold. However, I was not asked to pay any fees until 2 months ago when I received out of the blue a bill for £83,000 and told by the social worker that it was my responsibility as his financial attorney to settle direct with the care home in future. As far as I know, his certification as seriously mentally impaired by his G.P. and also his inability to carry out almost all the tasks specified in the Care Act 2014 have not changed and so he still qualifies for LA support with the proviso that the LA can charge for care under the Act. I have taken this up with the Director of Adult care but as yet no reply. The LA have failed completely to comply with para 3.43 of the statutory care act guidance in that information about how much should be paid, when and why and how and about the charging framework for care and support. They have also failed to comply with para 3.44. They have also charged for intermediate care on release from hospital which should be free.
The LA have paid the full private fees to the care home, which has a majority of non paying residents, without any consultation. What I have not yet taken up with the LA is why they have paid different fees from those which they would normally pay to the home for the non paying residents, given the CQC report on the subsidisation of LA fees by private payers. My father in law is not technically a “self funder” according to the National Audit Office since this term should be used for those who arrange to fund their care privately and enter into a contract with the home direct. In his case, it is the LA who must contract with the care home according to the Court of Appeal in the case of Torbay Council v Torbay Quality Care Forum (2017). This is binding.
I am wondering if anyone has similar experience of this situation.
Mybmother has received NHS CHC Funding for the last 6 years. This year, 2024, it was decided she no longer had a nursing health care need, this despite no being able to verbalise, 20% vision in one eye and nothing in the other eye, hearing problems, along with wax in the ears which affect hearing aid use, unable to walk, double incontinent, unable to eat solid food, or drink without a thicker added, Dysphagia, in fact, and suffers from hallucinations but all this doesn’t qualify as she doesn’t according to her Health Trust, have a primary health need plus she will be 101 in April 2025. I think the judgment made by the Continuing Health care team aren’t sound. It has to do with finance. She has been grated nursing care assistant at the lowest level. Needless to say we are in the process of going to an appeal, but the odds are stacked against us, not because of logic or need but protecting the budget.