Continuing Healthcare funding and choice of care home: Part 1
Do you have to move to a different care home once you receive Continuing Healthcare funding?
This two-part article looks at an issue raised frequently by families on our blog: It’s about Continuing Healthcare funding and choice of care home or care provider.
When you receive NHS Continuing Healthcare funding do you have to move to a different (cheaper) care home or change your care provider at home?
Families are also often told that if they want their relative to stay where they are currently, the family will have to pay part of the cost, i.e. top up the NHS Continuing Healthcare funding payments themselves – effectively paying for NHS care.
Let’s look at what the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care says about this. (The National Framework is the main set of guidelines for Continuing Healthcare assessments.)
But before we do, remember that the following 5 principals hold true regardless:
1. NHS Continuing Healthcare funding cannot be topped up. Top ups are only relevant to local authority means test care – not NHS care.
2. Continuing Healthcare funding must cover ALL assessed care needs regardless of where your relative is receiving that care. The NHS cannot neglect to fund all care needs identified during the assessment process.
3. Some Clinical Commissioning Groups (CCGs) are trying to impose a financial limit beyond above they will not pay for care. However, if your relative’s needs are high and their care costs are more than the NHS wants to pay, it doesn’t matter; the NHS must fund all the assessed care needs regardless.
4. Remember that when a person receives NHS Continuing Healthcare it’s because their care needs are such that they require NHS care and the NHS is legally responsible for paying – even if the actual care is provided by a private care home or care provider. It’s a bit like receiving care in hospital – you don’t have to pay. In England, just because a person is outside hospital when receiving their care, this principle does not change.
5. Continuing Healthcare is not dependent on where your relative is, i.e. in a care home, at home or elsewhere.
That said, there are certain paragraphs in the National Framework guidelines that are useful to mention here.
Let’s look at pages 117-119 of the National Framework…
Paragraph 99.1 states:
“The funding provided by CCGs in NHS continuing healthcare packages should be sufficient to meet the needs identified in the care plan, based on the CCG’s knowledge of the costs of services for the relevant needs in the locality where they are to be provided.”
“It is also important that the models of support and the provider used are appropriate to the individual’s needs and have the confidence of the person receiving the services.”
So…
- all the care needs identified during the Continuing Healthcare assessment process must be included in the care plan AND must be funded by the NHS through Continuing Healthcare
- the CCG must appreciate that there may be cost variances in different areas of the country
- the care provider must have the resource and ability to care for all of those needs – and if the cost is higher because of the needs of the person, the NHS still covers the cost.
Paragraph 99.2 states:
“…it will not usually be permissible for individuals to pay for higher-cost services and/or accommodation (as distinct from purchasing additional services).”
Paragraph 99.3:
“‘Topping-up’…is not permissible under NHS legislation.”
In other words, you cannot top up NHS Continuing Healthcare funding – and you should not be asked to do so. This would be illegal. It is NHS care funding. Top ups are relevant only to local authority means tested care.
Pages 114-115 of the National Framework also cover this issue, including page 114 paragraph 96.1c, which says:
“…patients should never be charged for their NHS care, or be allowed to pay towards an NHS service (except where specific legislation is in place to allow this) as this would contravene the founding principles and legislation of the NHS.”
It’s worth reading the whole of pages 114-115 in the National Framework in this respect.
What if you already have a higher-cost care provider or care home once you become eligible for Continuing Healthcare?
We’re going back now to pages 117-119.
Paragraph 99.3 states:
“…there are some circumstances where a CCG may propose a move to different accommodation or a change in care provision.’
Paragraph 99.4:
“In such situations, CCGs should consider whether there are reasons why they should meet the full cost of the care package, notwithstanding that it is at a higher rate, such as that the frailty, mental health needs or other relevant needs of the individual mean that a move to other accommodation could involve significant risk to their health and well being.”
Paragraph 99.6:
“CCGs should deal with the above situations with sensitivity and in close liaison with the individuals affected…”
In other words, it comes back to the care needs every time. This must be the priority.
If it would be detrimental to your relative for them to be moved to another care home, the NHS may have a duty to fund all care where they are at present – and to continue to do so. People with cognitive, behavioural and/or psychological challenges often need familiarity as a priority; moving someone with such needs to a new care home or care provider can be extremely damaging to their health and wellbeing.
But what if your relative does have to move to a cheaper care home or switch care provider? We look at this in Part 2.
What’s your experience of having to change care provider or move to a different care home?
My mum is in a lovely home and has just been given Continuing Healthcare (CHC) funding. The home has requested £80 a week payment, as the CHC payment doesn’t cover their bill. Is this correct?
It is a lovely home and far nicer than most in the area (and costs almost twice what the local authority pays /charges.) Mum has been self funding until the CHC payment given.
My mum is currently awaiting a multidisciplinary team (MDT) continuing healthcare meeting to see if she meets the criteria. If she doesn’t I have been told she will have to move to another care home as I can’t afford the top up fees. Is this right, as she had spent £90,0000 and has now run out of money. As I see it, it’s a case of I have had your money now go.
My dad is awaiting DST decision. I rang the OT today who was part of the MDT with the nurse assessor. The OT knows my dad well & has been extremely helpful &supportive. Dad has mixed dementia with challenging behaviour managed with antipsychotics. She pushed for a priority rating for behaviour in the assessment although the nurse felt it was severe. He also got severe for cognition. Dad has been paying for 2 live-in carers since Feb. It seems that the nurse has since raised a safeguarding alert because of his challenging behaviour recorded in the care log. I collated a mass of evidence which now seems to have worked against us as she is now recommending care in a secure environment with 24hr RMN cover. It seems she has breached many of the Guidelines in that the OTs were not given the draft DST to comment on or sign as members of the MDT. They are currently challenging this & I have emailed the nurse today asking for information. Can she insist on a change of care environment? We have fought so hard to keep dad at home & he is now in the end stages of dementia. We are prepared to fight this & will involve the psychiatrist who agrees home is best for dad. Thanks Pauline
With the help of your articles, I have just received correspondence confirming that my mum has been awarded Continuing Healthcare (CHC) Full Funding. My question is what happens next? My dad is currently mum’s main carer at home with two self funded carer’s visiting twice daily. As dad’s health is failing we have made the decision that a nursing home would be the best option for mum. What is the process at this point to get mum into a nursing home that the funding will cover or will the funding offered be expected to provide further care at home? Your advice would be much appreciated.
Hello.
We have just had the Decision Support Tool (DST) meeting for my Mum and were told at the end that they would not be recommending Continuing Healthcare (CHC) although she has very, very high needs, they don’t class them as health!! During the meeting there were a couple of things where they did not follow their own guidelines and even after I pointed them out they still refused to acknowledge them. One was regarding her skin integrity, my Mum is very prone to bed sores and has to be turned every 2 hours and cream applied otherwise they appear and very quickly. The assessors where arguing with me that because there were no open wounds at present it could only be scored low, while I said that it should be high as it is still a need even though it is being managed and if she was to be left there would be open wounds in a matter of a day or so but they weren’t having it. They also said that because her cognition was Severe her mood and emotions could only be Low. Again I quoted their own guidelines that every domain needs to be weighted in their on right, but again they wouldn’t listen. It was logged (I think) that I disagreed. Finally after the decision the assessor did say she was on the cusp of receiving the Funded Nursing Care but then cut us off by saying that my Mum would have to be moved. She has been in a residential home for 3 years so although she is unaware of where she is, she is familiar with the carers and they know her needs very, very well. Moving her to a nursing home where no-one knows her needs would be very damaging so we decided against it. Am I right in thinking that the CHC or the Funded Nursing Care can still be given in a residential home? We can’t decide whether to appeal as we don’t want her to be moved if successful.
My son is in a critical care unit for nearly 2 months now, he has a peg is situ, needs non invasive ventilation both at day time and night, also requires cough assist, requiring manual shaking, suction and at a high risk of aspiration results in pneumonia or chest infections. He has a cardiomyopathy and respiratory failure. He has unpredicted bowl movements and prone to pressure sore issues. He did qualified for fully funded Continuing Healthcare (CHC) but the CCG refused to implement his needs which was decided by a Multidisciplinary Team (MDT). The CCG only pays £11 pound per hour which includes cost of third party provider, pension contributions, payroll cost, cover for sickness and holidays. The hospital is planning to draft a care plan and MDT very soon. I am trying to sort the mess out for 3 years now but no joy. Does anyone knows any person who can support me with the care plan so that my son can come home.
My husband has young onset Alzheimer’s and is now in full time residential care. The care home generally meet his needs, as in all things I know nothing is 100% perfect. I have asked for a review and assessment for NHS Continuing Healthcare (CHC) because I believe his primary health need is his Alzheimer’s and sleep apnea. County have agreed to assess but tell me the home isn’t registered to receive CHC and that if he is successful he would have to move to a home that would deal primarily with behavioural issues. Now my husband’s agitation and paranoia are well managed with medication and good care so I don’t see how moving homes would help my husband. Can anyone confirm whether this scenario is correct? I am wondering if I have been told this to dissuade me from CHC although it would benefit County if we were successful. Any advice would be very welcome.
Thank you
My mother has dementia and has been through carers at home, but for the last 6 weeks she has been in a holding ward at the local hospital as she now needs to be fully looked after in a care home. We have a full CHC is place and was told we could now find our own homes as well as the list given to us. Two weeks ago they told us they were moving Mom to a home that we had already visited and agreed with the dementia specialist would not be in the best interest of my mother, so we got injunction in place and this was successful while we looked at other homes. Last week we have found a very suitable home within 10 minutes of my Father (who is 80 years old next year) that has agreed to take mom. Unfortunately this last Monday we were told the mom was being moved to the previously rejected care home and was moved Monday afternoon without any consent from any family member. Can you please advise me on what steps I can take, because the lady involved with authorizing the move is adamant she has done no wrong and has acted in the best interest of the hospital and patient which we 100% disagree with, but even though we have another home she will not listen to our plea.
It is challenging enough when a loved one gets dementia, but being treated so disrespectfully just makes it worse
Help!!
Thanks in advance Alan