This month’s top 5 questions are answered...

Question 1: My relative has dementia.  Do they automatically qualify for NHS Continuing Healthcare Funding?

No.  There is no automatic right to CHC Funding prescribed within the NHS National Framework.  Each case depends on its own merits.

Although many people who suffer with dementia do qualify for CHC Funding, dementia alone is not a guaranteed ‘win’ on its own.  If therefore you are told that your relative will win their case without providing a detailed account of their care needs, be very cautious.  Determination of eligibility is not based on a condition, or label, but by reference to the patient’s health needs, when considered in conjunction with the four key indicators (or ‘characteristics’), namely nature, intensity, complexity and unpredictability of their needs.  There can be many people with the same diagnosis (e.g. dementia) but who all have differing levels of care needs.  Some of those needs may be the type that could be provided by Social Services e.g. support and friendship; whereas other needs may be more intense, especially when coupled with other medical conditions as set out in the twelve Care Domains (eg breathing, mobility, nutrition, behaviour and cognition etc to name a few…)

Question 2: What happens if I don’t qualify for NHS Continuing Healthcare Funding?

If you do not qualify for NHS Continuing Healthcare Funding then you will need to undergo a financial assessment by the Local Authority to determine, what, if any, contributions they will make towards the cost of care.

Your relative’s finances will therefore be ‘means’ tested, and if they have assets or savings over the current £23,250 threshold, then your relative will have to pay towards the cost of their care until such time as the money runs down below this figure.

The cost of care can therefore be hugely expensive, eating into life-savings and sometimes forcing the sale of an asset – usually the house – to pay for care.

But, if your relative’s health needs change (ie deteriorate) then consider a re-assessment for NHS Continuing Healthcare Funding as this could potentially save many thousands of pounds in care fees being paid out of private funds if your relative’s health needs now meet the eligibility criteria.

Remember, it is worth re-visiting this question periodically even if the individual concerned does not qualify for CHC Funding initially.

Question 3: I have been told that my relative has to be at ‘death’s’ door to qualify for NHS Continuing Healthcare Funding – is that correct?

No, this is a myth and utter nonsense.

You can be assessed for NHS Continuing Healthcare Funding at any stage of life if you have ‘healthcare’ needs – and not just when the individual is at an end of life phase. So don’t be fobbed off. Push for an assessment if you think it is appropriate.

What’s more, your relative may be entitled to NHS Continuing Healthcare Funding whether they are living in their own home, a care home or a nursing home. The setting where the care is needed is actually irrelevant.

Fundamentally, is it the healthcare needs that are the paramount consideration when determining eligibility for CHC Funding.

There is, however, a process available for fast-tracking individuals for assessment of funding who have a rapidly deteriorating condition and may be entering an end of life situation – using the Fast Track Pathway Tool.  See paragraphs 217 to 245 of the National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (revised 2018). It is quite common to receive funded care for the terminal phases of life, when the individual’s health needs can be acute.

However, generally speaking, in a high percentage of cases we hear about, CHC funding is awarded (or at least should be awarded) well before the terminal phase, and indeed, some people qualify for CHC funding once going into a care/nursing home environment and go on to receive funding for 12 months or even longer.

Question 4: Is there a legal way to avoid paying care home fees?

Potentially, you can protect your assets and put them into trust so as to reduce your capital below the £23,250 threshold when being means-tested for Local Authority Funding.  You can put your assets into a protective trust – but beware! The Local Authority can view these arrangements as a deliberate attempt to carry out anti-avoidance measures, otherwise known as ‘depravation of capital’.

If the trust or gift of your relative’s home is made within six months of entering into residential care, the Local Authority can still render their charges, and treat your relative as owning that asset, even if they have gifted it away.

This is a complex legal area and we can offer no guidance here, save to say that if you take the correct financial and legal advice far enough in advance of needing to go into care, then you could potentially avoid paying the cost of the care, regardless of whether or not you are eligible for NHS Continuing Healthcare Funding.

By the time most people going into care realise that their wealth could be means tested and want to take protective measures, it is often far too late to take advantage of legal trusts to protect assets from means testing. However, children looking at their parent’s savings being swallowed up to pay for care should realise the importance of not creating the same mistake and planning ahead before old age.

This is an area where we suggest that you do seek professional legal help to see if you are able to legally protect your /your relative’s assets before it is too late.

Question 5: I have had a Checklist assessment and told that I have got too many ‘high’ scores.  The assessor wants to downgrade some of the scores – can she do it?

Absolutely not!

This is OUTRAGEOUS and totally unacceptable!

The scoring across the 11 Care Domains is supposed to give an indication as to the level of need within each heading. The care domains are as follows:

1. Breathing*
2. Nutrition – food and drink
3. Continence
4. Skin integrity (including tissue viability)
5. Mobility
6. Communication
7. Psychological/emotional needs
8. Cognition
9. Behaviour*
10. Drugs/medication/symptom control*
11. Altered states of consciousness *

On the Checklist form you’ll notice that each domain has three categories of need: A, B and C.  A is for high needs, B is somewhere in the middle and C represents relatively low needs.

In order for the CCG to consider doing a comprehensive full assessment (Decision Support Tool), you have to have a minimum ‘score’ in the Checklist:

• 2 or more ‘A’s
• 5 or more ‘B’s (or it could be an A and 4 Bs)
• or at least 1 A in a domain with an asterisk*

So, to deliberately try and downgrade scores in order to tow the CCG’s ‘party line’ or with a view to preventing funding or for ‘financial safeguarding’ purposes – is frankly scandalous.

The scores should be accurately recorded and not downgraded.  If anything, in the event of doubt, it is arguable the higher score ought to be applied. That is the whole point of the assessment process – which should be done fairly and robustly.

If this has happened to you, you must lodge a complaint immediately with the CCG at the highest level.

Share your questions with us and help others…

If you have any burning questions or tips that you would like to share to help others going through the Continuing Healthcare assessment process, add your comments below.