Who pays for care when someone is Sectioned?
Understanding who pays for care when someone is Sectioned is something that is actually quite straightforward. It’s important to be aware of some key points, though.
One of the most important things to be aware of is the connection between the Mental Health Act and NHS Continuing Healthcare funding…
Dementia, care funding and the Mental Health Act
Severe dementia often goes hand in hand with challenging behaviour. When someone needs full time care because of these needs, they should have an assessment for NHS Continuing Healthcare, and all their care needs should be taken into account. (NHS Continuing Healthcare is full funding for people who need full time care primarily for health needs.)
As a separate thing, if a person’s behaviour and/or mental health poses threat to themselves and/or to others, that person may also be ‘Sectioned’ under the Mental Health Act.
Being Sectioned means the person is effectively detained, either in hospital or in another kind of care facility (including a care home) for everyone’s safety.
The person will be detained under Section 3 of the Mental Health Act, and the care they need (known as aftercare) relates to Section 117 of the same Act. This care is often known as ‘Section 117 aftercare’.
So who pays for care when someone is Sectioned?
In a nutshell: Clinical Commissioning Groups (CCGs) and local authorities pay. The individual should not be charged.
However, there are several things to keep in mind…
- Under Section 117 CCGs/NHS and local authorities are obliged to provide free care until the Section is lifted.
- This free care relates to the needs arising from the actual mental disorder or cognitive impairment that led to the Section. It applies to people with or without dementia who have, for example, challenging behaviour or who are a risk to themselves.
- The person may have additional care needs that are not related to the Section – and these needs should be assessed separately, for example via the NHS Continuing Healthcare process, just as they would be if no Section were in place.
- The budget for Section 117 aftercare is not the same as an NHS Continuing Healthcare budget.
- Regardless of whether the 117 aftercare services are provided by the CCG or the local authority, this 117 care should never be means tested.
- There is no long funding assessment process for 117 aftercare services (unlike with NHS Continuing Healthcare where the process can be extremely drawn out). Instead, if a person is Sectioned, the relevant care is funded by the state – and that’s that.
- All other Continuing Healthcare rules remain the same, regardless of whether a Section is in place. Also, just because a person is in receipt of 117 aftercare does not mean NHS Continuing Healthcare funding can be ignored for additional needs.
- The availability of 117 aftercare services doesn’t mean that everyone with severe dementia and challenging behaviour will automatically receive free care. There needs to be a Section in place first, and this is a separate thing to Continuing Healthcare. However, the two can run in parallel.
- Even if a Section is lifted, the person still doesn’t necessarily have to pay for care just because they have savings. As in all cases, it depends on a person’s health needs first and foremost. The NHS’s duty to provide funding for nursing care – and its duty to assess all needs properly – still applies, and no Section should be lifted without proper re-evaluation beforehand.
If your relative is currently under a Section, and that Section is then lifted, be sure to check this has been done with full and proper review and reassessment. If you suspect the Section has been lifted to force your relative back into means testing, be sure to complain.
In addition, if you find that a Section has been conveniently lifted the day before an NHS Continuing Healthcare funding assessment, question this thoroughly.
Do you have personal experience of this issue?
Find out more about NHS Continuing Healthcare funding and how your relative could be eligible.
Hi again. I wrote a Message before but this section is more suited to my questions. Dad went into Clatterbridge hospital on 1st July after being sectioned under the Mental Health act 2. He will be there for 28 days. I live abroad and its very difficult to talk to those in charge of my Dad. I know he`s undergoing some type of assessment but, which one? I read that he could have an initial assessmet process havinf two stages, an initial screening to roughly estimate his potential eligibility for NHS funding and a full assessment? What does that mean? Why dont they just do the NHS continuing Health Care assessment then its done With? Dad had Care People coming in 3 times a day before he was taken to hospital and I think he needs full time care afterall, they came in to Administer medication, make him his Food, Change his clothes. He also has a cancer sore on his forehead which should be removed but Dad refuses. This is all New to me I dont quite know where to start. Adrienne
Hi Adrienne – thanks for you comment. There are a few things you can do at this point: 1) If you haven’t already done so, subscribe to our free information bulletin (scroll up on the right hand side) and you’ll receive a link to an extra free guide that explains the basics. 2) Take a look at this article, which highlights some of the assessments you may come across: http://caretobedifferent.co.uk/assessments-needed-for-long-term-care/ and 3) This article outlines the stages of the assessment process: http://caretobedifferent.co.uk/what-are-the-different-stages-of-nhs-continuing-care-assessment-and-appeal/
You’re not the only one to have lost trust in the system. Adrienne. Sadly, it has shown itself often not to be trustworthy. If you need one-to-one advice at any point, we’ll be happy to help. You’ll find a link at the end of the book you’ve purchased. I do hope you’ll find the book useful.
Hi Angela.
Yes I would like one-to-one help actually but, I cant find the link at the end of the book your talking about? Please let me know on which page I can find it. In the meantime, I talked with the Consultant Psychiatrist on our telephone meeting last Wed. He told me that they are undertaking a Memory assesment and that my Dad is at the Moderatley/Severe stage. His 28 days is up on Sunday but, they will probably keep him in indefinatley. The Doctor didnt think he is entitled to NHF continue funding because thats only for people with severe needs and who need one-to-one care 24 hours. Thats it so far. They are looking to send him to Macclesfied until a Care home is found which fits his needs. Thats it so far.
Hi Adrienne – the doctor’s statement about likely eligibility is, sadly, typical of many people who work in the health and social care system. Many families are told that Continuing Healthcare is only for severe needs, or that’s it’s only for this that or the other, when that’s actually very misleading, as it places an undue emphasis on specialist medical supervision in determining eligibility.
Hi, my father in law has just been moved on to a Section 3 of the mental health act. His psychiatrist at the meeting today said because my father in law is now subject to a Section 3 he will automatically be able to access section 117 aftercare. Unfortunatley we have been misinformed on a number of occassions so far so are reluctant to automatically presume this is correct without further clarification, can you comfirm or suggest where I could look further to confirm. Many thanks.
My father was sectioned under Section 2 but was detained in the hospital for 56 days and then taken to a care home nearer to my mum. I have asked why he isn’t receiving 117 aftercare? His social worker said that when his section 2 came to an end on the 28th day he was placed on an urgent Depravation of Liberty Safeguard. I have asked who applied for it and when but i have had no reply since the 7th july and i have sent it twice now. I am no health professional but even i can tell you that he is no better. No one has advised my mum about aftercare, and all anyone wants do is a financial assessment by the county council. So as he was assessed by a doctor, a mental health professional and a psychiartrist and they agreed that he should be Sectioned under the Mental Health Act should he be receiving aftercare.
Please can anyone tell me what are the conditions required to be released from a Section 2 and 3 of the Mental Health Act?
Since I cannot at the moment access any records prior to 1983 to confirm my dad’s section but I am sure he was sectioned.
I’m now trying this approach – the conditions that have to be met for someone who is sectioned to be released from that section. I can then look at my dad’s situation and go from there.
Any help much appreciated.
Vanessa
Is it true that if they are held under section 2 for more than 28 days then it moves to a section 3? I am having a massive battle with social services and now waiting to speak to NHS again. Very stressful and disgraceful way to behave. It’s been a nightmare!
I have read the following extract from a document called “……….
“NHS Continuing Healthcare Guide for Health and Social Care practitioners”
There is the following information about exceptions to CHC assessments listed below my question.
My question is this please.
I HAVE A RELATIVE CURRENTLY ON A SECTION 3 OF THE MENTAL HEALTH ACT. SHOULD I REQUEST A CHC ASSESSMENT WHILE THEY ARE STILL BEING HELD UNDER THE SECTION 3 BEFORE ANY DISCHARGE PLANS ARE MADE? (sorry for capitals but I wanted to make my question stand out from the actual document I have referred to).
Exceptions
a) Section 117 . The main exception to the above is where the individual is subject to Section 117 of the Mental Health Act 1983 and solely requires care and support for his/her mental health aftercare needs. Section 117 applies after an individual has been the subject of a compulsory order under the Mental Health Act 1983 (usually section 3, but it could be a hospital order made under section 37, or a hospital direction made under section 45A or a transfer direction made under section 47 or 48). In such situations the NHS and LA have a statutory joint responsibility to arrange and fund the necessary support under the terms of their local arrangements for this. An individual subject to section 117 should only be considered for NHS CHC where they have significant healthcare needs which are not related to their mental health aftercare needs [see Framework 118-122].
I am a bit confused as to how/who/when to ask the questions .
Appreciate any comments/opinions/advice anyone has to offer. Thank you for your kind assistance.
Jane
My husband who has frontal lobal dementia and has been under Section 3 and in hospital for 2 years is due to be discharded to an assisted living accomodation on Monday, where I’m expected to pay for everything from his disability living allowance, which is not yet due. I cannot afford his pensions to be used as I need it to live. on. I know I wont be able to pay the rent although they have applied for housing benefit which he won’t get as his pension income is 1,200 a month. I refuse to pay his future rent. He will be on Section 117. He has not been asessment for NHS funding. I think he needs to and wants to come home and so do I. Can he be forced to stay under section 117?
Thankyou very much for your reply. Now I must work on getting the necessary forms to fill in in which I had already asked the hospital to provide this assessment, but they said an assesment has already been made by the council but I dont think they bothered to apply for this Continuing Care. He is due to be discharged soon under section 117 to assisted accommodation where the caring only will be funded but not the rent, water, gas electric etc or rent which is substantial at 140 a week. The private company has applied for housing bebefit but I know he wont get it. due to his pension income of 1,200 which they take into consideration as a single person which would leave me nothing to live on! There is something wrong and I have to do a lot of reading and form filling to fight this.
My child has been sectioned and sent to a hospital miles away. Where can i get help to pay for travel to see her?
My husband has been in hospital for two years under Section 3 and released on Section 117 to supported living without my knowledge and consent. I only agreed for a trial night and they moved all his things secretly. It was a collaboration between a private organisation and the doctor at the hospital. I agreed to pay for food and utility bills from his disability allowance. After being there 3 weeks they have sent me an invoice for £400 and water rates for whole year. If I dont pay they are applying for deputyship over his pensions and everything. I am already financial appointee but have not got power of attorney. I will have to apply for deputiship which will leave me with no savings. They have been trying to apply for housing benefit but nothing yet. I want him back home and off this Section. What can I do? Its terrible.
A friend signposted me to your site. My mum had mental health issues of chronic depression through the later years of her life. As the sole carer around four years ago she was admitted into a residential care home after a very difficult Christmas.
I was never offered any direct support or a Continuing Healthcare (CHC) assessment. In 2012 after watching Martin Lewis I was advised to process a claim for an NHS Continuing Healthcare assessment in respect of episode of care: 1 April 2004 and 31 March 2012.
I processed this claim on the 12/9/12 and have recently had their response after nearly four years. Throughout the process I had very little or no contact from their team (I did all the chasing). I was told that I could submit my evidence throughout the process. I requested that I could do this at the end. My request has been turned down as my mum did not meet the criteria. She has been admitted to Clatterbridge hospital on several occasions but went voluntarily. On one occasion she took a small overdose and was admitted. My mum was at her happiest when recieving help from health professionals. I do believe if she refused to go she would have been sectioned.
The trigger questions state “detained under sections 2.3.35, 36 or37/41 of the Mental Health Act 1983 or patients admitted compulsory to hospital (NHS or independent) under the terms of the mental health actor a patient who would meet the requirements of the Act but are willing to be admitted voluntarily”. I have all the paperwork and have been told I have twelve months to process my complaint although I see it more as an appeal. I am at the point of requesting her health records. Please could you advise as I am pretty exhausted. It is not about the money but more of the principle.
My mother is being assessed in a hospital assessment ward. When she was admitted she was sectioned, they have now put her on a DOLS. She has Dementia/Alzheimer’s and urinary incontinence, Hallucinations. Today a Continuing Healthcare Checklist was completed by the Nurse. A social worker was also present together with my wife and myself. Her score wasn’t high enough to apply for NHS funding. Does her being on a DOLS qualify her for funding?
My question is a bit similar to the previous comment. My mother has been in care for the last 3 years following a best-interest decision related to her dementia. It is a locked door environment. Recently, I received a DOLS notification and assessment report. She is (quite rightly) being detained but not so far as I know (I hold registered POA for her) under any Section. Is this possible? In either case should she be paying for her care? Grateful for any advice.
Hi again it’s Peter
My Mother was originally detained under a section 2, when the 28 days was up they put her on DOLS
Is this just a financial move from the NHS, Can she still be eligible for section 117.
2016 changes to Section 117 aftercare: http://bit.ly/2czSiNC
Hello, my father has dementia and has escaped several times from the nursing home he was at. The last time involving him being found by the Police and taken into hospital, he returned to the home, but a few weeks later they served notice saying they could not meet his needs, as he was occasionally aggressive, over protective to females and basically got himself into trouble. Shortly after this, I got a call to say they were going to get a team of doctors to section my father, I was horrified, as I was due to go on holiday and had lost my mother in law. On the following week and the day of the funeral, they called to say dad was being sectioned. I explained I was going on holiday that night, and they couldn’t tell me what time this would take place. It was done at 11.30pm – horrendous he must have been asleep to be awakened, sectioned and taken to a secure unit at the hospital. I didn’t get to see him until I returned from holiday 10 days later. He is very confused, he is still getting aggressive. The section 2 ran out on Tuesday and he is now under a section 3, as they are trying to sort his medication out to make him less anxious and aggressive. Obviously he still needs EMI nursing care and there are very few decent homes locally, especially with beds available. Dad previously has continuing healthcare funding but now I am expected to ring around 3 EMI nursing homes invite them to assess him, get a quotation for his care so that it can be looked at by the funding body. Problem is nobody will come out and do it because they have no availability only one home which is the one I want him to go to – but it could be thrown out because I haven’t provided three quotes, how ridiculous is this – my dad isn’t a decorating job – its his future. I’m so cross at the process that I now have to go through again after such a short period less than a year and through no fault of his own, the nursing home being inadequate and can’t take care of him; they don’t have enough staff and they just section him. At the end of the day I need my dad settled and hopefully happy. My mum died 18 months ago ;sometimes he cant even remember her. We just want the best for him not locked up and expected to sit in a chair all day with no stimulation. It’s so sad to see him, especially when he cries. Any guidance would be greatly appreciated.
I was under the impression that when the authorities put someone on a section 3 they become responsible for that persons welfare. They should be doing the searching for a placement for your father. They (the NHS) will be funding him under section 117 they should do the leg work in finding a suitable home,
Of course you will want to be involved
But they need to do more.
Do you have any case law references citing section 117 in section 117… even any published appeals against trusts/local authorities?
Hi
My mother in law was in a care home when she was sectioned. Her care home fees are now being paid by the LA even though she is no longer sectioned. This will remain as she is at risk of being re-admitted. However, what concerns me is she still retains her full pension and part of her disability benefits (just not the care bit). Surely in these days of austerity she shouldn’t be entitled to all this money? She doesn’t spend hardly any as everything is paid for. She has a huge nest egg which could quite easily go to someone more needy.
My brother is on section 3 he had Alzheimer’s, what happens to his state pension?
My mother has dementia and was sectioned for her own safety. She is currently on a short term detention with a view to moving her to a care home, as she is no longer safe in her own home.
She had no insight into her illness so has refused to accept she needs extra care. She will not go willingly so they are talking about moving her with the mental health act and maybe a compulsory treatment order.
Can you explain what this means and who should be paying for her care?
Hi my mum has been under a Deprivation of Liberty Safeguards (DoLS) for over 2 years now and living in a care home and paying her own fees. She had Vascular dementia, COPD and diagnosed with a personality disorder and was was Bi-polar. Sadly she passed away last week and we were wondering as a family whether the LA should of been paying her Care fees over the period whilst she was under the DoLS.
Plus in this section there comments about Continuing Healthcare which we were not made aware of. Just wondering should my Mum’s social worker given us this information at the time of the DOLS being enforced.
Many thanks
My father has been resident in an EMI nursing home since November 2015. He was placed there by the Local Authority (LA) following a long stay in hospital and is sectioned under a 117. Since then the LA has charged us family top up, which is a lot of money (my father has no money of his own.) We are finding it very difficult to pay that amount. Should they have been doing this?
Hi, I wondered if someone could help me. My mother is in a residential home and funds her own care. We could no longer cope with her at home because of her being a risk to herself, wandering and aggressive behaviour. She has Lewy Body Dementia, Vascular Dementia, TIAs, frequent UTIs, scoliosis, osteoarthritis and osteoporosis. The residential home telephones us constantly to say that she has shown aggression and have contacted us on more than 3 occasions to ask us to move her to another home (we have never been given formal notification to quit). The psychiatrist she was seeing prior to going into the home has put her on Risperidone, twice daily. The home manager wants another dose in the night as she wanders into other resident’s bedrooms and disturbs them. My mother was admitted to a mental health hospital in the 1960’s for ECT treatment and so the Mental Health Act 1959 applies. Is this enough to push for her to have an NHS Continuing Healthcare assessment?
My father has been in hospital for 5 months and has been ready for discharge into a nursing home for 9 weeks. We have already been up some blind alleys trying to secure funding. We know now that he should be funded under section 117, and has been in the past. Two suitable nursing homes with places have been identified, first by family and then, after some time, by his social worker. The homes contain mostly state funded residents (including section 117 funded) and are within reach for family members. However, his social worker seems to be taking little meaningful action, and during every phone call refers us to two homes she has identified that are much further away and difficult for family to access, which she describes as ‘best value for money’. What leverage do we, his family, have in this situation – do we have the right to refuse their suggestions and insist on the homes that meet his best interests?
We are desperate to prevent him being isolated in his last weeks /months.
Thank you
Just posting an update to where I am at with trying to get funding for my mother. She was put on Risperidone by the mental health team and was found on the floor of her residential home a few weeks later. We had a meeting with her psychiatrist and asked her to be taken off the drug. We were never consulted prior to her being put on it despite having LPoA. The psychiatrist agreed (my mother has lost her mobility and a trip to hospital did not find a physical reason). My mother was put on the drug without our consent. A few weeks forward and my mother had an episode of aggressive behaviour and they want to put her on it again, permanently. I have declined stating that her needs are not managed in the residential home who are threatening to section her at the next episode. The adult mental health team are now pressuring me to put her back on the drugs as carrying out the threat means she will automatically be eligible for NHS Continuing Healthcare. I have sent off a letter of complaint and asked for a proper assessment that will lead on to stage 2 and the Decision Support Tool. She also has frequent UTI’s (hospitalised twice since a resident with acute kidney failure), stage 4 kidney disease, osteoarthritis, osteoporosis, kyphosis, high BP, heart murmur, Lewy Body Dementia and vascular dementia (advanced), anxiety and depression and a history of suicide. She received ECT in 1963. I am contacted constantly to have consent to put her back on the drug and I’m standing my ground. No drug in this unsafe environment. Anyone else been through this?
Hello everyone, I’m looking for some advice.
My mother developed advanced stages of dementia after my older brother passed away, it got very bad very quickly. I had no choice but to section my mum back in 2007 to a care home called Franklin House in Oldham. She resided there between 22.10.2007 and 19.12.2010, where she passed away.
My father passed away in hospital shortly before this.
It was only recently whilst speaking to a solicitor to try and deal with my mum and dads house, that he mentioned my mother should have been given free care. I’ve looked into this and can see that it is apparently ok to have incorrectly charged care fees, as long as it was before 2012!
I’m struggling to find someone to speak to, I know they won’t pay back the £20,000+ (which they really should) that my father paid, but they also have a land registry on my parents house for roughly £51000. What should / could I do to make someone see sense, and get the registry removed? It is for money that shouldn’t be owed…… I have to leave the house there rotting until this is resolved, and I’m not prepared to let it go to paying a debt that shouldn’t be there, my parents worked hard to but the house.
Any help / advice will be gratefully received!
Jason
hi, my mum was sectioned but have no idea which section. my father had taken care of that. my mum is in a care home and as far as im aware he has never paid for her care. he took power of attorney over her financial affairs as she has vascular dementia. unfortunately my father was diagnosed with stomach cancer back in March this year. it got progressing worse and unfortunately spread very aggressively to other parts and he passed away yesterday. what do we need to do to ensure we dont perhaps need to start paying for her care? i know we will need to move power of attorney to my sister and i. any help much appreciated. thanks
Hi, I wonder if anyone can help me to understand something relating to Section 117 funding? My mother is currently under section 3 and we are in the process of discussing her discharge with the mental health team. They have told me she needs EMI Nursing and told me to look at 3 places. Only one feels as though it could meet her needs and I have been told that this one would require a very high “top-up” fee (£350 per week) as it is more expensive than the others. As I understand it, funding is a matter of needs rather than budget. I appreciate that if all places can meet her needs then it would seem reasonable that a top up would be due. However, having visited all of them I do not think that two of them would be the right place for my mother – both have 50+ residents, the layout of one is very unsuitable and the only available bed is on the 3rd floor and away from the EMI Nursing section, ownership of one of the homes has just transferred but the identity of the new owners is “confidential”, one of the homes “Requires Improvement” according to QCQ. I have concerns with all of these points specifically in the context of the way my mother’s dementia presents itself. Would these be valid points for me to argue that the only place they have proposed that can meet her needs is the more expensive one and should not be subject to top up?
Hi
My Mum is under 117 as sectioned under Section 3. She had an assessment for CHC which she passed scoring 2 A’s and 5 B’s, etc and was recommended for DST by Mental Hospital who did the CHC. Also Local Council said that a DST was going to be done. Now I have been told that because of 117 they do not have to do a DST. My Mum has very challenging behaviour, very intense & unpredictable. Are they correct in saying she doesn’t need to have a DST done?
Hi My Mum passed the CHC with 2 A’s in the Priority domains yet despite Mental Hospital & SW saying she had to have a DST done they are now saying she doesn’t need one. Are they correct??