Care Home Funding
A recent, heart-wrenching article in This is Money by Andrew Penman highlighted a reality that, as a solicitor specialising in Continuing Healthcare (CHC), I see far too often. The headline figures were staggering. Penman’s uncle, Richard, has paid nearly £1 million in care fees over a 30-year period.
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For many families, reading that figure is terrifying. But the most "infuriating" aspect of Richard’s story wasn’t just the cost - it was the battle resistance encountered in looking into this funding, which should be made available to people with complex needs.
The "Holy Grail" of Funding
NHS Continuing Healthcare (CHC) is often described as the "holy grail" of care funding because it covers 100% of care fees, including accommodation, and crucially, it is not means-tested. It can be worth thousands of pounds every week for those with significant physical or mental health needs.
However, as the article correctly points out, the rules are "opaque" and access is fiercely guarded, with increasingly high numbers of all CHC claims currently being rejected. The article cites 83% of all cases, which is a huge increase on previous numbers.
The Care Home Conflict of Interest
One of the most critical takeaways from Andrew Penman’s experience is a warning I frequently give to my own clients:
Do not rely on your care home to tell you when or how to apply for CHC.
In Richard's case, when his nephew asked the nursing home about eligibility, he was told there was "not enough complex nursing care evidence to support this." Yet, simultaneously, the home was using Richard's "increasing care needs" to justify hiking his annual fees to over £74,000.
The contradiction is maddening. How can a resident have needs that are complex enough to warrant massive fee increases, but not complex enough to warrant NHS funding?
The uncomfortable truth touched upon in the article is that supporting a CHC application is often not in a care home's financial interest. Private beds are generally more profitable than NHS-funded beds. As a solicitor, I do everything in my power to help families to bridge that gap and ensure your relative's assessment is undertaken pursuant to the criteria.
It’s About the Care, Not the Illness
Another common misconception highlighted in the piece is that eligibility depends on a specific diagnosis. This is incorrect. As the article notes, the criteria for funding isn't the illness itself (whether it's a stroke, dementia, or otherwise), but the "care required as a result."
Even if CHC is refused and no appeal is to be pursued, families should be aware of other options, such as NHS Funded Nursing Care (FNC). However, it’s important to note that, whether not FNC serves to reduce, the fees payable will likely depend on the contractual agreement the service user has with the care home. Families should also consider taking independent financial advice to ensure options for servicing long term care fees is fully explored.
Don't Take "No" for an Answer
If you have received a rejection letter, do not assume it is the final word. The system is described by experts as "unfair and inconsistent," but you have the right to appeal to the local Integrated Care Board within six months.
Navigating the "maze" of CHC is daunting. But with fees easily reaching £74,000 a year, ensuring you are receiving every penny of funding you are entitled to is not just a right - it is a necessity.
If you are struggling with a CHC checklist, a Decision Support Tool, or an appeal, our team is here to help. Call us on 0113 320 5000 or email jub@winstonsolicitors.co.uk.
