Nearly all treatment provided by the NHS is free and un-beknown to many this can also include long term care, but only if your need is primarily a medical or health need not just a social need to help with maintaining independence.
This is called NHS Continuing Healthcare and can be provided in any setting (your own home, hospice, or care home).
NHS continuing healthcare is also sometimes described as NHS Continuous Care or fully funded NHS care. It is given in limited cases to avoid people remaining in hospital long term to avoid so called “bed blocking”.
Eligibility is not dependent on disease; diagnosis or more importantly the amount of money you have.
It is only assessed on whether you primarily have a health need as opposed to just an adult social care need (such as needing help to get dressed or use the toilet). Therefore, everyone who needs long term care should first ensure they are assessed to see if they would qualify for NHS Continuous Care as then the care needed would be fully funded entirely by the NHS.
Key indicators as to what may constitute a primary health need include the nature, intensity, complexity and unpredictability of the need.
Firstly you need an assessment. This you can request at any stage and would normally be carried out after any discharge from hospital if it’s clear you may need some further assistance.
Your local Clinical Commissioning Group (CCG) is ultimately responsible for carrying one out. You should check that an assessment has been done and if not you should either ask your Local Authority Adult Social Care team to arrange one, or if residing on a care home ask the Manager to request one, or contact your local CCG. Find your local Clinical Commissioning Group.
In England an initial assessment is carried out by a single trained assessor using an new initial checklist to assess whether there is any chance of qualifying and if so a more detailed assessment is carried out by 2 or more professional using a more detailed Decision Support Tool.
If this more indepth assessment deems you should qualify, a recommendation is made to your local Clinical Commissioning Group, who will be ultimately responsible for deciding whether you qualify or not.
Both the initial checklist and the more detailed decision support tool looks at 12 different domains or need areas and the support tool also rates you as either low (L), moderate (M), high (H), severe (S) or in some cases priority (P) in each domain:-
Behaviour - L,M, H, S, P
Cognition - L,M, H, S, P
Psychological and emotional needs L,M,H
Mobility_ L,M,H, S
Nutrition – food and drink - L,M,H, S
Continence – L,M,H
Skin and tissue viability – L,M,H,S
Breathing - L,M, H, S, P
Drug therapies and medication: symptom control - - L,M, H, S, P
Altered states of consciousness - L,M, H, S, P
Other Significant Care Needs – L,M,H,S
If this preliminary checklist results in;-
A full assessment using the decision Support Tool should be undertaken.
Should this more detailed assessment indicate
A recommendation of eligibility for NHS Continuing Care should then be made to the Clinical Commissioning Group . Likewise if the assessment suggests that there is:-
This can also indicate a primary health need.
However please note neither of the above outcomes on their own will determine whether you are eligible, with the final decision being taken by the local Clinical Commissioning Group after also taking into account the healthcare's experience and judgement.
If your claim for NHS Continuing Healthcare is because you or your relative is entering a terminal phase due to a rapidly deteriorating condition and you need a package of care to be put in place urgently, you can ask a Ward Sister or GP to consider an immediate provision of NHS Continuing Healthcare provision under the Fast Track process. If an assessment makes a recommendation for urgent care your local CCG should accept it and provide it immediately but can then reassess using the usual decision making support tool.
If your health merits it, you may receive NHS Continuing Healthcare indefinitely, but your ongoing entitlement will be subject to regular reviews.
Even if successful and you are awarded funding a review of eligibility will be carried out after three months and then again each year.
If at the checklist stage you are told you do not meet the criteria for NHS Continuing Healthcare and are therefore not given a full assessment, you can first ask to see your paperwork and then challenge the assessment through the NHS Complaints process.
Should your appeal be successful, the cost of services they deem you need and you have incurred should be refunded to you.
Should you still be unhappy you could take your complaint to the Parliamentary and Health Service Ombudsman (PHSO) The PHSO can be contacted on 0345 015 4033 or via their website www.ombudsman.org.uk.
The affect receiving NHS Continuing Healthcare will have on other benefits will depend on where you receive your care.
Care at Home – Social Security Benefits and State Pensions shouldn't be affected, so you will still be able to claim AA or DLA as long as you meet the eligibility criteria for these benefits.
Living in a Care Home – State pensions not affected (nor any private or occupational ones) but you will lose Attendance Allowance or care component of DLA /PIP after 28 days. Any mobility element of DLA or PIP can continue to be received but only if in a Residential Care Home but would be lost if it is a Nursing Home.
Should you not qualify for NHS Continuing Healthcare and any appeal is unsuccessful, your need for care becomes the responsibility of your local authority, not the NHS. Your local authority is then duty bound to do a financial assessment to see if you can pay for your own care.
They will only provide any help towards your care if your assessable capital is below £23,250 England, £28,750 Scotland or if you live in Wales £24,000 if you need domiciliary care or £50,000 for care in a care home (2021/2). If not, you will need to pay for your own care.
These threshold figures will include the value of all your own bank accounts, savings, investments, national savings, plus where married or in a civil partnership, also 50% held in any joint accounts. It also includes any money believed to have been deliberately given away over any time period (not just 7 years) if at the time care could have been foreseen. It also will include the net value of any main residence (unless a spouse or civil partner or certain qualifying relatives) will remain living in it and will certainly always include the value of any 2nd property or holiday home you have an interest in, so unfortunately most people do not qualify and have to fund their own care.
To find out more about all options you may have to fund your own care you may like to view paying for care. To ensure your care can continue indefinitely and your money doesn’t erode totally you should consider a Care Fees Annuity or care fee funding plans).
These are specialist care fees plans which you can buy with just a single premium which then guarantees to pay an income – (your requested benefit -usually just the difference between the cost of care and the income your or your parent/relative will continue to enjoy) indefinitely to meet the cost of care. The benefit, if paid directly to your care home or registered care agency is also paid tax free under current rules, and is totally portable, so no matter whether you need to change care providers it will continue to pay for the rest of your life.
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