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Do you have to pay for care home fees?

by Ridley&Hall in James Urquhart-Burton, NHS Continuing Healthcare posted February 12, 2020.
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When you need care, the first concern is how your needs will be met. Depending where you are at this point, making this decision might involve you, your family, hospital staff or social services but sooner or later, the cost of your care placement must also be addressed.

Whether or not you have to pay for your care fees depends on a number of different things and it is really important to know where you stand.

Social Services, or sometimes just called the Local Authority, has a duty to assess your needs under the Care Act. Once it has been determined that you have “eligible needs”, the Local Authority will usually want to assess the extent of your income and capital to decide whether you need help to pay for your care home fees.

If you have capital assets which have a value which is less than £23,250, then social services will need to top up your income to help meet your care fees. In other words, social services will help you pay for your care, but you will usually have to pay something and you must meet the requirements of their means test.

Be mindful that the means test can be more complicated than initially meets the eye. For example, whilst your home is potentially a form of capital which can be included within the means test, there are certain circumstances in which that capital should be disregarded from the assessment, such as if your spouse lives there. Issues can also arise where property is jointly owned with someone other than a spouse. In our experience at Ridley & Hall, social services may view unusual circumstances of ownership with suspicion and it is important to seek expert legal advice from a solicitor if problems arise.

Funding for care home fees may also be payable by the NHS Clinical Commissioning Group where, following a detailed assessment of your needs, you are assessed as having a Primary Health Need and are eligible for NHS Continuing Healthcare Funding.

The Clinical Commissioning Group must follow the guidance set out in the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care, the latest version of which can be found here.

The Clinical Commissioning Group is responsible for undertaking these assessments but unfortunately some people slip through the net and because the criteria is not straight forward, people may wrongly tell you that you are not eligible, so there is no point in getting an assessment. Our solicitors are experts in this field and in our view the only way to be sure is to ask for an assessment. It should be borne in mind that even if you are assessed as ineligible for NHS Continuing Healthcare Funding, these decisions are not always right and there is an appeals process which can be followed in the event of disagreement.

In the end, it is really important to ensure that both the Clinical Commissioning Group and social services are aware that you need care and support and to be proactive in asking for assessments of eligibility for help with care home fees.

Call us on 0800 8 60 62 65 if you need legal help or advice.

James Urquhart-Burton

James Urquhart-Burton – Solicitor




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