How are care home fees usually paid?

The rules are complicated and vary depending on your personal circumstances, but broadly, care home fees are usually paid in one of three ways:

• By the care home resident, in full. This is known as “self-funding”. You should only be required to fund your own care if you do not meet eligibility criteria for full NHS funding, paid by the Clinical Commissioning Group (CCG) or means tested support from the Local Authority.
• Contributions made by the care home resident following an assessment of their financial means by the Local Authority. The Local Authority will usually make up the difference between the resident’s contribution and the full amount of care fees.
• Paid in full by the CCG on the basis that following an assessment of your needs, you have a “Primary Health Need” and you are eligible to receive fully funded NHS Continuing Healthcare.

When should the Local Authority or CCG usually assess eligibility?

Generally, assessments both for means tested funding and also for NHS Continuing Healthcare Funding should happen whenever your financial circumstances or your needs change. You might need to be proactive and contact the Local Authority or CCG for an assessment.

Hospital discharge or care home admission are opportunities for the Local Authority and CCG to become aware of you and your needs, and to arrange for an assessment to be done.

What happens now that we are dealing with the Coronavirus Pandemic?

A new law has been passed called the Coronavirus Act 2020 which recognises that Social Workers and Nursing staff may need to be diverted away from assessing eligibility for funding for care.

The key changes to note are:

1. Local Authorities and CCGs are not required to undertake care funding assessments during this time of emergency.
2. You can still ask either for an assessment, because some Local Authorities and CCGs will be coping better than others and some may be processing assessments as normal.
3. Local Authorities and CCGs must make sure that care packages continue to meet the needs of people who are receiving care.
4. Anyone who requires a new care package, such as when you are first discharged from hospital to a care home, will be fully funded by the CCG on a temporary basis from 19 March 2020.

Should I be concerned about the changes?

It is of course understandable that Local Authorities and CCGs need to divert their resources to deal with the Coronavirus Pandemic. However, this will leave a lot of people not knowing whether they will ultimately have to pay for their care for an undetermined period of time.

We expect that many Local Authorities and CCGs will be attempting to operate as normal. If you want a funding eligibility assessment from either, you should still ask as some will be processed.

Whilst it is very helpful that some people will be fully funded during the emergency period, once things return to normal, eligibility assessments will need to be undertaken by Local Authorities and CCGs and they will withdraw financial support for anyone who is deemed to be not eligible. Exactly how this will take place is not yet clear. There will be those who feel the decision to withdraw support is not fair.

For those authorities who choose not to do any care funding assessments during the emergency period, this will create a substantial backlog of assessments which will need to be completed once things settle down.

What should I do?

If you believe you may be eligible for support then you must request an assessment, even if no action can be taken to assess your eligibility at the moment. You need to ensure that there is a written record of your request.

If you are awarded full funding on an emergency basis then you need to be aware that when the dust settles your funding may be withdrawn. It is essential that you ask for all paperwork relating any decisions made and that you understand what rights you have to challenge the decision, as well as any time limits which might apply to you.

Whether you are in receipt of funding which has been withdrawn or you are concerned that the Local Authority or CCG is not treating you fairly then it is important that you take prompt professional advice. James Urquhart-Burton is a solicitor who has many years experience of funding for care home fees and is always happy to have a chat with you in complete confidence. If you need legal help or advice, you can speak to James on our freephone 0800 8 60 62 65.

James Urquhart-Burton – Solicitor & Partner