Family recovers £53,000 in care home fees after | European Markets

A household has recovered £53,000 in care home prices after interesting a determination for assist from the NHS.

Shirley O’Sullivan, 97, was affected by Alzheimer’s illness earlier than she handed away in 2017. Together with her care home charges reaching round £550 a week, the household utilized for the NHS’s Persevering with Healthcare (CHC) to help with prices however have been initially denied the assist.

NHS CHC is a fully-funded package deal of care that some people are entitled to obtain as a end result of incapacity, accident or sickness.

It’s out there in England and Wales to people who’ve complicated, intense or unpredictable wants and may be offered in a nursing home, in a hospital or a particular person’s own home. Those that are accepted obtain fully-funded care from the NHS.

Nonetheless, resulting from its strict tips, the scheme is notoriously troublesome to gain approval.

Mrs O’Sullivan’s son, Patrick, 75, from County Durham, informed The Specific: “The whole process took many years before the NHS settled the claim. In fact, it was settled in two parts as initially, the claims were not accepted.”

He credited the eventual success to “patience” and the “tenacity and determination” of his solicitors, Hugh James, in reaching a settlement.

Mr O’Sullivan stated: “My mother suffered with Alzheimer’s disease. Her condition during the last two years of her life was very severe. She was doubly incontinent and needed considerable care from the care home.

“She was also very depressed, had no interest in mixing with other residents and was unable to recognise me when I visited.”

Lisa Morgan’s group at Hugh James managed to get well round £53,000 for the household. Mr O’Sullivan stated: “We were absolutely delighted as my mother and indeed my late father, who was a GP, would have been very pleased that at least they were able to bequeath at least some part of their modest wealth.”

Ms Morgan, a associate and head of the care home charge restoration group at Hugh James, stated: “Most people are unaware of the existence of NHS Continuing Healthcare (CHC) – a vital source of funding for those in care. Eligibility is entirely unrelated to a person’s or their family’s wealth.

“If a person requires long-term care, the first consideration must be their health needs rather than their ability to pay. For individuals whose primary need for care is because of their health, as opposed to ‘social’ reasons, it is the NHS’ responsibility to fully fund their care.”

Nonetheless, she famous: “Unfortunately, many individuals who should be deemed eligible are turned down for this funding having been incorrectly assessed by the NHS. A lack of awareness of the funding scheme, coupled with guidelines that are often forgotten or applied too restrictively, means more people could be eligible for CHC.”

The method for recovering care home charges

Ms Morgan defined that step one in recovering care home charges is to make sure the person has been correctly assessed for CHC by a multi-disciplinary group evaluation. Anybody requiring long-term care resulting from sickness ought to be assessed by their Built-in Care Board (ICB) in England or the Well being Board in Wales.

If an particular person is discovered to not be eligible for NHS funding, the accountability falls to the native authority. Nonetheless, in contrast to the NHS, native authorities assess an particular person’s potential to pay for care. In England, if a particular person has capital exceeding £23,250 (£50,000 in Wales), they need to meet the complete price of care.

If a particular person is dissatisfied with the end result of a CHC evaluation, they’ve the proper to problem the choice by a review process.

In phrases of recovering charges, Ms Morgan additional defined that ICBs in England will review unassessed durations of care courting back to April 2012. In Wales, the method is more restrictive, with opinions restricted to only one yr back from the date of request. The authority will assess whether or not somebody’s care wants on the time ought to have certified them for CHC, even when the person has since handed away.

Ms Morgan added: “There is a thin line between healthcare and social care. However, the impact on the individual is the difference between free care and means-tested care. It is not because an individual is wealthy that they should be dismissed by a service with a legal duty to fund their or their loved one’s care home fees.”

An NHS spokesperson stated: “Eligibility for NHS continuing healthcare funding is determined on an individual basis by health and social care professionals in line with guidance and regulations set by the Department of Health and Social Care, to ensure there is a consistent approach across the country.”