What does continuing healthcare mean for you?
If the NHS fully funds continuing care in a care home, then the patient does not have to make any contribution towards the cost of that care.
However, if the care is not NHS funded, then the patient has to fund much of the care themselves or it is funded by social services with the patient expected to contribute according to their means.
How do I know if I am eligible for continuing healthcare?
There’s no clear list of health conditions or illnesses that qualify for funding.
Most people with long-term care needs don’t qualify for NHS continuing healthcare or NHS continuing care because the assessment is quite stringent.
But don’t let that put you off. Free healthcare could be worth thousands of pounds each year, so it’s important to find out where you stand and if you qualify.
What are eligible health needs?
As a guide, ‘eligible’ health needs might include:
- Mobility problems
- Terminal illnesses
- Rapidly deteriorating health
- Long-term medical conditions
But the only sure way to know if you’re eligible is to ask your GP or social worker to arrange an assessment.
How do I apply for continuing healthcare?
The assessment process usually takes place when you are ready for discharge from hospital and require a package of care, or you live in the community or a care home and your health needs have increased significantly.
What can I expect from the process?
- An initial checklist – the aim is to get a general indication of your level of health needs. You should note that the threshold for passing to the next stage is quite low.
- Full assessment – a ‘Decision Support Tool’ document is filled in at a meeting involving family members and health/ social care professionals.
What happens at the Assessment?
The decision support tool meeting will be held and should include the following people:
- a nurse from the Clinical Commissioning Group (the local NHS provider)
- social worker
- and a member of your care team
You will be invited to attend and you can bring along someone to represent you.
At the assessment, you will work through a decision support tool. This document looks at your health needs under twelve ‘domains’ which include areas such as mobility, behaviour and psychological needs. A score, ranging from ‘no needs’ to ‘severe’ is awarded for each domain. The higher the score awarded, the more likely it is that you will have a ‘primary health need’ and therefore be eligible.
The professionals at the meeting make a recommendation of eligible/not eligible, which is then presented to a local panel for ratification.
What happens if I am found to be eligible?
Your care package will be funded from the 29th day after the checklist was received. Your eligibility will be reviewed after three months and if you are still eligible will be reviewed every year after this. It is important to remember that you can lose this funding and have to make a significant contribution to your care.
Can I appeal if I have been told that I am not eligible?
You can appeal the decision if you believe the eligibility criterion has not been applied properly or the meeting has not been properly conducted. However, this can be a long and taxing process so an appeal should be made if you believe you have a clear reason for the decision to be overturned.
How can we help you?
Working with a Continuing Healthcare funding solicitor from Keoghs will help improve your chances of being eligible for Continuing Healthcare as the process is thorough and complicated.
Our team of Continuing Healthcare funding solicitors are able to help in a number of different ways. Whether you are at the beginning of the process or have already started an appeal, our expert solicitors will give you the best opportunity to get the decision that you want, no matter what stage of the process you are at.
We can help by:
- Aiding you with the application process for Continuing Healthcare funding.
- Advising on the appeal process if you have been denied Continuing Healthcare funding from start to finish if necessary.
- Managing as much or as little of the claims process as is required, whether this is communicating with the NHS’s Clinical Commission Group or submitting the claim itself.
At Keoghs, Nicholls Lindsell & Harris LLP we have a specialist team of Continuing Healthcare funding solicitors led by Michael Sandler with a wealth of experience. We offer tailored and comprehensive support to clients and their loved ones who are going through this complex assessment process.
We provide a bespoke high quality professional service. It is therefore important that we see our clients in person both at the start of the case and from time to time thereafter. Due to logistical and time constraints for both clients and ourselves, as a general rule most of our clients are based in the North West including Cumbria and the Peak District, North Wales, South and West Yorkshire and Staffordshire.