Reclaiming Care Home Fees after Death

Hannah Morris
Care Home Fees Associate Lawyer

NHS Continuing Healthcare Funding assessments are often carried out in relation to individuals about to enter care. However, an assessment can also be undertaken in relation to those already in care homes and paying ongoing fees. And if an individual dies, a claim can also be made on behalf of a deceased resident, with representatives seeking to claim back care home fees paid on behalf of their Estate.

In cases where care home fees have already been paid, there is potential for the NHS to backdate eligibility for Continuing Healthcare Funding. Bear in mind though that this is not limited to care home fees, but can also be in relation to care fees for individuals in other settings, such as their own home.

At Simpson Millar, we have recovered over £12 million in care fees for our clients since 2013. To discuss eligibility for NHS Continuing Healthcare Funding, or to discuss claiming back care fees already paid, get in touch with our Care Home Fees Solicitors for a no-obligation discussion.

Call us on 0808 239 6218 or request a callback

What is NHS Continuing Healthcare?

NHS Continuing Healthcare Funding, also known as CHC Funding, is a package of care funded by the NHS if an individual is deemed to have a Primary Health Need, as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.

A Primary Health Need is the situation where the main aspect or majority of the individual’s care is focused on addressing or preventing their healthcare needs. It’s also identifiable as being over and above what a Local Authority can be expected to provide.

Claiming Back Care Fees for Past Periods of Care

As the NHS has a responsibility to undertake assessments for all individuals who may be eligible for CHC Funding, it’s possible to request Clinical Commissioning Groups (CCG) carry out assessments of past periods of care. 

This can apply to both living residents but also those who have died. In each case, the assessment can be requested where it’s believed there is evidence they presented with a Primary Health Need, but weren’t assessed for their eligibility for CHC Funding. Should eligibility be found on these retrospective assessments, CHC Funding is backdated and residents or their Estates are reimbursed the care fees that were paid during the period of agreed eligibility.

In order to make a CHC Funding claim for someone who has died, the claim must be authorised and/or brought by someone with legal capacity to discuss the individual with the NHS and access their care and medical records, i.e. an Executor or Administrator of the Estate.  

The period of time for which backdated CHC Funding review requests can be made is limited. In England, due to Department of Health Deadlines, a request for review can only currently be asked to consider back to 1st April 2012. The situation is different in Wales, where the NHS can only be asked to consider the 12 months prior to the request for review. Given the cost of care and care home fees, reimbursement of care fees in either location can be significant amounts of money. 

In most circumstances, the NHS will only consider requests for periods of care where an individual’s eligibility for CHC Funding hasn’t already been considered; or ‘previously unassessed’ periods of care.

Once an assessment is undertaken, if there is disagreement on the outcome, there is a 6-month period to lodge an appeal of that decision. However, there are some circumstances where periods can be reconsidered, such as when individuals or their representatives aren’t correctly involved in the assessments or aren’t informed of their appeal rights on decisions of ineligibility.

For a discussion with no obligation call our Care Home Solicitors

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