Care home fees reclaiming - Watch out for the next deadline of 31st March 2013


Earlier this year the Department of Health issued a deadline to close any claims for unassessed episodes of care where there is evidence that the individual should have been assessed for NHS Continuing health care funding. What many people were unaware of was that the NHS have a pot of funds to award full funding to people in need of care.

Care Home Reclaim Fees

NHS funding is granted to those patients who can show they have a primary health care need this must be something over and above social care.

The first deadline of 30th September 2012 has passed and that covers periods of care between 1st April 2004 and 31st March 2011. The next deadline is 31st March 2013 and this covers the cost of care for the period between 1st April 2011 and 31st March 2012.

It is very important for those whose loved ones have been in care or are currently in care to act now. The Department of Health are unlikely to consider a request for a retrospective assessment outside the deadline unless in very exceptional circumstances, although what those 'exceptional circumstances' are, is yet to be clarified by the Department of Health.

Leading up to September this year we have had in excess of 500 enquiries alone from people wanting to reclaim care home fees. Primary Care Trusts which are entrusted by the Department of Health to administer NHS continuing health care funding are now struggling with the volume of requests so much so that some Primary Care Trusts are writing to us to advise us that it will take them longer than usual to process these requests.

It is easy to impose deadlines, but the challenges faced by the patient and their families are undermined and overlooked. It can be very difficult for a family to deal with their mother or father being in care and added to that the family have to find the funds to pay for the cost of care which can be quite substantial sometimes around £30,000 a year. Some elderly clients of ours have had to sell their homes to fund the cost of their care.

Where patients have a genuine primary health care need they ought to receive full funding which is not subject to any financial assessment unfortunately, in our experience families are either not aware of this facility or they are not given the help to enable them to ask for funding. At the very least they should have been assessed to see if they are entitled to funding. We are finding instances where a person is placed in a specialist nursing home due to a specific serious health issue but no assessment is carried out. This should happen as a matter of course especially, if a patient is being discharged from hospital or where someone ‘s needs or situation changes and NHS continuing health care may be appropriate.

We act for elderly patients and their families who need help claiming the cost of care be it past or future fees paid for care at home, in a nursing home, a specialist home or indeed for the cost of care in the patient’s own home. Where the patient has been wrongly denied or deprived of full funding if they have paid fees between 1st April 2011 and 31st March 2013 they must ask the appropriate Primary Care Trust for a retrospective assessment before 31st March 2013. But getting the request in before the deadline does not automatically mean the care homes fees will be paid but it does mean there is an opportunity to ask for an assessment and obtain a refund where it is agreed the patient has a primary health care need.

Head of Care Homes Recovery, said: "Our team will be happy to assist clients who require advice and help. If you know of someone who is struggling to meet the cost of care and they have a serious health problem which requires them to pay for the cost of their own care then they should explore whether they are entitled to reclaim the fees they have paid."

"Remember 31st March 2013 is fast approaching don’t leave it too late."

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