Care Homes - FAQs

If you're dealing with care home arrangements and need some advice, our Care Homes team has the answers to some of the questions that you might be asking.

Care Homes - FAQs

What Funding Can I Or My Relative Access?

We can help identify whether you or your relative can access NHS Continuing Healthcare funding.

Even if you're not eligible for NHS Continuing Healthcare, we may still be able to help you access funding from your local authority or the Department for Work and Pensions (DWP):

  • If you have capital assets of less than £23,250, your local authority may help with your fees
  • The value of your property, or part of it, can be ignored in this calculation in certain circumstances
  • If you don't want to sell your home, you may be able to enter into a 'deferred payment' scheme, where the fees don't need to be paid during your lifetime or until you leave care
  • Where one of a couple is going into a home, you need to make sure that your remaining spouse is provided for financially

You should also:

  • Check whether you're entitled to certain welfare benefits from the DWP
  • Check the terms of the care home contract
  • Consider whether a third party needs to pay towards care costs

How Can I Or My Relative Claim NHS Continuing Healthcare?

If you or your relative have complex healthcare needs and require ongoing care you might be entitled to NHS Continuing Healthcare.

NHS Continuing Healthcare is free and available for anyone over the age of 18 who is being cared for outside of a hospital and whose main need is health-related.

Your local Clinical Commissioning Group (CCG) will assess whether you're eligible for funding. A health or social care worker will carry out an initial assessment of your needs or those of your relative using a screening tool, which is known as the Checklist Tool. If they find that you or your relative are entitled to NHS Continuing Healthcare, they'll arrange for a full assessment to be conducted using a Decision Support Tool.

If you are eligible for this type of funding, then the full cost of your care home fees might be met by the NHS.

What Information/Documentation Do I Need To Be Able To Make A Claim?

If you're asking for an assessment on behalf of someone else – who lacks capacity – and that person is still alive, you need to be appointed as their Attorney or Deputy. If the person has the capacity to make their own decisions, then they should be the one to ask for the assessment.

If the request is regarding a person who has passed away, you must have legal authority to act on behalf of the estate. This means you are either named as Executor of their Will or are entitled to their estate under the rules of intestacy.

If you aren’t sure who should bring a claim, we'll happily discuss it further with you.

When bringing a claim, it's important that you have evidence of the fees that have been paid. This would include bank statements, invoices, and/or a statement of account from the care home. This evidence will help to support your case when we are asking the NHS to look back and refund fees that have already been paid.

Once an assessment has been requested and arranged, it will be completed by a nurse who will review the following:

  • Care home records
  • GP records
  • Hospital records
  • Social services notes and mental health notes

This will help them establish the health needs of the individual being assessed.

I Have Already Lodged A Claim/My Relative Has Been Assessed And I Disagree With The Decision Made – Can You Help Me?

If you or your relative haven't been referred for a full assessment and believe that you, or they, should be assessed again, you can make a complaint to the CCG. If you're not quite sure how to go about doing this, we can walk you through what you need to do.

If you disagree with a decision that's been made and want to appeal against it, speak to one of our solicitors as soon as you become aware of the outcome. We'll be happy to review your case and will be able to advise you on whether you can make an appeal.

Call us now on freephone: 0808 129 3320 or email us using our Online Enquiry Form

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James Urquhart | Partner, Care Home Claims | Simpson Millar LLP - Leeds

James Urquhart-Burton
Partner, Care Home Claims

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