Bellow you will find a list of the FAQ cleint's ask our continuing healthcare experts most regularly. Please click on the question's boxes below.
Lasting Power of Attorney (LPA) is necessary when dealing with the NHS. An LPA is only valid if the individual has the mental capacity to set it up.
There are two types of LPA, Health and Welfare and Property and Finance.
A Health and Welfare LPA is the most useful when pursuing a claim for NHS continuing healthcare funding, as most NHS-related establishments will attempt to insist on it before liaising with someone on behalf of a patient. The NHS can refuse to disclose medical records relating to an individual if the family are not in receipt of a Health and Welfare LPA.
The NHS finding fault with the type of LPA, demonstrates some of the unhelpful delaying practices adopted by the National Health Service when dealing with continuing healthcare funding applications and flies in the face of the idea set out in the National Framework for NHS continuing healthcare that the process should be open, transparent and consistent.
I am next of kin, why should an LPA be in place?
There have been many instances where the NHS has refused to engage with next of kin regarding continuing health care.
My relative lacks capacity but doesn’t have Power of Attorney
Family or friends must obtain a Deputyship through the Court of Protection if they wish to be involved with decisions surrounding their relative’s ongoing care. A Deputyship works in the same way as a Power of Attorney, authorizing a person to make decisions for Health and Welfare and/or Property and Finance on behalf of their incapacitated relative. The Court of Protection will decide if it is necessary for ongoing decisions to be made on an individual’s be half.
The Decision Support Tool (DST) – used in NHS continuing healthcare funding decisions – is a document which helps to record evidence of an individual’s care needs to determine if they qualify for continuing healthcare funding.
As the Decision Support Tool (DST) fits into the continuing healthcare decision-making process, it is important to understand the procedure in its entirety to fully appreciate the importance of the DST.
The first step for most individuals will involve a healthcare professional using the continuing healthcare checklist to decide whether it is appropriate to undertake a full NHS continuing healthcare assessment. It is important to note that this initial checklist does not decide if an individual is eligible for funding, only whether they should be recommended for a full continuing healthcare assessment, as evidenced by the National Framework for NHS continuing healthcare (2012):
If the checklist identifies the need to carry out a full assessment, your Integrated Care Board (ICB) will be contacted. The full assessment is carried out by a multi-disciplinary team comprising two or more health or social care professionals familiar with your needs. In some cases, the multi- disciplinary team will contact the specialists involved with your care to build a better picture of your needs.
The information gleaned from your full assessment will be used by the multi- disciplinary team
to complete a ‘Decision Support Tool’ (DST). The DST document was developed to ensure
assessments are carried out as consistently as possible across the national NHS network.
The 12 Areas of Need in the Decision Support Tool
The DST identifies twelve areas of need or ‘domains’ – 11 specific domains and an additional
domain for recording needs that don’t immediately fit into the other 11.
The National Framework states:
In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here. In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need and take that need into account (and record in the 12th care domain) when deciding whether a person has a primary health need. Each domain is divided into levels of need from: ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’. The levels reflect the nature, intensity, complexity and unpredictability of a need.
The multi-disciplinary team will allocate a level of need to each care domain to determine if
the individual has a ‘primary health need’ and then make a recommendation to the ICB as to
whether the individual should be entitled to NHS continuing healthcare.
A clear recommendation of eligibility would be expected if the individual undergoing assessment
has:
If the following apply, this may, depending on the combination of needs, also indicate a primary health need:
if a patient’s level of need is assessed as being priority in any area, eligibility for full funding is automatic. Or, if a patient’s level of need is assessed as being severe in any two areas, eligibility for full funding is also automatic.
A patient can still be found eligible without a priority level of need in any one care domain or two care domains with a severe level of need. This is where determining eligibility becomes increasingly grey and open to interpretation. If a patient is assessed as having one severe and a number of other needs, or a number of high needs, this can still indicate eligibility.
Simply put, the lower the levels of need, the less likely a patient is to be found eligible. Health authorities are obliged, under the National Framework, to consider the totality of a patient’s needs, how they interact and the level of skill required to meet those needs.
The ‘National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care’ gives clear guidelines to all ICBs and local authorities on the timescales that should be followed. It makes clear that the time between the checklist being received by the ICB and a continuing healthcare funding decision being made should not exceed 28 days.
If the timeframe is longer than this then funding should be met by the NHS whilst a decision on eligibility is met.
We’d never heard of NHS continuing healthcare funding.
60% of people surveyed by the Continuing Healthcare Alliance, a group of 13 organisations who believe NHS continuing healthcare needs to improve, did not know about the existence of the funding until very late in their dealings with the health and social care system.
The NHS CHC package of care can be received in any setting outside of hospital including care homes, hospices or even within your own home. A person’s health needs, not their location, is the key factor to receiving continuing healthcare funding.
Can you avoid paying for care home fees?
We’ve received a care bill, do we have to pay it?
Paying care fees is an expense that many people are unaware they are liable for until it is too late. Clients tell us that they incorrectly assumed the cost of care in their old age would be met by the state, and were under the impression that because their only asset is the family home they wouldn’t be liable for any costs.
In fact, the reality is that the value of the family home is taken into consideration when calculating whether an individual has assets exceeding the means testing threshold of £23,250. Due to the fact the average home in the UK is worth in excess of £300,000 the typical scenario is that anyone that owns a home will be means tested.
Once the individual’s assets fall below £23,250 they have to continue to contribute towards the care costs from their assets until they fall to the lower level of £14,250. Sadly even once the capital assets are below £14,250 the individual will continue to have to pay towards their care from any income they receive, normally from any pension they may have. Their home will be liable for the full cost of their care.
Social Services, financial assessments and NHS Continuing Healthcare explain
Social Services will conduct financial assessments to determine who (Local Authority or the patient themselves) is responsible for paying care fees IF the patient is not eligible for NHS Continuing Healthcare funding. The starting position, in the absence of NHS funding, is that if an individual has assets exceeding £23,250 then they are liable to pay for the cost of their care in full, whether they receive care at home with carers, or if they are paying care home costs in a residential or nursing home.