NHS care home funding is provided where a person satisfies certain criteria which indicate that their health needs are of a sufficient nature, complexity, intensity and unpredictability. The effect is that a person who qualifies has their care costs met in full by the NHS, regardless of their own financial position.
NHS Care Home Funding
The process for NHS funding assessments and guidance for the Clinical Commissioning Groups (“CCG”) in this respect is laid down in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (“the National Framework”).
Step 1: Continuing Healthcare Checklist
Anyone who is receiving care in a nursing home, or in their own home, can apply to be considered for NHS Continuing Healthcare. The process begins with the completion of a Continuing Healthcare Checklist (“CHC”) which looks at 11 care domains (cognition, behaviour, skin integrity, nutrition, mobility, continence, communication, psychological/emotional, drug therapies and medication, breathing and altered states of consciousness). Patients are scored on a scale based on their health needs in these areas. If an appropriately high score is achieved, the patient moves onto the next stage of the process.
Step 2: Decision Support Tool and Multi-Disciplinary Team Meeting
The second stage is for a larger and more complex assessment to be undertaken by a “Multi-Disciplinary Team” (“MDT”). In essence, this involves appropriate assessors from the Local Authority and the NHS and should usually involve the patient (where possible), any Deputy or Attorney for the patient, the care home/carers and any other relevant family members.
This MDT group completes their assessment by way of completion of a “Decision Support Tool” (“DST”), which is a more complex and detailed version of the earlier CHC. This is your opportunity to ensure that your loved one is scored in the most appropriate and relevant categories for their needs.
The MDT will usually confirm their recommendation for NHS care home funding to be approved or denied at the end of the meeting. Their recommendation is then sent to the appropriate CCG for ratification. The decision of the MDT is usually upheld by the CCG at first instance.
Step 3: The Result
A letter is received following ratification by the CCG to confirm whether or not NHS Continuing Healthcare funding has been granted in full, whether a contribution will be applied in the form of a Funded Nursing Contribution (“FNC”), or whether the patient does not come close to receiving any form of NHS care home funding.
Step 4: Challenge / Appeal
If you are dissatisfied with the outcome of the assessments, we can help. Our advisors can review the procedure followed and the completed DST against care home notes, evidence and records to assess the likelihood of succeeding with an appeal for a fixed fee.
We are also available to support and guide you through the assessment process itself, whether that be by providing our input at the CHC or DST meetings with you or by reviewing care home notes and presenting arguments and our thoughts ahead of the meetings. Our aim is to arm you with the information you need to provide you with the best chance of fully supporting and representing your loved one during the assessment.
Following the October 2018 publication of the National Framework, it is now obligatory for the NHS to fund your care in the interim period between when you leave hospital and when a CHC is undertaken and a decision made.
Talk to Tollers
For specific advice about NHS Care Home Funding, Talk to Tollers, contact our Elderly and Vulnerable Client Unit on 01604 258558 or alternatively, complete the form below.