With the average annual bill for a care home room now exceeding £30,000 in some areas of the UK, elderly people and their relatives are facing increasing difficulty in finding funds to support themselves. Sixty-two percent of people now believe that they may face ‘significant financial sacrifice’ in order to secure care for their loved ones’ later life.
What is NHS Continuing Care?
If ill-health is the main reason for a person going into a home, then it’s likely that they’re eligible for a NHS program, Continuing Healthcare. Under this initiative, the NHS is liable to cover all costs, including accommodation, with no ceiling on the amount paid out and no means test.
Not everyone with a disability or long-term condition will be eligible.
Qualification for the program is not dependent on a particular disease or diagnosis, rather an individual assessment of specific care needs. Providing the patient’s needs are primarily health related and not social care, then they could be eligible.
The qualification process begins with a preliminary assessment carried out by healthcare professional (commonly a GP, nurse, or social worker). They will make a decision on whether to proceed with the case based on the outcome from a number of criteria:
- Psychological and emotional needs
- Skin and tissue viability
- Drug therapies and medication: symptom control
- Altered states of consciousness
- Other Significant Care Needs
If the case is pursued, a further assessment will be carried out on the patient using the Decision Support Tool. This is a more in-depth assessment of the above criteria carried out by a ‘multi-disciplinary’ team.
For each of the aforementioned criteria, a level of need is identified using a scale of: ”priority”, “severe”, “high”, “moderate” or “low”. This enables the team to draw conclusions about:
- what help is needed
- how complex the patient’s needs are
- how intense and unpredictable the needs can be
- what risk the patient could face if adequate care was not provided are established.
For continuing healthcare to be awarded, the person in question must either:
- exceed the standard of healthcare required for at least two criteria, or;
- meet the standard of care required for at least five criteria
What if the condition is terminal?
If the person in question is entering a terminal phase of illness and deteriorating rapidly, a Ward Sister or GP may consider an immediate provision under the ‘Fast Track’ process. If an assessment makes a recommendation for urgent care, the PCT should accept it and provide it immediately. However, they will reserve the right to reassessment at a later date.
How can I arrange an assessment?
Get in contact with the Primary Care Trust (PCT) for the area in which the patient’s GP practice operates to get the ball rolling.
This guest post was contributed by Laura Moulden on behalf of Cheselden. To find out more about valuable care home claims, visit our website today.