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Where do I get care for my relative and who pays for it?

WITNESSING the deterioration of a loved one’s health can be heartbreaking. If a member of your family is admitted to hospital as a result of poor health, it may also be that they require long-term care following their discharge.

If you haven’t experienced this situation before, it is daunting to work out what steps should be taken prior to your relative’s discharge from hospital to determine who is responsible for the cost of their ongoing care.

Firstly, if the hospital believes that a patient has a primary health need which requires ongoing care then they should be assessed for NHS Continuing Healthcare. This is a package of care arranged and funded by the NHS, regardless of the individual’s personal wealth. The process of assessing eligibility for NHS funding commences with the completion of a checklist assessment prior to discharge from hospital. This is a basic screening tool, used by the Health Authority to determine whether a full assessment for NHS Continuing Healthcare funding is required.

If you are not sure if such an assessment has been carried out or you want to request one for a relative, it is possible for you to contact the local Clinical Commissioning Group.

However, assuming the thresholds in the checklist assessment are met then a Decision Support Tool (DST) is then used to consider a patient’s needs within 12 specified care domains. This means that 12 aspects of health which include such matters as behaviour, cognition, nutrition and continence are assessed and scored. Crucially, the 12th domain for assessment purposes is ‘other healthcare needs’ and this is not always assessed. The families of patients need to be alert to this category and provide evidence and information of any other health needs that their relative has to ensure that issues which are not in the specified list but which nonetheless are serious are not overlooked. This is particularly important as there is no set scoring for this domain which means that it is subjectively tested.

It is important to note that if there are delays in assessing eligibility for NHS Continuing Healthcare, the relevant health authority will be responsible for funding the individual’s care in the interim period. Therefore, even if someone is discharged from the hospital into care, they should not be responsible for the cost of their care until they have been fully assessed.

The Health Authority will send out a written decision to a patient and/or their representative. If the assessment is positive, the care will be fully funded by the NHS. If a patient is not assessed as having a primary health need which is eligible for NHS Continuing Healthcare, it may be that they have a need for social care only (care to help them with daily living and perhaps to enable them to maintain their independence). This type of care is subject to means testing and a person’s savings and assets will be assessed to determine whether they can cover the cost of their own care.

It is worth noting that if a person does not pass the assessment for NHS Funding, that there is an appeal process.

It is often the case that families faced with these processes are regrettably dealing with a crisis that has arisen with a family member. It is not always made clear to them that the assessment of eligibility for NHS Continuing Healthcare should be carried out before any assessment for means tested care. This means that some families lose out.

If a health authority doesn’t carry out the NHS Continuing Healthcare assessment first it is failing to follow guidelines. If this should happen, I recommend that you contact the relevant health authority (a Clinical Commissioning Group in England or Health Board in Wales) directly in order to request that an assessment be undertaken.

Navigating these processes can be overwhelming for many families and it is often difficult to know what to do next if you believe that your relative has been unfairly denied NHS Continuing Healthcare.

For information and assistance in such circumstances, contact Isobel Mann at Borneo Martell Turner Coulston Solicitors on 01604 622101.

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