Long term care fees
Articles:
Paying for care
Crossing the boundary between nursing care and social care
What is nursing care?
It is narrowly defined as “care provided, delegated, monitored and supervised by a registered nurse”. This does not include the care provided by a nursing or care assistant, even if that care is delegated or supervised by the registered nurse. It is the act of supervision or delegation that is classed as “nursing”, rather than the care itself. Personal care is not defined as nursing care.
Paying for care
People in need of care in the community either fund the care themselves (“self funders”), or seek assistance from social services or the National Health Service (NHS). Support given by social services is means tested. Social services support is free of charge to persons on low income and capital. If social services arrange for care in the community they must pay the fees charged by the home provider and recover the cost from those not eligible to receive free care. In some cases the responsibility for providing community care transfers to the NHS. Care given by the NHS is referred to a National Health Service Continuing Health Care (NHS-CHC) and is free of charge.
NHS Continuing Health Care
To qualify the patient must have a “primary health need”. They must show that::
- The nursing services they receive are not merely incidental or ancillary to the provision of accommodation. That is, nursing services are more than a minor or supportive part to the provision of accommodation. If so, then the NHS has a duty to provide care - the test is the quantity of care.
- The nursing services are of such a nature that social services cannot be expected to provide - the test is the quality of care. Where the needs are considered complex, intensive, unpredictable, and unstable, the NHS must pay for the care received.
NHS funded nursing care
NHS funded nursing care is the funding provided by the NHS towards the costs of a place in a care home with nursing for those people assessed as requiring help of a registered nurse. This type of funding is known as “registered nursing contribution to care”. There are two levels of contribution. In the financial year 2008/09 there is a standard weekly rate of £103.80 and high band rate of £142.80 for those residents assessed with higher nursing needs.
NHS healthcare assessment
When asked to do so, the NHS must assess if a patient’s care needs entitle them to free NHS-CHC care. A multi disciplinary team comprising doctors, nurses, and NHS staff have a duty to consider all the factors and make a recommendation about entitlement to NHS CHC. The factors concern the patient’s health and include:
- The patient’s behaviour. How challenging is it?
- How well can they communicate and understand?
- What are their psychological and emotional needs?
- To what extent are they mobile? Do they need assistance to get about?
- Are they incontinent? Is a catheter needed?
- What assistance is required to feed or drink? Is the patient PEG fed?
- The types of drug therapies and medication prescribed.
When carrying out an assessment the NHS must apply a decision making tool designed to provide a fair and effective way of establishing individual entitlement to continuing health care. The tool measures the extent of the person’s various health care needs, using it to decide whether or not these needs are met by the NHS or social services. The needs are measured as “no need”; “low”; “moderate”; “high”; “severe”; or “priority”. It is considered that continuing care would be recommended if a person has a priority need in any one of the four domains that carry this level, or a total of two or more incidences in the severe category. It is upon individual judgement if people with lower level needs than this qualify for NHS funding.
The NHS Review Process
NHS guidance states that applications for CHC should be reviewed three months following initial assessment and at least yearly thereafter. The first process involves a “local resolution” by the Primary Care Trust (PCT) review panel followed by a further review by the Strategic Health Authority (SHA) panel. After local resolution has been exhausted the case can be referred to the SHA Independent Review Panel. The panel’s job will be to determine whether the PCT has correctly followed the assessment process.
The review procedure is different if the complaint is about the care package, the treatment the patient is receiving or the location of any NHS funded care. Such concerns are dealt with by the ordinary NHS complaints procedure.
Stan and Mary - A True Story
The firm recently advised an elderly couple Stan and Mary (not their real names). They lived together in a large house belonging to Stan. When they married Stan already owned the property and always intended to put Mary’s name on the deeds but never got around to it. Stan had savings in a sole account and he and Mary had a joint savings account made up of an inheritance given to Mary. Stan also had a one half share in a property held jointly with and occupied by his daughter Sarah. Stan and Mary had wills, gifting their estate to each other and then to Sarah on the death of the survivor.
Stan always kept an active life, until one day he fell whilst descending the stairs and broke his hip. When he came out of hospital he was not the same person. He began to get confused and could no longer manage his day to day affairs. He found it a struggle to climb the stairs to get to his bedroom. Mary could not cope with Stan’s care needs because she herself suffered from Parkinson’s disease. She came to see us seeking advice. She was worried about contacting social services to help with Stan’s care because her neighbour “lost everything” to pay for his care and she did not want her daughter Sarah to lose her inheritance. Mary was advised by a friend to put everything in her name so “social services cannot touch it!” When Mary tried to sort out Stan’s finances his bank refused to speak to her because she did not have lawful authority to speak on behalf of her husband. Also Mary wanted to put the house on the market for sale so she could move to a smaller property.
The first thing we did was to put Mary’s mind at ease regarding care fees. People in need of care in the community either fund the care themselves (“self funders”), seek assistance from social services or the National Health Services. Support given by social services is means tested. In some cases the responsibility for paying for care falls on the NHS where you can show the person needing care has a “primary health need”. We advised Mary to approach the local authority for help in putting together a care plan, because her husband needed care and she required support. We informed her that the council had a duty to carry out a financial assessment and Stan’s retirement income and savings up to a limit would be assessed as available to pay for care, but the property and their joint account would be disregarded. The property is ignored because she lives there and the joint savings ought to be treated as irrelevant since it is made up of money belonging solely to her. We told Mary that Stan should resist any attempt by the local authority to take his share in the flat he held jointly with their daughter to pay for his care. We said Stan’s share in the property had little or no value because a prospective purchaser would not pay anything for a share in a flat that Sarah intended to occupy.
A solicitor saw Stan the following week, and after assessing he had capacity, prepared a lasting power of attorney appointing Mary and Sarah as his attorneys. Following the registration of the lasting power of attorney at the Court of Protection, Mary and Sarah were able to deal with Stan’s bank accounts. Our clients took the opportunity to review their wills and set up trusts, giving them peace of mind and helping them to avoid inheritance tax.
The firm’s estate agency department successfully marketed the property for sale. Because we offer a one stop shop service our solicitors were able to deal with the legal issues, allowing the process to run quickly, smoothly and efficiently.