Continuing Health Care
Long term care is a key financial consideration for many in later life. Specifically, qualifying for Continuing Health Care (CHC) can mean having all of your long-term care needs paid for by the NHS. Not qualifying for CHC can mean self-funding individuals having to pay a huge amount on long-term care – in some cases upwards of £75,000 a year. This is a big deal.
There are three main funding routes for care:
1. Health-related care via NHS-funded CHC is free at the point of delivery. The choice of care setting and/or delivery is restricted and you cannot make a top-up contribution to access upgraded care. There is a complex assessment and strict criteria in order to qualify.
2. Social care (Local Authority funded). If you have assets under £23,250 then the Local Authority will fund your care, although you will have to contribute from your income. Here you have less choice but can top-up, perhaps from a friend or family member, if that is available to you. If applicable you will receive an NHS funded nursing care contribution if you are in a nursing home.
3. Social care (Self funded). If you have assets over the £23,250 threshold then you pay. Here you have the freedom to choose the setting and type of care you receive. You will still receive an NHS funded nursing care contribution if applicable.
CHC Eligibility: Health Care v Social Care
There is no doubt its becoming harder and harder to qualify for CHC. The numbers qualifying for CHC are getting smaller even though the population is getting older. It shouldn’t be the case, but funding is being squeezed and this must be having an impact on qualifying decisions.
CHC is a package of ongoing care funded soley by the NHS. The recipient must have a primary health care need taking into account all of their needs. It’s not based on a specific medical diagnosis, it’s based on need. A health care need tends to be around treatment of an illness or disease or some other medical condition. Understandably, the definition can be a bit broad and woolly. This is what can lead to disputes and appeals against CHC decisions.
Social Care on the face of it, has a lot clearer a definition. It’s about managing nutrition, personal hygiene, toilet needs, living safely in the home, maintaining relationships, accessing local community services and education. Some people might just need a bit more help around the house.
The CHC Application Process
As we have said, the application process is extremely stringent and the criteria for qualifying is high. Initially there is a screening checklist to see if it’s worth even applying. If you pass this stage then you should have a full assessment with a multi-disciplinary team involving doctors, social workers, family and others who are directly involved in the care of the applicant. A successful application should reach conclusion within 28 days from the first screening. From here a care package is commissioned followed by a review at 3 months and then annually thereafter.
A key principle is that the individual (and their attorneys and family) should be front and centre of the whole process with communication at each stage.
Decisions can be appealed through the local ICB (Integrated Health Board) that made the decision, through an Independent Review Panel via NHS England and finally through the PHS (Parlimentary Health Service Ombudsman).
Top CHC Tips
1. Start your research early and plan ahead before you need care – always think about the next stage
2. Get LPAs in place and especially before you lose capacity
3. Use your entitlements – for example the 12-week property disregard, Deferred Payment Agreements
4. You and attorney should be fully involved at all stages of the process (right at centre of the process)
5. Check that the MDT (multi disciplinary team) comprises various professionals involved in the care of the individual
6. Keep accurate up to date written evidence / files AND verbal evidence to support your case
7. You have a right to at least a checklist if your going into a nursing home or ‘may’ be eligible for CHC
8. Watch out for unlawful top-ups – top-ups to NHS funded care are not allowed
9. Push to exercise your rights – the system is under pressure and there is lots of misinformation out there
10. We have trusted specialists in the area of CHC – to give your application more chance of qualifying or to help with appeals and disputes.
Finally don’t forget, as attorney for your loved one, as important as CHC is, don’t forget all of the other financial planning decisions that you will need to make, in their best interests. In particular if your CHC application is not successful, how best and most tax efficiently will you pay the care costs? What decisions need to be made around their investments , pensions? Is there an inheritance tax issue? We would recommend you take advice from a local specialist in this area.
Don’t hesitate to get in touch with the office for complimentary initial chat. We can be reached at 50, High Street, Westbury on Trym BS9 3DZ, office@haroldstephens.co.uk or telephone us on 0117 3636 212.