The Gullands guide to Continuing Care Claims

There has been a considerable amount of media attention to nursing home fees in recent months.

Many people have mistakenly been charged nursing home fees when they should in fact be paid by the relevant Primary Care Trust (PCT). They assume that if they have a reasonable amount of savings or own their own property that they would not be eligible for nursing home fees to be paid for them.

In fact the criteria is not financial stability, it is the primary need for health care. The individual’s needs are assessed and if it is agreed that the primary need for the individual going into a nursing home is that of healthcare, the NHS is responsible for all of the nursing home costs. Not just the healthcare costs, all of the costs.

It pays to understand nursing home fees.

Media coverage has often implied that the opportunity has now passed to make such a claim but this is not necessarily correct. If you have paid nursing home fees between 2004 and March 2011 the deadline to register a claim was 30 September. However, if you have already written to the PCT and not yet received a response you will possibly have complied with the deadline. As such your claim is in time and in the system. It is possible that you are now waiting for a retrospective review of an assessment. In some cases the first assessment may be about to take place.

Following initial investigations claims are sometimes rejected on the basis that there is no Primary Health Care need. The rules and regulations surrounding this are quite complex. There are several stages of appeal available and some cases have been agreed on the second or third appeal.

For care fees paid between 1 April 2011 and 31 March 2012 the deadline for making the application is not until 31 March 2013. Claimants should submit an initial letter to the PCT so the matter can be investigated. Once the request for review is logged and accepted, the process has begun.

The assessment process is based on twelve areas of care needs from behaviour to an all-encompassing “other significant care needs”. The areas include cognition, mobility and continence. Each of the different sections is graded on the level of care needed between “no need” and “priority need”. The level of care assessed will decide whether you are entitled to be considered for continuing care. It is this twelve step criteria that makes the process complicated and time consuming.

Clearly it is important that people who should not have paid for care are refunded and in the future those entitled to have their care paid for by the PCT are properly assessed.

If you have a relative or are thinking that you may need to go into nursing care, it is worth knowing and understanding the questions to ask at the initial process and ensuring that a formal request for assessment is made.

If you have paid nursing home fees you may still be entitled to a refund.

For further information about continuing care contact Jacqueline Beadle by:
Email at:  j.beadle@gullands.com
Direct dial:  01622 689751  

Website:  www.gullands.com

Gullands Solicitors

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