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.
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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
Gullands Solicitors
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