Money
Retirement
Easing the cost of care
Thousands more people should have their care home fees paid in full under new rules. The new guidance sets out when the NHS should pay for fees in England. In the past each Strategic Health Authority (SHA) set its own rules, leading to a postcode lottery of who had care paid for and who did not
The rules will apply in England (but not in Scotland, Wales or Northern Ireland) and should make decisions more consistent. The Government says the change will cost £219 million a year and should mean that 5,500 more people will have their fees paid in full. But campaigners such as Age Concern say that is an underestimate and up to 20,000 more people should move on to full NHS funding.
The changes follow a court ruling last year that one SHA’s guidance about when the NHS should pay fees in full was “fatally flawed”. The case reflected the great confusion about when the NHS should pay and when it should not.
In a hospital all care and accommodation is free. But in the past the NHS has discharged patients straight into a care home and then refused to pay towards the costs. That has led to several court challenges and, finally, the new national guidance from the Department of Health.
From October 1, people in care homes are divided into three categories of need. Those who require continuing health care: The NHS will pay the full cost of nursing, care and accommodation, just as in a hospital. Those who require only social care: This is the responsibility of the council social services department. Residents are means-tested. Some will have the bulk of the fees paid by the council, though most will pay something from income or capital. Others with a high income or capital will pay the full cost. Those who require some care from a registered nurse: The NHS will pay a flat rate, expected to be £101 a week, towards their nursing costs. If they pay in full for care they will get this as a reduction in fees. If they do not pay in full, the contribution will reduce the amount social services pays towards their fees.
Anyone who goes into a care home either straight from hospital or from home, will be assessed jointly by the NHS Primary Care Trust (PCT) and the council’s social services department, using the new National Framework to assess needs in 11 areas such as behaviour, mobility, and continence. Each area is assessed on a six-point scale from priority, through severe and moderate to none. One priority need, or two severe needs, or a number of high and/or moderate needs mean continuing health care is required and the NHS should pay the full cost. If the person has less pressing needs, the same framework is used to assess if they need some nursing care. If they do, that will trigger the flat-rate nursing payment.
Transition
Before October 1, nursing care was paid for in three bands at £40, £87, and £139 a week, depending on the degree of nursing required. People on the two lower bands should move up to the new standard rate from October 1. People on the higher band will continue to get £139 until their case is reassessed. Most should probably be moved to continuing care and get their fees paid in full by the NHS. However, some may not and they will see a cut in the contribution towards nursing care. The Government estimates that up to 20,000 people currently get the highest band of nursing but only 5,500 extra will move to full NHS funding. Campaigners say anyone on the highest band who is reassessed and does not get full funding should lodge an appeal.
Appeals
A resident who thinks a decision on continuing NHS care or nursing care is wrong can appeal to the SHA on the grounds that procedures have not been followed or that the eligibility criteria have been wrongly applied. The SHA will try to resolve the appeal informally but may refer it to a formal Review Panel. Its decision can be appealed further to the Health Service Ombudsman. An appeal against a decision that was made before April 2004 must be made to the SHA before November 30 this year. Appeals relating to time before April 2004 will not normally be considered if made after that date.
Paying for care
People who do not get their care paid for in full by the NHS will be means-tested to assess their contribution. The test looks at capital assets and income. Normally people will be allowed to keep £20.45 a week from their income but the rest will be taken towards fees. If their capital is £13,000 or less it is ignored, as is any income it earns. If it is above £21,500, no help is normally given. The person is expected to spend capital until it falls below that level. If capital is between the two limits, a contribution of between £1 and £34 a week has to be made. The value of a resident’s home does not count as part of capital if their spouse or partner lives in it or if another relative who is over 60 or is disabled lives there. Even if no one lives in it the value is ignored for the first 12 weeks in care. After that its value is counted as part of capital. That will normally mean the resident has to pay the whole cost. But it does not mean the home has to be sold.
Instead, social services will make a “deferred payment agreement”. It continues to provide care and the cost of the fees accumulates as a debt. Only when the resident dies will the home have to be sold and the debt paid. The advantages are that the debt builds up interest-free until 56 days after their death. It may be possible to rent out the home to help pay for care. And the value of their house will probably rise while they are in care. As a result it is likely there will still be money left for the heirs.
Attendance Allowance
People who pay all their fees may be able to claim Attendance Allowance, worth up to £64.50 a week. Almost everyone ill enough to be in a home will be entitled to it. It can be claimed even if a contribution towards nursing care is being paid by the NHS (but not in Scotland). And it can be claimed even if the resident has made a deferred payment agreement on their home. Department for Work and Pensions staff sometimes misunderstand these complex rules and wrongly refuse claims for Attendance Allowance to people in care homes in these two groups. If that happens the resident can ask for the decision to be revised or, if that does not work, go to appeal. Citizen’s Advice can help with appeals.
Further information
* See the Department of Health website, dh.gov.uk (or ring 020 7210 4850) for a copy of the new Framework, a useful document called Decision Support Tool and a checklist that goes with it. These explain when the NHS should pay for care in full.
* NHFA has financial advice on care home fees: nhfa.co.uk (or ring 0800 99 88 33).
* The Health Service Ombudsman: ombudsman.org.uk (or call 0845 015 4033).
* The website direct.gov.uk has sections on attendance allowance and care homes
