SAGA — Doing things properly

Advice on nursing homes and free care

The question of free care for people discharged from a hospital into a care home has been through the courts and investigated by the Parliamentary Ombudsman, the Department for Health and the House of Commons Health Select Committee. The committee said it was "an area in which confusion has reigned over 10 years", writes Paul Lewis

If you are discharged from hospital into a care home and your primary need is health rather than social care, the NHS should pay. However, the dividing line is difficult to draw. Each of the 28 Strategic Health Authorities in England has its own criteria.

Social care includes washing, dressing, eating, and using the toilet. Health care means attention from trained medical staff. The longer a nurse is required each day the more the care falls on the “health” side. But faced with the huge cost of funding everyone discharged from hospital into care homes, the NHS often rejects such claims, so that health care is included in social care, which it does not have to pay for.

Post-hospital care home placements: Who should pay? Anyone who believes they need health rather than social care should apply to their local Primary Care Trust and ask for “continuing NHS health care”. Most applications are refused and refusals should be challenged if family, or the person in the home, think they are wrong.

First, ask for an independent review. The more a need for frequent medical care is demonstrated, the greater the chance of success. If that fails, make a formal complaint and if that does not produce change, take the case to the Ombudsman on grounds of maladministration.