Reclaiming care home fees

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Reclaiming care home fees: Your entitlement to funding

The cost of care is increasing and many of those entitled to ‘Continuing Healthcare’ funding are not aware of their rights to claim.

In order to make a Continuing Healthcare Claim for yourself or your loved one, the primary care need must be for ‘healthcare’ rather than social care. In order to determine whether you or your loved one’s needs can be confirmed as primary health needs, an assessment will need to be undertaken using the National Framework.

If you or your loved one is in hospital, then before discharge to a nursing home or into health and social care, an assessment should be undertaken to determine the level and complexity of needs.

The assessment will score those needs as to whether they are:

  • A (high),
  • B (moderate) or
  • C (low)

Each case is assessed according to:

  1. breathing,
  2. nutrition,
  3. continence,
  4. skin,
  5. mobility,
  6. communication,
  7. psychological and emotional needs,
  8. cognition,
  9. behaviour,
  10. drug therapies and medication and
  11. altered states of consciousness.

To be eligible for a full assessment, two or more A scorings, 5 or more B scorings or 1 A scoring and 4 B scorings will be required.

If the healthcare needs meet further assessment criteria, there will then be a Multi-Disciplinary Team, of at least two professionals within different healthcare professions or one professional who is from a healthcare profession and one person who is responsible for assessing a person. The team will score the needs as low, moderate, high, severe or priority in view of their complexity, intensity, nature and unpredictability in respect of the areas identified above.

The funding assessment should be provided no later than 28 days following the assessment and meeting with the Multi-Disciplinary Team.

The final decision, together with the reasoning of the Care Commissioning Group, should then be forwarded to you or your loved one to confirm eligibility for NHS Continuing Healthcare.

If the Care Commissioning Group confirms that you or your loved one is eligible for NHS Continuing Healthcare, the NHS will be responsible for funding health and associated care needs, including accommodation, which will not be assessed on a means tested basis.

Reclaiming care home fees retrospectively

If you or your loved has been granted NHS Continuing Healthcare but they have required care on a private basis for a period of time prior to funding being confirmed, we may be able to assist in reclaiming care home fees for care costs already incurred or for alterations to the home.

Free helpline

For further information about continuing healthcare funding and reclaiming care home fees, please contact our specialist team for a free assessment on 0808 139 1606. Alternatively send an email to us at info@sbclaims.co.uk