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Paying for Care


According to “Age UK’s Older People in the UK: Key Facts and Statistics” it is estimated that in 25 years' time, the UK's population aged over 60 will have increased by almost 50%. The care that the population may need in their older years is an important social and political issue, as well as a personal one. 

What is a care home?

A care home is a home which is registered under the Care Standards Act 2000. Before a Local Authority takes responsibility for the cost of an individual’s care, it carries out a number of assessments relating to the care requirements and the payment of the care required.

Who pays for care?

If an individual is assessed by the Local Authority as needing care in a care home there will be a financial assessment, looking at both the capital and income of the individual. An individual with capital of less than £23,250 may still be liable to pay a contribution to their care if they have capital over £14,250. Capital is assessed to show an assumed income or tariff, which is calculated so that for every £250 (or part thereof) of capital over £14,250, the individual is assessed as having an extra £1 of income. If an individual has less than £14,250 of capital, they may still have to contribute from their income to the care costs. There are a number of exclusions that apply when calculating the cost of care and one of our Private Client team would be more than happy to discuss this with you.

What is NHS Continuing Care?

The Department of Health introduced new guidance with effect from 1st October 2007, to apply across the board, in the form of a national framework (The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care 2007). The framework was revised in July 2009 to provide further clarity although it did not change the basis of eligibility or the overall principles. Certain individuals are entitled to have the full costs of care in a care home funded by the NHS Continuing Care is described as:“ care provided over an extended period of time, to a person aged 18 or over to meet physical or mental health needs that have arisen as a result of a disability, accident or illness”.

There are four key indicators that are assessed:

  1. Nature – the type or condition of treatment required and its quality and quantity.
  2. Complexity – how symptoms interact to make care and management more difficult.
  3. Intensity – one or more severe needs requiring regular, sustained care.
  4. Unpredictability – the degree to which unexpected changes in the condition occur affecting the level of risk and care needs.

If you wish a continuing care assessment to be carried out you will need to establish who is the individual’s local Primary Care Trust to ask them to carry out the assessment. You should ask them to provide you with information about the process, when the assessment will be carried out and for sight of their full decision making criteria before you comment on your perceptions of the individual’s care need.

A review of eligibility for Continuing Care should be taken at 3 months and then annually to ensure that the individual continues to be eligible for fully funded care.

If following an assessment, you disagree with the decision made and you feel that the care should continue to be fully funded, you should refer to the Health Authority’s review procedure. The nursing home coordinator, who may be employed by the Primary Care Trust, Local Authority or Health Authority, is responsible for ensuring a person’s care needs are met in full, and if you have concerns, this person should be contacted.

What is the Registered Nursing Care Contribution (“RNCC”)?

The National Health Service (NHS) (through Primary Care Trusts (“PCTS”)), is responsible for funding the care element of the costs of care provided by registered nurses in a care home. With effect from 1st October 2007, a single rate was introduced to meet these costs. It is important to note that the RNCC is not the same as NHS continuing care. The current RNCC rate is £108.70 per week for those assessed after 1st October 2007, but £149.60 for those assessed prior to 1st October 2007. The rates differ for Wales and Northern Ireland. Before 1st October 2007, there were three bands of assessed nursing care needs. 

The law clearly states that where a person has a ‘primary health need’ and has a complex medical condition, requiring substantial and on-going care needs, all of their care, whether nursing or personal should be paid for by the NHS. Even those who do not qualify for fully funded care, if they receive nursing care in some form should qualify for NHS funding. 

If you or your relative are facing long term care either in a nursing home or at home and have been assessed as having to pay for care, all or in part, then either ask for a review of the assessment form the Primary Care Trust which covers your area or contact your local NHS Complaints Agency.If you are already paying for your care in a nursing home or being cared for at home, you need to write to the Strategic Health Authority where the decision about funding was made and ask for a review to look at whether you should be funded by the NHS. 

If you are not happy with the response, you can complain through the NHS Complaints Agency.If you have asked for a review and gone through the complaints procedure and are still not receiving a satisfactory response, you should then write to the Heath Service Ombudsman at OHSC, Millbank Tower, London,SW1P 4QP. Helpline number : 0845 015 4033.

As the population ages and the cost of care rises, it becomes all the more important to plan for care costs. There can be real concern about your lifetime of savings being exhausted in old age by the payment of care fees. We can help you plan ahead and preserve your assets for future generations. Please contact us to discuss the options that are available to you and your families.