At the height of the COVID-19 pandemic in March 2020, many hospital inpatients were relocated to care and nursing homes in order to free up beds for the looming crisis.
As part of this rapid movement out of an acute setting, many patients were given what has been known as COVID funding for that placement. The regional Clinical Commissioning Groups were funded to pay for patient’s care home fees which removed many a headache for the individual and their families when it came to ensuring quality and funded care was administered.
However, come September 2020 and at the time, the relaxing of COVID restrictions, many families faced the prospect of being reassessed to determine whether their loved ones are eligible for long term funding, not due to COVID, but in line with NHS Continuing Healthcare guidelines. This reassessment process continues to this day with many families worried about the financial implications of that reassessment of need.
For many families, a loved one would have inevitably become settled in a placement and there could be a reluctance to move them away from an environment that has been looking after them for potentially over 12 months. However, the reality of the situation is that in order for an individual to continue to receive health-based (and therefore, free) care funding, then they will need to be able to demonstrate that their needs are primarily health based and go beyond the provision of social care funding. That is the basic assessment and test that an applicant must satisfy if they are to be eligible for NHS Continuing Healthcare (CHC) funding.
Should that person not be deemed eligible for CHC funding then the responsibility for paying for that person’s care in the first instance falls to the Local Authority and social services. As social care in this country has always been means-assessed, it will mean for a number of residents and their families the prospect of paying the care home fees in full if they are over the financial limit for any form of financial assistance.
Faced with the scenario of having been forced into a move due to COVID and then potentially being resistant to moving them again, many families will find themselves potentially facing a large care home invoice. On top of visitation restrictions, this is a lot to take in for anyone.
The CHC process itself and the eligibility criteria are complex. There is after all a huge amount of information to process and meetings to attend and clinical reviews to complete. Any review needs to capture the needs of the individual in question and assess the level of support the home are providing. Depending on how that support is conducted, what interventions are required, how long do staff need to spend with that person, how skilled do they need to be etc. these are the fundamental questions that needs to be asked with any review. Additionally, individual domains such as cognition, behaviour, mobility etc are all considered and assigned a weighting dependent on the level of need. It can be an upsetting process documenting what a loved one can’t do due to a physical or mental condition.
Not everyone will of course be eligible for CHC funding. Such was the urgency of the evacuation of hospital beds, the vast majority would never have met the eligibility criteria had they been assessed for this funding prior to their hospital discharge. However, there will be many people that will be and should continue to receive free care home fee funding going forward.
This does not always mean that the CCG will assess them as being eligible, however. The eligibility criteria is complex and requires a good understanding of the domains and regulations as evidence of need can be overlooked or marginalised during the assessment process. There are options if a negative decision is received, and CHC decisions can be appealed under the National Framework – the regulations that underpin CHC.
We can assist in assessing the merits of any review that the CCG have conducted, and a non-eligibility decision has been made. We can do this free of charge with a number of funding options available in the event we believe the decision should be challenged.
Please contact Nicholas Endean, Associate Solicitor in the Community Care Team at Moore Barlow for more details.