A 90 year old woman with dementia has received a cheque for £94,000 to cover the cost of her care after her son fought a two year battle with the NHS.
Vicki Keiller lives in a care home near Cambridge. Her son Don, who is 60, has been battling with the NHS for the past two years to prove his mother’s entitlement to state support covering the cost of her care, regardless of her income or assets.
The support is available under the NHS Continuing Healthcare scheme (CHC) which few people are aware of. If a person is eligible under the scheme, the state will pay for all of their care costs, including accommodation where residential care is needed, even if they own their own home or substantial assets.
If a person is not entitled to care under the scheme, the Local Authority will ask them to pay for care themselves if they have more than £23,250 in assets. If they have between £14,250 and £23,250 in assets, they will be expected to make a contribution to the cost. When assets are depleted to less than £14,250, the state takes over and pays for the cost of care.
Often, however, people requiring care will receive incorrect advice about their options. Local Authorities are quick to carry out a means test to see if they can afford to pay for care themselves. In fact, the first step should be an assessment of their needs to see if they are eligible under the Continuing Healthcare scheme.
A complex scheme
Funding under the Continuing Healthcare scheme does not depend on having any particular condition. Some people with dementia will be entitled to funding, while others won’t. The scheme requires those who want funding to go through an assessment procedure. This starts with a simple questionnaire completed by a healthcare professional which identifies that the person might be eligible to receive funding. If this stage is passed, a more detailed assessment is carried out by two healthcare professionals. They will look at various aspects of the person’s daily life including, for example, their behaviour, communication and mobility. Needs are marked as priority, severe, high, moderate or low. If the person has one priority or two severe needs, they will qualify for funding. If however they have one severe need and other moderate or high needs, they might also qualify.
The assessment process is difficult to understand and even healthcare professionals struggle to understand the system.
Reform is desperately needed, given that most people are not even aware that CHC funding even exists – and those that do know about it are often ill informed about its availability. The Continuing Healthcare Alliance is expected to publish new evidence next month offering key recommendations on how the current system might be improved.
If you have an elderly relative, make sure they have made a Lasting Power of Attorney for health and welfare. This gives you the right to be involved in decisions relating to their care. A Lasting Power of Attorney can only be made if the person has mental capacity (i.e. they can make decisions for themselves). If they have lost mental capacity – for example, because they are suffering from dementia – it is possible to apply to the Court for a Deputyship Order to secure the same rights.
Note that a diagnosis of dementia does not automatically mean the person does not have mental capacity. In the early stages, they may still have sufficient understanding to give you Power of Attorney. Speak to us if you are unsure.
If a relative has an initial or full assessment and you do not agree with the outcome, you can ask for it to be reviewed, and you can also complain if necessary.