Reclaim Care Home Fees

NHS Continuing Healthcare Funding Challenges

Pearson Solicitors have acted for a number of families who have challenged care home funding and have been awarded thousands of pounds in compensation for fees they should not have been paying in the first place.

If you or a relative are in a nursing home because of mental or physical illness then you might be paying for something which could be funded by the NHS.

Here’s what our clients had to say about our services:

"Excellent service and very honest. Our solicitor did not get our hopes up too much but the end result was excellent."

"My father had significant health needs, he was eligible for funding but I knew nothing about it, he was entitled to that money, he had worked hard all his life. Mr Talbot was sensitive in the handling of the case and helped my family and my father get what he deserved."

NHS continuing healthcare funding FAQ

1. What is NHS continuing healthcare funding?  

Continuing Healthcare is care provided by professionals over an extended period of time to meet the physical or mental health needs of a patient.  These could have been caused by disability, accident or illness and continuing care needs are likely to be complex and substantial, with ongoing care needed. 

It is funded by the NHS and can be provided either in a care home or your own home.

In 1999 a landmark ruling said the NHS was responsible for funding if the primary reason for extended care was a health need and each Primary Care Trust has its own procedures for dealing with such requests.

The average weekly fees in a care home in England are £530 per week, that’s £27,560 annually and for a specialist home with nursing care it rises to £730 a week or £37, 960 a year.

If you need ongoing healthcare outside of hospital, such as in a care home or in your own home, then the NHS will pay for your care needs in full irrespective of your means if you qualify for NHS Continuing Healthcare.

2. Who is eligible for NHS continuing healthcare funding?  

Anybody who satisfies a list of criteria for eligibility for funding; anybody who has a significant level of need in a number of assessed areas such as Communication, Nutrition, Mobility.

You have to show that your needs are complex, intense or unpredictable, not of a nature to be provided by Social Services and not incidental or ancillary to accommodation which Social Services are required to provide.

Each case is assessed on its merit and each Primary Care Trust has different procedures for dealing with cases.

Decisions can also be overturned if a person’s condition changes.

3. When is eligibility assessed/reviewed? 

Most commonly when a person in hospital is assessed as not being fit to go back to their home address but instead to a care or nursing home. Once continuing funding is in place eligibility is reviewed after 3 months.

4. Who does the assessment? 

A combination of NHS and Local Authority staff with input from the patient, where appropriate and family members.

5. How can Pearson Solicitors help? 

We have experience in challenging NHS continuing healthcare funding eligibility decisions, whether it be an initial decision not to grant funding, a decision to revoke funding previously in place or to help reclaim nursing home fees you have paid in the past that should have been funded by the NHS. We can help by making representations and provide Advocacy representation at Appeal/Review meetings.

Our team is led by Mike Talbot who has built up extensive experience in helping families recover what is owed to them and challenge NHS continuing healthcare funding decisions.  He has also reviewed cases retrospectively where potentially eligible people have since died. 

Pearson Solicitors are committed to giving all our clients honest straightforward advice and will guide you through the process involved using common sense language and a friendly approach. 

You can start the process to find out whether you have a reasonable chance of challenging a decision or reclaiming care home fees, by contacting our experienced team of specialist solicitors on 0161 785 3500 or email enquiries@pearsonlegal.co.uk with your contact details and the subject line: ‘Care home fees’ and a member of our team will call you back to discuss your claim.

6. What does Continuing Healthcare funding cover?  

It covers nursing or care home fees or the cost of your care at home. The individual must have a ‘primary health need’, which means their main or primary need for care must relate to health. Healthcare and personal care costs are met, care home fees, board and accommodation, without other assets being taken into account.

7. How are NHS continuing healthcare funding eligibility claims funded?   

We can offer competitive and economic quotes to do the necessary work including in appropriate cases a no win – no fee funding option.

8. Is it worth challenging a funding decision?   

In appropriate cases, yes. NHS Primary Care Trusts paid back more than £10 million in nursing home fees wrongly charged to residents in care homes across England and Scotland and Wales in 2011. Any challenge to a funding decision is be made to the NHS organisation who made the decision. Pearson Solicitors can help with that challenge, we have expert solicitors ready to take up the challenge on your behalf. We can also call on expert assistance to fight funding decisions and have helped people reclaim thousands of pounds worth of nursing home fees they should not have paid. If you have a relative who has now died but you think may have been wrongly assessed we can help review the case retrospectively.

Mike Talbot, a partner with Pearson Solicitors has been working for a number of local families who are challenging the local Primary Care Trust. People sell their homes to pay for care, or other family members worry about how the bills will be met, what they do not know is that they can challenge their eligibility for continuing care. They may be paying for something which should be funded by the NHS, in successful cases significant sums of money can be reimbursed to the relative or their family even if they have since died.

Pearson Solicitors and Financial Advisers will assess each case on its merits to determine whether a claim can be made for a refund, or that the NHS should fund future care and they will offer No Win No Fee funding in appropriate cases. Please telephone us on 0161 785 3500 for an initial no-obligation discussion.

 

Case Study

CARE home fees of over £4,000 have been refunded after Pearson’s took up the case of a local man.

Mr Malcolm Parkin’s mother Florence was in a Saddleworth care home, Stoneswood Care, Delph, and the Jonathan Grange Nursing Home, Mossley.  The claim was for retrospective funding going back to 2006 and was pursued for the estate of Mrs Parkin, after she had passed away.

Speaking about cases such as this, Solicitor, Mike Talbot said:  “If you or a relative are in a nursing home because of mental or physical illness then you might be paying for something which could be funded by the NHS.

“We have acted on behalf of a number of people and claims can be from just a few thousand pounds to over £100,000.”

After NHS Oldham considered this latest case they agreed Mrs Parkin should have received NHS Continuing Healthcare Funding for her care and accommodation for the last 2 months of her life, inclusive of 9 years interest.

Her son, Malcolm, said:  “I use Pearson’s because their professional and pragmatic approach comes with a friendly and not over-formal attitude which helps me understand quite complicated situations.”

 

Care Home Funding Compensation Of Over £20,000

A woman whose family recovered over £20,000 in care home fees which need not have been paid have said they are grateful to Pearson Solicitors for taking on their case and battling on their behalf.

Our client, Mrs C, has sadly died but when her family found out they could claim NHS Continuing Healthcare Funding retrospectively they felt it was something she would have wanted.

Mrs C was a resident at Shawside Nursing Home, Shaw, between December 2008 and October 2011 when she died.  We recovered over £19,500 care fees, plus interest, for a time period when she should have been entitled to NHS Funding.

Speaking about the case, solicitor Mike Talbot, who is an expert in care home funding cases said:

The key point here was that from looking at the relevant records, we were able to show that an assessment recommended fully funded Continuing Healthcare but there was then a failure to implement that recommendation by a NHS Panel Meeting. In essence the family were paying for something that should have been fully funded.

“The guidance states that only in exceptional circumstances and for clearly articulated reasons should a Multi Disciplinary Team’s recommendation not be followed. In this case the recommendation was neither ratified nor was there a refusal to ratify. We only discovered this omission by going through the retrospective application process,” he added.

“Believe it or not, I am now dealing with another case where something similar has happened and there has again been a failure to follow clear recommendation for NHS Funding,” said Mr Talbot.

If you think you might have a care home fee compensation claim call now 0161 785 3500 or email enquiries@pearsonlegal.co.uk