Self funding/ social care fees .new contract for care home

My mum is in a carehome , she has nursing needs as she has Parkinson’s and has just inherited a large lump sum taking over the threshold quite a lot so we are now in the process of paying for her care
I’ve contacted the local authorities to let them know the amount so they can adjust her financial accessment
Also I’ve told the home , today the administrator informed , ive to sign a new contract on behalf of my mother ( I’m her power of Attorney ) and she asked how much over the threshold my mother is, which I told her
I was wondering does the amount over the threshold depend on how much they charge as oppose do to social care fee , is it graded for self funding
I know we will have to pay full fees but I don’t really want to pay above the social rate for the amount of capital
She has been accepted for continuing healthcare at a rate of £158 a week and she gets attendence allowance and part pension credit
She has been in the home 6 months now
I am picking up the contract on Wednesday so will know how much her care is then as self funded and would be so grateful for any advice or suggestions
Thank you in advance

Hi Tracy.

One bit sparked my interest :

She has been accepted for continuing healthcare

Are we talking about CHC / NHS Continuing Healthcare here ?

Main thread :

( If so , where does the " Fee " element arise when ALL care is fully funded by the NHS … I’ll gladly expand on that aspect IF it proves to be the case. )

Others , with experience in care home matters , will be along to provide their insight.

That’s not Continuing Healthcare, that’s Funded Nursing Care. Your mum should only get this AFTER a Continuing Healthcare Assessment. When was this last done.
Also, if she is over the threshold and self funding she is entitled to claim and receive Attendance Allowance now. Be sure to claim asap.

I suspected as much … the poor person’s CHC … when it comes to health needs ?

( £ 158.16 per week … towards the bottom in what follows … a lighthouse for a clue ! )

Full sp from the main thread … colour coded as per the original :

Allied topic … NHS Nursing Funded Care ( NFC ) :

NHS-funded nursing care
NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.

Who is eligible for NHS-funded nursing care ?
You may be eligible for NHS-funded nursing care if :

you’re not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse.

you live in a nursing home.
How will my needs be assessed ?

You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care.

Most people don’t need a separate assessment for NHS-funded nursing care. However, if you do need an assessment or you haven’t already had one, your clinical commissioning group (CCG) can arrange an assessment for you. Find your local CCG.

Outcome of the assessment

If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided by registered nurses employed by the care home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.

If you’re not eligible for NHS-funded nursing care and you don’t agree with the decision about your eligibility, ask your CCG to review the decision.

The cost of NHS-funded nursing care

NHS-funded nursing care is paid at the same rate across England. In April 2018, the rate was set at £158.16 a week (standard rate).

Before October 1 2007, there were 3 different levels or bands of payment for NHS-funded nursing care – low, medium and high.

If you moved into a care home before October 1 2007, and you were on the low or medium bands, you would have been transferred to the standard rate from that date.

If you moved into a care home before October 1 2007, and you were on the high band, NHS-funded nursing care is paid at a higher rate. In April 2018, the higher rate was set at £217.59 a week. You’re entitled to continue on this rate unless:

you no longer have nursing needs.

you no longer live in a care home that provides nursing.

your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £158.16 a week, or
you become entitled to NHS continuing healthcare instead

Thank you for the info
She was accessed for NHS CHC in March and was entilitled to nhs funded nursing care at the £158.16 a week
She is getting attendance allowance now
Her needs were accessed in March and she wasn’t entitled to nhs continuing care , can I ask for it to accessed again ?

Yes … if health deteriorates , a better chance of success ?

Slightly morbid but … so is the subject matter.

Main thread again … follow the colour :

CHC … Applied for but refused ?

Links to specialist , external , sites with guidance therein :

NHS Continuing Healthcare denied? Here’s what to do first...
How Do I Appeal An NHS Continuing Healthcare Funding Decision? • Continuing Healthcare


CHC not on the cards BUT … NHS Continuing Healthcare as an alternative ?

NHS continuing healthcare
Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.

Where can NHS continuing healthcare be provided ?

NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.

Am I eligible for NHS continuing healthcare ?

NHS continuing healthcare is for adults. Children and young people may receive a “continuing care package” if they have needs arising from disability, accident or illness that can’t be met by existing universal or specialist services alone. Find out more about the children and young people’s continuing care national framework.

To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:

what help you need.

how complex your needs are.

how intense your needs can be.

how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time.

Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.

You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.

A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.

If you aren’t eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.

If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.

Information and advice

The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS continuing healthcare.

Visit the Beacon website or call the free helpline on 0345 548 0300.

NHS continuing healthcare assessments

Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.

For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently – for example, if you’re terminally ill – your assessment may be fast-tracked.

Initial assessment for NHS continuing healthcare

The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed, and be asked for your consent.

Depending on the outcome of the checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.

Being referred for a full assessment doesn’t necessarily mean you’ll be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.

The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.

You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK.
Full assessment for NHS continuing healthcare

Full assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care.

You should be informed who is co-ordinating the NHS continuing healthcare assessment.

The team’s assessment will consider your needs under the following headings :

nutrition (food and drink).
skin (including wounds and ulcers).
psychological and emotional needs.
cognition (understanding).
drug therapies and medication.
altered states of consciousness.
other significant care needs.

These needs are given a weighting marked “priority”, “severe”, “high”, “moderate”, “low” or “no needs”.

If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare.

You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.

In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.

The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.

You can download a blank copy of the NHS continuing healthcare decision support tool.
Fast-track assessment for NHS continuing healthcare

If your health is deteriorating quickly and you’re nearing the end of your life, you should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.

Care and support planning

If you’re eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.

Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget.

If it’s agreed that a care home is the best option for you, there could be more than one local care home that’s suitable.

Your CCG should work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.
NHS continuing healthcare reviews

If you’re eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.

Refunds for delays in NHS continuing healthcare funding

CCGs will normally make a decision about eligibility for NHS continuing healthcare within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.

If the CCG decides you’re eligible, but takes longer than 28 days to decide this and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.
If you’re not eligible for NHS continuing healthcare

If you’re not eligible for NHS continuing healthcare, but you’re assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you’ll be eligible for NHS-funded nursing care.

This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees.

Read more information from NHS England about NHS continuing healthcare.

Frequently asked questions about NHS continuing healthcare

I have a local authority support package that works well. I’m now eligible for NHS continuing healthcare – will my support package change?

If you’re concerned about changes to your care package because of a move to NHS continuing healthcare, your CCG should talk to you about ways that it can give you as much choice and control as possible. This could include the use of a personal health budget, with one option being a “direct payment for healthcare”.

Can I refuse an assessment for NHS continuing healthcare? If I refuse, will I be able to get services from my local authority?

An assessment for NHS continuing healthcare can’t be carried out without your consent, so it’s possible to refuse. However, if you refuse, although you’ll still be entitled to an assessment by the local authority there’s no guarantee that you’ll be provided with services. There’s a legal limit on the types of services that a local authority can provide.

If you refuse to be assessed for NHS continuing healthcare, the CCG should explore your reasons for refusing, and try to address your concerns. If someone lacks the mental capacity to consent to or refuse an assessment, the principles of the Mental Capacity Act will apply and in most circumstances an assessment will be provided in the person’s best interest.

My relative is in a care home and has become eligible for NHS continuing healthcare. The CCG says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different care home. I think a move will have a negative effect on my relative. What can we do?

If there’s evidence that a move is likely to have a detrimental effect on your relative’s health or wellbeing, discuss this with the CCG. It will take your concerns into account when considering the most appropriate arrangements.

If the CCG decides to arrange an alternative placement, they should provide a reasonable choice of homes.

Is it possible to pay top-up fees for NHS continuing healthcare?

No, it isn’t possible to top up NHS continuing healthcare packages, like you can with local authority care packages.

The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you’re assessed as needing from the NHS. These private services should be provided by different staff and preferably in a different setting.

My mum has been in a care home for 2months approx. Her mobility is not good and she has been diagnosed with onset dementia. Her savings are less than 10,000 will she have to pay for her care?

Hi Patricia … recommend starting a new thread … your posting may get buried in this one ?

Tracy, I would strongly suggest you DO NOT sign any contract with the home directly, keep going through Social Services, so they pay, and you pay them. This is quite lawful. It’s never a good idea to tell the home anything about a resident’s money.

Hi Patricia

Who is currently paying for her stay in the care home ?

As I understand the rules if someone has under £23,500 and over £14,000 there is sliding scale of charges levied by the Local Authority - under £14,000 I believe her care should be free. (the figures may have changed since I last had cause to check them out).However if the LA are paying then they will only pay for a home within their budget restraints.

I would suggest that you arrange a needs assessment with your local Social Services (which will include a financial assessment). At the same email our own Adviceline for a definitive answer on the figures involved.