Most people requiring ongoing healthcare will be expected to contribute either partially or fully toward the cost. We know through experience that when families are faced with planning long term care that the cost of care is a significant decision. Whilst many families will have to finance their own care (known as self-funding care), some will be entitled to care funding. There are two types of care funding; social care funding provided by Local Authorities and healthcare funding provided by the NHS. Here we explore what healthcare funding is, factors that affect your eligibility for funding and how you can access funding.
What is healthcare funding?
Healthcare in the UK is free at the point of delivery. Therefore, if you have an identified healthcare need and are receiving live-in care in your own home, you may be eligible for NHS Continuing Healthcare funding, which is arranged and funded by your local Clinical Commissioning Group (CCG). A healthcare need relates to the treatment, control or prevention of a disease, illness, injury or disability and the after care of a person living with these conditions.
Having a disability or having been diagnosed with a long-term illness may not, on its own qualify you or your loved one for NHS Continuing Healthcare funding. The assessment undertaken by the CCG must conclude that they have a ‘primary health need’ – that is that the overall need is health related and not considered a social care need.
NHS Continuing Healthcare is non-means tested and funding can be used to receive care in your own home. The level of healthcare funding available will be determined by not just your health needs, but the location of your CCG in the country, as this impacts availability of funding.
At The Good Care Group we work with ‘Care to be Different’ an organisation who supports families through the sometimes, lengthy process of securing NHS Continuing Healthcare funding. Born from her own frustrating attempts to secure funding for her parents, founder Angela Sherman provides practical advice and support for those seeking funding.
How can I access NHS Continuing Healthcare Funding?
If you or your loved one feels you are eligible for NHS continuing healthcare funding, it is worth noting that whilst funding is free the qualification criteria is robust and there are several steps involved in accessing funding that may be available.
You firstly need to request a continuing care assessment from your local GP or social worker. The medical professional allocated to your claim will conduct an initial ‘screening’ either at your home or in hospital to determine whether you may be likely to be eligible for funding. If it is deemed, you are likely to be eligible you will undergo a thorough assessment of your condition and your on-going health needs.
Each individual need will be categorised either as low, moderate, high, severe, priority. If you have at least one priority need or more than one severe, you will be eligible for support.
The results of your assessment will be sent to your local CCG, who will make the final decision as to whether you will receive financial assistance from the NHS.
The CCG will then write to you with their decision and the reasoning behind it.
If the CCG has concluded that you are eligible you will be invited to discuss with them details of how and where you wish to receive the care you need, as well as the organisation you would prefer to provide care.
Sadly, for many, specialist conditions like dementia are not in isolation considered a healthcare need so dementia care is not necessarily funded by NHS Continuing Healthcare. It is always worth checking though, as funding can considerably contribute to the overall cost of a care and in many cases will fund the total cost.
Personal budgets and direct payments
If you are eligible for NHS Continuing Healthcare you can either ask the CCG to manage your budget and find suitable care you need, or you can opt to receive a personal budget with direct payment of funds to yourself for you to make your own care arrangements.
A personal budget is the overall cost of the care and support the CCG has decided will be available to you. Direct payments are a funding choice in personal budgets, whereby you receive the payment to manage and organise your own care arrangements, whether that is in your own home or from moving into residential care.
If you manage your own personal budget you will be free to choose the provider you wish to receive care from, where as if the CCG manage it you will be restricted to using a provider from their preferred supplier list.
NHS funded nursing care
If you have an identified nursing need, the NHS may pay a weekly rate for nursing care delivered by a home care provider or a registered nurse to visit you either in a residential home or when receiving care at home. The assessment process is the same as NHS Continuing Healthcare and it is likely you will be offered this funding if you have failed to qualify for Continuing Healthcare. At The Good Care Group we provide a high quality nurse-led care service for which this funding can be used to contribute to the overall weekly cost of care at home.
Social care funding
If you have been unable to secure NHS Continuing Healthcare funding, you may be entitled to some level of funding towards the cost of care from your local authority. The level of funding available is means tested based on your personal financial circumstances – your savings, investments and property. If your capital is assessed at over £23,250 you will not be entitled to local authority funding and will be faced with having to self-fund the care you need.
Local authority support
In addition to social care funding, you may be entitled to other local authority support that contributes to funding the care you need, including exemption of discounts on your council tax, attendance allowance and savings credit – all of which can reduce the cost of receiving care in your own home. Find out what local authority support could be available to you here.