Abolish continuing care and make all social care means tested

[Figmentofmyimagination]

My mother - who is in a nursing home costing £950 a week with severe dementia and other serious medical conditions - has been assessed as meeting the eligibility criteria for continuing NHS care. This means that even though she has a house worth £250k+ and a pension income of £18,000 p.a., including her state pension, the whole of her care is now taxpayer funded.

She no longer has a practical need for any regular income. Instead, apart from the odd birthday present bought for grandchildren on her behalf, occasional new clothes, haircuts and the odd visit to the chiropodist, her whole pension income, including state pension, will simply build up in her bank account until she dies.

If there are to be £30 billion of "welfare cuts" then non-means tested continuing care must surely be abolished.

3littlefrogs there is a legal obligation to assess everyone as long as they have needs, regardless of financial circumstances. Therefore, I disagree strongly with your last statement because a local authority would only financially assess if they were providing means tested services.

Part of my job role is completing CHC assessments and presenting them to CCG panel. Financial questions are not asked and I have no idea of a patient's financial position when CHC is recommended or not. It is irrelevant. The assessment is purely based on health needs.

I didn't say it was impossible, just extremely difficult. IME over the last 20 years, the first question asked by social services is about how much money/assets the elderly person has. If you don't want to provide full financial disclosure you have to state that you will be self funding.

Once you need residential care you are more or less obliged to disclose.

MIL is in a dementia unit with severe dementia. She has numerous complex medical conditions and cannot do anything for herself at all. She is self funding, but qualifies for the continuing care component of her care which is about £100 a week. She still pays £850 per week from her pension, attendance allowance, savings.

We are selling her flat at the moment, the proceeds will go towards her care fees.

I find it really hard to understand how the OP's mother is getting all her fees paid if she has savings and a house.

Thanks Tenerife!

So how do the NHS decide whether people have health needs and should be funded? Aren't there lots of elderly people with dementia in care/nursing homes funding their own care?

I realise we are talking about different things.
The assessment for the continuing care component is not based on finances.

I am talking about the initial assessment of need for care packages or residential care. The continuing care needs assessment is a different process.

What 3frogs says is how I understood the system to work

So when does the continuing care assessment happen, please?

I agree with 3 little frogs, above.

Are you sure the whole cost of her nursing home fees will be paid? I thought it was just a small percentage for her medical needs. The rest, food, accommodation, social care will be paid by her, until her capital, including proceeds from the sale of her house, drops below something like £23,000.

MIL's continuing care funding is based only on her need for a daily injection.

Her severe dementia, incontinence, heart disease and inability to feed/wash/dress herself is not considered relevant as it is "personal care" and therefore she must pay for it.

Obviously she is also paying for her accommodation and food.

Are you sure the whole 950 is paid?

My mother was assessed for CC when she was on the Liverpool Care Pathway. They wanted to move her out of hospital.

The CC assessor decided she didn't need it on the basis of a 30 second look at her and a skim through her notes. She had dementia and was dying, refusing food and liquid, but didn't have anything that required a qualified nurse.

The LA were involved, because, apart from her house, her savings were below the threshold. They disputed the assessor's findings, on the grounds that she needed someone qualified to judge whether she had changed her mind about eating/drinking. They would have had to subsidise her costs in a nursing home till the house was sold.

I got the letter saying she did qualify 3 days after she died.

Thymeout.

Yes. It is so stressful and heartbreaking isn't it.

I was given one voucher for the car park (for one day only) for the 2 weeks it took my mum to die. Meanwhile they were arguing over whose responsibility it was to find and pay for a nursing home. That was the sum total of help we were offered by the Macmillan nurse.

There are two different things being discussed here. There is about £108 a week paid towards nursing care if you are deemed to have a condition deemed to need care in a Nursing Home by a RGN. Then there is CHC which is where the health authority pay total cost of care if meet certain criteria of need.

It can be very hard to get full CHC for Dementia as people often told it comes under a social rather than medical need.

This is the nursing one, £112 a week now at a quick read through.

I think we need to be absolutely clear that continuing health care is funded by the NHS and only in the case of severe medical need, terminal illness etc. It is not easy to obtain. In our case, DF was diagnosed with terminal cancer 4 months ago. He was supposed to be on fast track discharge and out of hospital into a fully funded care home (as is his entitlement under the current system, rightly or wrongly). We ended up with a month of wrangling between the NHS and social services as to whether this was really necessary. One social worker talked repeatedly about 'when he got better'. Thankfully me and my siblings were clued up enough not to be fobbed off and fought his corner (he was incapable of doing this himself, brain tumour, paralysed...). Ultimately, I threatened legal action and fast track discharge was backdated. Make of that what you will.

To be honest, I was surprised that DF was entitled to anything at all as he has his own home, savings etc and could have afforded to pay. However, terminally ill people who are expected to live fewer than 6 months do get all their costs covered. Cynically, one could say that it's because it's not a long term investment...

Social need for care is very different from medical - I guess that's what I'm saying.

Yes - it is the nursing care component I was referring to.
I didn't think you could get any other sort of funding if you have assets or savings. Certainly not for accommodation and personal care.

There is a very high threshold for NHS Continuing Healthcare. If someone Is deemed eligible after a very in-depth assessment then the NHS pay for all their careincluding all care home fees. They have to have what is called a primary health care need. Someone could be in a nursing home, not be eligible for NHSCH but would have what is called Funded Nursing Care. This i theory pays for the nursing care provided by the home.
it is a very, very clunky complicated system and really difficult for people to understand.Basically NHSCH is funding judged on need wheras funding for social care is means tested.
Assessment can be done at any time. In many areas it will take place before a patient leaves hospital or in the community. There is a pre-assessment checklist which acts a filter to decide who should be considered for the full assessment.

If it's severe enough to be funded it's not social care it's medical care.

3littlefrogs something else I have found out while navigating the care system, which might interest you, slightly off topic:

Until my mum' s care became fully NHS funded, she was privately paying (+plus, obviously, the non-means tested care component of £100+ per week others have mentioned).

However, as she owned a home, once her liquid assets dropped below £24k she became eligible for the local authority deferred payment scheme.

Under this scheme, the fees are paid interest free by the local authority, to be repaid when the house is sold or my mum dies, whichever happens earliest.

But this is where it gets a bit random and unexpected. Because the deferred payment scheme involves the LA paying the fees on the resident's behalf, for as long as the house remained unsold, they are charged at the local authority rate (£750 pw-ish) rather than the private rate (£950 ish), even though she is classed as privately funded.

By contrast if I had sold the house, the rate would immediately have increased to the private rate, moving forward. The difference is not recovered retrospectively.

In other words, leaving the house empty instead of selling it, and using a local authority deferred payment scheme to fund the fees, produces a saving in this example of around £800 each month.

Obviously you have to be ready to sell it quickly when the time comes as the debt will become interest bearing as soon as it is due.

It is a minefield. I doubt local authorities are consistent across the country but it is something to bear in mind.

3littlefrogs, you are getting muddled between the FNC contribution for people who require nursing care in a nursing home, and Continuing Heath Care (CHC). I dont blame you, it is very confusing.

As a pp said, the FNC rate is a small part of the nursing home fees. So if you have assets and are self-funding, AND your nursing needs are non-complex, then you'll have £112 of your fees paid per week by the NHS, you will have to cover the remainder. If you don't have assets, then the Local Authority will pay the remainder up to a certain level, known as "benchmark".

If your nursing needs are complex AND you meet eligibility for CHC funding (which is a lengthy and detailed assessment process), then the full cost of your care will be paid. This comes out of the health budget, not Local Authority. It's not means tested.

Most people in nursing homes don't qualify for CHC funding.

OP, in the title of the thread you are mixing up NHS continuing care with social care and nursing needs. Someone gets NHS continuing care and is fully funded by the NHS because of the 1948 National Assistance Act which created the National Health Sevice. From the cradle to the grave every one of us are entitled to free healthcare for all whose medical condition means they medically NEED it. A subsequent legal judgement in the Court of Appeal deemed that if your primary need is a medical need then the NHS pcks up the social care costs as well.

Do you want everyone who spends a night in hospital to be means tested and have to pay for their bed and food?

Becoming NHS continuing Care funded is EXTREMELY difficult, the bar is already set extremely high in that you have to have a complex medical condition that is unstable . It is a very different set of circumstances from someone who has high nursing needs.

The people who qualify for NHS continuing care are the most vulnerable in our society, severely disabled, without a voice, completely dependent on others, many young people not just elderly.

Very laudable that you in this position do wish your inheritance to be spent on your DMs care, but I disagree with you.

CHC is apart of the NHS and therefore must be free to those who need it. There is no need for your DM to be blocking a bed in a hospital, her care needs can be met well in a nursing home, but they are still NEEDS rather than WANTS! Therefore must be funded!

As an older persons social worker I can say that CHC is very, very difficult to get. It requires loads of hard work and advocating on their behalf to fight with someone from CHC who believes that the need for peg feeding and specialist nursing input is 'social care' and so they should pay.

I think the checks are stringent enough (and then some) to ensure that it is only those who really, really need it that get it.

Just last week I had to fight to get a GP to agree to fast track (when someone is dying all it takes is GP sign off rather than months of meetings) my client. GP felt he wasn't quite palliative enough... He died 4 days later.

So, YABU.

We are going though the process of getting my very father-in-law assessed for NHS CHC. The system is an absolute bloody nightmare. It is not easy to get AT ALL. You have to jump through hoops just to get the assessment done, and unfortunately, many of the staff involved in the process don't understand the law relating to CHC and social care at all.

The system needs a total overhaul. Elderly care in this country in the 21st century is an absolute disgrace.