joint funding package

[bewilderedhedgehog]

Hi - hoping someone has experience here. We had a CHC assessment meeting for my father, who has a PEG and has carers come 4x a day to sort his food and medication. The conclusion was to recommend a joint funding package. I cannot see online whether this means that we have to contribute or whether costs are picked up by NHS/local authority jointly?
welcome advice and experience please
Many thanks

My understanding is that the LA and CCG would agree a split normally done as a percentage. Your parent would be assessed for a means based contribution towards the percentage of package funded by LA. Ring the LA financial assessment team next week to double check.

Example: LA pay 60% of a package costing 1000 your parent would be assessed for their contribution towards the 600. Unless your parent is a self funder there will be capped charge determined regardless of the package. For example your parent might be assessed as having a capped charge of 250 towards there care, and qt present there care might cost 1000 so the LA would pay 600 and invoice your parent for 250 of that and the CCG would pay 400.

I'm not completely sure so please double check.

See this website

www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/

It sounds to me Dad isn't eligible for continuing healthcare funding but they recognise he has some health needs at home that might be onerous for community nurses to meet (eg relating to some aspect of his PEG feed) so proposing CCG fund those (NHS funded so non chargeable) and Adult social services fund the rest (chargeable)

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 are not 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.

Thank you both for these comments and links - really helpful - this is a new issue for us so we are working our way through it. The element I don't understand is that his only needs are for the PEG feed/maintenance. His medication is also given through this. These seem to be health needs rather than social needs, so I'm not clear about what the social element is. When we get the paperwork I hope this will be clearer. Will work my way through the links!

They didn't do a very good job explaining it , during the CHC meeting then. Ask for a copy of the Decision Support Tool report from the completed CCG (health) continuing health care team. That hopefully will clearly identify what is health and what is social care element. You should have been sent details on it when you got the letter

@bewilderedhedgehog

Thank you both for these comments and links - really helpful - this is a new issue for us so we are working our way through it. The element I don't understand is that his only needs are for the PEG feed/maintenance. His medication is also given through this. These seem to be health needs rather than social needs, so I'm not clear about what the social element is. When we get the paperwork I hope this will be clearer. Will work my way through the links!

Help with eating/drinking is classed a social need rather than a medical need, if his PEG feed is routine and not particular complex or intense to manage (I.e can be done by social care staff with minimal training) then it's lawful for this to be funded as a social care need. If it's complex, unpredictable, or an intense care need to manage his PEG then this could be funded as a health need.

He will however, have got the NHS funding due to the medications also being administered by PEG as this is a clear health need.

If as you say this is his only care need then he won't have been eligible for fully funded care but it's absolutely right that the NHS chips in for the medical bit of his care and social care funds the rest.

The social care bit will just be financially assessed as standard, just on the bit they are funding.

Talk to Beacon: www.beaconchc.co.uk/ You can get free legal advice there. 1.5 hours of phone advice is free.

Your situation is interesting as it used to be that it was illegal to have joint funding between SSD and health, as a decision had to be made as to whether the needs are predominantly social care or health care, and it was all or nothing.

This needs to be your first question to Beacon - is joint funding even legal?

Assuming it is now legal then the fundamental difference between the two is whether your father has to contribute financially or not.

The Health funded strand should be free (although some health authorities now set a ceiling above which they will not pay any more - but as this is only half the package it is unlikely to reach their ceiling figure).

SSD funding is means-tested and takes into account all incomes that your father receives (including benefits) and also his savings (only his half of joint savings, and not your mother's).

Please feel free to PM me - I was steeped in all this for several years before my OH died last year. I successfully appealed his refusal for continuing health care funding.

@Mischance

Talk to Beacon: www.beaconchc.co.uk/ You can get free legal advice there. 1.5 hours of phone advice is free.

Your situation is interesting as it used to be that it was illegal to have joint funding between SSD and health, as a decision had to be made as to whether the needs are predominantly social care or health care, and it was all or nothing.

This needs to be your first question to Beacon - is joint funding even legal?

Assuming it is now legal then the fundamental difference between the two is whether your father has to contribute financially or not.

The Health funded strand should be free (although some health authorities now set a ceiling above which they will not pay any more - but as this is only half the package it is unlikely to reach their ceiling figure).

SSD funding is means-tested and takes into account all incomes that your father receives (including benefits) and also his savings (only his half of joint savings, and not your mother's).

Please feel free to PM me - I was steeped in all this for several years before my OH died last year. I successfully appealed his refusal for continuing health care funding.

It's never been illegal. That's nonsense.

The CHC decision can't have an outcome of 'joint funded' its got to come to a clear conclusion of either eligible for fully funded CHC or not eligible for fully funded CHC. It can't be 'eligible for fully funded CHC but we still want social care to pay for some of it'

However it's perfectly possible for a person not to be eligible for fully funded CHC but still be eligible for health to pay for any health needs that they may have that are over and above what is lawful for the local authority to fund.

That is what will have happened in this situation. He isn't eligible for CHC but health have still agreed that they should be responsible for funding part of his care.

This happens in every single nursing home where the NHS pays the weekly 'funded nursing contribution' for people who have nursing needs.

It happens in people's own homes and in residential care homes where social care workers do the social care funded care tasks and district nurses are funded by the NHS to meet any nursing needs.

Thank you both. I am working through the beacon documents which are very helpful - and thank you for suggesting the free consultation with them. I think I need to do a lot of reading, and then re-read when we have received the paperwork from the CCG which I expect to be within the next 2 weeks. I thought the nurse who carried out the assessment was excellent and thorough. As he has 28 visits a week though, this could turn out to be financially challenging - they are above the means test level, but were relying on using their savings to modify the house because he cannot go up the stairs, a stair lift is not possible, and neither is an actual lift. The attendance allowance makes a difference - does anyone know if they keep or lose this please? Thank you again for your advice and help - it is much appreciated.

Has he looked at getting a disabled facilities grant through the local housing authority (i.e whoever he pays his council tax to)

Has an OT been to assess and make recommendations?

His savings can still be used on disability related expenses (DRE) and this will be accounted for and allowed within any financial assessments he has, as long as the costs are genuine.

Hatgirl - thank you. We have had a visit from the OT in the stroke team and they are looking at sorting out a ramp as at the moment we cannot get him out of the house in a wheelchair at all, and although he can walk slowly with a frame, cannot manage the steps. We thought that other modifications were down to us - but as they are related to his disability perhaps that is a possibility. For example there is a downstairs toilet but no washing facilities (except the cloakroom sink), so we were going to change that and/or somehow find a way of getting him upstairs, but so far we have not found a solution to the second!

hatgirl - before I retired I was working in this field and it was indeed illegal to have joint funding. If it was decided that the needs were primary health needs, then SSD was not allowed by law to be involved at all in the funding although they could provide advice on care agencies etc.

Mischance I DO work in this field, now, and have done for more than a decade, nearly two if you count before I was qualified.

You are correct that if someone is found to be eligible for CHC then it is unlawful for social services to fund any part of their care, I even say this myself in my post above.

But that isn't the situation here, and it also isn't the case that generally jointly funded packages of care are illegal and never has been. If someone isn't eligible for CHC then they can still have a jointly funded package of care. It's not all or nothing.

There's jointly funded packages of care all over the place. From basic Nursing care right up to s.117 funding and jointly funded complex LD care packages.

hatgirl - I hear you!! It has changed since I was involved.

Thank you - it's very complicated - but you have both given me some good ideas here - thank you. I may come back and ask for more advice when we've got the paperwork through!!

Good luck!

Achieving a successful appeal (as I did) required a certain dedication to the task and an eye for detail.

You can apply for a grant for adaptations, it can be up to 30k iirc. There can be a 6 month + wait but could be sooner. You need to ask for an OT assessment.

Attendance allowance: he will keep it as long as he is at home.

If he goes into a care home at any point, he will lose AA unless he is wholly self funded

@MrsPelligrinoPetrichor

You can apply for a grant for adaptations, it can be up to 30k iirc. There can be a 6 month + wait but could be sooner. You need to ask for an OT assessment.

They can't get DFG disabled facilities grant as currently funds are above adult care threshold savings, which is higher than the eligibility threshold for DFG

It sounds like OP has professional team dealing with all these things. It's an OT who would assess then give advice regarding adaptations, OP 'S parents can contact the local authority ones by ringing adult social care number. It sounds like the MDTvis already involved.

hatgirl is right
Mischance misunderstood hatgirl's point & it has not changed

What has changed is that years ago "district nurses" used to pop round multiple times a day to patients on their case load in community, but community nurses in integrated community care teams no longer have time & resources to do certain tasks, that may require for eg multiple daily visits routine tasks as they focus on the difficult nursing needs and doing nursing clinical oversight.

So the local CCGs- in specific carefully assessed circumstances - may choose to recognise for that individual their health needs and instead spot purchase to meet that health need in community for that patient from alternative skilled trained staff- which is why they (CCG = health) fund that element and are responsible for ensuring it is a suitably trained worker to deliver it.

It's similar to some NHS patients having some operations contracted out by NHS (health trust or CCG) to private hospitals when a particular service has too long waiting lists or during winter pressures.

Patients get mixed of NHS and social care funded services all the time (for those nowhere near CHC eligible level!) . That's what re-enablement is, winter pressure projects, but they are on block contexts not individually (spot) purchased for the area.

Thank you all. I have to say I am at a low ebb with all of this today. The cost of essential adaptations is looking like approximately £20k, so we are trying to get that booked (although not sure what the waiting time for installation is). In the meantime we are dealing with a UTI and leg ulcers, but have had to call 999 already this week because we can't get my father out of the house, the practice haven't come round, and these are things which the carers can't deal with (although they are fantastic and without them we would be in a real pickle). My parents are dispirited but trying to keep positive. I am hoping that over the next 4 weeks we achieve some stability. No outcome of last week's assessment yet, so waiting for that (but to be fair it hasn't been a full week yet).

They can't get DFG disabled facilities grant as currently funds are above adult care threshold savings, which is higher than the eligibility threshold for DFG*

My mother just has and is well above the usual criteria. I think it depends on what is wrong maybe?

www.gov.uk/disabled-facilities-grants/what-youll-get

www.gov.uk/disabled-facilities-grants

Ah my mistake. Any savings over £6,000 and income over a certain level is financially assessed for how much person pays towards the adaptations and how much contribution comes from disabled facilities grant you get- so if you have more savings than even adult services threshold that might be a larger amount -
On the smaller adaptations such as stair lift if someone has considerable savings it can mean they self fund it.

Anyway here are is info on DFGs from HMGov site. I'm not an OT but work alongside them in multi agency meetings

It is a slow process and it has to follow OT adesssmebt, recommendations, OTs application to DFG panel in local borough council. Can take several months

I was surprised what my mother received- I was sure she wouldn't be entitled to anything but she was. We had to pay for a stairlift as the wait was too long. I'm sure it differs from council to council too.

@MrsPelligrinoPetrichor

I was surprised what my mother received- I was sure she wouldn't be entitled to anything but she was. We had to pay for a stairlift as the wait was too long. I'm sure it differs from council to council too.

DFG grants financial assessment rules don't differ between councils as I'm pretty sure they arise from legislation (see HMGov website a PP linked earlier)

Perhaps your mum had large costly adaptations done and DFG contributed a lot . Perhaps she contributed towards it quite a bit and didn't tell you that bit. Perhaps - & hopefully not- she didn't declare all her saving accounts. It's difficult to know bc people/ relatives can be private about finances, even with their relatives.

Anyway, back to OP as thread is getting waylaid

OPs relative has had an assessment done including an ineligible CHC assessment and a care package recommended that will have health (ccg) and social care funding.

It would be useful for OP to follow up with her father- if he can ask for copies of full CHC DST or the CHC checklist report and copy of decision making about care support. They don't usually give you a copy unless it is requested by someone , it might help OP understand. It sounds as if social care are involved and they will supply at least a Care Act 2014 needs assessment report to father (particularly if he asks for it)