Financial Implications of Residential and Respite Care

Caroline Davies, Citizens Advice Bureau Case Worker

There are several options available for residential and respite care. It is possible to receive NHS care free of charge if a person is eligible for Continuing Health Care or if they have a low income. In other cases, financial contributions to health care are means-tested. Financial issues relating to care are extremely complex. The information below is just a brief introduction and we strongly urge anyone considering applying for respite or residential care to seek independent advice regarding their case.

Continuing Health Care

What is Continuing Health Care?
Continuing Health Care is a general term that describes the care that people need over an extended period of time as a result of illness, accident or disability. It can address both physical and mental health needs. Continuing Care can be provided in a range of settings, such as a hospital, a registered care home or a person’s own home. The type of health care services provided include primary health care, respite health care, community health services, health care equipment. The range and amount of NHS services provided varies in each case. Continuing Health Care can either be fully funded by the NHS or jointly funded by the NHS and Social Services.

Who can apply?
In order to receive Continuing Health Care, a person must fit the eligibility criteria. A person’s diagnosis (e.g. Frontotemporal dementia) does not on its own make them eligible for Continuing Care. At the moment, eligibility criteria differ between regional Strategic Health Authorities. However, as from April 2007, new national criteria will come into place. An important aspect of these new criteria is that they will outline provisions for people with dementia, something that is not included in the current criteria.  

As an example, in the Greater Manchester area, a person is considered to be eligible for Continuing Care if they fulfil the following criteria:

1. The person has a health condition resulting in:

  • complex health care needs &/or
  • intensive health care needs &/or
  • unstable / unpredictable health care needs
  • rapid deterioration  

AND

2. The person requires significant health care inputs, such as:

  • regular supervision by a member of the NHS care team (e.g. a consultant, therapist)
  • routine use of specialist health care equipment

How do you apply?
Any person, relative, carer or service provider can request an assessment for Continuing Care. The first point of contact will generally be your GP. He/she will discuss the eligibility criteria, and if it is possible that the person’s needs fit the Continuing Care criteria, they will contact the Continuing Care Lead in the Primary Care Trust (PCT). You can also contact your local Continuing Care Lead directly to kick-start the process.

Who performs the assessment?
All professionals concerned with a person’s care (Consultant, Social Worker, Therapist) take part in the assessment process. The person and their family’s wishes are also taken into account. A meeting is then held to discuss the assessments. If it is thought that the person’s health care needs meet criteria for Continuing Care, a recommendation is made to the Continuing Care Lead at the PCT. The person will then receive a letter from the PCT informing them of the decision for Continuing Care. 

What if my application is rejected?
If you have been assessed and have not been found eligible for Continuing Care, you may request a review of the decision concerning your eligibility. To request a review you should contact your Continuing Care Lead at your local PCT. They will then forward your request on to the Review Panel at the Strategic Health Authority.

Paying for Care

If your partner/relative does not fulfil the criteria for Continuing Care, they will have to contribute financially towards their own personal care and accommodation costs. Paying for care is assessed on a case-by-case basis and takes into account the type of care required (temporary or permanent residential care), the person’s contributions as well as their financial assets.

What is temporary and permanent residential care?
Temporary care is a stay in residential care of less than 52 weeks. Residential care becomes permanent if it exceeds 52 weeks.

How much will I have to pay?
If the person holds assets of more than £21000, they will have to pay the full fee. If their assets are less than £12000, they receive care free of charge. For assets of £12000 to £21000, a scaled income tariff applies (please check for exact tariffs).

How are financial means assessed?
Only the person’s financial assets, not their partner’s or relatives’ assets, are assessed. If the person holds a joint account with their partner, only the person’s share of the account (half) will be assessed. Charges on the person’s property are only placed if it is currently unoccupied. Property is disregarded if the spouse or a relative under 60 (e.g. children) is currently living in it.

Useful contacts

Continuing Care
North West Strategic Health Authority
For more information concerning Continuing Care and the review procedure.
www.northwest.nhs.uk

Carers Federation
Provides a wide range of support services and useful information. Their Independent Complaint Advocacy Service provides advice to patients and relatives concerning decisions made by the NHS.
www.carersfederation.co.uk
Tel: 0845 120 3735

Combined Hospitals CAB                                       
Independent free advice and representation to patients, carers and visitors at Hope Hospital. The CAB Community Carer can advise on Continuing Care issues.
Tel:0161 206 4713

Caroline Davies, CAB case worker, can also come to the CFU clinics to give you free, individual advice. If you would like to meet her, please notify Brenda, our CFU social worker, in advance on 0161 206 2175.

Care Home Standards
Social Care Institute for Excellence                        
An independent registered charity whose role is to develop and promote knowledge about best practice in social care.
www.scie.org.uk