Who Pays for Care?

Who Pays for Care?

Long term care (especially for someone with complex needs or poor health) can be very expensive.  Those needing 24-hour care at home or a place in a nursing home, can incur costs of thousands per month.  

For most of our lives we do not have to worry about the cost of medical care thanks to the NHS providing a comprehensive health service, free at the point of need.  This of course continues into old age - but costs of medical care do not include the costs of care needed as we lose mobility or develop dementia in old age. 

Private Sector - Home Care

Private home care is available from companies like ourselves at Right at Home Mitcham Streatham and Dulwich.  For those that can afford it, the service we provide is ideal for those of us (the vast majority) who wish to remain safe and cared for, in our own home for as long as possible.

Social Services – Home Care

For those that cannot afford private home care local social services are available to provide home care on a “means tested” basis and subject to the local authority’s own assessment to determine what care is to be provided.  As you can imagine, social service teams are under a lot of pressure due to high demand from the community and a finite budget to meet those needs.

NHS Continuing Healthcare

In limited circumstances it is possible the NHS will cover the costs of home care. 

To qualify for NHS continuing healthcare, you have to show you have a “primary health need”.  That is that your care requirements are primarily for healthcare rather than social or personal care needs.  This can be a grey area at the intersection between “health care” and “social care”.

Eligibility for NHS continuing healthcare is judged in a two-step process: first a checklist, then a full assessment.  In England, the NHS system is fragmented into 42 different integrated care boards (ICBs).  Each region varies as regards how they assess patients for NHS continuing healthcare.  However in general terms, to qualify you must have ongoing significant health needs that (taking account of all your needs) mean that the majority of the care you need is to meet those health needs.

Each case turns on its own facts.  In practice NHS continuing healthcare is not readily agreed and hard to get.  Many health conditions you would expect to qualify for do not end up being assessed that way.  For instance, many people living with dementia do not qualify because they are not deemed to have behaviour “challenging” enough to the extent that it “ticks the right boxes” on the form. 

Independent professional persons with a healthcare or social care background usually complete the checklist and assessment on behalf of the NHS.  The claimant may challenge what is decided and any answers given on the form.  They may also appoint their own expert to complete the checklist and an assessment.  Also if the claimant is turned down, they can re-apply later, usually after six months but sooner if there is a sudden deterioration.  Applications for persons placed on an end-of-life pathway tend to be more likely to succeed as their health needs become more prevalent.

Mental Health – After Care

Finally for people detained for treatment in a psychiatric hospital under section 3 of the Mental Health Act (which may include those living with dementia) once detention under Section 3 is lifted and the person discharged into a care home, the cost of the so-called “aftercare” will be met by the state under Section 117 of the Mental Health Act.  Such detention can happen for a variety of reasons, including refusing care or behaving in a manner potentially harmful to themselves or others. 

For more information contact Right at Home Mitcham Streatham and Dulwich.

0208 004 9644