NHS continuing healthcare means a package of care that is arranged and funded by the NHS and is free of charge to the person receiving the care, be it in a care home or in their own home and is usually referred to as “fully funded NHS care”.

As one in three women in Britain, and one in five men, will eventually need long term care, the funding of such care is an issue that is likely to touch most people’s lives in one way or another. So over the last few years, the Government has attempted to make clear in law the type of healthcare needs that qualify for NHS continuing healthcare.

A national framework has been developed to provide guidance to the NHS about this and to try to ensure that consistent decisions are made across the country.

NHS continuing healthcare assessments

Primary care trusts (who manage local health services) are required to carry out an assessment for NHS continuing healthcare where health services might be needed for elderly home care.

The assessment should be carried out for Continuing Care when a patient is discharged from hospital before referring the person to social services for help with social care needs. Also, an assessment should be requested if the physical or mental health of the person you are looking after deteriorates significantly. Some people who need an urgent decision, such as those who are terminally ill, should be fast-tracked to receive NHS continuing healthcare immediately.

Where is NHS continuing healthcare offered?

NHS continuing healthcare can be provided by the NHS in any setting, which includes a care home, hospice, hospital or the home of the person being looked after. Where NHS continuing care is provided in the home of the person being looked after, it will cover personal care and healthcare costs.

Responsibilities of social services

If NHS continuing healthcare is provided for care in the home, then the local social services may still have responsibilities to provide some services in addition to the home care. It is possible to receive ‘mixed’ packages of care, where some services come from the NHS and some from social services. Where local social services provides the care services, it will usually do a financial assessment to decide whether the person you look after must make any financial contribution.

The NHS team will consider each of the healthcare needs of the person looking for continuing care funding, which are:

- behaviour,
- cognition (understanding),
- communication,
- psychological/emotional needs,
- mobility,
- nutrition (food and drink),
- continence,
- skin (including wounds and ulcers),
- breathing,
- symptom control through drug therapies and medication, and
- altered states of consciousness.

An example of the type of care that might warrant continuing care funding is “Fred has been diagnosed with Alzheimer’s disease. His Alzheimer’s has reached an advanced stage and because he lives at home he needs assistance with all of his personal care tasks. In particular Fred needs help with his washing and eating and he also has both bowel and urinary incontinence, and needs constant supervision to ensure his safety.”

The value of Continuing Care may exceed £1,000 per week, but You do not receive the cash directly yourself, but instead the NHS spends it on your behalf in accordance with the needs and aims stated within a Care Needs Assessment. The health authority (Primary Care Trusts in England, Health Boards in Scotland and Wales) are obliged to take the wishes of the client into account though. So if you want, for example, to have a live-in carer provide you with the care you need at home you should make this clear to the NHS, as early as possible during the care needs review.

If you want to continue this discussion you will find the sam esubjuect on our forum here – NHS Continuing care funding for the elderly.

A “Lifetime Mortgage” would allow you to withdraw capital up to a certain level to meet the cost of funding your care. The attraction of a lifetime mortgage is that there is no requirement to make any payments of interest or capital to the lender during your lifetime. All interest payments are deferred and the overall debt is settled on your death.

If you would like to know more about this service, please let us know and we can arrange a free consultation with a firm of Chartered Financial Planners, who will be able to advise you whether a lifetime mortgage would be suitable for you.

A person must be able to give their consent to receiving direct payments and be able to manage them even if they need help to do this on a day-to-day basis.

Who is eligible?

If you already receive social services
Your local council is obliged to offer you the option of direct payments in place of the services you currently receive. There are some limited circumstances where you are not given this choice and your council will be able to tell you about these.

If you’re not receiving social services
To get direct payments you’ll need to contact your local council to ask them to assess your needs. Social services – and therefore direct payments – are normally available if you are:

– disabled and aged 16 or over
– a carer aged 16 or over, including people with parental responsibility for a disabled child
– an older person

If you’ve been refused social services
If your local council has decided that you do not need social care services, it will not offer you direct payments. If you think your needs or circumstances have now changed, ask your local council for a new assessment.

How much do you get?
The amount you receive will depend on the assessment your local council makes of your needs.

How it’s paid
Direct payments are made directly into your bank, building society, Post Office or National Savings account.

If you need someone who cares for you to collect your money, or you are registered blind, payment can be made by sending a cheque which can be cashed at the Post Office.

How to apply for direct payments locally
If you already get services, ask your local authority about direct payments.

If you are applying for services for the first time, your social worker should discuss the direct payments option with you when they assess your care needs.

The following link will let you enter details of where you live and then take you to your local authority website where you can find out more and/or apply online.

Find out more and/or apply for direct payments locally (opens new window)

What you can use direct payments for
The money is for you to use to pay for the services and/or equipment which will meet the needs the local council has assessed you as having.

As a general principle, councils should aim to leave you to choose how best to meet your assessed needs as long as they are satisfied that agreed support arrangements made, are being met.

What you can’t use direct payments for

You cannot use direct payments to:

– pay for permanent residential accommodation – but you may be able to use direct payments to secure occasional short periods in residential accommodation, if your local council agrees that is what is needed
– secure a service from your spouse or civil partner, close relatives or anyone who lives in the same household as you, unless that person is someone who you have specifically recruited to be a live-in employee (other than in exceptional circumstances, which your council may agree with you)

Record keeping
If you receive direct payments, you’ll need to account for the money you spend. Your local council will tell you what records you need to keep and what information you’ll be expected to provide: such as timesheets signed by personal assistants, or receipts for services from agencies.

The council will have to satisfy itself that the needs for which it is giving you direct payments are being met. They should tell you how they will go about this. This may involve a visit to your home.

Carers and direct payments
If you are a carer aged 16 or over, including people with parental responsibility for a disabled child, you may be eligible for direct payments.

However, you cannot use direct payments to buy services for the person you care for. They can only be spent on getting the support you, as a carer, have been assessed as needing.

Direct payments for carers – arranging care and services (caring for someone section)

Effect on other benefits
Direct payments are not a replacement of income and therefore do not affect any other benefits you may be receiving.

What to do if your circumstances change

If your social services needs change
If your needs change, contact your local council as soon as possible so that they can reassess the level of payments you require. It doesn’t matter whether the changes are long- or short-term.

For example, if you don’t need to spend the full amount because your condition improves temporarily, or you go into hospital, they may need to adjust your payments.

If you don’t want to continue with direct payments
If you decide you don’t want to continue, the local council will arrange services instead. If the council decides you cannot manage with direct payments, it might decide to stop making direct payments and provide services instead.

For details on this click this link to Direct.gov.uk