Recent reports of a ‘crisis’ within the health and social care sectors may have hit home with many families across the country with loved ones requiring residential or nursing care. As people are living longer, strains on the care sector continue to increase. A lack of social care funding along with an increase in the national living wage has left many care homes struggling.

In order to meet the costs of running the homes, many operators are increasing costs for so called ‘self-funding’ residents. With the average care home fees costing over £600 per week in England and Wales, many families struggle to foot the bill of their loved one’s care. This affects many care home residents throughout the country who do not qualify for council funding of their care – social services will only fund a resident’s care when their finances drop below £23,500. A recent study by a dedicated charity for the elderly, Age UK, found that the number of care home residents funding their own care has risen by 28.5% within the last decade. Councils are often unable to provide the necessary care for elderly people to remain in their own homes, leaving families with no other option than to seek residential care for their relative.

The study further highlights that many families are rushed into signing contracts with care providers with unfair terms, leaving them open to sharp annual rises in care home costs. The decision to accept that a loved one requires 24 hour care in a residential or nursing home is never an easy one to make. The decision is often made out of necessity, when a patient is ready to be discharged from hospital and is told that they are unable to return to their own home. With the well-publicised pressures on the NHS and the lack of beds available in our hospitals, the highly emotional decision is often made quickly without giving families the opportunity to scrutinise the fine print in contracts for care. As care home fees continue to rise, many families are put in the difficult position of deciding how to fund their relatives’ care.

With funding from local authorities limited to those on the lowest income, many people are required to fund their own care from life savings or the proceeds of sale from their homes. However, this is not the only option. If a patient’s primary need is for health then their care should be paid for by the NHS.

NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals outside of hospital who have ongoing health care needs. In the face of ever rising care costs and increased financial pressures on the social care sector, finding alternative sources of funding is now even more important. However, many people are unaware that their family member may be eligible for full funding of their care by the NHS. The specialist work of the Nursing Care department helps many families pursue continuing healthcare claims for loved ones either through a current assessment or the retrospective review process. At present, the amount reclaimed in wrongly paid care home fees by our department stands at £80 million.

Patients should be assessed regularly whilst in care to consider whether their primary need is for healthcare and therefore whether their care should be funded by the NHS. A patient’s needs are considered across a number of different areas to gain a full picture of their needs. If the assessment determines that the eligibility criteria have been met, the care fees will become the responsibility of the NHS. Health professionals should also consider a patient’s needs retrospectively to see whether they should have been eligible for continuing healthcare funding previously. If this is the case, any care home fees which have been paid should be refunded by the NHS.