In England and Wales, thousands of people have been wrongly paying their own care home fees. It is a common misconception that people who are in care homes are automatically liable for their own expenses. If someone requires care as a result of their health as opposed to their social care needs, the NHS are responsible for meeting all of their care costs.

For the NHS to recognise that someone requires care as a result of their health needs, stringent tests are carried out to determine whether they have a ‘primary health need’. Someone is identified to have a ‘primary health need’ when their needs are found to be high in nature, complex, intense or unpredictable. When determining whether someone’s needs meet the above criteria, a number different aspects of their health are taken into consideration, such as their long and short term memory, whether they are able to mobilise independently, whether they require for their food and medication to be managed or if they require continence care. These are just a few examples of the many aspects of health which are considered when determining whether someone has a ‘primary health need’.

If you are currently meeting your own care home fees and believe that your needs exceed basic social care requirements, it is important that this is raised as soon as possible. This is due to deadlines which have been put place over recent years which prevent people from claiming back their wrongly paid care home expenses. This means that even if someone should have been found eligible for NHS continuing healthcare funding, the NHS can refuse to review past periods of care and refuse to reimburse wrongly paid care home fees.

It is important to note that English and Welsh claims are dealt with under separate regulatory bodies and therefore, the deadlines for people who were being cared for in England and Wales are different. In England, people who have not already registered their claim will only be able to challenge the NHS for their care home expenses from 31 March 2012 to date. In Wales, due to rolling deadlines put in place by the Welsh Government, people are only able to challenge the NHS for their care home expenses from 1 November 2015 to date.

We anticipate that further deadlines will be put in place in the future. It is therefore important that if you feel you are wrongly paying for your care, you raise this as soon as possible to ensure that you do not lose the right to challenge the NHS and to ensure that your claim is registered. The Welsh Government are active in setting new deadlines every year and therefore, if you are receiving care in Wales and believe you have a claim, it is important not to delay in ensuring that the period you are able to claim for is not cut short.

The first step is to contact our specialist nursing care team.