CHC Funding: Don’t Go It Alone

The Genesis of Care Necessities: A Personal Mission

Stephanie Ford’s journey began with a life changing personal experience. Following a car accident at 19, while recovering in the hospital, she helped look after a fellow patient named Betty, a lady with a broken hip and dementia. This direct, personal experience highlighted the strained resources of nursing staff and the urgent need for advocacy for those who can’t speak for themselves. This experience was the catalyst for Stephanie’s career shift: from nursing, where she grew frustrated by system politics, to retraining in law, eventually merging the two fields to establish Care Necessities.

The company’s ethos remains rooted in Betty’s story, emphasising the importance of ensuring people are “truly seen and cared for with dignity,” especially those with dementia.

 

Read on or watch the full interview HERE

 

Services and Collaboration

While Care Necessities primarily focuses on NHS Continuing Healthcare (CHC) funding, their advocacy services have expanded to include:

• Hospital Discharges: Ensuring smooth and properly funded transitions from hospital settings.
• Wellness Visits: Conducting annual visits for solicitors, deputies, and attorneys to ensure clients are receiving all necessary care.
• Advocacy: Making sure the voices of vulnerable individuals are heard and needs are met.

The company thrives on collaborative working with other professionals, including solicitors financial advisors, and care companies like The Live In Care Company. This ensures clients benefit from a full spectrum of expertise.

 

Understanding NHS Continuing Healthcare (CHC)

A core focus for Care Necessities is helping families understand the difficult and often misunderstood area of NHS CHC funding.

Key Facts About CHC

• Not Means Tested: Unlike local authority funding, eligibility for CHC is not based on wealth (income, savings, or homeownership).
• Eligibility Criteria: Funding is based on the nature of the individual’s needs. The key is having a “primary healthcare need,” meaning the needs are primarily health related, not social.
• Assessment Factors: CHC eligibility is determined by an assessment that focuses on four key characteristics of the person’s needs:
  1. Intensity
  2. Complexity
  3. Unpredictability
  4. Severity

 

The Postcode Lottery and Complexity

The framework for assessing CHC has been revised over time, with guidelines on what constitutes a health versus a social need removed in the most recent national framework (2022). This has opened the process up to interpretation, making it challenging to navigate and leading to a “postcode lottery” where decisions can vary across different Integrated Care Boards (ICBs).

 

Types of Funding

There are three possible outcomes for funding:

1. Nil Fund: No NHS funding is awarded.
2. Joint Funding: A joint package of care funded by the local authority and the ICB (or Funded Nursing Care if in a nursing home). This can be applied to individuals in their own homes, which is highly relevant for those receiving live-in care.
3. Fully Funded: NHS Continuing Healthcare (CHC) covers the full cost of care.

 

The Value of Advocacy in Securing Live-In Care

The importance of skilled advocacy is powerfully illustrated by a challenging case involving “Mrs. H,” a pre-pension age woman with advanced dementia.

Care Necessities successfully challenged an initial denial of CHC and a plan to move Mrs. H to a care home, arguing that one-to-one live-in care was a safer and, in this instance, more cost effective option than a care home with one-to-one support. By thoroughly documenting the complex nature of her needs, they secured full NHS CHC funding for live-in care at home. This kept the lady in her preferred environment and saved the family an estimated half a million pounds over three years.

 

Live-In Care vs. Other Options

For Stephanie, the major advantages of live-in care are:

• Familiar Environment: Crucial for people with dementia who can be overwhelmed by new settings.
• Continuity of Care: Preservation of dignity and a truly person centred approach.
• Unmatched Support: The one-to-one support of live-in care “cannot be matched in any care home setting.”
• Client Preference: If asked, most individuals would prefer to be cared for at home.

When applying for CHC funding for live-in care versus residential care, the initial eligibility question is the same: Is the person likely to meet the CHC eligibility criteria? The funding is not accommodation specific. If eligible for CHC, it can cover live-in care just as it would a care home setting.

A challenge arises when the individual is not CHC eligible and is subject to means tested contributions from the local authority, who may be reluctant to fund the sometimes higher cost of live-in care (dependent on several factors such as location). However, with the right advice, it can still be secured through local authority funding, potentially using direct payments and, if necessary, a top-up payment from the family.

Since 2018, the option of a Personal Health Budget (PHB) allows for flexibility, including top-ups, which was previously illegal. If a fundamental need for live-in care is proven, the family may avoid any top-up at all.

 

Legal Framework and Timely Action

Key Legislation

While the National Framework for NHS Continuing Healthcare Funding and Funded Nursing Care (2022) is the main guidance document (though not legislative), Care Necessities also draws on key laws to protect client rights:

• The Care Act: Invaluable for individuals being cared for at home or those who do not meet CHC eligibility.
• Mental Capacity Act: Ensures best interest decisions are made for those who lack mental capacity.
• Mental Health Act: Used to support clients who have been sectioned.

 

Urgency for Retrospective Claims

Stephanie Ford strongly urges families with potential retrospective claims (applications for funding that should have been awarded in the past) to apply now. Currently, claims can only go back to 2012. She anticipates this deadline may be tightened again soon.

The previous deadline change saw settlements take over ten years to process due to backlogs, causing immense stress and delaying closure for grieving families. Immediate application is advised to avoid being excluded by any future cut off date.

Advice for Overwhelmed Families

For any family feeling overwhelmed by the complexity of the application process, Stephanie’s advice is simple: “Take a little bit of a step back. Breathe. And if you don’t want to go it alone, just give us a ring.”

The system is designed to be complex, but families have rights and options. Advocacy provides an ally in what can often feel like an intimidating “battleground” assessment, helping families to:

• Best prepare their case.
• Gather evidence.
• Ask questions.
• Avoid being intimidated by those leading the assessment.

There is currently no legal aid type funding for CHC advocacy. Although the framework advises against seeking legal support, advocates are considered essential by clients who have experienced the difficult nature of the assessments.

 

The Best Part of the Job

For Stephanie, the most rewarding aspect of her work is being able to “do good for people that need it.” This fulfils the mission she set out to achieve in nursing but was thwarted by bureaucracy: “to be heard for the people I was looking after.”

The satisfaction of winning an application is immense, as is being able to “lift a burden off somebody’s shoulders,” allowing families to focus on caring for their loved ones without the added stress of a complex, misunderstood funding battle.

 

Contact Care Necessities

Listeners can find Care Necessities online at carenecessities.co.uk or call them directly. They offer a free initial call with an advocate to determine if their involvement would add value to the client’s individual circumstances.