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Care home fees are a complicated issue, which has led to many people paying care home fees that they were not supposed to.

In some cases, families can reclaim those fees, even on behalf of a relative who has passed away.

Who pays for care home fees?

Typically, if your net assets, including savings, are worth less than £23,250 then you will be eligible for all or part of your care to be funded.

If you receive care at home, then your home is not taken into account, but if you need residential care then, in most cases, their home IS taken into account, unless a spouse or partner remains in the home.

Can I reclaim care home fees?

It is unfortunately not as straightforward as we would like and there are a number of important facts that relate to the ability to claim back care home fees.

The root cause of the confusion is that people with ‘primary health needs’ may qualify for what is known as NHS continuing care – but very few people understand what a primary health need is, or what their rights are if they do qualify.

What is a primary health need?

The concept of a primary health need is central to deciding whether someone’s care needs should be met by the NHS or the local authority. An individual has a primary health need if the main reason they require care or most of it is to prevent these health needs.

The national framework states that a healthcare need is one related to the treatment, control or prevention of a disease, illness, injury or disability, and the care or aftercare of a person with these needs.

There is a good, clear guide to primary health needs here – but if you are confused, then you are welcome to speak to us for guidance.

No doubt you will have heard about the tax on dementia the Government tried to bring in.  Bizarrely dementia is not considered a PHN.  The position on care fees is likely to change as the Government is conscious of the need to find a way to pay for the care needs of an increasingly elderly population that is living longer.

Please feel free to contact us if you would like to be kept updated on these changes.

So if I have paid for care when I shouldn’t have done, can I reclaim?

In theory, it is possible to claim back care home fees if it is established that there was previously an unassessed period of care and that during this period the individual’s needs were so complex in their nature that they could overall be classed as primarily health needs.

If you receive care in England because of primary health needs them the NHS must pay for the entire cost, without means-testing. This is regardless of how old you were when care was received and how much you had in savings or assets.

Again, we can offer guidance and support on this – and if you have a claim, we can help you to negotiate the process.

Who can reclaim?

Anyone that has received care themselves can reclaim and you can also reclaim for relatives or even relatives that have passed away.

How to reclaim care fees:

Provisional assessment:

Firstly, you will need to get a provisional assessment to find out if the NHS thinks you are likely to qualify.

Find your local NHS continuing healthcare co-ordinator and get the Checklist completed by a health or social care professional who knows the process and understands the extent of your care needs.

Find the full checklist here.

Full assessment:

If the checklist shows that further assessment is needed to make a decision, then the local primary care trust (PCT) has to have a comprehensive look in your needs. This might require some evidence regarding your care.

The review will take a maximum of 28 days and you will be given a yes or no answer. If the claim is successful, the NHS will pay for all the costs that occurred during the period you were assessed for.

If rejected:

If your claim gets rejected but you have a strong case, we would suggest getting advice from an experienced lawyer and also speaking to the NHS Patient and Liaison service.

Lastly, you can also complain to the Health Ombudsman. The Parliamentary and Health Service Ombudsman can resolve complaints that have not been resolved by the NHS in England, government departments and other public organisations.

How can DMA Law help?

Here at DMA Law our solicitors have been working with clients across the North East for years. All our clients have different requirements and that’s why we always tailor our services to meet their needs.

Whether you want advance directions for medical treatment and personal care or you want to reclaim your fees we are here to support you through the process, every step of the way.

We are happy to provide you with a free initial consultation and if you need more details of our competitive prices please get in touch by using the contact form on our website or by calling your local branch.