Care Home Claims

The Basics Of Care Home Claims

There are times when families need to reclaim care home and nursing home fees which have been paid incorrectly. This will often happen when an individual in care is incorrectly assessed for their eligibility for NHS Continuing Healthcare funding. There are also times when an individual is not assessed at all. Many of the cases that are dealt with are when a relative has passed away in care and used their life savings or sold their home to pay for care unfairly or unnecessarily.

The process for reclaiming care home fees which have been incorrectly paid is similar to that of the Full Assessment. The primary difference is that the assessment will be done on a retrospective basis making use of evidence from the hospital, care home or GP along with any Full Assessments carried out in the past.

The company that you use to help with the claim will generally have a specialist term of nurses who carry out a retrospective analysis of the clinical data. The analysis will generally look at the care the individual needed over their period in care. Specialist solicitors will then have to present an argument for entitlement to NHS Continuing Healthcare Funding in front of the Clinical Commissioning Groups. These groups will then assess the retrospective eligibility through a Panel Meeting.

If the CCG’s only agree to a refund for part of the period in care, it is possible to appeal against the periods that are still in dispute. The solicitors will also need to look at the issue of interest payments which are due on the care costs which were paid. They will generally complete complex interest calculations to determine the refund that you are entitled to.

It is important to note that there are deadlines imposed by the government in relation to when refunds for incorrectly paid care costs cannot be reclaimed. Retrospective care cost claims can only be made for any costs which were paid after 31 March 2012. If you paid care costs incorrectly before this date, you will not be able to reclaim them.

However, there is an exception to this and that is claims which have already been made for the period before 31 March 2012 which were unsuccessful. In these situations, you will still be able to challenge the assessment and claim the costs dating back to 2004. There is a similar deadline in Wales, but the date there is 31 July 2013. There is also a rule that states that the claim period to be considered cannot be longer than 12 months from the date of the first application.

While these deadlines are meant to be well publicised, there are still very few people who are aware of them. These deadlines may also be subject to legal challenges as it is seen as a cynical and obvious move by the government to protect their budget without any regard to unfair practices. These unfair practices come from the NHS which often failed to properly assess people for NHS Continuing Healthcare Funding entitlement.

There are many circumstances which lead to people missing out on funding including:

  • Being discharged from a hospital and straight into a care home.
  • Those who receive NHS Nursing Care which pays for nursing but does not cover accommodation and were never assessed for the benefit that covers their accommodation.
  • Those who have been assessed and rejected, but have had a condition which worsened.
  • Affluent patients who assumed that no help would be available, but NHS Continuing Healthcare Funding is not means-tested and is qualified for based on health reasons.

If you believe that you might be entitled to claim back care home fees, you need to contact a solicitor. They will be able to provide you with a free initial assessment where you will talk about the situation and they will determine if you have a claim.

If the solicitor feels that you might be able to reclaim the fees, they will generally offer a no win no fee payment basis. This means that you will not pay a penny to the solicitor if they do not recover your care costs.