HEALTHCARE FUNDING
When planning long-term care and support for a loved one, it is sensible to start thinking about financing the care they need as soon as it is practically possible. At HBN Caring, we have been helping families up and down the country to understand how they can finance care, whether that is through funding available to them, or financing initiatives that can contribute to the cost of care. If you are living with a complex need and require nurse-led care you may be entitled to healthcare funding to receive care at home. Here we explain what you need to know about receiving funding for your care.
WHAT IS HEALTHCARE FUNDING?
If you have an identified primary healthcare need, this care in the UK is provided free at the point of delivery, whether you receive this in a primary or acute care setting, or choose to receive care and support in your own home. NHS Continuing Healthcare funding is organised and funded by your local Clinical Commissioning Group (CCG). A healthcare need is defined as ‘the treatment, control or prevention of a disease, illness, injury or disability’ and is different from social care funding. Social care funding is ‘to provide assistance with activities of daily living, maintaining independence, social interaction, enabling an individual to play a fuller part in society, protecting them in vulnerable situations and helping them to manage complex relationships.’ Your CCG will conduct a comprehensive assessment of your needs, to determine whether you are eligible for healthcare funding. The assessment must conclude that your needs are ‘primary’ and not considered a social care need for you to access this funding. At HBN Caring we have developed strong relationships with many CCGs that are based on a shared goal of securing the right funded care package for our clients, that enables them to get the right care, at the right time, for all of life. We work in collaboration to ensure that the care and support provided evolves with changing needs. Throughout the process we engage with our client and their family, so everyone is involved in making sure clients’ can live a meaningful and fulfilled life, with independence, whilst their family gets all the support they need.
UNDERSTANDING THE NHS CONTINUING HEALTHCARE CHECKLIST
The Continuing Healthcare Checklist is a screening tool used by the NHS to identify individuals that should be referred for a full assessment of eligibility for NHS Continuing Healthcare. It is the first step in the assessment process of determining whether you are eligible for healthcare funding.
The NHS Continuing Healthcare Checklist is an 11-point checklist that considers your care needs from a number of “domains”. These domains are simply various areas of your life where you may require extra support such as nutrition or mobility.
It is a relatively quick process to go through and the threshold for passing onto the next stage of your assessment is low. If you require any form of extra care or support, then you are likely to go through to the full assessment.
HOW DO I FIND OUT IF I AM ELIGIBLE FOR HEALTHCARE FUNDING?
The process of finding out whether you are eligible for NHS Continuing Healthcare funding can be a lengthy one, as the qualification criteria is rigorous. This can be overwhelming for some families. As we have formed strong relationships with CCG teams locally, we are able to work effectively together to deliver the best outcome possible for our families.
NHS Continuing Healthcare Full Application Process:
Here is a step-by-step guide to the full application process:
- Requesting a screening: The first step is to ask for a continuing care assessment from your social worker or GP
- Initial screening – “The NHS Continuing Healthcare Checklist” – A medical professional will be assigned to your application and will arrange with you to undertake an initial screening at home, or if you are in hospital, they will visit you there
- The full assessment – Each of your needs that is determined to be a healthcare need will be categorised as low, moderate, high, severe, or priority. You will be eligible for support if you have one priority and more than one severe need\
- Breathing
- Nutrition
- Continence
- Skin integrity
- Mobility
- Communication
- Psychological needs
- Emotional needs
- Cognition
- Behaviour
- Medication and drug therapies
- Altered state of consciousness
- Behaviour
- Receive your decision- You will then receive the results from your assessment via your CCG. They will then make the final decision as to what level of funding you will receive. They will write to you and explain how they made their decision.
- Appeal the decision – If you are deemed as not eligible, you can appeal this decision. The first step is to appeal by writing to your local CCG, but it is also a good idea to start considering other healthcare finance and funding options available. Your CCG has five days to acknowledge your request.
- When appealing your decision, be sure to provide evidence supporting your claim. Your CCG has three months to look through everything you’ve provided and work out the next step to take. If you are not found eligible the second time, you can escalate your claim to NHS England for an Independent Review Panel.
HEALTHCARE FUNDING FOR CARE OF CONDITIONS
We provide specialist care of complex conditions and nurse-led care that enables people to live safely and happily at home, with independence and an improved quality of life, for all of life. Whether you are a child living with spina bifida or cerebral palsy, an adult with muscular dystrophy or an acquired brain injury or an older person with dementia or Parkinson’s if your condition is considered a ‘primary healthcare need’ you could be eligible for part or full funding for your care and support. Unfortunately for many living with dementia they are not considered as having a healthcare need, as many CCGs will define dementia as a social care need, so they do not always qualify for the funding they need or deserve
NHS FUNDED NURSING CARE
If you have a nursing need that requires nurse-led care, the NHS will pay the weekly fee for the nursing care you receive in your own home. As with an application for NHS Continuing Healthcare funding, you will need to have an assessment of your needs. In the first instance, you should attempt to access NHS Continuing Healthcare funding, but if you have been declined, NHS Nursing Care funding is another way to get a contribution towards your care. For many families, this is a welcome payment to help with the overall cost of care.
HOW WILL I RECEIVE MY HEALTHCARE FUNDING?
PERSONAL HEALTH BUDGETS
If you are an adult eligible for NHS Continuing Healthcare Funding or a child in receipt of Continuing Care, or NHS Funded Nursing Care, you will be offered the choice of receiving your funding through a personal health budget (PHB). The purpose of a PHB is to give those living with long-term health conditions and disabilities choice and control over how their funding is spent on their health and well-being needs, whether that is in their own home or in a residential care or specialist care setting.
The funding is provided by your CCG and in some instances can be jointly funded with your local authority depending on your care package.
There are options as to how you manage your funding and care arrangements:
DIRECT PAYMENTS
You or your representative receives the funding directly to procure and manage the care, support and services you need. Whilst there are procedures to follow and guidance governing how it is spent, this gives you more freedom and control to decide what is best for you. You will have to provide evidence as to how the direct payments have been spent.
NOTIONAL PERSONAL HEALTH BUDGET
The funding available to you based on your assessed needs will be managed by your NHS team. They will arrange the care and support you need, including choosing the care provider and pay for the care directly, which means you do not get any funding directly. If you manage your own personal budget you will be free to choose the provider you wish to receive care from, whereas if the CCG manages it you will be restricted to using a provider from their preferred supplier list. However, it is worth noting that you can rest assured that the care providers on the CCG or social services approved suppliers list will have gone through rigorous checks for safety and compliance.
PRIVATE CARE FUNDING
For those who do not have complex healthcare needs, they may find they do not qualify for healthcare funding, but will need to finance the cost of care themselves. This is referred to as private care funding or self-funded care.
Many families who have an elderly loved one receiving care at home to assist with day-to-day activities, such as cooking/preparing food, personal care or who require companionship, may find they will have to self-fund the care they need. Funding for elderly care at home may be available for this type of care through your local authority, depending on your financial circumstances. It is always worth exploring what elderly care funding is available, as this could considerably contribute towards the cost of care.
HEALTHCARE FUNDING RESOURCES
If you require independent information and advice about your home care funding options, there are a number of charities and advisory services that can provide you with valuable guidance, including:
- Age UK
- Independent Age
- Money Advice Service
There is an organisation called Care to Be Different, who can provide you with useful advice on how to navigate NHS Continuing Healthcare funding. Care To Be Different was formed by Angela Sherman following her own frustrating and lengthy attempts to secure healthcare funding for her parents. The website has lots of practical tips on funding, funding assessments and care fees.
Get in touch with our friendly care experts about your care and support needs or contact a location near you. We provide impartial guidance and advice, so you make the right choice for you and your family.
