Reclaiming wrongly paid care fees: Mr and Mrs Pearson’s story

As our Nursing care team reaches a major milestone on behalf of families who have wrongly paid for care fees, successfully recovered over £200 million for families, we take a look at the Pearson’s case and their journey with reclaiming wrongly paid care fees.

When Mr Pearson’s mother, Kath was diagnosed with Alzheimer’s they were thrown into an emotional and confessing world. As her condition deteriorated the family decided the safest place for her was in a residential care home as she had reached a point where Kath needed a professional level of care.

As is often the case, the Pearsons were not even made aware of NHS continuing healthcare (CHC) funding, despite having meetings with social services about Kath’s care funding. The family took on full responsibility for covering Kath’s care fees and as a result, they were forced to sell Kath’s home. Kath’s care cost all her life savings as well as the cost of her home, over a quarter of a million pounds.

About NHS Continuing Healthcare (NHS CHC)

Often referred to as ‘fully funded care’, NHS CHC is a package of care arranged and funded solely by the NHS, which can be received in a care home or at the individual’s home.

If an individual demonstrates a primary health need, then the NHS must pay for their care in full, regardless of their personal wealth. To qualify, the individual must demonstrate that their needs are:

• Complex, intense or unpredictable
• Not incidental or ancillary to the accommodation a local authority is under a duty to provide, or
• Not of a nature typically provided for by a social services department.

Therefore, if someone is in a nursing or care home because of physical or mental health needs they may be paying fees that should be funded by the NHS.

In the final year of Kath’s life, Mr and Mrs Pearson became aware of NHS continuing healthcare. They got in touch with the Hugh James Nursing Care team and a current assessment and a retrospective review was requested. Following significant delays, Mrs Pearson was deemed eligible, and the NHS met her ongoing care fees, which meant they did not pay the £2,500 per month in care fees. However, the family felt that she should have been eligible for NHS continuing healthcare much earlier on and so wanted to make a retrospective claim.

They felt it was unfair that people like Kath are left with nothing to pass on to their children and grandchildren when there is funding available which they are entitled to but are being denied.

After many appeals, Hugh James was successful in obtaining £40,000 back for the Pearsons.

The Hugh James team, which is led by partner Lisa Morgan, have over the past 16 years, successfully challenged countless current and retrospective decisions to refuse NHS funded continuing healthcare to long-term nursing home residents.

With thousands of people wrongly paying care home fees every year, the department acts on behalf of families of vulnerable people across England and Wales to help claim NHS Continuing Healthcare funding.

Lisa Morgan, Partner and Head of the Nursing Care department, commented:

All too often, individuals and their families are needlessly forced to sell their homes and other assets or investments to pay for care; it is disappointing that the NHS continue to incorrectly assess cases and put people and families in this position. Put simply, if the primary reason for an individual receiving care is for health, then it should be the responsibility of the NHS to pay for their care, regardless of the wealth of the individual.

Our team fight tirelessly to secure the funding our clients are entitled to and to reclaim wrongly paid fees, to give families back what should never have been paid in the first place.

Watch the Pearson’s story