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NHS continuing healthcare and dementia care fee recovery

Some individuals suffering from dementia qualify for NHS continuing healthcare , so that some all of their care needs and costs associated with the condition can be met.

However, the application process isn’t always straightforward and getting the full funding you are eligible for can be complex.

If you or someone you know qualifies for continuing healthcare (CHC) funding for dementia, then you will receive a letter from the NHS Integrated Care Board to confirm your eligibility and the level of care you will be getting. The funding for this care will either be paid for by the NHS to your care provider directly or to someone who is looking after the affected individual through a PHB (personal health budget).

When it comes to getting the appropriate NHS continuing healthcare funding for dementia, the solicitors at Hugh James can assist by reviewing past care home fees for retrospective claims. This ensures that you are able to recover any fees already paid either before or after death, that is, if your loved one qualified for CHC funding dementia at the time.

What is NHS continuing healthcare for dementia?

The NHS’s continuing healthcare for dementia is a care package which fully provides funding for adults who have complex ongoing health needs. This includes dementia.

Continuing healthcare funding for dementia is awarded to those individuals who have been identified as having a ‘primary health need’. This means that their day-to-day care needs are to be met and funded by the NHS solely.

Securing funding for NHS continuing care for dementia involves a two-step process which can get complicated and even a bit tricky at times. This is why it is strongly recommended that you consult a solicitor specialising in ‘NHS CHC dementia’, as this ensures that the affected individual gets the full funding that they are entitled to, and also has any paid care fees recovered as per the current eligibility criteria.

CHC funding for dementia: what you need to know

When it comes to CHC funding for dementia, here’s what you need to know:

Once your loved one qualifies for NHS continuing healthcare’ funding, a specialist nurse will work with them to ensure that the support plan fully meets their care needs.

As for the CHC funding for dementia specifically, it can be paid in two ways; directly to the individual’s care service provider, or as a Personal Health Budget, as mentioned earlier. In case of the latter, a designated person, such as a social/health care professional, a carer, or family member, will manage the budget and decide how it is spent.

Many people choose the latter funding option as it offers them better control over how the funding is utilised.

How NHS continuing care helps dementia patients

CHC funding for dementia can help individuals suffering from the condition by providing funding to cover their care needs.

Continuing care funding for dementia can be very helpful for sufferers as the NHS will be solely contributing towards the cost of nursing care. This can be a big help to the affected individual, along with his/her loved ones, as it relieves them of a major financial burden by providing ongoing financial support.

Treatment for dementia needs to be consistent and ongoing in order to be effective and this is where NHS continuing care funding for dementia can be very helpful indeed.

Eligibility for NHS CHC when suffering with dementia

An individual suffering from the condition is eligible for ‘NHS continuing healthcare’ funding once their care needs have been assessed professionally to be intense, complex, or unpredictable. Therefore, a dementia diagnosis alone does not necessarily point to the fact that they will automatically qualify for continuing care funding.

In order to determine eligibility, a team of health and social care professionals will assess your loved one’s care needs. The assessment includes determining how the individual’s needs are currently affecting them in daily life, and, the type of support required to manage those day-to-day needs.

Once eligible, CHC funding will cover the entire cost of care, which includes any residential care and/or professional care home services fee.

Applying for CHC funding for dementia can be a difficult and even emotional process, particularly for the more complicated cases. Make it easy on yourself and your loved one by contacting one of our solicitors for a free initial consultation. They can guide you on how to proceed with the process and how to ensure that your loved one gets the full continuing healthcare funding for dementia that they are eligible for.

Free no-obligation assessment

Key contact

Lisa Morgan

Partner

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 25 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.



The Pearson’s story

Mr and Mrs Pearson came to Hugh James solicitors for help with Kathleen Pearson’s nursing care fee recovery. The family had taken 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. After many appeals, Hugh James was successful in obtaining £40,000 back for the Pearsons.

Read more about the Pearson’s story here.

View more stories


Frequently asked questions

It is possible for you to pursue a claim independently without instructing a solicitor or advocate. However, it is a difficult process and we have many clients who have initially tried themselves and found the process challenging.

There are many companies who specialise in this area. However, as solicitors we are regulated and very experienced in what we do.

The team at Hugh James have more than 15 years of experience and have won awards from The Law Society and Age Cymru for their work.

Some of our clients question how non-medically qualified professionals can challenge health decisions. Whilst the people making decisions regarding eligibility for continuing healthcare are health and social care professionals, their decisions are being challenged and it is our job to demonstrate they are unsound by analysing medical evidence and applying it to the criteria. Whilst the process is not legal, it is a dispute resolution process and many Independent Review Panel chairs are former solicitors and barristers.

Due to Hugh James experience and depth of knowledge, we are respected by health and social care professions and panel chairs for the work we do.

The skills developed by lawyers – analytical, evaluating, interpreting and advocacy is key in being successful and it is of no surprise that all companies employ law graduates to undertake this work.

Unlike solicitors, unregulated advocacy companies are not obliged to provide clients with the best advice and be clear and transparent about their charges. They cannot advise on the option of court proceedings against health authorities for unsound decisions by way of Judicial Review, as they cannot by law undertake reserved legal activities. NHS Continuing Healthcare: Can you challenge an Independent Review Panel decision?

The other added advantage of instructing a solicitor is protection if something goes wrong. Sadly, we have seen first-hand, companies not providing accurate advice leading to clients losing the chance to proceed or companies no longer being in business. Solicitor practices are far more stable, but in the unlikely event that something does go wrong, clients can at least rely on solicitor’s professional insurance policy. They can also have recourse to the Solicitors Compensation Fund.

While we will ask the case proceeds as soon as possible, we have no control over the speed in which the health authorities progress the claim and it depends on the decisions made by the health authority. In our experience, it takes 24 months for a case to reach a retrospective panel. However, current assessment should be undertaken in a timely manner and are usually completed within 3-6 months. We will always keep you up to date as your case progresses.

Our team have been working in this area for over 15 years and have been successful for over 6000 families in securing free NHS funding through current assessment and/or retrospective reviews.

We provide a free initial assessment and we will advise you at the outset whether you have a case.

We have recovered £200m for our clients. The most any one firm or company has recovered in the UK.

Read what our clients say about our service here.

We understand that instructing a solicitor may be daunting, but unlike advocacy firms, as solicitors we must be open and transparent about our costs. There cannot be any hidden charges.

Following a free initial assessment of your case, we offer a number of funding.

In most cases our clients are offered the choice of a ‘no win no fee’ Contingency Fee Agreement and an hourly rate basis. The Contingency Fee Agreement is popular with our clients as it provides certainty; they know exactly what we will charge if we win the case and it makes no difference how much time we spend pursuing the claim to a successful conclusion. In addition, there is peace of mind that if we pursue the claim and we lose, you do not pay us anything.

Retrospective cases

This is where money paid for care home fees is recovered.

If we succeed with a retrospective claim (monies are recovered), we take 25% plus VAT of the monies recovered.

It is common, as NHS Continuing Healthcare is based on the type and amount of care needs, that eligibility is only awarded for part of the period in care. Our average amount to recover is £30,000 and our average fee is £7,500 plus VAT.

Current assessments

Where someone is awarded free NHS funding.

If a current assessment awards full NHS funding, our fee is 25% plus VAT of the monies we preserve for you for the first four months, or until eligibility for NHS CHC is lost, whichever is first.

If, for example, the date of a current assessment is 1 June and eligibility is found and you were paying £800 per week, and over four months £12,800. You will pay us £3,200 plus VAT.

Hourly rate charging basis

All our clients are also offered an hourly rate option. Our current hourly rate is £200 plus VAT.

We will provide you with an estimate of costs. Giving an estimate at the outset of a case is difficult and is dependent on the circumstance of each case. Many of the factors which will influence the eventual amount of costs are unknown. Whilst it is difficult for us to say how long the claim may take and how much work we will need to do (since often this will depend on the way that the health authority deals with the claim) our estimate of our costs will be provided to cover the work for assessing all the medical records, advising on merit, requesting an assessment and appeals.

It is difficult to estimate how much time is spent on a case, but we suggest a typical case from start to finish will be 40-60 hours.

We regularly update you on the costs incurred. Our costs are payable win or lose on an hourly rate basis.

Will there be any surprise costs at any time

No. At the outset of the claim, we will write to you to explain the funding options. As a firm of solicitors, we must be clear and transparent about our costs.

Whilst we do not envisage you will be unhappy with the cost or service we provide, it is good for you to know that if you were unhappy, unlike unregulated advocacy companies, you can make a complaint through our internal complaints procedure. If you are not satisfied once you have been through our complaints procedure, you can contact the Legal Ombudsman.

The process will depend on a number of factors, such as whether you are starting your claim from scratch or if you are coming to us to appeal a negative decision; whether you are claiming on behalf of a loved one who has since passed away or has just moved into long-term care.

If you believe that you or a family member has wrongly paid care fees, then the first step is to complete our questionnaire. This will be assessed by our Nursing Care legal team who will be able to advise on whether or not you have a case, and if so, what the process will be. This initial questionnaire is free to complete and there is no obligation on you to proceed with a claim should you decide not to.

We believe we are one of the leading national experts in the recovery of wrongly paid care home fees. Here are just some of the reasons why our clients choose to work with us:

  • We have recovered over £250 million in wrongly paid nursing home fees since the department was set up in 2006.
  • Our success and client stories are regularly featured in the press as we are recognised as leading the way in reclaiming wrongly paid care home fees. This includes The One Show, Dispatches, ITV News, The Telegraph, The Sunday Times and The Mirror.
  • We work in partnership with many of the leading older peoples’ charities, helping us to ensure our service meets the needs of the people we, and the charities, represent.
  • Unlike many other companies who focus on reclaiming wrongly paid care fees, we are a firm of solicitors regulated by the Solicitors Regulatory Authority (SRA) and comply with the solicitors’ code of conduct.
  • The Hugh James Nursing Care team is the leading and most experienced team in the niche area of continuing healthcare, giving you complete peace of mind that your case is being dealt with by fully qualified lawyers who specialise in reclaiming nursing and care home fees.
  • The team is also one of the biggest teams focusing exclusively on this area in the UK with over 40 dedicated lawyers.
  • We promise to deal with your claim from start to finish and will not pass your claim on to a third party. We offer a complete service for you with dedicated team members to contact.
  • Head of the team, Lisa Morgan, won the highly acclaimed Law Society Junior Lawyer of the Year 2010 Excellence Award due to her work in this area. She was also recently awarded the Cardiff University Simon Mumford award. In 2017, the department was highly commended at the Age Cymru Awards in the large business category for its commitment to helping older people.