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If an individual is in a nursing or care home because of physical or mental health needs, the cost of their care should be covered by the NHS Continuing Healthcare funding scheme, regardless of the individual’s wealth. However, with around 40% of Britain’s 440,000 care home residents self-funding their care, thousands of families in England and Wales could be wrongly paying care fees.
Therefore, if you or a relative are paying care home fees, you could be due a refund.
Below are some examples of how we helped our clients.
Doreen Homewood entered a care home in Wakefield in 2014, at the age of 82, due to a number of deteriorating health problems. She was unable to communicate her needs and required comprehensive assistance in daily life and taking her medication. She remained at the care home until she sadly died in October 2018.
Her family applied to NHS Continuing Healthcare for reimbursement of her care fees. They were turned down on multiple occasions. Following numerous appeals and finally, assistance from Hugh James, care fees exceeding £100,000 have been reimbursed to the family.
Doreen’s son, Tony Homewood, said: The assessment procedure is gruelling and no matter how well you think you can fight your own corner, trust me, it’s difficult, time-consuming and the whole thing is loaded against you.
Barbara Stretch was diagnosed with Alzheimer’s disease and lived at Ashburnham House care home in Morecambe from November 2003 until she died in June 2011.
Due to her Alzheimer’s disease, she was unable to manage any of her own care. Barbara could also demonstrate aggressive and unpredictable outbursts of behaviour and was sectioned under the Mental Health Act.
Her daughter applied for a retrospective review of eligibility for NHS care funding in 2012. Midlands and Lancashire Commissioning Support Unit (CSU) was asked to review the case on behalf of Morecambe Bay Clinical Commissioning Group (CCG). Unfortunately, it took them until 2016 to deny the funding, which Hugh James appealed.
The appeal was rejected on several occasions. Hugh James then sought an independent review in 2019. The family recovered over £43,000 this year, for fees that should never have been paid. Due to the unreasonable delays by Morecambe Bay CCG, an interest payment of almost £12,000 was included in the figure.
Barbara’s daughter, Mrs Greenwood, said:
Continue. Don’t give in. It hurts when they say no to funding. They said my mother wasn’t ill at the first meeting. I will never forgive them for that.
Florence Mitchell was admitted to hospital age 84, after fracturing her hip in a fall at home. She was transferred to Harrowby Lodge in Grantham, Lincolnshire to be closer to her daughter and lived at the home until she died in 2007.
Mrs Mitchell suffered from Alzheimer’s disease which made her confused, disorientated and caused short- and long-term memory loss. She was totally dependent on care staff for all her needs.
She was awarded NHS care funding in 2006, but it was removed six weeks before she died. In 2012, her family asked Hugh James to help them get a retrospective review of full NHS funding.
Arden and GEM Commissioning Support Group (CSU) were asked to review the case on behalf of Lincolnshire Clinical Commissioning Group. After four years, they refused to review the case as Florence had been assessed before she died. Hugh James challenged this and eventually, they reviewed her case but decided Florence was not eligible for care funding. Following a number of appeals, her family have now secured full NHS funding for the whole period and have been refunded £75,000 for care home fees which they should never have had to pay.
Florence’s daughter, Jacqueline Mitchell said:
This is not money we have ‘won’ – it is money that never should have been taken from my mother in the first place. When mum went into care, we were simply told she would have to sell her home pay for the costs of her care. That’s not right.
Eric Halloway was diagnosed with Alzheimer’s disease and lived in care homes in South Kent from 2004 until he died in 2009. He sold his home to pay his care fees.
Mr Halloway suffered with severe dementia. He was also anxious and depressed, unable to communicate, incontinent and in pain. In 2012, Hugh James requested a full retrospective review of Mr Halloway’s period in care. In July 2016, an organisation working on behalf of the NHS concluded that Mr Halloway was not eligible for NHS funded care at the time.
Following numerous appeals and partial overturns, the case went all the way to an Independent Review Panel in January 2020. The panel decided that Mr Halloway was eligible for a full refund of all care fees. After 8 years of fighting, the family recovered a total of over £170,000 in settlement of the claim – all fees plus interest.
Eric’s son, Richard, said:
My father spent 22 years in the RAF – we felt it wrong that he should have been forced to sell his home and use his savings to fund his care. This process has taken 8 years to complete. I urge other families not to be swayed by the system.
Sheila Flower has been a resident in a care home in Newport since in 2004 at the age of 61 due to her deteriorating mental and physical health.
Mrs Flower suffers from bi-polar, diabetes, depression and hallucinations. Mrs Flower has often refused to eat and take medication and has been admitted to hospital a number of times.
Mrs Flower’s daughter contacted Hugh James in 2012 after she was denied continuation of NHS healthcare funding. A retrospective review of Mrs Flower’s needs was requested. Unfortunately, it took until 2019 for the health board to reach an initial decision regarding part-funding. Following negotiation, Mrs Flower was refunded £75,000 covering three years of wrongly paid care fees and interest.
Mrs Flowers’s daughter said:
The assessment process feels like a tick box exercise and is not a reflection of my mum’s needs. Whilst we’ve had some victory, we are still waiting for the whole claim to be determined.
Mrs Patricia Heywood Patricia Heywood suffers with Alzheimer’s disease and due to her health is currently cared for in a nursing home on the outskirts Huddersfield.
She entered a residential home in 2018, but as her health deteriorated, she was moved to a nursing home in 2019. Due to suffering with dementia, Patricia can exhibit challenging behaviour, is disorientated to time, place and person. She cannot communicate effectively, requires all her medication to be administered to her and is mobile, but at a high risk of falls.
Mrs Heywood’s daughters approached Hugh James in 2019 and we requested an assessment of her current needs and a retrospective review from Mrs Heywood’s entry to the residential care home in 2018. A Decision Support Tool was completed in August 2019 which found Mrs Heywood eligible for NHS Continuing Healthcare and her ongoing care home fees of over £3000 per month to be met by the NHS.
A retrospective review was then completed and following resolution meetings in 2021 confirmed that Mrs Heywood should have been eligible for NHS Continuing Healthcare since her admission to the care home in 2018. Mrs Heywood was reimbursed over £40,000 which included all the care home fees she paid from 2018 together with interest.
Debbie Emms said:
I would not hesitate to recommend Hugh James. Without their legal expertise I definitely wouldn’t have been able to secure mum’s retrospective reimbursement.
Hilda Underwood was diagnosed with dementia and lived in a care home in Leigh On Sea in Essex from 2007 until she died in 2011.
Mrs Underwood suffered with severe dementia. Due to her dementia, she had challenging behaviour, unable to communicate effectively and required all care to be provided to her. Initially, she was able to mobilise, but suffered a number of falls. As her health deteriorated, she became immobile.
Hugh James requested a retrospective review, in 2012, of Mrs Underwood’s past care. Following numerous appeals through Arden and GEM Commissioning Support Unit and to an NHS England Independent Review Panel, the NHS concluded that Mrs Underwood was eligible for NHS Continuing Healthcare for the last year of her life and her care fees should be refunded. Her family recovered over £35,000 in wrongly paid care fees and interest.
Lisa Morgan
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