Information on any Benefits & Continuing Health Care

When your local authority completes your financial assessment they’ll assume that you’re receiving all the benefits you’re entitled to. So it’s important to find out what benefits you should be getting, and claim them before you ask for financial help.

Even if you think you’re getting all your benefits, your entitlement may change when you move into a care home, so it’s a good idea to make sure everything is up to date.

If you move into a nursing home you should qualify for the Registered Nursing Care Contribution. This benefit is not means-tested, so you’re entitled to it even if you are paying for care yourself.

If you have assets worth more than £23,750 (for England and Wales, £24,750 for Scotland) you won’t be entitled to help towards the cost of care. Usually this figure includes the value of your family home. However, if your spouse, partner or a relative over the age of 60 lives in your home it’s not included. It’s also not included if your care needs are temporary.

Find out more about the recent government changes to funding and how it might affect you. Visit Eldercare for more information.

NHS continuing healthcare is free care outside of hospital that is arranged and funded by the NHS. It is only available for people who need ongoing healthcare and meet the eligibility criteria described below. NHS continuing healthcare is sometimes called fully funded NHS care

Where is care provided?

NHS continuing healthcare can be provided in any setting, including a care home, hospice or the home of the person you look after. If someone in a care home gets NHS continuing healthcare, it will cover their care home fees, including the cost of accommodation and healthcare costs.

If NHS continuing healthcare is provided in the home of the person you look after, it will cover personal care and healthcare costs. It may also include support for you as a carer.

Eligibility

To be eligible for NHS continuing healthcare, the person you look after must be assessed as having a “primary health need” and have a complex medical condition and substantial and ongoing care needs.

Not everyone with a disability or long-term condition will be eligible. The assessment process is outlined below.

Guidance says that the assessment for NHS continuing healthcare should be “person centred”. This means that the person being assessed should be fully involved in the assessment process. They should be kept informed, and have their views about their own needs and support taken into account. As a carer, you should also be consulted where appropriate. It’s a good idea to make it clear that you would like to participate fully in the assessment process.

A decision about eligibility should usually be made within 28 days of an assessment being carried out.

If they are ineligible

If the person you care for doesn’t qualify for NHS continuing healthcare, their local authority will be responsible for assessing their care needs and providing services if they are eligible.

However, if they don’t qualify for NHS continuing healthcare but are assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For someone who lives in their own home, this could be provided as part of a joint package of care, where some services come from the NHS and some from social services. If the person you care for moves into a nursing home, the NHS may contribute towards their nursing care costs (see NHS-funded nursing care, below).

Care services from the local authority are usually means-tested, so if the person you look after is eligible for local authority care, their finances will be assessed. Depending on their income and savings, they may need to pay towards their care costs.

If the person you care for is found to be eligible for NHS continuing healthcare, the next stage is to arrange a care package which meets their assessed needs.

Depending on the person’s situation, there may be different options that could be suitable, for example, being cared for in a care home, or support in their own home. If it’s decided that someone needs care in a care home, there could be more than one local care home that meets their assessed needs.

Your PCT should use the views of the person you look after as a starting point when agreeing their care package and the setting where it will be provided, but they can also take other factors such as the cost and value for money of different options into account. For more details about individual choice and NHS continuing care packages.

If the person you look after is awarded NHS continuing healthcare, their case will be reviewed after three months. Their care needs will be reassessed and their eligibility will be looked at again. The review also looks at whether someone’s existing care package meets their assessed needs.

Following this, reviews should be carried out at least once a year.

If the outcome of someone’s review means that their care package will change, they should be told in writing. If they don’t agree with it, they will need to use the NHS complaints procedure.

If someone isn’t eligible for NHS continuing healthcare, but they are in a nursing home (a care home that is registered to provide nursing care) they may be eligible for NHS-funded nursing care. This means that the NHS will pay a contribution towards their nursing home fees, often known as the Registered Nursing Care Contribution (RNCC).

NHS-funded nursing care is only used to pay for the costs of nursing care. People who get it will still need to pay for their accommodation, board and personal care, or have a community care assessment to see if they can get help with these fees from their local authority.

The assessment for NHS-funded nursing care should be done automatically when someone moves into a nursing home. Eligibility depends on whether the person is assessed as having needs that require a nursing care environment.

NHS-funded nursing care is currently £108.70 per week in England.

Before September 2007 there was a three-tiered system for nursing care. Anyone who was on the highest band of NHS-funded nursing care can continue to get this until their circumstances change. This is paid at £149.60 per week