Care Home Fees Recovery

If you or a relative has a serious long term health condition you may be entitled to NHS Continuing Healthcare. This means that the NHS may be responsible for paying in full or part the cost of your care needs, including accommodation and nursing costs if you live in a care home, or paying for nursing care at home.

Unfortunately, many people are wrongly denied NHS funding and many more could claim money back for care fees they have already paid.

Compensation Solicitors Online can help. With our assistance and expert advice, you could:

  • Reclaim any wrongly paid care fees;
  • Have nursing home fees refunded;
  • Avoid paying care home fees altogether.

TIME LIMIT: 6 MONTHS AFTER YOUR ASSESSMENT

Men aged 65 and over have a 7 in 10 chance of needing some care before they die.

Women aged 65 and over have nearly a 9 in 10 chance of needing some care before they die.

Today people may live longer but doubtfully healthier lives. Many people live with conditions such as arthritis, dementia, or the effects of a stroke.

On average a 65 year-old can expect to need ‘care’ with a cost of £30,000 during retirement. Moreover, 5% will need care costing more than £100,000.
However, ‘care’ does not include accommodation costs. Thus, these Government figures can potentially double. In the case of a couple the figures may be doubled again if they both require care.

LANDMARK CASES

THE COUGHLAN CASE
Pam Coughlan took action against her local health authority because of their refusal to pay her nursing home costs. In 1999 she won her case which has been established as a landmark ruling.

THE GROGAN CASE
Maureen Grogan was chronically ill and she was placed in the care of a nursing home in 2003. Following the decision of her local health authority not to fully fund her nursing care, she was forced to sell her come in order to cover these costs.

The Honourable Mr Justice Charles of the High Court found the NHS funding guidelines, which were relied on by the health authority, to be ‘fatally flawed’. A decision was made in favour of Mr Grogan thus overruling the original decision not to fund her care.

SOME FACTS ABOUT NHS CONTINUING HEALTHCARE FUNDING

  • It is not necessary to be terminally ill in order to qualify. Your eligibility will be determined by the NHS according to the national eligibility criteria, the ‘National Framework’ and a standard assessment process.
  • The NHS has no general duty of paying for your care despite you having paid your taxes all your working life. The NHS’s only duty is towards people with ‘primary health care need’.
  • You can get funding regardless of whether you are being cared for in a nursing home or at your home.
  • A diagnosis in dementia does not guarantee qualification for NHS Continuing Healthcare funding.
  • You may qualify for NHS Continuing Healthcare funding even if you have your own savings and assets which can cover the costs.
  • You may get NHS CHC funding even if your carers are managing your needs well.
  • The NHS is not obliged to pay for care related to any severe medical condition. The eligibility criteria will still be applied.
  • The landmark cases in this area are only guidance and there is no strict definition of what constitutes a ‘primary healthcare need’. Eligibility will be individually determined based on the relevant criteria.
  • You may be entitled to get involved in the assessment or appeal if you have registered Lasting Power of Attorney (LPA), or Enduring Power of Attorney (EPA), or you are a Deputy (appointed by the Court of Protection), or you are able to advance a ‘Best Interest’ argument.
  • NHS Continuing Healthcare funding is awarded for the duration for which the individual continues to meet the eligibility criteria.

MENTAL CAPACITY

The Mental Capacity Act 2005’s aim is to protect people who cannot make decisions for themselves or lack the mental capacity to do so. There are various reasons why a person might lack mental capacity, including mental health condition, a severe learning difficulty, a brain injury, a stroke or unconsciousness due to an anaesthetic or sudden accident, etc.
Under the Mental Capacity Act 2005 there is the presumption that a person has the capacity to make their own decisions ‘unless all practical steps to help him (or her) to make decision have been taken without successes’. Moreover, incapacity is not based on the ability to make wise or sensible decisions.

In order for a person to have capacity, s/he must be able to:

  • Understand the information relevant to the decision;
  • Retain this information;
  • Use or weigh the information up as part of the process of making the decision;
  • Communicate the decision s/he has made.

If a person is unable to do all of the above, then he may have mental incapacity. The test to determine mental incapacity is two-fold:

  • Has the person have an impairment of the mind or the brain, or some other disturbance which affects the way their brain works?
  • If so, is the disturbance so great that the person lacks the capacity to make the particular decision for themselves?

If this is the case, then a decision will be made by someone else. In any event, any decision made for a mentally incapacitated person must be in the best interest of that person. The Mental Capacity Act 2005 sets out things to be considered when deciding what is in the best interest of that person:

  • All relevant circumstances must be considered.
  • Assumptions should not be made on the basis of age, appearance, condition or behaviour.
  • It must be taken into consideration whether and when the person will have the capacity to make the decision herself/himself.
  • The person’s express wishes, beliefs and values must be taken into consideration.
  • The views of others with an interest in the person’s welfare should be taken into account.
  • You must not make a decision about life-sustaining treatment ‘motivated by a desire to bring about her/his death’.
  • You should support the person’s participation in any acts or decisions made for them.

The Mental Capacity Act 2005 came into force on October 1 2007. It affects the way in which people can decide their affairs in the event of mental incapacity with regards to the following:

Lasting power of attorney (LPA): a person can grant an LPA to another person or persons in order for them to make decision over her/his personal welfare, property and financial affairs. An enduring power of attorney (EPA) previously only enabled a person to make decisions over another’s property and financial affairs. EPAs made before the coming into force of the Mental Capacity Act 2005 are still valid.
Deputies: these may be appointed by the Court of Protection to make decisions for a mentally incapacitated person.
The Court of Protection: it oversees the operation of Mental Capacity Act 2005 and deals with all issues related to decisions for people who lack the mental capacity. It also resolves problems of dispute where the meaning of what is ‘in the person’s best interest’ is challenged.
The Public Guardian: oversees LPAs, EPAs and deputies.
The Code of Practice for the Mental Capacity Act 2005:complements the Act and provides guidance for professionals in applying and interpreting the Act.

POWER OF ATTORNEY

A legal power of attorney enables another to make personal welfare, property and financial affairs decisions if the time comes when you lack the capacity to do so for yourself.
A Lasting Power of Attorney is granted in a legal document which must be as clear and precise as possible. Compensation Solicitors Online’s specialist Power of Attorney solicitors will help you in drafting and obtaining Power of Attorney, keeping the process for you as simple and straightforward as possible. Furthermore, we can assist you in applying to the Court of Protection to be appointed as Deputy in the event of the lack of a LPA or an EPA.

SAFEGUARDING VULNERABLE ADULTS

Social services may get involved in safeguarding an adult who lacks mental capacity. However, this might also be necessary for an adult who is not mentally incapacitated. In such cases it is sometimes necessary for Social Services to get involved in order to ensure that all property, finance and personal welfare decision are made in the best interest of the adult. The borderline of some of these cases with family/domestic disputes calls for some ‘encouragement’ from a specialist solicitor in order for Social Services to get actively involved safeguard the interests of the adult.

An enquiry can be initiated by family member, carers, service users, friends, neighbours of the vulnerable person, i.e. any person with interest in the welfare of the vulnerable person.

YOUR CASE

With the cost of nursing and care home fees ever increasing it is important that you get sound legal advice as to whether you should in fact be paying fees.

There are two grounds on which we can advise you as to whether you have a claim for the refund of care home fees.

FINANCIAL ASSESSMENT
If you have need for care in a care home, you should be assessed financially by your local authority to determine whether you are expected to meet the cost of your care from your own savings, income or other means.

Currently if you have savings above £23,250 you will be expected to fund your own care in its entirety, you may also be forced to sell your home to pay for your care.

The legal rules relating to what should and should not be taken into account when being assessed are lengthy and complex but if understood and applied correctly, could mean that even though medically you may not be entitled for the NHS to pay for your care, you may still be eligible for funding on financial grounds.

This is another reason to go for a firm of solicitors over a non-legally trained claims management company as the Claims management companies cannot undertake the court work that is often required in pursuing this type of claim.

As solicitors we can advise on this complex area of law and if appropriate pursue your claim fully through the courts.

CONTINUING CARE CLAIMS
NHS Continuing care is available to those who have a ‘primary health need’ and have a complex medical condition and substantial and ongoing care needs. Not everyone with a disability or a long-term condition will be eligible.

If you meet the eligibility criteria, then the NHS should meet the cost of your ongoing care needs.

If you are already in a nursing/care home or you are about to go into one, you should have been assessed to see if you qualify for NHS Continuing care.

In addition, if your health deteriorates you should ensure that you have been re-assessed as you may now qualify for NHS Continuing Care where previously you did not. Regardless, your case should also be regularly reviewed to see if your needs have changed.

Unfortunately, NHS care funding decisions are often arbitrary and many people do not receive NHS continuing healthcare even when they are eligible. What qualifies one patient for continuing care may not do so for another.

As specialist litigation solicitors, we have experience in understanding complex legal arguments, in obtaining the necessary evidence and presenting the claim in order to conclude the Claimant’s case with success.

WHAT CAN WE DO FOR YOU?

We understand that bringing a claim can be stressful or daunting particularly given that you or your relative may already be in care and have serious health concerns.

We can pursue your claim sensitively and tactfully on a NO WIN – NO FEE basis.

TIME LIMIT
The Government have set sew deadlines to limit the amount of fees that can be repaid. As of April, 1 2012 a claim to the relevant authority must be made within 6 months of your assessment otherwise you will be out of time. These limits are strictly enforced and there is little scope to challenge if you are out of time.

Please do not wait to contact us to discuss your claim as you may become time barred.

WHY COMPENSATION SOLICITORS ONLINE?

Compensation Solicitors Online is a successful, well established firm of solicitors that specialise in obtaining NHS continuing healthcare for our clients and reclaiming care home fees that have been incorrectly paid.

We work on a no win, no fee basis, so if we are unable to reclaim any fees you have already paid then you do not pay us a penny.

  • SPECIALIST LITIGATION SOLICITORS
    We have a vast experience in successfully suing large multinational companies and Government bodies.
  • ALL OUR WORK IS CARRIED OUT IN HOUSE
    We do not sell on your details as leads like some Claims Management Companies.
  • LAW SOCIETY MEMBER AND PROFESSIONALLY REGULATED
    Giving you peace of mind that your claim is in good hands.
  • FACE TO FACE HOME VISIT
    We complete all the paperwork for you.
  • SENSITIVITY
    Our solicitors have experience of handling litigation for elderly/vulnerable clients and can act for estate of patients who wrongly paid care fees during their lifetime.
  • TRULY NO WIN – NO FEE
    No upfront or ongoing fees of any kind.
  • FREE ASSESSMENT
    We offer a free assessment of your claim to see whether you are entitled to a refund of care home fees or are eligible for NHS continuing healthcare.

We pride ourselves with frequent recommendations from our existing clients. This is due to the straightforward and professional manner in which our lawyers deal with our clients. CSO is reliable and has been running for over ten years recovering compensation for clients.

DIFFERENT FROM A CLAIM MANAGEMENT COMPANY
As specialist lawyers, Compensation Solicitors Online believes in fighting hard for our clients, but also fairly. If required we can pursue the claim all the way to court. This is a job that is not possible to be performed by Claims Management Companies and non-lawyers as the law only permits qualified solicitors to perform this task.
If you require NHS continuing care or need help reclaiming fees wrongly paid, then entrust your claim for to specialist lawyers.

We can complete your claim from start to finish on a no win – no fee basis and claim back your compensation without passing the work on.

USEFUL LINKS

Care Homes: http://www.carehomestoday.co.uk/
Community Care: http://www.maxwellgillott.com/community_care_services_maxwell_gillott.htm
Elderly Care: http://www.thegoodcaregroup.com/
Home Care: http://www.careathometoday.co.uk/
NHS Care and Support: http://www.nhs.uk/CarersDirect/Pages/CarersDirectHome.aspx
Nursing Homes: http://www.nursinghomestoday.co.uk/

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