Think care home fees are high? Just wait for Labour’s Budget to set in

Care home fees are already alarmingly high, but Labour’s Budget is likely to see them climb even higher, writes Lisa Morgan

Mrs Thomas was 87 years old when she died in a care home, having developed Alzheimer’s eight years prior. She spent 11 years in care, and the crippling costs which rose year after year led to her exhausting her savings of over £250,000. She had to sell her beloved family home to continue funding her care – a monthly burden of £2,500.   

Mrs Thomas’s children, Sarah and John, were not informed about the option of applying for Continuing Healthcare. Known as CHC, this is a package whereby the NHS has a legal obligation to pay the full cost of their care – irrespective of a person’s financial situation – in cases where a person’s primary needs are health-based. 

To fund her care, Sarah and John had to sell their mother’s beloved home after her savings were exhausted – a decision they never thought they would be faced with. It wasn’t until their mother’s final year in care in 2019 that the children learned about CHC and contacted the team at Hugh James law firm for a thorough assessment and retrospective review. We secured funding approval for their mother, relieving them from their staggering monthly care fees, and also managed to reclaim £40,000 for the family after many persistent appeals. 

Sadly, cases where families are being wrongfully denied care funding are becoming increasingly common. NHS England data shows that, despite an ageing population, the number of people deemed eligible for CHC funding has fallen by over 20 per cent since 2015. 

A further blow to the cost of care was dealt in the latest Budget announcement by Chancellor Rachel Reeves, whereby the rise in employer National Insurance contributions will inevitably hike care fees up further. 

Whilst NHS and public bodies are exempt from the rise, private care homes who provide services for the NHS are not. The cost of care has increased by an alarming rate over the past decade; it has risen by 10 per cent in the past 12 months alone, resulting in fees of, on average, over £41,600 a year for a residential care placement and over £56,056 for a nursing home placement. 

However, this immense financial burden of care can be lifted for those individuals who qualify for Continuing Healthcare. If the needs are deemed ‘social’, they will not qualify. This is the only legal criterion for eligibility, independent of their financial circumstances. Whether a person receives CHC, however, depends on how the person is assessed. Assessment and deemed eligibility have become an increasing issue.

Unfortunately, a lack of knowledge and increasingly stringent assessment criteria have resulted in individuals being unwittingly wrongly assessed by the NHS, with 30 per cent of those who should be entitled to fully funded nursing care being turned away. The guidelines for funding have been found to be too restrictively applied and often amount to a postcode lottery. Many people are therefore missing out on the financial help that they are legally entitled to. 

When a person is not the NHS’s responsibility, they must be assessed by their local authority. In this case, unlike the NHS, the authority can determine their ability to pay. If a person possesses over £23,250 (£50,000 in Wales), they will meet the full cost of their own care. 

However, £23,250 doesn’t go far when fees are increasing, meaning patients are finding themselves in need of financial support. Care homes are turning to family members, asking them to pay monthly ‘top-up’ fees of around £400 a month to bridge the gap between what the local authority is prepared to pay and the cost of the care home. Friends and family are met with the upsetting dilemma of scrounging up hundreds of pounds a month or moving them to another care home, which can be very disorienting for their loved ones.

But families unhappy with the outcome of initial CHC assessments may challenge the decision through a review procedure. Cases which are initially turned down can be challenged and through dogged persistence, a successful outcome can be achieved.

Many more people could be eligible for CHC if the guidelines were applied less restrictively. We have successfully recovered £200m for our clients in wrongly paid care home fees together with thousands in future savings. Statistics from the department of health show that of those who challenge decisions at ICB level, 20 per cent are successful, with a further 30 per cent at national level. It takes commitment and determination, but the results justify the effort. 

Lisa Morgan is partner and head of the nursing care fee recovery team at Hugh James