Reclaiming care home fees

When an elderly relative needs care, difficult choices can result in an emotional time for everyone concerned. 

The elderly person may be facing a loss of independence for the first time, while the rest of the family must select the right care home and help their loved one through the settling in period.  On top of this, there is often a worry about funding.  However, it is not always understood that private care fees can sometimes be covered by the NHS.

Over the years, people requiring residential care have been assessed for NHS funding by their local Primary Care Trust (PCT).  If they don’t meet the criteria, they have often had to pay privately. 

Because different PCTs have applied different criteria, this has led to inconsistency and uncertainty but recent challenges to those decisions have increasingly meant that people have been successful in reclaiming care home fees.

Reclaims are not limited to people who are still in residential care.  They can include reclaims by executors of estates where the person who was receiving the care has since died.  The refunds can often be very significant.  Claims for care fee refunds must be submitted to the Department of Health by 31 March 2013 for the period.

between 1 April 2011 and 31 March 2012.  Eligibility for a refund is assessed against four indicators – the nature, intensity, complexity and unpredictability of the individual’s need.  It does not matter what the condition is (or was), where the care was provided, or whether the person’s care needs have increased since the original assessment.

Caroline Dowding has helped many people make a claim.  As well as retrospective claims, she has also helped those who wish to challenge the result of an assessment.  Claims can be made by the individual receiving the care or by another person who has the appropriate authority, such as their Power of Attorney.  Claims can be submitted privately or through a legal firm; Birkett Long will only charge a fee if a refund is granted.