NHFA Infosheet 8
NHS
Contribution to Nursing Care for Nursing Home Residents
NHS
Fully Funded Continuing Care
NHS CONTRIBUTION
TO NURSING CARE FOR NURSING HOME RESIDENTS
The
Royal Commission on the funding of long-term care for older people
recommended that the Government should provide free personal and
nursing care to all older people in any setting, be it care at home
or in a care home. In response to this and as part of the NHS plan
the Government has introduced, “free nursing care” to
residents of nursing homes. This is met by a contribution to their
care costs by the NHS.
Older people who
require nursing care either at home or in a residential care home
will continue to have access to their district nurse for such care
needs.
The NHS contribution towards nursing care costs in nursing homes is payable in three bands: lower band £40 per week; middle band £87 per week; and higher band £139 per week.
What is Nursing Care?
Nursing Care is registered
nurse input into providing, planning, delegating and supervising
care in a nursing home. It does not include time spent by other
members of the nursing home’s staff including care assistants.
Neither does it include personal care needed to assist with activities
of daily living for example, bathing, dressing, toileting, feeding
and mobility.
How will this be delivered?
All existing and
new residents of nursing homes should undergo an assessment by a
NHS registered nurse to ascertain the amount of registered nurse
input required to meet your care needs. This assessment will place
people in to one of three bands, each corresponding to a level of
NHS funding:
Low Band £40 per
week - People whose nursing care needs can be met with minimal
input of a registered nurse. The assessment may reveal that their
care needs could normally be met in another setting, for example
at home or in an ordinary care home, but they have chosen to live
in a nursing home.
Medium Band £87
per week - People who may have multiple care needs requiring
the intervention of a registered nurse at least daily as well as
being readily accessible. Their condition would be regarded as predictable
and stable as long as their care continues.
High Band £139
per week - These people will have complex needs requiring registered
nurse input into frequent mechanical, technical and/or therapeutic
interventions throughout a 24 hour period. Their condition will
be unstable and/or unpredictable. Individuals or their carers will
be notified after the assessment into which band they fall. Those
residents benefiting from the twelve week property disregard, i.e.
funding from the local authority, will be assessed and the contribution
towards nursing care will be paid after the twelve week period has
ended.
How will this money be paid?
The NHS will pay
this money, probably monthly, direct to the nursing home. The nursing
home will be expected to reduce its fees accordingly.
What if I disagree with
the assessment?
Each Health Authority
will have a review procedure. Immediate concerns should be addressed
to the nursing home co-ordinator being a person employed by the
Primary Care Trust, Health Authority or council to ensure nursing
care needs are met. This may lead to referral to the Health Authority’s
continuing care panel for a review of the decision.
How often will the assessment
be reviewed?
The assessment should
be reviewed after three months and again after 12 months. If, however,
needs change perhaps as a result of deteriorating health then a
review can be requested through the nursing home.
What if my stay is temporary?
If the stay in the
nursing home is for a period of less than six weeks then a registered
nursing care contribution assessment does not have to take place.
The NHS contribution can be paid based on information obtained from
the nursing home or GP etc. This is particularly worth noting for
those older people who may have short periods of stay for example,
a weeks respite care.
What else is included?
Residents of care
homes will also be assessed as to the extent they may need continence
aids and these will be paid for by the NHS. They will also have
access to the full range of specialist NHS support available in
other settings for instance, chiropody, or physiotherapy as well
as equipment including pressure relief mattress, mobility or communication
aids etc.
Which Health Authority is
responsible?
Every nursing home
resident should be registered with a GP. The responsible authority
is that in which this GP practice resides.
How does this affect my
Social Security benefits?
The contribution
towards your nursing care will not affect your benefits, for example
if you are receiving attendance allowance you will continue to do
so. The situation in Scotland is different. Those receiving the
higher contribution towards personal and nursing care in Scotland
will cease to be eligible to attendance allowance from the DWP.
What happens if I go into
hospital?
If you need hospitalisation
your nursing home payment will stop. Your care home may however
require you to continue paying the full fee, if you wish to retain
your room.
NHS FULLY FUNDED
CONTINUING CARE
The Health Service Ombudsman found evidence that the Department
of Health guidance following the Coughlan judgment in 1999 on eligibility
criteria for continuing NHS care has been misinterpreted and misapplied
by some health authorities.
The range, type and
level of services to be arranged and funded by the NHS to meet continuing
health needs are decided by policies and eligibility criteria set
locally. The Ombudsman’s report does not change things overnight.
If you think you (or a relative or friend) primarily have health
care needs and are wrongly paying for care that should be paid for
by the NHS, contact the local Primary Care Trust (PCT) and ask for
a review of your care needs against the continuing care criteria.
State clearly that this review should be undertaken in the light
of the recent Health Service Ombudsman’s report. You can get
contact details for your PCT from NHS Direct on 0845 4647.
If you are unhappy
with the result of the re-assessment you can ask for a review of
this decision, and /or go through the usual NHS complaints system.
You usually have to go through all the different stages of the NHS
complaints procedure before contacting the Health Service Ombudsman.
Contact the Health Service Ombudsman at: The Health Service Ombudsman
for England, 13th Floor, Millbank Tower, London, SW1P 4QP. Helpline:
0845 015 4033 Website: www.ombudsman.org.uk
There is a very fine
line between what is considered to be free health care and means
tested social care. The guidance following Coughlan HSC 2001/15
sets out to define the responsibility of the health authority. The
NHS is responsible for arranging and funding a range of services
to meet the needs of people who require continuing physical or mental
health care. these include:
• primary health
care;
• assessment involving doctors and registered nurses;
• rehabilitation and recovery(where this forms part of an overall
package of NHS care as distinct from intermediate care);
• respite health care;
• community health services to people at home or in residential
homes;
• specialist health care support to people in nursing homes
or residential care homes or the community;
• healthcare equipment;
• palliative health care;
• specialist transport services.
Clearly the National
Health Service and Community Care Act 1990 does not define where
the divide between health and social care lies and it is feared
that budgetary constraints may influence local policies.
Advice and information available to all
The financial and
legal implications to be considered when paying for care are wide,
and require careful planning. Older people or their relatives should
seek specialist advice, before taking on any commitment that they
are unsure of being able to afford. They should seek advice on what
their entitlements are from the State, what legal matters they should
attend to and how best to use their capital and income to meet ongoing
care costs and possible changing care needs.
Care Directions works with NHFA Care Fees Advice, whose expert advice and information on these issues is available to all regardless of means. Further 'callback' information, an appointment with your local NHFA Care Fees Adviser, or a free copy of the NHFA Long Term Care Guide can be obtained, without any obligation, by submitting the following form.
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