‘One view of who is eligible for care will differ from another’
to determine eligibility for continuing care funding, but they are open to interpretation. This, said Ms Morgan, means that authorities in different areas of the country make decisions in different ways.
“One person’s view of who is eligible for continuing care will differ from another,” she said. “That is why there is disparity across the country.” Anyone in long-term care should be assessed to see whether the NHS is responsible for their funding if their primary need is health-related. If so, the full cost of care should be met by the NHS.
Common reasons for eligibility include having had a severe stroke that affects communication or mobility, severe arthritis, chronic pulmonary disease and some forms of dementia. Those receiving care should be assessed annually, as their care needs may develop to the stage where they are eligible for continuing care funding.
If you have a relative in care, the care home should be advising the family to get an assessment. If you think the assessment incorrectly ruled that funding could not be granted, a local review process can be carried out, although Ms Morgan warned that it was a “time-consuming, frustrating and bureaucratic” process. It is possible to go through the appeal alone without legal help. Those who make a retrospective claim must be armed with records of care and details and evidence of the level of care required. This is more important if the family member in care has since died.
Any care costs incurred before 2012 can no longer be claimed for. A rush of claims before the cut-off point took effect is partly to blame for the backlog in the claim system today. There is no cap on the amount of money that can be reimbursed.
Mr Gibson received back the entire amount paid out over the period his father was in care. However, as he used Hugh James on a no-win, no-fee basis, the law firm look 18pc of the money, plus VAT. The reimbursement is awarded to the care home resident, not the family, so it went to his father’s estate, meaning that inheritance tax was also due.