Funding Long-term Care

Funding Long-term Care - Investments 10

Healthcare or Social Care?

When it comes to funding long term care, as financial advisers it is our job to arrange your finances to help fund the cost of care and/or the cost of a care or nursing home.

This can be done by arranging a care annuity which pays a tax free income directly to the care giver and has the effect of protecting other assets over the longer term.
Or we can advise, arrange and help you apply short term assets required to pay for care over the initial years and apply longer term assets into investments that may or may not be required for the payment of immediate care needs but have the potential for greater growth than being left in cash accounts.

However before you even consider this aspect of how the cost of care can be arranged it is vital that you establish firstly whether the need for care is Health Care related or Social Care related because if it is health care related this should be paid for by the NHS without means testing – it is only if the care is Social Care related, that the means testing and self-funding comes into play.
The assessment process for NHS Continuing Care is very complicated and sometimes difficult to prove, even if the evidence is glaringly obvious but if successful then the saving in astronomical Care Fee costs is immense.

Social Care – often described as dealing with ‘activities of daily living’ such as feeding, washing, dressing, mobility but also maintaining independence, social interaction and protection from vulnerable situations.

Healthcare – treatment , control, management or prevention of a disease, illness, injury or disability and the care or aftercare of a person whether or not a healthcare professional is involved.

A primary health need imposes an obligation on the NHS to provide care free of charge, known as NHS Continuing Healthcare, and the NHS should provide and pay for the care including the care home or residential home fees.

If the NHS can show that there is no primary health need then they can pass the responsibility for the payment of care over to the Local Authority. This is the main issue around Care… neither the NHS nor the Local Authority wants the responsibility or cost so it is a fight to get NHS funding.

Therefore before you start considering how to afford the nursing home fees, you need to first establish whether you need to pay for the care or whether the NHS should be paying for the care.

In order to establish this you can do this yourself but we recommend speaking to Farley Dwek Solicitors who specialize in supporting clients in making the NHS Continuing Health Care Applications first.

You can find more about them here,

How to apply for care funding from your Local Authority

The provision of social funding from your local authority is dependent upon two assessments:

1/ An assessment of your care needs and
2/ A financial assessment.
Everyone is entitled to an assessment of their care needs.

The first step to apply for care funding from your local authority is to contact them in order to arrange a care needs assessment. Contact details for your local authority can be found using the local authority website.

Your local authority will need to assess your finances to determine whether or not you are eligible for the partial or complete funding of care provision.
If your financial assets are valued at less than £23,250 you should be eligible for care funding from your local authority. If the value is below £14,250 you should be entitled to the highest level of subsidy although you may still be expected to contribute a proportion of your income.

 

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How to apply for care funding from the NHS

If you, have ongoing healthcare needs and are not hospitalised, you may be eligible for NHS Continuing Health Care. This is the collective name for a package of care that is arranged and funded solely by the NHS.
Unlike care services arranged via your local authority, NHS Continuing Health Care is provided entirely free-of-charge to those who qualify for it.

To apply for care funding from the NHS it is necessary to undergo an assessment of your condition and care needs.
The first step to applying for care funding from the NHS is to arrange an initial screening with your GP, nurse or healthcare advisor.

To qualify for NHS Continuing Health Care the assessors must be satisfied that you have “a complex medical condition and substantial and ongoing care needs. You must have a “primary health need”, which means that your main need for care must relate to your health”. Having a disability or a long-term illness does not automatically mean that you qualify for NHS care funding.

They will use an assessment known as the ‘Checklist Tool’ which compares your health and care needs against a list of eligibility criteria.
If the outcome of the initial screening suggests that you may be eligible to receive NHS Continuing Health Care you will be referred for a ‘Full Assessment’ of your healthcare needs with a team of health and social care professionals.
They will then make a recommendation to your local Clinical Commissioning Group (CCG) which has the final say as to whether or not you will receive funding.
Even if you are deemed ineligible for NHS Continuing Health Care there may be options for partial NHS care funding that may be open to you.

NHS Continuing Care - The Checklist assessment

The NHS is under an obligation to undertake a Continuing Healthcare assessment which will determine whether you are eligible for NHS Continuing Healthcare Funding.

This assessment is done in two stages.
The first stage is called a Checklist assessment. If you are already in a care home, or about to go into a care setting for the first time (perhaps following discharge from hospital), or being cared for in your own home, you are entitled to request that the NHS undertake an initial Checklist assessment. The Checklist assessment is a preliminary ‘screening’ tool to see whether you would trigger the second stage – a Full Assessment for NHS Continuing Healthcare at a Multi-Disciplinary Team meeting.

Who can ask for a checklist assessment?
Anyone can ask for a Checklist assessment to be carried out. Speak to a health professional, your GP, hospital doctor, social worker, care provider or care home to request a Checklist assessment.
The Checklist assessment should be performed within 14 days of it being requested. (although timescales are rarely met). You can ask for a Checklist assessment at any time during care and it can take place wherever you are currently living – whether in a care facility or your own home.
It is usually ‘preferable’ for the Checklist assessment to be deferred and dealt with after discharge from hospital i.e when you return to your own pre-hospital admission environment (e.g. back in your own home or back to the care home) as a hospital setting might not accurately reflect your longer-term needs. If you are discharged from hospital to a care home for the first time, a Checklist should be completed once a settling in period has passed so that any package of support measures has taken effect, to determine whether this improves long-term prognosis.

There is also a Fast Track Pathway assessment for cases relating to acute conditions, often in so-called “end of life” scenarios.

The Checklist Assessment
The Checklist can be completed by a variety of health and social care practitioners, who have been trained in its use, including, for example: a registered nurse employed by the NHS, GPs, other clinicians or local authority staff (such as social workers, care managers or social care assistants).

The Checklist looks at 11 criteria called Care Domains, which are:
– Breathing*
– Nutrition
– Continence
– Skin integrity
– Mobility
– Communication
– Psychological/Emotional needs
– Cognition
– Behaviour *
– Drugs/Mediation/Symptom Control *
– Altered states of consciousness *

The outcome of the Checklist depends on the number of A’s, B’s, and C’s scored. In order for the CCG to consider doing a comprehensive Full Assessment, you have to have a minimum ‘score’ in the Checklist
– 2 or more ‘A’s
– 5 or more ‘B’s (or 1 A and 4 Bs)
– or at least 1 A in a domain with an asterisk*

Once the assessment is completed, you must be given a written copy of the Checklist outcome. The Checklist score may mean that you automatically progress through to the Full Assessment stage. Or, the score may mean that you fall short, but you should still be given information about the process to challenge the outcome of the Checklist.

If you agree that your needs do not meet the necessary criteria for NHS Continuing Healthcare Funding, you will move from the care of the NHS into the care of the Local Authority/Social Services.

Nevertheless, once a proper Checklist assessment has been undertaken, it will form the baseline for any future assessments. Knowing your score and the areas in which you have healthcare needs, means that you have a starting point to compare any deterioration of your condition over time. You can refer to the Checklist as the basis to request a reassessment.

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NHS Continuing Care - The Full Assessment

If your Checklist assessment is successful, you will progress to a Full Assessment using the Decision Support Tool (DST).
The Full Assessment should happen within 28 days of the Checklist assessment taking place (although these timescales are rarely met).

The Full Assessment is carried out by a Multi-Disciplinary Team (MDT). This team must consist of at least two people, one Healthcare Professional and one Social Services Professional, but may well include more Healthcare Professionals depending on your condition. An MDT Co-ordinator will be appointed by the CCG to lead the assessment process.
The Assessors must be properly trained in the NHS National Framework and the assessment process. They should also be knowledgeable about your health and social needs, and where possible, have recently been involved in your treatment or care.
You will be advised when the assessment is taking place and your advocate should be entitled to attend.

Prior to the Full Assessment, the MDT are required to review all the relevant medical and care notes in relation to your needs.

The Full Assessment follows a similar process to the Checklist assessment, but uses a Decision Support Tool (DST) instead. The DST has all the same Care Domains as the Checklist (see above), plus one further Domain for “Other” significant care needs.
Whilst the scoring system isn’t scientific generally speaking you should qualify for NHS Continuing Healthcare Funding if you score ‘Priority’ in any of the * domains, or a ‘Severe’ in two or more domains.

Needs are assessed as either-
– No Needs
– Low Needs
– Moderate Needs
– High Needs
– Severe Needs
– Priority Needs

You could still qualify if the scores are not as clear cut as this, as it is the totality of the healthcare needs that are being assessed.
It is also worth noting that the NHS Guidelines state that if there is any uncertainty or disagreement within the MDT about what score to allocate, then the higher of the scores should be applied.
This is important to understand when you are putting your case across.

Once the Full Assessment has been completed, the report is sent to the CCG in your area, who make the final decision on whether you qualify for NHS Continuing Healthcare Funding or not. It is not the MDT who make the decision, although they will make a recommendation. In most cases, it is expected that the CCG will follow the MDT’s recommendations. The CCG will send you a written copy of their Decision with a copy of the DST (and process for appealing).
If you disagree with the CCG’s outcome or the rationale for their Decision to refuse NHS Continuing Healthcare, you have the right to Appeal, and must lodge your written appeal submissions within 6 months of receiving the Decision.
If your Full Assessment is successful, you will qualify for NHS Continuing Healthcare Funding, and it is then the responsibility of the NHS to pay for 100% of the care including the cost of the care facility.

The NHS will undertake another Full Assessment after three months, and thereafter annually, at which point you funding may be withdrawn. You will be advised when any further assessments are going to take place, and you will have to prepare for this reassessment in exactly the same way.

If, following the Full Assessment, you agree that your care needs are not primarily healthcare needs, then you will move from the care of the NHS into the care of the Local Authority/Social Services – which is means-tested.

How to ensure your NHS Continuing Care Application is properly assessed

You can of course deal with the NHS yourself to ensure that a proper assessment of your entitlement to NHS Continuing Healthcare Funding is undertaken, however there are professionals who will work on your behalf in a private capacity in order to ensure the process is followed correctly and fairly and this may be a cost worth undertaking to be sure of the correct outcome considering the enormous cost of nursing homes and the cost of care over the longer term.

Farley Dwek Solicitors will support your NHS Continuing Care Application and offer the following Services dependant on the stage your application is at.

– Initial Triage Call – a quick free phone call chat to establish whether NHS Continuing Healthcare Funding is a possibility for your circumstance and to give you an idea of likely fees and timescales involved.

– Nurse Advice Line – a 45 minute phone call with preliminary feedback to establish whether an application might be accepted.

– Clinical Review Service – to support your application at the full assessment stage – includes a visit to the care home, a review of the care home records and a review of the GP records with a full report that follows the same format as the Decision Support Tool used by the NHS supporting your case, on your behalf to the Multi-Disciplinary Team Meeting (MDT).

– Advisory/Advocacy Service – acting as advocate throughout the process, working collaboratively with you with access to Farley Dweks specialist legal knowledge as well as their clinical knowledge from a team of specialist nurses who understand the clinical basis of the assessment process and acting as your personal advocate in representation at the MDT decision making meeting which can often be challenging and adversarial.

– Reclaims Service – Records Review Service – a clinical retrospective analysis of care needs – a process for claiming back care home fees incorrectly paid, wrongly assessed or never assessed at all, by undertaking a retrospective assessment using evidence from GP, hospital and care records and any previous full assessments that may have been carried out.

Contact:
Farley Dwek Solicitors
Tel: 0161 272 5222
email: andrew,farley@farleydwek.com
w: www.farleydwek.com

 

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NHS-funded Nursing Care

If your relative has been turned down for CHC following a Full Assessment, but has other needs which include nursing needs they may still be eligible for NHS-funded Nursing Care (FNC) instead.

FNC applies to individuals living in a nursing home who needsome element of nursing care from a registered nurse.

FNC is not assessed, or means-tested, and is tax free.

FNC is a weekly sum paid by the Clinical Commissioning Group directly to the care home, as a contribution towards the cost of your relative’s nursing care needs that are provided by a registered nurse, employed by the nursing home.

From 1 April 2023, the rates for NHS funded nursing care in England are: Standard rate: £219.71. Higher rate: £302.25.

FNC can be withdrawn if it is no longer appropriate. For example: (a) if your relative no longer lives in a nursing home; or (b) lives in a care home but does not now need any level of nursing care from a registered nurse; or (c) your relative’s healthcare needs have changed, and they have become entitled to fully-funded free NHS Continuing Healthcare instead.

Care at Home

Staying at home can be a realistic alternative, someone to cook and clean, helping get in and out of bed or help with daily tasks such as washing and dressing. This could be provided on an hourly basis or on a more regular schedule.

‘Live in’ care provides support where the carer lives in the house with the person that they have been asked to look after.

Carers usually follow a bespoke care plan, created between the agency and the individual and will include the need for companionship, personal care and housekeeping.

Receiving care in the comfort of your own home can offer an excellent level of quality, one-to-one care, delaying the need to move away from familiar surroundings, prolong a feeling of independence with minimal change to routine and with freedom for visitors to call. Costs can be similar to a care home option.
Your home will not be included in any financial assessment if you receive care and support at home or if you go into a care home on a short-term or temporary basis.

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Sheltered Accommodation/Downsizing

This allows you to live independently, if your house becomes too big or difficult to manage. This is usually in a smaller, purpose-built and easier-to-manage self-contained apartment with:
– Laundry facilities
– Communal areas, rooms and gardens
– Security & safety systems including manager/warden and 24 hour assistance via an alarm.

Care villages or close care
These are usually purpose-built sites that combine the independence of sheltered housing with other on-site services, such as dining facilities, medical support, on-site carers, housekeeping, transport access and various social activities. Some offer separate houses or bungalows, and some a range of flats within a main building.

Legal power to act on long-term care decisions

You must have the Legal Power to Act if you want to look after the welfare or financial affairs of the person needing care. The most effective way is by means of a Lasting Power of Attorney (LPA).

This is a legal process where the person you are acting for (the donor), gives permission to you (the attorney) to act and make decisions about their property and financial affairs, on their behalf, either immediately or at a specified time in the future. Your attorneys can use this lasting power of attorney only after it has been registered by the Office of the Public Guardian.

There are two different types of LPA.

Property & Financial Affairs LPA. This allows you to choose attorneys to make decisions about your property and financial affairs, when you are unable to make decisions for yourself. This can include running your bank accounts, decisions about your investments and home. Your attorneys can make decisions for you as soon as this lasting power of attorney is registered – both when you have mental capacity and when you lack mental capacity, unless you put in a restriction.
Health & Welfare LPA: allows you to choose attorneys to make decisions about your health and personal welfare, when you are unable to make decisions for yourself. This can include healthcare, medical treatment, where you live and day-to-day decisions about your personal welfare, such as your diet, dress or daily routine and the type of care you receive. Your attorneys can only act when you lack the capacity to make the decision in question. You may have capacity to make some decisions about your personal health and welfare but not others.
Until September 2007, power of attorney was given using ‘Enduring Power of Attorney’; these documents are still legal, and it will be possible to use the powers within these existing documents. It is worth noting that:
– No new Enduring Powers of Attorney can be made.
– The authority given is in respect of property and financial affairs only, not health and welfare.
– Amendments cannot be made to existing documents.
– It is not necessary to register the Enduring Power of Attorney, providing the donor still has mental capacity.
– The Enduring Power of Attorney must be registered with the Office of the Public Guardian at the onset of mental incapacity.

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What if no Power of Attorney exists?

If the person needing care has already lost mental capacity an application to the Court of Protection for the appointment of a Deputy needs to be made. A representative (relative, close friend or solicitor) will apply to become their Deputy, this involves a fee and a vetting process, resulting in the Deputy being legally responsible for:
– Finances
– Property, where they live and care arrangements
– Healthcare, including medication and surgical consent
– Personal welfare, such as clothes, food and general well-being

The Mental Capacity Act 2005 has five statutory principles that the Deputy must be able to comply with:
– A person must be assumed to have capacity, unless medically established, that he lacks it.
– A person is not to be treated as unable to make a decision, unless all practical steps have been taken to assist, without success.
– A person is not to be treated as unable to make a decision, merely because he makes an unwise one.
– An act done or decision made, on behalf of a person who lacks capacity, must only be in their best interests.
– Regard must be given, to whether the purpose for an act or decision can be achieved, in a way that is less restrictive of the person’s rights and freedom of action.

Deputies should seek advice from qualified financial advisers, when looking to fund care fees.

Funding long-term care

With careful planning it may be possible to structure finances in a way, that care fees can be paid indefinitely, without worry about what might happen if the money runs out.

Most families want to ensure that their relative can stay in their chosen care home for the rest of their lives, as well as safeguarding as much of the existing capital as possible.

Attendance Allowance
The first thing to check is whether this benefit is eligible and being claimed. Attendance Allowance is not means-tested i.e regardless of your income and assets.
It is paid every four weeks and there are two rates dependant on eligibility
Higher Rate £92.40 (2022/23)
Lower Rate £61.85 (2022/23)
Attendance Allowance is not payable after the first 28 days of being in a care home, unless you are completely self-funding and will also stop after 28 days of being in hospital
To claim this allowance contact the Attendance Allowance Helpline on 0800 731 0122

Immediate care plans
Immediate care plans are tax efficient policies designed to cover all, or part of, the cost of a person’s care fees. Once established, the plan will pay an agreed tax-free amount, directly to the care provider, for the rest of the person’s life. Benefits can increase each year to help keep pace with care fee increases.

A lump sum is needed to purchase a plan and is calculated individually, on various factors.

The cost of the care, at the care home of your choice, together with any current and ongoing income, is taken into account and any shortfall is identified. The guaranteed income, together with any annual increases, ensures that there is no investment risk to the investor. The risk is, instead, passed on to the insurer, who takes on the risk of the return achieved from the capital sum, thus ensuring that your capital will not run out. It also ensures that any excess capital not needed for care can be protected for inheritance.

This type of policy should always be considered as part of the solution of the overall financial plan as it can help to cap the cost of care and protect the elderly person from outliving their capital.

Capital protection can be included, in case the elderly person dies shortly after purchasing the plan.

Immediate care plans are not the only solution to funding long-term care but should be the starting point of any discussion because of its lower risk nature. Veracity Financial Planning will discuss the pros and cons of all the available solutions available to you ensuring you are in a position to make an informed choice.

Care plans are portable, if a person establishes a plan to cover their care at home, and at some time in the future, moves to a care home, the plan can move with them.

It is not possible to purchase a plan directly as both the Financial Conduct Authority and the companies providing these policies require you to use the services of a suitably qualified adviser.

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What does care cost?

Care at home – the average cost is between £17.00 to £30.00 an hour. Live-in care – costs between £44,000 to £54,600 per year. You have the option to use a live-in care agency or to employ a carer yourself. Residential care – The average cost of a residential care home in the UK is between £30,000 and £58,000 per year. If nursing care is required makes this even more expensive, raising the price by about a third of this cost.

How is my home taken into account?

With careful planning it may be possible to structure finances in a way, that care fees can be paid indefinitely, without worry about what might happen if the money runs out. Most families want to ensure that their relative can stay in their chosen care home for the rest of their lives, as well as safeguarding as much of the existing capital as possible. Attendance Allowance The first thing to check is whether this benefit is eligible and being claimed. Attendance Allowance is not means-tested i.e regardless of your income and assets. It is paid every four weeks and there are two rates dependant on eligibility Higher Rate £92.40 (2022/23) Lower Rate £61.85 (2022/23) Attendance Allowance is not payable after the first 28 days of being in a care home, unless you are completely self-funding and will also stop after 28 days of being in hospital To claim this allowance contact the Attendance Allowance Helpline on 0800 731 0122 Immediate care plans Immediate care plans are tax efficient policies designed to cover all, or part of, the cost of a person’s care fees. Once established, the plan will pay an agreed tax-free amount, directly to the care provider, for the rest of the person’s life. Benefits can increase each year to help keep pace with care fee increases. A lump sum is needed to purchase a plan and is calculated individually, on various factors. The cost of the care, at the care home of your choice, together with any current and ongoing income, is taken into account and any shortfall is identified. The guaranteed income, together with any annual increases, ensures that there is no investment risk to the investor. The risk is, instead, passed on to the insurer, who takes on the risk of the return achieved from the capital sum, thus ensuring that your capital will not run out. It also ensures that any excess capital not needed for care can be protected for inheritance. This type of policy should always be considered as part of the solution of the overall financial plan as it can help to cap the cost of care and protect the elderly person from outliving their capital. Capital protection can be included, in case the elderly person dies shortly after purchasing the plan. Immediate care plans are not the only solution to funding long-term care but should be the starting point of any discussion because of its lower risk nature. Veracity Financial Planning will discuss the pros and cons of all the available solutions available to you ensuring you are in a position to make an informed choice. Care plans are portable, if a person establishes a plan to cover their care at home, and at some time in the future, moves to a care home, the plan can move with them. It is not possible to purchase a plan directly as both the Financial Conduct Authority and the companies providing these policies require you to use the services of a suitably qualified adviser.
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Deferred payments agreement

The local authority may agree to help with the cost of care if, after the first twelve weeks the property has not been sold. The money is repayable once the property has sold or the resident dies but for the most part the loan is interest free, providing the money owed is paid back within 56 days.

Local Authority agreements and self-funders
People who have capital above the thresholds, are asked to enter into funding agreements with the Local Authority. They are still classed as self-funding residents, but may find that they are paying their care fees directly to the Local Authority and not the care home.

Should we rent the house out?

When a person moves into a care home there is often a property left empty. Bear in mind that rent will probably be subject to tax, and the net income may not be sufficient to cover the care fees. As care fees tend to rise above inflation the rent may not increase at the same rate as the fees each year. There could also be periods of vacant tenancy, maintenance continues and there may be other costs that need to be considered.

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Should we sell the house?

Selling a property could ensure that some or all of the proceeds could be used to purchase an Immediate Care Plan with the remainder invested for growth. Properties can be difficult to sell quickly in order to release the money tied up with a need to rely on the Local Authority to provide the Deferred Payment Scheme or ask the care home to run up a debt, or fund the fees themselves.

There are companies who will manage the sale of your property, who will release a proportion of the equity so that the purchase of an Immediate Care Plan is available without delay, however this usually comes at a cost.

Using Equity Release to pay for care

Equity release is a term used to describe the various ways people can release money from the value of their home. Equity release enables you to raise capital or income while continuing to live in the property. Borrowers are free to use the monies however they wish, but it may be a realistic way of enabling people to receive care in their own homes, delaying or preventing the move into alternative accommodation.

NHS funded nursing care
Individuals assessed as needing nursing care at home or in a nursing home, are entitled to receive an additional nursing care allowance. This allowance is not means-tested and tax-free and is £165.56/week in England.

In addition to the above a person may qualify for NHS fully-funded continuing healthcare, where the cost of care is paid for by the NHS (but to qualify for this benefit, patients must be unstable and/or unpredictable and need constant 24-hour specialist/acute nursing care). The local Primary Care Trust will carry out a NHS Continuing Care assessment on request.

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Why choose Veracity?

This can be a very stressful time for all involved and we are happy to sit and chat and help you understand your options before advising you to do anything that might be unnecessary – ensuring
that you explore in the first instance, the avenues where the NHS may primarily fund costs and only when it is evident that this will not be the case should you begin to put in place alternative plans to pay fees.

Contact Veracity

If you want a review of your Pension(s) or would like to understand more about how pensions work; get in touch with our advisers to arrange an initial consultation.

 

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