Care Funding Services Explained
Thank you for expressing an interest in Farley Dwek and our Care Funding Services.
Whether you’ve just downloaded our Free Guides for information, or already spoken to us about your circumstances, we hope that our range of legal services will be of assistance to you, either now or in the future.
Our Care Funding Services Explained.
In simple terms we will act as your relative’s advocate throughout the NHS Continuing Healthcare Assessment process.
This means that you and your relative will have access to our specialist legal knowledge of the Assessment process at all times. You will also have access to our specialist clinical advice as we employ a team of experienced nurses to support our clients.
Whilst we understand the legal requirements, our experienced team of nurses understand the clinical basis of the Assessment process.
If we believe that your relative is eligible for Funding, then we will offer to act on your/their behalf as their advocate and we will explain the costs associated with providing that service.
If you agree with our terms, we will ask you to enter into an agreement with us.
In terms of our Advisory Service, the first step will be to arrange a Checklist Assessment date, this is arranged through your Care Home. If the Checklist Assessment is positive your relative will be referred for a Full Assessment. If the Checklist Assessment is negative, you will need to send us a copy of the Checklist which we will review.
Once we have a Full Assessment date, one of our experienced nurses will attend the Assessment with both you and your relative. The nurse will come to see you and your relative ahead of the Full Assessment to check if anything has changed since you completed the Questionnaire and to get to know your relatives condition in more detail. Remember, at this stage we already believe that your relative will be eligible for Funding based on the information provided.
The Full Assessment meeting is the key. Our experienced nurses will ask the NHS Assessor to go through each of the Care Domains and explain the “score” they intend to allocate to each Care Domain. If our nurse disagrees with the NHS Assessor about the “score” being allocated, they will put across their alternate view based on their clinical assessment of your relative’s condition and their view of what the “score” should be. In other words they will fight your corner.
The advantage you have, is that all our nurses have years of experience in the Assessment process and know exactly how the other side works and thinks. It’s our nurse’s job to convince the NHS Assessor to revise their assessment in line with our assessment.
Although we can never guarantee success, we have a very high success rate at Full Assessment meetings.
Once the Full Assessment is complete, the NHS Assessor will make a recommendation for funding to a Multi Disciplinary Team (MDT) within the CCG, who make the ultimate decision on whether to approve funding based on the Assessment Report. You will then be sent a copy of the outcome decision, which we will review.
If the MDT denies Funding and our nurse believes that the Assessment supported a decision to fund, we will launch an Appeal on your behalf.
Once Funding is agreed, you will be notified by the CCG who will arrange to make payments directly to the care provider. There will usually be a review after 3 months and then every 12 months after that and our nurse can attend the initial review at 3 months, to ensure that the Funding is continued, as part of our service.
Clinical Review Service
Often, even with the further information you have provided about your relatives care requirements in the Questionnaire, it will still be difficult for our nurses to determine whether your relative may be eligible for funding or not.In these circumstances we may offer to undertake our Clinical Review Service to you.
If you proceed with our Clinical Review Service, we will send one of our experienced NHS Healthcare Funding specialist nurses to meet both you and your relative to carry out an independent assessment of their care needs, face to face.
Following the assessment meeting, our nurse will produce a detailed report which we will send to you setting out our nurse’s assessment of you relatives care needs. This report follows the same format used by the NHS in determining a patient’s eligibility for NHS Continuing Healthcare Funding.The report will help you to understand whether in our view there is any realistic prospect of arguing that your relative should potentially qualify for NHS Continuing Healthcare Funding.
If the report concludes that our nurse believes that your relative may not qualify for funding at the moment, you will be able to use the report going forward in order to monitor important changes in your relative’s condition, which may mean that they are likely to meet the funding criteria in the future. Furthermore, the report will also give you the reassurance of knowing that the matter has been assessed objectively by a skilled nurse who has a wealth of experience in this field, but who is completely independent of the NHS.
If, following the assessment, we believe that your relative could potentially qualify for NHS Continuing Healthcare Funding, we can offer you further services to assist and guide you through the process of applying for the funding. Or, you can use the report to help you to apply for funding yourself.
The Clinical Review Service is provided on a fixed cost basis.
Supported Assessment Service
It may be that you have already started the process of requesting an Assessment for your relative yourself. Or, you may have used our Free Guide to help you to start the process.
If you have already succeeded in progressing through the initial Checklist stage and are awaiting a Full Assessment date, or have a date scheduled for a Full Assessment, we can offer to assist you with our Supported Assessment Service.
By using this service, we will arrange for one of our experienced nurses to accompany you and your relative, as their advocate, at the Full Assessment meeting. You will provide our nurse with all the relevant documentation ahead of the meeting and our nurse will arrange to meet you ahead of the meeting to explain the process.
Our experienced nurses will ask the NHS Assessor to go through each of the Care Domains and explain the “score” they intend to allocate to each Care Domain. If our nurse disagrees with the NHS Assessor about the “score” being allocated, they will put across their alternate view based on their clinical assessment of your relative’s condition and their view of what the “score” should be. In other words they will fight your corner.
Clearly our nurses will not have had the benefit of previously assessing your relative’s condition and care needs, so there can be no guarantees of success, but you will benefit from their support and experience of what can often be challenging and adversarial meetings.
We offer our Supported Assessment Service on a fixed fee basis.
Our Reclaims Service helps families to recover care costs which have been paid incorrectly because an individual in care was wrongly assessed for their eligibility for NHS Continuing Healthcare Funding, or not assessed at all.
In many cases, we act for the families of relatives who have passed away in care and often they have used their life savings, or had to sell their homes to pay for care unnecessarily and unfairly. Or a claim can stem out of an Advisory Assessment.
The process for our Reclaims Service is slightly different to the Advisory Service, because we are dealing with the issue of whether NHS Continuing Healthcare Funding should have been provided historically.
The Retrospective Assessment is still based on the information provided in the Questionnaire, but relies on further historical evidential support in the form of care home records, GP and hospital notes.
We use our specialist team of Nurses to undertake a clinical retrospective analysis of the individuals care needs over their period of care and our specialist solicitors present the arguments for entitlement to NHS Continuing Healthcare Funding to the CCG’s, who will assess the retrospective eligibility arguments through a Panel Meeting.
In some circumstances CCG’s agree refunds for part periods of care only and our legal team then decide whether to appeal for refunds against those periods in dispute. There are also issues of interest payments due on the care costs paid and again our legal team are highly skilled at working out the often complex interest calculations, to make sure that the maximum entitlement is refunded.
Naturally this process takes longer to be assessed by the NHS as they are also examining past records. If a refund of fees is denied we will consider the reasons and may agree to launch an Appeal on your behalf.
To date our average reclaim is £60,000 including interest.
It should be noted that the Government has now imposed deadlines beyond which refunds of incorrectly paid care costs cannot be reclaimed. Any retrospective claims can now only be made for care costs paid after 31st March 2012. Care costs paid before that date cannot be reclaimed.
However, if you have already made a claim before 31st March 2012, which has been unsuccessful in terms of its assessment, you can still challenge that assessment, for payments made for care dating back to 2004.
In Wales a similar deadline was imposed limiting claims to any period after 31st July 2013. However in Wales, the rules also state that the claim period to be considered will be no longer than 12 months from the date of the first application.
Whether you need help with a current Assessment, or need help to recover previously paid care home fees, we can help.
The first step in either process is for us to undertake a Free initial assessment of your relative’s circumstances.
In order to complete a full Free initial assessment you will need to complete our Questionnaire in which we ask you to provide us with details of your relatives care requirements and health needs.
We appreciate that the Questionnaire is detailed, but a detailed level of understanding is required for us to advise you properly on your prospects of securing NHS Continuing Healthcare Funding, or a refund of care home fees already paid.
If you are unsure about whether your relative is likely to qualify for Funding, then it’s a good idea to call us first to discuss their circumstances and condition. Very often we will be able to give you an initial assessment over the telephone.
If we don’t think that your relative will qualify for Funding at this stage that’s by no means the end of the line. An individual’s health condition and health care requirements can change very quickly. We will be able to advise you on what to look out for in terms of your relative’s health and you can contact us to discuss their condition as often as necessary and our advice will always be Free of charge.
If we do believe, having spoken to you, that your relative may be eligible for Funding, then we will ask you to complete the detailed Questionnaire.
We are happy to answer any questions you may have about the process at any time and we will NOT charge you for the time we spend in helping you to assess your eligibility.
Lasting Power of Attorney
Before any assessment for NHS Continuing Healthcare Funding can take place, your relative will need to provide their consent for the process to take place, which includes sharing their personal information with different organisations involved in their care and of course sharing information with us as their advocate.
As long as your relative has the capacity under the Mental Capacity Act 2005, they can provide that consent either verbally or preferably in writing.
However, your relative’s capacity could deteriorate very quickly and once its determined that they don’t have the capacity to make decisions for themselves, their advocate will have to apply to the Court of Protection for what’s called a Deputyship Order in order to gain “control” over their affairs.
This can be expensive and most importantly it takes time, which delays the process.
If your relative sets up a Lasting Power of Attorney (LPA) whilst they still have the capacity, then this issue won’t arise.
Under an LPA your relative grants control over their affairs to another person, usually a relative or close friend who they trust. They can in turn appoint us as their legal advocate to help with their Assessment.
There are two types of LPA, one covering your relative’s Health and Welfare and another covering their Property and Financial affairs.
We strongly recommend that (you and) your relative set up both types of LPA immediately to help the process of managing their affairs in the future.
We offer a fixed cost service* to set up both types of LPA.
What do our Care Funding Services cost?
We charge for our services in different ways, some of our services are provided on a Fixed Fee basis, whilst others are provided under what’s known as a Non Contentious Business Agreement (NCBA). Essentially that’s a form of “No Win No Fee” * agreement, where we will only charge you if we are successful in securing NHS Continuing Healthcare Funding. If we do not secure Funding, then we will not charge you anything, save for the costs of disbursements, for example obtaining medical records.
If we are successful in securing funding, you will pay a one off fee, based on a percentage of what your Care Costs would have been had you not qualified for funding. Our charges will only be based on the next 12 months cost of your Care.
A number of companies offer advisory services, where they will charge you an hourly rate (which can range between £80 and £250 an hour) just to talk to you about the process, regardless of whether they can help to secure funding for you. We don’t do that.
In terms of our Reclaims Service, we only offer to provide this service under an NCBA.
We will always discuss all the funding options in detail with you before we agree to act on your behalf, to make sure you choose the option which is best for you.
Why use us?
First and foremost because we are experts in the area of NHS Continuing Healthcare Funding and already secured £millions in funding on behalf of families.
We are also a firm of solicitors, regulated by the Solicitors Regulation Authority. That means that we have to work to a very strict code of conduct and ethics. It also means that we are covered by Professional Indemnity Insurance, which protects you at all times.
Other companies offering advisory services who are not solicitors will be operating on an unregulated basis, which means that they do not have to comply with any regulatory standards. It is also unlikely that they will have Professional Indemnity Insurance covering the advice that they may provide to you.
A lot of non solicitor organisations will also charge by the hour for any advice they provide. As we’ve explained, under our “No Win No Fee” * arrangements, our advice will not cost you anything if we are not successful in securing funding for you, or we will act for you on a Fixed Fee basis.
Some companies will tell you that it is not necessary to use a firm of solicitors because the advice you require is not legal advice. That is true. But our solicitors have a wealth of experience in securing NHS Continuing Healthcare Funding on behalf of clients.
Equally as importantly, we also employ a team of experienced nurses who have all worked for the NHS for may years in this specialist area. Some other companies use what they call “caseworkers”, these are people who may well have experience of running cases in the area of Continuing Healthcare Funding, but they are NOT either qualified nurses or qualified solicitors. By combing the expertise of our solicitors and nurses, we believe we can offer you an unparalleled service.
We also sometime hear other companies saying that solicitors aren’t allowed to attend Full Assessment meetings or Appeal Meetings. That is simply NOT true, anyone acting as your appointed advocate has the right to attend the meetings with you. The NHS might not like us attending, but that’s because they know that we have the expertise to counter their arguments against approving your funding.
Please read some of our Case Studies to see how relevant they may be to your current circumstances.
You can download a copy of this page here.
* – Subject to terms and conditions