Funding your Care Package
Please also see related articles accessible via the left hand menu.
Many people have had to meet the costs of long term care when they are actually entitled to receive it free at the point of delivery.
There has been a huge amount of media coverage and controversy regarding the funding of care in recent months (you may have seen the Panorama programme investigations).Whilst the publicity had often centred around elderly people having to sell their homes to fund residential nursing care, the same funding issues exist for people with a long term conditions living at home.
I have wanted to write this article for some time so that people with tetraplegia have a simple tool to help them navigate the funding maze. As is so often the case, understanding the system is half the battle.
Six Key Principles
1. Where your needs are assessed as primarily health related, the support you receive should be provided at no cost to you.
2. Where your needs are assessed as primarily social, the support you are eligible to receive is means tested. This means that after the needs assessment by social services, your capital, income and expenditure may be assessed prior to funding being agreed.
3. Whilst local authorities are moving towards a single assessment process you may still be offered a social care assessment even if you feel your needs are primarily health related.
4. If you believe your care needs are primarily health care related, ask your GP for a continuing care assessment. This will be undertaken by your local Primary Care Trust¹.
5. Familiarise yourself with the local eligibility criteria² for continuing care before your assessment. You should be able to get these from your local Primary Care Trust. (At the time of writing the Department of Health are developing national continuing care eligibility criteria to try and promote greater consistency)
6. The Coughlan Case³, a 1999 Court of Appeal Judgement, may provide someone with tetraplegia appropriate precedent for continuing care, free at the point of delivery.
Explanatory Notes
¹ Primary Care Trusts or PCTs are NHS organisations which have been set up throughout the country to provide, plan and fund health services for their local people. PCTs are seen by the Government as the very foundation of the NHS, eventually controlling three quarters of the total NHS expenditure. Find yours here
² Eligibility criteria are based around key indicators such as mobility, continence, tissue viability, medication and seizures/altered states of consciousness.
³ For more information on Pamela Coughlans successful appeal case look HERE
.jpg)
Explanatory Notes
¹ Capital refers to assets such as savings, stocks and shares and property (excluding your home).
² Income such as Disability Living Allowance (Care Component), DWP Benefits, Pensions are taken into account. ILF payments, child benefit, working family tax credits are not.
³ Examples include household expenses and disability related expenditure. There is a mandatory allowance equal to basic Income Support plus 25%
Conclusion
My advice to anyone with a high level spinal cord injury (tetraplegia) and who is not currently in receipt of NHS funded care, is to ask their GP for a continuing care assessment in order to establish whether their needs are primarily health care. The Coughlan Case may give appropriate precedent that can be used to claim NHS funded care, free at the point of delivery.
Pamela Coughlan (C5/6), the person at the centre of the 1999 Court of Appeal Judgement comments "I feel this article is an important step forward in raising awareness of these issues amongst people with tetraplegia. I would urge them to use the judgement to challenge PCTs who misuse eligibility criteria to absolve themselves of responsibility to provide NHS funded care. If all else fails, they should refer their case to the Health Service Ombudsman who, in my experience, is likely to find in their favour".
Contact details for the Ombudsman are;
The Parliamentary and Health Service Ombudsman
Millbank Tower
Millbank
London
SW1P 4QP
Complaints Helpline: 0845 015 4033
Website: www.ombudsman.org.uk
There are two further articles on our website the subject of Continuing Care. Both can be accessed via the links below.
For more information on how to fight for Continuing Care funding we recommend the following sites;
www.continuingcarecampaign.info
These articles were first published in Forward, the Magazine if the Spinal Injuries Association. If you have any questions or comments regarding this article please contact Andrew Allan, Managing Director, Active Assistance. See our Contact Us Page for more information.