Last chance to reclaim unfairly paid care home fees as deadline looms

Solicitors are warning that thousands could miss out on reclaiming unfairly paid care home fees as the window to appeal against council funding decisions approaches.

A 1999 Court of Appeal ruling states that if ill health is the primary reason a patient is in care, then the NHS should pay the full cost of that care.

Yet many families remain unaware that they may be wrongly paying fees for sick relatives, and thousands now only have until 30 September to submit a claim.

The Department of Health announced in March that those disputing fees paid between 1 April 2004 and 31 March 2011 must register their claim before September 30 this year.

A spokesman for the Department of Health told This is Money that the deadlines were put in place to prevent backlogs and ensure that claims are dealt with by primary care trusts (PCTs) within a reasonable time frame.

With care home fees costing as much as £50,000 a year and many families finding they have to sell a relative’s property or dip into their own savings in order to fund care fees, an appeal could represent a financial lifeline for many.

When the deadline was first announced, PCTs were asked to contact patients who may have been eligible, but many are still unaware that they have been paying care fees unnecessarily and are entitled to claim them back.

The problem has arisen because each council makes its own assessments and decisions on those who are eligible for NHS Continuing Healthcare.

This scheme which will pay for a patient’s care if the primary reason for requiring a care home place is ill health - as opposed to cases where a care home place is required because of general frailty associated with old age.

The distinction can be subtle and requires a thorough assessment by health professional. 

The extent and severity of the patient’s health needs as well as the quantity and quality of care needed to manage will be considered in an assessment, and The Department of Health says that local PCT assessments must be compliant with the National Framework guidelines.

However, the system has come under fire for not operating as it should. 

Tim Spring, Partner and Head of Clinical Negligence at solicitors Moore Blatch said: 'Many people may have been unfairly paying the costs of residential care for a relative.'

He told This is Money: 'Some PCTs do not even consider a patient’s medical records in their assessment and whilst a patient is supposed to be assessed by a multi-disciplinary team, they can find that they are not seen by a medical expert. You have to question why this situation is still happening.'

He says that anyone who has spent time in a nursing or care home due to a medical condition, whether for a physical or mental health care need, may be eligible to reclaim fees that have previously been paid.

Claims can arise from a wide variety of medical conditions and can still go ahead even if the person who received the care has since passed away.

Success rates for claims like these are high. Mr Spring said; ‘Since I started at Moore Blatch, we have never lost a litigated clinical negligence case’.  

‘With the deadline fast approaching we recommend any person who has managed the self-funding of a care home resident to investigate the requirements and take advice as to whether they have missed out.’

But the Department of Health was keen to stress that claims can be made without legal help. A spokesman said: 'To lodge a claim before the deadline, all someone would need to do is call their Primary Care Trust and request a review of the assessment.'

Sourced from This Is Money, 6th August 2012.