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Can I Claim Back Care Home Fees?

Author: Tim Davies LLB

Can I Claim Back Care Home Fees?

The often-asked question of ‘Can I claim back care home fees?’ is unfortunately not a straightforward yes or no. We look at more details below.

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Care home fees can be claimed back from the NHS where it is established that an individual’s need for care during the period in question was for primarily health reasons. In such circumstances, funding known as continuing healthcare funding should be provided where the needs are sufficiently complex, intense or unpredictable in their nature. In the same way that people receive funding via NHS continuing healthcare funding to pay for their care on an ongoing basis, where it can be established that the funding should have been provided as the eligibility criteria were met, but it wasn’t, individuals can secure reimbursement of their care costs from the responsible NHS Clinical Commissioning Group.

There are a number of important facts that relate to the ability to claim back care home fees;

Timeframes

The NHS in conjunction with the Department of Health has placed limitations upon the ability to seek retrospective reimbursement for claiming back care home fees for previously unassessed periods of care. What this means is that if somebody was in care for a number of months or years and was never assessed for continuing healthcare funding, there is an ability to request that the NHS look back over the period in dispute and decide whether care fees should have been paid because the individual was entitled to continuing healthcare funding. In recent years, the NHS has, however, placed a restriction on how far back it is possible to claim. The time limits have now passed and so the furthest back the NHS can be requested to consider at the present time is from the present day back to 2012. 

Was the Person Previously Assessed?

Claiming back care home fees for a period of unassessed care is possible, if, for example, the person was never assessed for continuing healthcare funding during the period you are asking the NHS to consider. If, however, they were assessed for continuing healthcare funding during a particular period, and they were deemed not to be eligible, it is not possible to ask for a further retrospective review as this would not be classified as an unassessed period of care. 

Clearly, it is not unassessed as during the period in question their entitlement to continuing healthcare funding was assessed, and they were deemed not to be eligible. If it were the case that the patient was to disagree with this decision the only avenue they would have would have been to appeal the outcome. However, there is a time limit of six months to be able to lodge an appeal for an assessment where you disagree with the outcome. As such, it is likely that the ability to appeal would have expired. 

In summary, the often-asked question of ‘Can I claim back care home fees?’ is unfortunately not a straightforward yes or no. In theory, yes, it is entirely possible to claim back care home fees if it is established that there;

  1. Was a previously unassessed period of care
  2. That the evidential position shows that during this unassessed period of care the individual’s needs were either complex, intense or unpredictable in their nature such that they could overall be considered to be primarily health needs

In such circumstances, there would be an entitlement to continuing healthcare funding being applied on a backdated basis and any care home fees paid reimbursed to the patient or whoever is entitled to the reimbursement if the patient has passed away.

Should you have any questions or queries regarding claiming back care home fees, you should not hesitate to contact one of our experts at Compass CHC for a free, confidential and no obligation discussion.

Author: Tim Davies LLB


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