The answer to ‘Can I claim back care home fees’ is unfortunately not a simple yes or no.
Care home fees can be claimed back from the NHS where it is established that an individual’s need for care during the period was for primarily health reasons. In this example NHS 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 NHS Continuing Healthcare Funding to pay for their care on an ongoing basis, where it can be established that funding should have been provided as the eligibility criteria were met, but it wasn’t, individuals can secure reimbursement of their care costs from their local ICB.
There are a number of important facts that affect the ability to claim back care home fees;
Timeframes
The NHS places 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, you can 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, restricted how far back it is possible to claim. The furthest back the NHS can be requested to consider is from the present day back to 2012.
Was the person previously assessed?
Claiming back care home fees for a previously unassessed period of care is possible, if the person was never assessed for continuing healthcare funding during the period. If they were assessed for continuing healthcare funding during a particular timeframe, and they were deemed not to be eligible, it is not possible to ask for a further retrospective review.
If the patient disagrees with this eligibility decision, the only avenue they have is to appeal the outcome. However, there is a time limit of six months to lodge an appeal for an assessment where you disagree with the outcome. As such, it is likely that the opportunity to appeal would have expired.
In summary, it is entirely possible to claim back care home fees if it is established that there;
- Was a previously unassessed period of care
- 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 these 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.
Learn more: We’ve received a care bill, do we have to pay it?
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