Care Review Bureau - News

Tens of thousands of families face a battle of up to 14 years to recover wrongly charged care costs

March 13th, 2013 |

Tens of thousands of families face a battle of up to 14 years to recover crippling fees that their elderly relatives were wrongly charged for nursing care.

Desperate families have flooded local primary care trusts in England with more than 60,000 claims to win care home funding enied to loved ones.

Under little-known rules, the elderly can have their care costs paid for by the NHS regardless of their income and assets — but only if their health needs are judged to be severe enough.

Known as continuing care, the financial support might typically be offered to an immobile pensioner suffering a debilitating disease such as Parkinson’s or advanced dementia.

The cost of such intensive nursing care, covering accommodation and nurses, can be between £3,000 and £4,000 a month — a staggering sum for families to find.

But many people were never given any inkling that they could claim these fees. In some cases, they were told that because they owned properties or had savings, they would have to pay for the care themselves.

Families denied help are left with no option but to use their loved one’s savings or sell their home to cover the nursing home fees.

But a loophole allows families whose relatives were eligible, but never applied for the funding, to claim back nursing fees. This also applies to those whose loved ones are still alive.

Families must be able to prove their relative is, or was, not just old but also seriously ill. The process is already long and tortuous — typically lasting up to three years with no guarantee of success. However, many families could be waiting much longer — in some cases, up to a decade or more.

The surge in claims to more than 60,000 is down to the publicity around the announcement of the new deadlines for claims — including one that runs out on March 31.

Many families applying for funding previously had no idea they could lodge a claim. But the deluge has caused a giant backlog.

Lisa Morgan, partner at law firm Hugh James, says: “There has been a huge volume of cases since the deadlines were announced. Primary care trusts don’t have the manpower to cope. Some NHS staff are concerned about the unprecedented volume and say it could take 13 or even 14 years at the current rate to plough through claims.

“Families have had to sell homes to pay for care, which should have been paid for by the NHS. It is important that this wrong is put right as soon as possible.”

The process of checking whether your loved one is entitled to continuing care involves a primary care trust officially visiting the parent to carry out a series of tests.

They include checking how complex the care would be, the gravity of the illness and any special physical demands. If your loved one qualifies, funding is awarded.

Some 57,633 elderly people in care homes qualify, but it’s thought the number who are eligible and don’t claim is much higher.

Many families are never even told the system exists and so don’t apply in the first place.

Scott Thomas, of New Law Solicitors, which representing some of the families, says: “Often people are never told they can claim for continuing care. In many cases, their relatives do not even receive a proper assessment to see if they are eligible for care funding.

“Some have had to use their savings or sell their homes to pay for care without having received an assessment. This is distressing and worrying.”

A significant proportion of other cases are turned down, forcing families to go through a long appeals process.

Though rejected cases are not subject to the same deadlines, experts warn the rush in new claims is likely to mean these cases are also delayed. If you succeed in your claim, you will get the care costs refunded plus interest at 8 per cent.

The cost to the NHS of refunding even a few of the claims could be staggering. Unsurprisingly, the health bodies are determined not to pay out unnecessarily.

Michelle Mitchell, director general of Age UK, says: “It is vital that claims are dealt with swiftly — for people to wait for years to get this cash back is unacceptable.” Insurance broker Nick Graham, 55, is waiting for his claim to be heard against Hertfordshire PCT to recover his mother’s £400,000 nursing bill. He launched his appeal last year.

His family had been denied help even though his mother, Patricia, then 83, could not dress herself or use a toilet and had to be hoisted in and out of bed.

“I felt they were looking for reasons not to pay out,” says Mr Graham.

“It was only after Mum’s death that I realised we should have challenged the decision. I’m ready to fight this for as long as it takes.”

A spokesman for Hertfordshire PCT says: “We know the backlog has caused frustration for some applicants and would like to reassure those affected that we’re doing everything possible to process applications as quickly as we can.”

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