- If it you need care for health reasons, the National Health Service funds.
- If you need care for social reasons but lack resources, local authorities should pay.
- If you have significant resources you may have to pay.
A critical consideration in determining who will pay for care is whether the care required is for social or health reasons. If the latter, the NHS is required to pay for continuing care. The line between the two, however, is increasingly blurred and decisions may seem arbitrary.
NHS assessors should remain pragmatic though may, subjectively, appear to ‘down play’ health care components of care need, emphasising the social. Assessments may prove adversarial and the agenda of the assessors skewed (from the position of the claimant). By definition healthcare in the UK should be fee so care should be free.
In broad terms, a healthcare need may be defined as: one related to the treatment, control or prevention of disease, illness or disability and the care – plus after care – of the patient with these needs. This is the case even if care is not supplied by a healthcare professional.
A social care need is considered to be assistance with: daily living; maintaining independence; social interaction and accessing resources.
The guidance appears relatively clear though ambiguity persists and there are grey areas. I have been through such a conflict myself, in the case of my grandmother, who, despite debilitating dementia, was ultimately offered NHS funded healthcare on the basis of poor eyesight. My personal (and undoubtedly, emotionally coloured) experience was of a densely bureaucratic and recursive process, in search of reasons to reject the claim, and wilfully ignorant of neurological issues with behavioural sequiturs.
The provision of care support of any kind supervenes on local authorities’ duty of care to its citizenry. The factors to which this duty relates, might be summarised thus:
- Needs associated with physical or mental conditions?
- Inability to achieve two or more key goals or outcomes without care or support?
- Potential for the absence of support to significantly impact your care or well-being?
‘Key goals’, in this case includes functions such as: proper eating, personal hygiene, toilet use, dressing, safety at home, domestic hygiene, socialisation, work or education, use of key services.
If performance of the above requires help, is unduly time consuming or causes pain, care may be indicated. To establish this, a social care need assessment may take place. These are not adversarial but exploratory and (usually by telephone), seek to establish:
- Emotional/social need
- Views, culture and support network,
- Health/housing need,
- Your needs, and what you would like to happen.
After the assessment a care plan should be agreed detailing needs and help that can be provided. If there is no obvious healthcare need, means testing will then be applied to calculate what you must contribute to care and support.
If you would like to discuss any of the issues raised feel free to contact Confidence Wills now at www.confidencewills.co.uk#contacts