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  • Which? Reports Continuing Healthcare Funding is a ‘postcode lottery’

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    Care patients are being hit with large bills because of a postcode lottery for NHS funding, a consumer group says.

    Which? said people can be “25 times more likely to get their costs covered depending on where they live”.

    It found South Reading Clinical Commissioning Group (CCG) paid social care costs for 8.78 patients per 50,000 people while Salford funded 220.38.

    The Berkshire CCG said Reading has a very low elderly population – 12% against the national average of 17.7%.

    The consumer group analysed NHS continuing health care funding data for October to December 2017.

    It found vulnerable people in England with the most expensive medical needs were not treated in the same way regardless of where they live.

    The NHS continuing healthcare funding is administered by local CCGs. It gives medics a national framework to assess patients, including older people with conditions such as dementia and motor neurone disease.

    Read the full BBC article here

  • New (revised) National Framework for NHS Continuing Healthcare

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    The revised National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care October 2018 (Revised) has now been published (Published March 2018).

    It comes into effect on 1st October 2018 and contains an additional 27 pages more than the 2012 version.


    View the document here;
    National Framework for Continuing Healthcare 2018

    The 2018 National Framework is intended to:

    1) provide greater clarity to individuals and staff, through a new structure and style

    2) reflect legislative changes since the 2012 National Framework was published, primarily to reflect the implementation of the Care Act 2014,

    3) clarify a number of policy areas, including:
    a) Setting out that the majority of NHS Continuing Healthcare assessments should take place outside of acute hospital settings. This will support accurate assessments of need and reduce unnecessary stays in hospital.
    b) Providing additional advice for staff on when individuals do and do not need to be screened for NHS Continuing Healthcare in order to reduce unnecessary assessment processes and respond to a call for greater clarity on this.
    c) Clarifying that the main purpose of three and 12 month reviews is to review the appropriateness of the care package, rather than reassess eligibility. This should reduce unnecessary re-assessments.
    d) Introducing new principles for CCGs regarding the local resolution process for situations where individuals request a review of an eligibility decision. The aim is to resolve such situations earlier and more consistently.
    e) Providing clearer guidance, including dedicated sections, on: the roles of CCGs and local authorities, NHS-funded Nursing Care, inter-agency disputes, well-managed needs, and the Fast Track Pathway Tool.

  • NHS England has issued new guidance to CCGs regarding hospital discharge and Continuing Healthcare assessments.

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    Watch out for more pressure on families to get relatives out of hospital!

    If you have a relative in hospital and they need ongoing care, you may soon come under even greater pressure to get them out before the proper NHS Continuing Healthcare assessments in hospital have taken place.

    NHS England has issued new guidance to CCGs regarding hospital discharge and NHS Continuing Healthcare assessments. It possible that CCGs may now do whatever they can to avoid assessing people while they’re still in hospital.

    The new guidance comes in the form of a letter sent by NHS England to CCGs.
    It’s dated 17th August 2017.
    READ THE LETTER HERE

    Interestingly, here’s what the letter says about NHS Continuing Healthcare assessments in hospital

    “CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting;”

    and…

    “These CCGs are required to submit a plan for improving this to less than 15% by March 2018…”

    As you’ll see in Appendix B in the letter, there are 84 CCGs which currently report it takes them longer than 28 days on eligibility decisions.

  • Care home fees: the scandal of secret mark-ups

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    Figures compiled for the Telegraph show those who pay for their own care are paying 13pc above the ‘real cost’.

    The widening gap between the actual cost of providing a place in a care home and the fees charged to those who pay for themselves is clear in figures published by the Telegraph today, which care Home Funding Advocates is sharing.

    They show that on average those people who fund their own care – because they do not qualify for assistance from their local authority – pay on average 13pc above the “real cost” of providing their care, in England.

    The “real cost” figure, which is generated from in-depth research into the constituent costs of providing food, accommodation and basic help, also includes a reasonable profit margin for the care home operator.

    The price paid by a local authority on behalf of someone who does qualify for State help is lower than this “real cost”.

    The conclusion, highlighted in a separate report by charity Independent Age, also published this week, is that middle-class residents with modest property or other assets, who are thus forced to pay for their own care, are further subsidising those paid for by the public purse.

     

    The figures will make uncomfortable reading for about 210,000 individuals, and their families, who are in the position of paying all or most of their care home fees. Under current rules, individuals in England must “self-fund” or pay their care home fees in full, with no help from the council, if their assets, including their homes, are worth more than £23,250.

    Many people make the move to a care home when their health has deteriorated, following the death of a spouse or in response to some other life change.

    They and their families tend to pay what is asked of them, charities and care fee advisers say – without knowing anything about the actual costs involved or, crucially, the fees being paid by other people enjoying precisely the same care and accommodation.

    Because the sums involved are huge the discrepancy, where it is discovered, creates resentment and anger. The figures differ by region.

     

    On average, in England, the cost of providing residential care, including the care home operator’s slice of profit, is worked out at £563 per week, according to Valuing Care, the consultancy which provided the data.

    Valuing Care provides information mainly to local authorities from records covering care placement costs in many hundreds of homes. It also undertakes mystery shopping exercises to see what homes charge “self-funders” for the same care, before averaging the data by local authority and region.

    In general, according to Valuing Care, local authorities use their bulk-buying power to push down care home rates to between 5-10pc below the “real cost” figure. Based on the English average, that would mean the fees paid by a local authority on behalf of someone qualifying for help would be as little as £507 per week – compared with the self-funder’s £636. Over a year, the cost for the former would be £26,364 and the latter £33,072, or a difference of nearly £7,000.

     

    In regions where self-funders appear to be paying most over the odds, such as the South West of England, the gulf is greater. Here, a council-funded resident of a care home would pay fees of £24,570 per year while the self-funder would pay £34,320, or an excess of £9,750. The two individuals might be in identical accommodation and receiving identical care.

    None of these figures include nursing care, which in England could add another average £700 to the weekly bill. For patients with dementia the sum could be higher still. Again, in what many would see as a cruel twist, those who self-fund tend to pay an average 4pc more for their nursing care than those who are paid for by the state.

     

    Chris Horlick of Partnership, the specialist insurer of the elderly or those with limited lifespans, explains how upsetting some families find this situation of differential costs – if they are ever made aware of it.

    He explained that of the estimated 350,000 people living in residential care, there are effectively two payment routes. Those who qualify for state help – about 40pc – and those who don’t.

    Where the state picks up the bill the local authority decides what maximum it will pay, usually in consultation with firms such as Valuing Care.

    Where the person is self-funding, they invariably pay whatever the home demands. “There are many homes that will accept the local authority rates and where the majority of their clients are funded that way,” said Mr Horlick. “There are also those which quite clearly price themselves more highly and are deliberately aimed at wealthier, self-funding clients who want a higher level of comfort or care. But the problems arise with the vast majority of homes where there are both state-funded and self-funded people living together. If people do not have to pay themselves, essentially because they have not saved or built up assets, it is upsetting for others who do have some modest level of assets to be paying out of their own pocket for the same care – and to be paying in some cases considerably more.”

     

    Why does the situation arise? Charity Independent Age argues the rapid rise in demand for care as a society, plus the constraints on public spending, is creating a growing “underfunding” problem in the sector – which it estimates at a staggering £700m per year. It says that between them “councils, care homes and ultimately older people and their families” are “filling the gap”.

    Ray Hart of Valuing Care said: “There is no clear explanation of the difference in fees between self-funders and those who are looked after at the state’s expense. Are the self-funders effectively subsidising those paid for by the local authority, because the local authority is not paying enough? Or are care homes simply using self-funders as a means of generating profit? Either way it does not seem right.”

     

    Changes being brought in by this government, which include the introduction of the controversial “lifetime cap”, supposed to limit the total any one person could spend on care, may make the situation worse. Details of how the cap will work have still to be finalised. But it is expected only to apply to nursing care. So the costs quoted above – and shown in the table – which deal merely with the “hotel” element of board, food and basic care, could rise without limit. And there would be no reason for the difference in rates charged to self-funders to move more into line with those charged to local authorities. In fact, warns Mr Horlick of Partnership, increased overall pressure on local authorities’ budgets could result in homes trying to pass even greater costs on to self-funders.

     

    With nursing care costs, which would be included within the cap, the changes could also make matters worse, Mr Horlick believes. This is because more families would register with their local authorities in order to “start the clock ticking”. When they had paid up to the level of the cap, which is expected to come in at £72,000, the burden would return to local authorities.

     

    Average weekly residential fees covering accommodation, food and basic care (not nursing)

     

    Region

    Actual cost*

    Fees if you pay for yourself

    Fees if your council pays for you

    East Midlands

    £540

    £615

    £486

    East Anglia

    £560

    £630

    £504

    North East

    £505

    £565

    £455

    North West

    £525

    £580

    £473

    South East

    £605

    £660

    £545

    London

    £685

    £770

    £617

    South West

    £600

    £710

    £540

    West Midlands

    £540

    £615

    £486

    Average

    £563

    £636

    £507

     

    *Includes a reasonable profit margin for care home operator Source: Valuing Care

     

    Families ‘should negotiate a fair deal’

     No one wants to haggle over something as crucial as the care for yourself or family member, but the sums are so huge that money has to be a consideration.

    There is also the issue of whether the funds available to those paying for themselves – “self-funders” – might run out at some future point, with all the potential problems that could cause. Speak first to charities such as Independent Age for help in understanding the complex care-funding regime, and to ensure that self-funding is indeed the only choice.

    When it comes to signing up with your chosen home, and discussing fees, information provided by consultants such as Valuing Care can help. The calculator at valuingcarefm.com allows you to compare a rate quoted by a home for certain types of care with other, local equivalent rates.

     

     Read more…

     

  • Surge in numbers of elderly put in care homes after Christmas

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    Elderly people are far more likely to be put into a care home after Christmas, research finds.

    Care Home Funding Advocates reports on the Telegraphs news story today that elderly people are far more likely to be put into a care home after spending times with their families over Christmas, research has found.

    Data held by an online directory of care homes shows a 40 per cent increase in the number of people searching for residential care for the elderly every January.

    Experts said the findings suggest that the extra contact with older relatives over the festive season meant families were more likely to realise how infirm they were, or to become overwhelmed by the burden of caring for them.

    The figures from carehome.co.uk, an online directory of care homes, shows that for the last three years the number of visitors to their site has surged after in the new year, by at least 40 percent, with almost 400,000 extra visitors to its website this January, compared with the month before.

    Martin Green of the English Community Care Association, which represents care homes in England said: “This phenomenon often results from the fact that people have been in contact with their relatives over the Christmas period and then they realise that they’re not able to manage because of illness or confusion.

     

    “This is quite difficult to pick up on if you only see the person occasionally, but over the period of Christmas, when people might be together over a week or more, it becomes apparent that their level of functioning is significantly reduced and people realise that their family member might need a care home in order to stay safe.”

    Neil Duncan Jordan, from the National Pensioners Convention, said: “I think its probably quite a complex picture – the other thing going on in January is the weather getting worse, so fraility becomes more of a problem. I don’t think it’s a question of everyone sitting around for Christmas and getting fed up with granny, and deciding to shove her in a home – I think it is very likely that it reflect a crisis in social care, because there is so little help available to keep people in their own homes.”

    Davina Ludlow, director of carehome.co.uk, said their figures showed a consistent trend for the last 3 years, with a spike of between 40 and 50 per cent in users visiting the site in January.

    She said: “We feel this increase is a reflection of how family members take positive steps in the New Year to assist their relatives.”

    “Residential care can often feel like a daunting step – but it can save someone from not only the day-to-day tasks which have become difficult, but also from feelings of loneliness and isolation.”

     

    Last week health officials made an unprecedented appeal for 100,000 people to pledge to look in regularly on an elderly friend or neighbour, in a campaign which is supported by the Telegraph.

    Now the Royal Voluntary Service is urging those who want to do more for older people in their community, but do not know a pensioner in need of help, to sign up for volunteering opportunities after making a pledge.

    David McCullough, Chief Executive of older people’s charity Royal Voluntary Service, said: “Many older people suffer chronic loneliness which is only exacerbated in the winter months, so even a simple cup of a tea and a chat, or a lift to the shops, can make all the difference and ensure older people have everything they need to stay warm and well. We all need to come together to prevent the tragic deaths of so many older people in winter and even a small amount of time a week really can help.”

    Read more…

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