Long Term Care Fees Nursing Care Nursing Fees Advice & Guidance

Crossing the boundary between nursing care and social care

What is nursing care?

It is narrowly defined as “care provided, delegated, monitored and supervised by a registered nurse”.  This does not include the care provided by a nursing or care assistant, even if that care is delegated or supervised by the registered nurse.  It is the act of supervision or delegation that is classed as “nursing”, rather than the care itself.  Personal care is not defined as nursing care.

Paying for long term care

People in need of care in the community either fund the care themselves (“self funders”), or seek assistance from social services or the National Health Service (NHS).  Support given by social services is means tested.  Social services support is free of charge to persons on low income and capital.  If social services arrange for care in the community they must pay the fees charged by the home provider and recover the cost from those not eligible to receive free care.  In some cases the responsibility for providing community care transfers to the NHS.  Care given by the NHS is referred to a National Health Service Continuing Health Care (NHS-CHC) and is free of charge.

NHS Continuing Health Care

To qualify the patient must have a “primary health need”.  They must show that::

  1. The nursing services they receive are not merely incidental or ancillary to the provision of accommodation.  That is, nursing services are more than a minor or supportive part to the provision of accommodation.  If so, then the NHS has a duty to provide care - the test is the quantity of care.
  2. The nursing services are of such a nature that social services cannot be expected to provide - the test is the quality of care.  Where the needs are considered complex, intensive, unpredictable, and unstable, the NHS must pay for the care received.

NHS funded nursing care

NHS funded nursing care is the funding provided by the NHS towards the costs of a place in a care home with nursing for those people assessed as requiring help of a registered nurse.  This type of funding is known as “registered nursing contribution to care”.  There are two levels of contribution.   In the financial year 2008/09 there is a standard weekly rate of £103.80 and high band rate of £142.80 for those residents assessed with higher nursing needs.

NHS healthcare assessment

When asked to do so, the NHS must assess if a patient’s care needs entitle them to free NHS-CHC care.  A multi disciplinary team comprising doctors, nurses, and NHS staff have a duty to consider all the factors and make a recommendation about entitlement to NHS CHC.  The factors concern the patient’s health and include:

  1. The patient’s behaviour.  How challenging is it?
  2. How well can they communicate and understand?
  3. What are their psychological and emotional needs?
  4. To what extent are they mobile?  Do they need assistance to get about?
  5. Are they incontinent?  Is a catheter needed?
  6. What assistance is required to feed or drink?  Is the patient PEG fed?
  7. The types of drug therapies and medication prescribed.

When carrying out an assessment the NHS must apply a decision making tool designed to provide a fair and effective way of establishing individual entitlement to continuing health care.  The tool measures the extent of the person’s various health care needs, using it to decide whether or not these needs are met by the NHS or social services.  The needs are measured as “no need”; “low”; “moderate”; “high”; “severe”; or “priority”. It is considered that continuing care would be recommended if a person has a priority need in any one of the four domains that carry this level, or a total of two or more incidences in the severe category.  It is upon individual judgement if people with lower level needs than this qualify for NHS funding.

The NHS Review Process

NHS guidance states that applications for CHC should be reviewed three months following initial assessment and at least yearly thereafter. The first process involves a “local resolution” by the Primary Care Trust (PCT) review panel followed by a further review by the Strategic Health Authority (SHA) panel.  After local resolution has been exhausted the case can be referred to the SHA Independent Review Panel.  The panel’s job will be to determine whether the PCT has correctly followed the assessment process.

The review procedure is different if the complaint is about the care package, the treatment the patient is receiving or the location of any NHS funded care. Such concerns are dealt with by the ordinary NHS complaints procedure.

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