After a brain injury, help and support may be needed from others to manage your day-to-day needs. If the care you need is complex, a package of care may be needed, adaptations may be required at home to make it possible for you to move around and receive care or you may need to live in a specialist setting.
What is Intermediate Care?
Intermediate Care, which is also known as ‘reablement’ or ‘rehabilitation’, is likely to be the first type of care service you come across if you have been in hospital. These are services provided to help you return home after a hospital stay or sometimes to stay in your own home instead of going into hospital. The Local Authority will provide a programme of care and support for a specified period of time which aims to enable you to maintain or regain the skills to live independently in your own home. This is free for up to six weeks regardless of your income and capital. However, you must have an eligible assessed need.
An eligible assessed need means that you need this help because of a physical or mental impairment or illness and are unable to achieve two of the following, without support, pain, danger, anxiety or it taking longer than previously, which will have a significant impact on your wellbeing:
- managing and maintaining nutrition;
- maintaining personal hygiene;
- managing toilet needs;
- being appropriately clothed;
- being able to make use of your home safely;
- developing and maintaining family and other relationships;
- accessing work, education, volunteering and training;
- making use of the local community;
- carrying out caring responsibilities for a child.
Continuing Care Needs
If you no longer require intermediate care but you have eligible needs, the Local Authority will need to meet these. If you are returning home but the adaptations are not yet complete, the Local Authority will have to fund suitable care until your home is ready, unless your capital assets are over a specified amount. If the value of your capital (savings, investments and some property) is above the specified limit, the Local Authority will not have to fund your care but can provide advice and arrange care in some circumstances. However, some of your assets are not taken into account – these are known as disregards. Examples of disregards are: compensation including interim payments (only if it is in a Personal Injury Trust, in the 52 week disregard period or managed by a Deputy under the Court of Protection); your main residence if your care is provided there; or if you are in residential care your main residence may not be taken into account – but this will depend on who still lives in the property and whether or not your stay in residential care is going to be temporary.
If the Local Authority does fund your care, it will take your income such as welfare benefits, pensions etc. into account and you will have to pay a contribution from your income. Your contribution depends on whether you are in residential care or at home and other factors such as your disability-related expenditure (for example extra heating, dietary needs, special bedding/clothing and care not arranged by the Local Authority).
NHS Continuing Healthcare Funding
Continuing Healthcare (CHC) funding is care arranged and funded by the NHS when your need for care is related to your health. It is not means tested unlike the social care provided by Local Authorities. To determine if you are eligible for CHC an assessor will apply a checklist which effectively works as a screening process. If this indicates a health need, a full assessment of your needs, known as the Decision Support Tool, will be carried out. If you are not eligible for CHC funding you may still be entitled to NHS Funded Nursing Care. This is paid to the care home towards the costs of care provided by a registered nurse for those assessed as eligible.
Can we appeal if we have been denied Continuing Healthcare Funding?
There is an appeals process against a negative decision. This is a two-stage process of requesting a “local resolution meeting” and then escalating this to an “independent review panel”, should the first stage be unsuccessful.
Continuing Healthcare Funding is increasingly difficult to secure and the assessment procedure itself can be complicated and daunting. It is important to be prepared for any assessment or meeting and to ensure that the professionals are given as much up to date evidence as possible so that they can make an informed decision.
Brain Injury Group can connect you with a specialist solicitor who can provide you with support to understand which kind of funding you will be entitled to, as well as explaining the process for getting that support and how your care package should be tailored to your needs. Our member solicitors will also be able to assist with appealing any decisions.
For initial, no-obligation, free advice, email firstname.lastname@example.org