Families warned they could save £10,000 on care bill with one simple move

NHS Continuing Healthcare (CHC) is arranged and funded by the NHS. (Image: Getty)

Families may be paying tens of thousands of pounds in nursing home fees for elderly relatives unnecessarily because they do not realise they can apply for a little-known form of financial support from the NHS.

As dementia and Alzheimer’s grows and care home fees surge past £50,000 a year, long-term care is placing greater pressure than ever on family finances.

Fees can ravage inheritances and force families to sell their homes, yet many who could get NHS funding do not realise it’s an option while those who apply can be wrongly rejected.

Some families have been able to claim back tens of thousands in care home costs years after appealing against a decision to refuse financial support for loved ones.

A package of ongoing care known as NHS Continuing Healthcare (CHC), arranged and funded by the NHS, will cover long-term care fees for elderly nursing home residents in England and Wales who have intense, complex and unpredictable care needs, including dementia. It is known as Hospital Based Complex Clinical Care in Scotland.

CHC, also known as fully funded care, is not means tested and may pay 100 per cent of care and residential accommodation, irrespective of wealth, following disability, accident or illness.

However, just one in six with direct personal experience of finding care for an elderly relative have heard of CHC and know what it is, according to figures from Just Group.

It does not apply to everyone receiving care but only those deemed to have a “primary health need”.

Applicants must be assessed by a team of healthcare professionals to determine eligibility for NHS funded care.

NHS England figures show the number of people eligible for this funding plunged from 62,939 in 2015 to just 50,650 in 2023, a drop of 20 per cent despite rising long-term care needs.

Caroline Abrahams, charity director at Age UK, said the application process is complex and many who do apply are unfairly rejected. “Others do not know it even exists because it is not widely publicised.”

She added: “The harsh reality is that some older people who should receive this precious support don’t get it, making their lives more miserable than they should be and forcing them to drain their own resources.”

Dan Harbour, managing director of Beacon, which offers gives free, independent advice on CHC, said everybody who has received NHS-funded care in a nursing home should receive a CHC checklist, but this does not always happen. “This can also be the case where people receive care in their own home and are never made aware of this option.”

While overall policy is set by the Department of Health and Social Care (DHSC), budgets and referral decisions are made by local Integrated Care Boards (ICBs), Harbour said. “There are 42 in total and their effectiveness varies.”

Harbour said NHS England and the DHSC have worked to raise awareness, but are also careful to manage expectations.

The CHC “screening threshold” is relatively low, but the majority who are given a full assessment for funding will be rejected.

There has been a gradual decline in positive assessments despite the ageing population, Harbour said. “The conversion rate from positive checklist to CHC eligibility has dropped from 34 per cent in 2011/12, to around 21 per cent today.”

Juliet Tizzard, director of external relations at Parkinson’s UK, said CHC can be an “incredible lifeline” but securing it is complex.

“The different ways in which ICBs interpret the national framework means that some people miss out on funding, while others are being repeatedly reviewed despite their care needs remaining unchanged.”

Post-Covid NHS waiting lists are making matters worse, as people face lengthy waits for care after becoming unwell, she added.

Solicitor Lisa Morgan has helped to recover more than £200million for families in England and Wales who have been unfairly denied CHC funding or never applied. Some families have recovered as much as £300,000 in care fees.

Morgan, who heads the Nursing Care Fee Recovery team at Hugh James Solicitors, said a growing number of those requiring care are being wrongly rejected by the cash-strapped NHS, as the application process gets stricter. “We are making more and more successful appeals due to wrongful assessments.”

At the same time, care home fees have rocketed 49 per cent in a decade to an average of £56,056 a year, according to figures from Laing & Buisson.

Morgan said: “Increasingly, people can’t afford their care anymore and so family members are having to pay ‘top up’ fees. Many are forced to sell family homes to fund care.”

She said CHC can be a financial life-saver: “People who were told they were not eligible can challenge NHS decisions, even retrospectively.”

Stephen Lowe, director at retirement specialist Just Group, said CHC has a complicated application and assessment process, and a postcode lottery on implementation. “Its existence is not being disclosed to those actively trying to navigate the system, denying many the right to find out if their elderly relative is eligible for this hugely valuable support.”

Typically, long-term care residents must pay their own fees in full – known as self–funding – until their total assets (including the value of their home) falls before £23,250 in England. Even then they must contribute from means-tested income.

An NHS spokesperson said: “Eligibility for NHS continuing healthcare funding is determined on an individual basis by health and social care professionals in line with guidance and regulations set by the DHSC, to ensure there is a consistent approach across the country.

“Eligibility is based on primary health need and not on a specific medical condition, disease or diagnosis.”