Withdrawal of NHS Continuing Healthcare

noclaf

**Long post warning** just an FYI for anyone who is kindly willing to read the whole post!

My father lives in a nursing home (since 2012) and has been in receipt of NHS Continuing Healthcare (CHC) (since he has lived at the nursing home to my knowledge). He was recently referred for an assessment of eligibility for CHC and the CCG has determined he is not eligible for CHC but will receive NHS Funded Nursing Care (FNC). A 'Decision Support Tool' was used by the CCG to make the decision. I did not attend the assessment due to work commitments.

Prior to being moved to the nursing home he was in residential care, the care home was shut down and the LA moved him to this nursing home, at the time they mentioned his care fees might need to be topped up but then confirmed it's all covered even though I wasn't aware how this was being funded. I now understand that CHC and possibly other funding (tbc) were used. My father has a long history of severe mental illness, was previously detained on multiple occasions under the s 3 MHA 1983 and as was confirmed in writing to me by the LA's legal team around 5 years back he was entitled to free after care services as this was an enforceable duty imposed by 117 MHA 1983 untill such a time that authorities are satisfied that he no longer needs these services. It seems that time has now arrived.

My father is bed bound, in his 80's and requires assistance with feeding, admin of medications and is deemed as not having any capacity at present.He needs 24 hr care with nursing based on his assessment (and I've seen that for myself based on his condition etc)

I do not have any oversight over my father's finances or any poa or deputyship etc I've never previously got involved with this side of his care etc

Here are the things that spring to mind for next steps, if I've missed anything please let me know:

1. Do I need to consider getting a deputyship for my father? I'm going through this with my mother and it's a long process but given his lack of caapcity doubt there are any other options. The LA have been acting as an 'apointee' for my father.

2. If the nursing care home fees have a shortfall as a result of the CHC withdrawal then will his pension or assets be considered? If a top-up is needed how will this be taken from his pension or assets, would I need to step in with a deputyship and administer? What if he is joint owner for a house (50/50) and the other joint owner still lives there? ( My mother and I live in the house, I am also a carer for my mother who has dementia).

- I don't know if other benefits are being received for my father or he might be elligible such as disability allowance but will check with the LA on this. Wondering if other benefits that my father is elligible for could also help to make up the potential shortfall in funding( if this is the case).

- What grounds would there be to appeal against the CCG decision? They have deemed he no longer has a primary care need but how can I verify their have followed the process to come to the decision correctly

- finally do I need to consider taking legal advice on any of the points raised above? I have no legal authority or oversight over my father, to have to undertake it while also dealing with the challenges of being a carer for my mother will not be easy so I'd rather not have to go through the hassle if possible but at same.time want to do the best by my father.

I have ideas about what I think I may need to do next but posting on here as hoping others who have knowledge or been through similar might be able to suggest how best to approach this all and if anything I have missed etc my father is frail and in his 80's and for this to happen now is quite stressful but trying to take a step back and deal with this as logically and pragmatically as possible so welcome any useful feedback or advice. Thanks

Keep_pedalling

As far as your home is concerned that will not be included in the calculation of care charges while your mother lives there. It will also not be included if this is also your only home and you are over 60.

Should your mother die before him or also have to go into residential care the house could come into the equation depending on your circumstances. Does your mother have a will in place that leaves her half of the house to you?

noclaf

Keep_pedalling said:

As far as your home is concerned that will not be included in the calculation of care charges while your mother lives there. It will also not be included if this is also your only home and you are over 60.

Should your mother die before him or also have to go into residential care the house could come into the equation depending on your circumstances. Does your mother have a will in place that leaves her half of the house to you?

Both parents (divorced) stated in their respective will's that their half of the property would be passed to me...however they did not break the joint tenancy in place on completion of the divorce  (house was purchased whilst they were still legally married) so this is something that I am already looking into with legal assistance. Not sure what can be done if anything but will explore options once deputyship is granted by the court of protection.

74jax

noclaf said:

Keep_pedalling said:

As far as your home is concerned that will not be included in the calculation of care charges while your mother lives there. It will also not be included if this is also your only home and you are over 60.

Should your mother die before him or also have to go into residential care the house could come into the equation depending on your circumstances. Does your mother have a will in place that leaves her half of the house to you?

Both parents (divorced) stated in their respective will's that their half of the property would be passed to me...however they did not break the joint tenancy in place on completion of the divorce  (house was purchased whilst they were still legally married) so this is something that I am already looking into with legal assistance. Not sure what can be done if anything but will explore options once deputyship is granted by the court of protection.

I'm a little confused. If they have a joint tenancy, how are they leaving their 'half' to you?  They don't own half? 
Are these home made wills? 

noclaf

74jax said:

noclaf said:

Keep_pedalling said:

As far as your home is concerned that will not be included in the calculation of care charges while your mother lives there. It will also not be included if this is also your only home and you are over 60.

Should your mother die before him or also have to go into residential care the house could come into the equation depending on your circumstances. Does your mother have a will in place that leaves her half of the house to you?

Both parents (divorced) stated in their respective will's that their half of the property would be passed to me...however they did not break the joint tenancy in place on completion of the divorce  (house was purchased whilst they were still legally married) so this is something that I am already looking into with legal assistance. Not sure what can be done if anything but will explore options once deputyship is granted by the court of protection.

I'm a little confused. If they have a joint tenancy, how are they leaving their 'half' to you?  They don't own half? 
Are these home made wills? 

They each own 50% of the property. They purchased the house together as a married couple. When the divorce was completed, there was a section to complete re severance of the joint tenancy..this was never done due to ill health of both parents at the time..dad was being shunted between hospitals and mum was undergoing depression so it got messy from an admin perspective. So as things stand each of their respective half share would not pass to me if one parent passes away.Hence I am looking at this aspect with a solicitor to see what options are available if any to unilaterally break the joint tenancy given its clear they both wanted/intended to pass their halves to me. However whilst I am looking into this with a solicitor, my expectation is the house may need to be sold at some stage, if not to help with dad's care fees then certainly mum's when her dementia progresses to the extent I can no longer support at home( we have carers in too) but there will come a point where it won't be practical to continue with home care. So I am working on a worse case scenario and planning accordingly e.g: house goes I need to find another place to live.
I've gone on a slight tangent here given complicated situation with both parents however in respect of this post, looking for advice solely regarding withdrawal of my father's CHC funding, the implications and the 'what to do next'.
To summarise the ask from my initial huge post:
- dad was sectioned over 15 yrs back under s117 and detained on a number of occasions in hospitals for treatment.
- LA then placed him in residential care, the care home shutdown and he was moved by LA to a nursing care home. He has been at the nursing home for 8 years and was receiving CHC funding, it's now been withdrawn on outcome of the review. I will speak to LA to find out what funding he receives (e.g:social care funding, DLA etc) but will also seek legal advice regarding the CHC withdrawal given his medical history and s117 obligations placed on the LA

gettingtheresometime

noclaf said:

74jax said:

noclaf said:

Keep_pedalling said:

As far as your home is concerned that will not be included in the calculation of care charges while your mother lives there. It will also not be included if this is also your only home and you are over 60.

Should your mother die before him or also have to go into residential care the house could come into the equation depending on your circumstances. Does your mother have a will in place that leaves her half of the house to you?

Both parents (divorced) stated in their respective will's that their half of the property would be passed to me...however they did not break the joint tenancy in place on completion of the divorce  (house was purchased whilst they were still legally married) so this is something that I am already looking into with legal assistance. Not sure what can be done if anything but will explore options once deputyship is granted by the court of protection.

I'm a little confused. If they have a joint tenancy, how are they leaving their 'half' to you?  They don't own half? 
Are these home made wills? 

They each own 50% of the property. They purchased the house together as a married couple. When the divorce was completed, there was a section to complete re severance of the joint tenancy..this was never done due to ill health of both parents at the time..dad was being shunted between hospitals and mum was undergoing depression so it got messy from an admin perspective. So as things stand each of their respective half share would not pass to me if one parent passes away.Hence I am looking at this aspect with a solicitor to see what options are available if any to unilaterally break the joint tenancy given its clear they both wanted/intended to pass their halves to me. However whilst I am looking into this with a solicitor my expectation is the house may need to be sold at some stage, if not to help with dad's care fees then certainly mum's when her dementia progresses to the extent I can no longer support at home( we have carers in too) but there will come a point where it won't be practical to continue with home care.

I think what 74jax meant was how is the house owned.
Is the house held with your parents as tenants in common or as joint tenants? If it's the former then they do own 50% so can leave their share to you or anyone they want. If it's joint tenants then in the death of one of them, the house automatically passes to the survivor.

noclaf

Owned as joint tenants at present so yes agreed, the house would automatically pass to the survivor if one passes. I don't know if it's possible to change this to tenants in common but am looking into this.

pmlindyloo

It is possible to appeal the decision that NHS continuing health care has been withdrawn.
A read of this link might be helpful:
https://www.continuing-healthcare.co.uk/continuing-healthcare-guidance/appealing-nhs-continuing-healthcare-funding-decisions
It is difficult to comment whether this would be successful or not.  The best I can suggest is to compare the criteria on which he was awarded it before, with the reasons why this is no longer the case (hope that makes sense)
I am not sure whether you would be able to make the appeal on his behalf since you do not have POA. It would seem sensible to apply for deputyship for your father.
If your father is no longer supported by NHS continuing care then the fees for the nursing home would have to be paid by your father through his pensions/any other income/savings.  The LA would do a financial assessment as regards the funding.
As already said the house could not be sold as your mother currently lives in it.
It is a complicated matter.
AgeUK may be able to help with any questions you have.
If you decide not to appeal the removal of the continuing health care decision then, as the LA are your dad's appointees, they will arrange for the financial assessment for the nursing home fees.  So, further information should be sort from them.

74jax

noclaf said:

Owned as joint tenants at present so yes agreed, the house would automatically pass to the survivor if one passes. I don't know if it's possible to change this to tenants in common but am looking into this.

OK. Going back to the will. If this was drawn up by solicitors I'd be going back to them. The very simplest of questions (how do you own the house) has not been asked. No solicitor would say a joint tenant owns half a house. They each own 100%. This would have me question the rest of the will.  Though not as pressing perhaps, but you need the will to be accurate and what each parent wants and to be fool proof if care homes are involved.  I'd be asking for a free review. 

noclaf

Parents wills were drawn up around 20 years back so I think it might be easier if I ask the solicitor I arranged who is helping with mum's deputyship application to look at everything holistically for mum and dad including the wills, situation with house and potential care fees then take it from there?
It's also a good point regarding the previous assesments that determined my fathers CHC funding would continue and why/what has changed since the last review (1 year ago).
I spoke to the LA's finance team recently who mentioned that they have no oversight over my dad's bank accounts or pensions so how exactly do they go about getting access for provision of his care funds or is this done automatically using the 'appointee' role they have been granted?

Keep_pedalling

74jax said:

noclaf said:

Owned as joint tenants at present so yes agreed, the house would automatically pass to the survivor if one passes. I don't know if it's possible to change this to tenants in common but am looking into this.

OK. Going back to the will. If this was drawn up by solicitors I'd be going back to them. The very simplest of questions (how do you own the house) has not been asked. No solicitor would say a joint tenant owns half a house. They each own 100%. This would have me question the rest of the will.  Though not as pressing perhaps, but you need the will to be accurate and what each parent wants and to be fool proof if care homes are involved.  I'd be asking for a free review. 

It sounds like the will was drawn up with the intention of severing the joint tenancy, but for various reasons neither parent did this. Unfortunately if neither parent has the mental capacity to do this then I believe that this can no longer happen.

If the OP if over 60 then this should not be to much of a problem, but if not it could get rather difficult for them.