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19 Community care

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1. Introduction

2. Who decides what sort of care I need?

3. Who pays if I get care in my home?

4. How much will I have to pay?

5. What if I am coming out of hospital?

If you are in an NHS hospital, you should be assessed before you leave to work out what support or services you may need.

This assesment looks at whether:

  • your needs mean that the NHS should remain responsible for 'continuing care' (even if you go into a care home or return to live in your own home) ;
  • you need to do into a care home with social services support (with or without some nursing care); or
  • you can go home and get the health care you need as an outpatient, in your own home or at a local centre.

In England, the hospital must tell your local social services department if you are likely to need care services after leaving hospital. If you are coming out of hospital where you were receiving ‘acute care’ (for example, after an operation or treatment following an accident), your local council must carry out a care assessment within strict time limits and put together a care plan so that it is safe for you to leave hospital. If you have a carer, the care plan must consider their needs.

After you've been assessed you should be given written details of:

  • how much you are likely to have to pay for care after you leave hospital;
  • any benefits you may be able to get; and
  • which parts of your care will be arranged and paid for by the NHS.

If you are unhappy about plans for you to leave hospital, you can use the NHS complaints procedure (see ‘What if I have a problem with NHS care?’). 

Local NHS authorities, like councils, have limited budgets. They can decide, within limits, what services they can afford and who will get them. Strategic Health authorities, primary care trusts (in England) and local health boards (in Wales) must publish a 'continuing care statement' describing the services they will give  patients who have 'non-acute' needs (people who are in longer-term or respite care, for example). This statement should explain how the authority decides which patients will qualify for NHS support.

If, for example, you are in hospital and are assessed as needing to go to a care home that provides nursing care, you could ask your local primary care trust or health board to pay for this care because you come within its 'continuing care eligibility criteria'. If it agrees to this, it will pay all the home’s fees and you will pay nothing.

If your assessment shows you need some nursing care in a care home, but not the kind that qualifies as ‘continuing care’, you will get some NHS help with the fees if you want it – but only to cover those parts of nursing care that require a registered nurse (see ‘What if I need nursing care?’).

If you qualify for other specialist NHS ongoing healthcare services as an outpatient such as diabetic advice, physiotherapy or chiropody, these will be free whether you get them in your own home, at a day centre or in a residential or nursing home.

What if I don't agree with what has been decided for me?

If your assessment says you don't qualify for NHS continuing care and you don't agree with this, you may have a 'right to a review' of the decision by an independent panel of people arranged by your strategic health authority. But this panel will not look at whether the policies are fair, only at whether the rules have been applied properly to your case.

You should not have to leave NHS care while your review is taking place, which should happen within two weeks of you asking for it. You should receive the result of the review in writing. If you're not happy with its findings – or if you think the continuing care rules themselves are the problem - you can complain using the NHS complaints procedure (see 'What if I have a problem with NHS care?').

Normally you can also refuse to leave NHS care to go into a care home if the NHS will not pay for your care. You cannot generally stay in an NHS hospital for an unlimited time, though, so all the organisations involved should try to find suitable alternatives. These could be, for example, a package of services that mean you could go back to your own home.

You can ask to be reassessed by if your situation changes and you think you may now meet the rules for NHS continuing support.

6. What happens if I need to move into a care home?

7. What if I need nursing care?

8. Will I have to sell my home?

9. What benefits may I claim?

10. What choice of home do I have?

11. What if I want to move to a care home that costs more than the council will pay?

12. What if my move into a home is temporary?

13. What rights do I have when I am in a care home?

14. What if I have difficulty getting the care I need?

15. Further Help

16. About this leaflet

This leaflet is published by the Legal Services Commission (LSC).  It was written in association with Sue Bloomfield, a freelance consumer affairs writer.

The leaflets are regularly updated but the law may have changed since they were printed so the information in them may be incorrect or out of date.

Leaflet Version: May 2019

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