Funded Nursing Care

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NHS Funded Nursing Carein Nursing Homes

What it means for you

A Guide for People Living in or GoingInto Nursing Homes, their Families and

their Carers


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Assessment a comprehensive examination ofyour health and social care needs carried out bya team of professionals (doctor(s), nurse,occupational therapist, social worker, and othersas appropriate). There will be an assessment of

all your individual health and social care needsby the NHS and council to decide what type ofcare you need. Separately, the nursing home mayneed to carry out an assessment to make surethat it is the right home for you. A NHS

registered nurse will be involved who will beable to assess the extent of any registered nurseinput required for your care. Yourself, yourrelatives and/or your carers will have theopportunity to be involved in each stage of theassessment process if you wish and should

receive copies of:

q A statement describing whatyou need tomaintain your health and social care;

q A written care plan, setting out precisely

whatyour health and social care needs areand how they will be met; and

Glossary of Terms Used inthis Leaflet


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q A care package, which explains howyourhealth and social services will be deliveredto you and by whom (e.g. the involvementof therapists) in any setting.

Care assistant someone who assists nurses andother professionals in caring for people.

Care homes residential or nursing homes orhomes that provide both types of care.

Continuing NHS Health Care is a packageof health care that is arranged, provided andfunded solely by the NHS. It can be providedin hospital, peoples own homes or in nursing

homes. In a nursing home the NHS will meetall the fees. Each health authority will takeaccount of the nature, complexity,unpredictability or intensity of your medical,nursing or clinical needs.

Intermediate Care a range of short-termtreatment or rehabilitation services, withappropriate care support, designed to promoteindependence, particularly for older people.It is provided in a variety of settings, includingpeoples own homes. These services aim to

reduce the length of time people stay in hospitalunnecessarily when they are able to stay at or


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return home, and provides services designedto ensure they are able to cope independentlyagain both physically and emotionally, as soonas possible.

Periods of intermediate care are free and usuallylast no longer than 6 weeks and often no morethan 1 to 2 weeks.

Nursing care in this leaflet, nursing care meanscare by a registered nurse in providing, planningand supervising your care in a nursing home. Itdoes not include any time spent by any other staff,such as care assistants, who may also be involved in

your care. However, it would include the time

spent by a nurse in supervising the care you getfrom others and in monitoring any aspect ofyour care delegated to other staff. It is differentfrom personal care (see opposite).

Nursing home co-ordinator an identified person

within a Primary Care Trust, Health Authorityor council who is responsible for ensuring thatthe nursing needs of local nursing homeresidents are met. May act as a source of adviceto nursing home residents and their families.


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Patients Advocacy and Liaison Service (PALS) asource of information and advice in every NHSTrust from April 2002.

Personal care care that you need to help youkeep up with daily activities, such as help withgoing to the toilet and other personal needs suchas bathing, dressing and undressing, and help

with eating. It might also cover advice,

encouragement and supervision in theseactivities. Care assistants, rather than registerednurses, will usually see to your personal careneeds. Personal care costs are met either byyourself or by local authorities on a means-testedbasis so there may be a charge for this aspect of

your care, depending on your circumstances.Where the NHS is providing fully fundedcontinuing NHS health care, all care is providedfree of charge. Where you are receivingintermediate careall care should also be free

of charge.Preserved Rights to higher levels of income support People with these preserved rights were in acare home before 1993. From April 2002 they

will receive help from local councils rather than

as income support. The Department for Workand Pensions will be writing to everyone affectedbefore that date.


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Primary Care Trust a body providing primaryhealth care (doctors, dentists, etc) andcommunity health care (nursing andoccupational therapy services, etc) in a locality,accountable to the Health Authority. (Some maycurrently be known as Primary Care Groupsuntil they achieve trust status.)

Registered nurse means a nurse registered by the

United Kingdom Central Council for Nursing,Midwifery and Health Visiting and who hasqualifications in nursing, midwifery or healthvisiting recognised by the Council.

Respite care giving carers or family a break or

breathing space in looking after you, perhapsat home.


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There are some important changes thatare being made to the way in whichnursing care in nursing homes is paid for.

q The changes will affect anyone aged18 or over receiving care from aregistered nurse in a nursing home

q From 1 October 2001 the NHS will

pay for nursing care carried out by aregistered nurse for those whocurrently pay for it themselves

q From April 2003, the NHS willarrange care from a registered nurse for

everyone else in nursing homes whoreceive financial support from localcouncils

q All care home residents should beregistered with a local GP

1

Summary of the Main

Points in this Leaflet


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q These changes will not affect yoursocial security benefit entitlements

(including Attendance Allowance),except for those with preservedrights who currently receive higherrates of income support and who willbe supported by councils from April2002

NHS Funded Nursing Care in Nursing Homes

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(Some words may be unfamiliar. They arewritten in italics the first time they appearand can be found in the glossary at the front)

From October 2001, the Government isintroducing important changes in the waythat nursing care in nursing homes isarranged. From that time, people, whopreviously have had to pay for care from a

registered nurse, will have that care paid forby the NHS in England1. This group issometimes referred to as self-funders orfull payers.

From April 2003, the NHS will also become

responsible for paying for the care neededfrom a registered nurse by the following:

q Anyone who is getting support from acouncil towards the costs of theirnursing care; and

Introduction

1 The information in this leaflet applies to England only. Different arrangements will applyin Wales, Scotland and Northern Ireland.


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q Anyone who up to now has paid theirnursing home fees from benefits paid

to them by the Department for Workand Pensions (formerly theDepartment of Social Security). Thisrefers to those people with preservedrights to income support acquiredbefore 1993. (Further informationabout this group is set out below.)

Who The Information In ThisLeaflet Applies To

The information in this leaflet applies toanyone aged 18 or over who is currentlyreceiving care from a registered nurse in anursing home or who is assessed as requiringnursing home care after October 2001.

The NHS will continue, as now, to provideany specialist nursing care for instance,cancer, continence advice or mental healthnursing that you may need over and aboveany nursing care provided by the nursing

home.


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Some people in nursing homes alreadyqualify for continuing NHS health care,

where the NHS pays all the costs of careincluding accommodation and personal carecosts. This will not change.

If you are considering going into a nursinghome after 1 October, you can receive a

health and social care assessmentinvolvingthe relevant NHS and local councilprofessionals: a nurse, occupationaltherapist, doctor, social worker and others asappropriate. The NHS will be involved in

deciding whether a nursing home is theright place for you. If you wish, the NHSwill then pay for the care from a registerednurse that you need, when you have chosena home that can provide the care you need.

Equipment

The NHS will cover the costs of anyadditional equipment related to a healthcondition that nurses need for your care in

addition to the standard equipment that anursing home provides as part of its services.


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Residents ofcare homes(residential andnursing homes) should have access to the

full range of specialist NHS supportavailable in other care settings and at home:for instance, chiropody or physiotherapy, as

well as to the full range of availablecommunity equipment services, includingpressure relief mattresses, aids to mobility,communication aids, etc. For those fundingtheir own care, the NHS will pay forany continence aids that you need from1 October 2001.

Nursing Care in Residential HomesIf you are a resident of a residential homeand you require nursing care, the NHScommunity nursing service will usuallyprovide this direct. You will not need to payfor your nursing care, but you may need tobe assessed to make sure that your care cancontinue to be provided in your residentialhome.


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Access to a GP

If you are a resident of a care homeit isimportant for you to be registered with alocal doctor (GP) so that you can get the fullrange of available NHS services andprescriptions. If your care home is near to

where you used to live, you may want toremain registered with your existing GP. Ifyou are new to the area you will need toregister with a local GP. Some care homesmake arrangements with local GPs toprovide services to their residents and you

may wish to register with one of those.

You can also get access to a range ofappliances, including continence aids, as

well as to the domiciliary oxygen therapyservice by NHS prescription through your

GP or NHS nurse.

What you need to do

You do not have to do anything at all if

you want the NHS to arrange and pay for


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the care you need from a registered nurse.An assessmentof your needs may be

required.

If you are currently paying all your nursinghome fees, the Health Authority or localPrimary Care Trust closest to your nursinghome will be in contact with the nursing

home. They will arrange to pay the nursinghome for care you receive from a registerednurse.

If you do not wish the NHS to be involvedin your care you should inform the nursinghome co-ordinator.

People who fully fund theirown care

If you are resident in a home on1 October 2001

If you are in a nursing home on 1 October2001, your nursing home will automaticallyreceive a payment from the NHS to cover

the costs of your nursing care. You should


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continue to receive all the nursing care youneed and you will no longer need to pay the

nursing home for the care from a registerednurse, for which the NHS is paying. A NHSregistered nurse may visit you to determinehow much nursing care you need.Depending on the outcome of this, theNHS may need to change any payments itmakes to the home for your nursing care.

Your nursing home should reassess your feesto take account of the fact that the NHS iscontributing to your care. Nursing homes

will receive the NHS fees directly.

If you enter a nursing home after1 October 2001

If you are assessed as requiring nursing

home care after 1 October, a NHS nurseshould also have determined the level of carefrom a registered nurse that the NHS willpay for when you go into the home. You

will have been fully involved in that processand will have received a personal copy ofyour own care plan that will have explained


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what your needs are. A future date will havebeen set to review your nursing care needs.

If you have been assessed as requiring someother form of care whether residential,intermediateor care at home or at a daycentre but you or your family decide thatyou nevertheless prefer to go into a nursing

home, you will need to meet all of yourcosts yourself. In these circumstances, theNHS will not fund nursing care youchoose to receive. However, if your needschange, you can always ask for an

assessment to be carried out. The NHSwill fund care from a registered nursewhich the assessment confirms thatyou need.

Residents Supported by Councils

Between October 2001 and March 2003,your council will continue to pay thenursing home for all aspects of your care,including any nursing care. In most cases

you will be charged the same as before bythe council, because of your financial status.


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After April 2003

The NHS will become responsible for yournursing care from this date.

Your council will continue to pay thenursing home fees for all the other servicesyou need (including your accommodation

and anypersonal carecosts).If you have been in a care home since before

April 1993 and receive an increased rate ofincome support at apreserved rightrate, yourcouncil will assume responsibility for your

care management and all your care costs,including nursing care, from 8 April 2002.The NHS will become responsible forpaying for your nursing care from April2003. Your income support will be reducedto take account of these changes.

Will I receive any money for this?

No. Neither you nor your family will needto get involved in any of the financial

aspects of your nursing care. This will be the


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responsibility of the NHS, possibly the localcouncil, and the care home. You should no

longer be charged by your nursing home forthat part of your care which the NHS ispaying for, though you may wish to pay thehome for any additional services that yournursing home may provide that is not paidfor by the NHS.

If your nursing needs change

Anyone entering a nursing home afterOctober 2001 should have their nursing

needs reviewed, usually within 3 monthsand again after 12 months. There may alsobe circumstances where your needs will haveto be reviewed before then, for instancefollowing medical treatment. Your nursinghome will arrange for this. However, youshould always receive the nursing care thatyou need, even if it takes some time for theNHS to reassess you.


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Short Term Nursing Care

There may be occasions where you needto go into a nursing home for only a shortperiod of time, other than for intermediatecare:

q for respitecare;

q in an emergency or crisis, for instanceif your carer or relative is suddenlytaken ill themselves and they are notable to look after you;

q for a trial period to explore whetheryou would prefer to move into a carehome on a permanent basis (this

would not apply if you were already apermanent resident of a nursing home

and wanted to find a new one); orq if you need to move to a nursing home

for rehabilitation or while awaiting acare package that would allow you toreturn home.


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If your stay in a nursing home is expected tolast less than a few weeks you will not need a

full assessment. The reason you have goneinto the home will allow the NHS to decidehow much to pay the nursing home for yourcare from a registered nurse.

ComplaintsAny general complaints about servicesprovided in the nursing home should bereferred in the first instance to the nursinghome manager or, if you would prefer,

through the health authority/local authorityInspection Unit, until April 2002, whentheir functions are transferred to theNational Care Standards Commission.

A complaint about the nursing care paid for

or provided by the NHS can be made usingthe NHS complaints procedure. If you needhelp or advice about making a complaintyou should first speak to someone in thehome or, alternatively, contact the Primary

Care Trust or Health Authority. They will


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also be able to put you in touch with otherorganisations that can offer you advice or

support.

Appeals

Any concerns you or your family may haveabout the level of nursing care arranged bythe NHS should be referred directly to thenursing home co-ordinator. If necessary, theHealth Authoritys continuing care panelcan review the decision made by the NHS.

Advocacy ServicesAn advocate is an independent person whowill act on your behalf and represent yourinterests to another party, be it a nursinghome, the NHS or a council. An advocatehas your interests at heart and is skilled athelping you present views that you may finddifficult to express yourself. From April2002, nursing homes will need to assistresidents in gaining access to advocacy

services. Your local Primary Care Trust,


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Patients Advocacy and Liaison Service (PALS)from April 2002, local Health Authority or

your local council should also be able to putyou in touch with independent advocacyservices. You can obtain further informationabout these services through local voluntarygroups or Citizens Advice Bureau as well.

Social Security Benefits

The introduction of these arrangements forproviding nursing care will not affectanyones entitlement to social security

benefits received while in a nursing home.2

2 Those receiving higher rates of income support will have their benefits reduced when localauthorities support their care from 8 April 2002, and anyone who qualifies forfully fundedNHS continuing health carehas their benefits downrated as if they were in hospital.


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Who To Contact About NHSFunded Nursing Care In NursingHomes

If you have any queries contact your localHealth Authority.The telephone number

will be in your local telephone directory.

The Health Authority may then direct youto the appropriate person to deal with yourquery. Anursing home co-ordinator, whereverthey are based, will arrange for adetermination of your nursing needs to becarried out; will make arrangements forhealth and social care assessments to becompleted; and will arrange for a review ofyour nursing needs to be carried out if youfeel this is needed.


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Organisations,

Further Informationand Leaflets

Age ConcernAstral House, 1268 London Road,

London SW16 4ERTelephone: 0208 765 7200Email: [email protected]

Website: http://www.ageconcern.org.ukFreephone information line: 0800 009966

A national charity that cares about all olderpeople. It produces a range of Factsheetsdesigned to provide practical information forolder people.

Alzheimers Society

Gordon House,10 Greencoat Place,London SW1P 1PHTelephone: 0845 300 0336 (helpline)Monday to Friday 8.30am6.30pm,answerphone at all other times

Email: [email protected]: http://www.alzheimers.org.uk

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Produce factsheets and provide advice to sufferersof Alzheimers and their carers.

Action on Elder AbuseAstral House, 1268 London Road,London SW16 4ERTelephone: 0808 808 8141 (helpline) Monday toFriday 10.00am4.30pm, except Bank Holidays

Offer help and information about abuse of elderly.

Counsel and Care for the ElderlyTwyman House, Lower Ground Floor,16 Bonny Street, London NW1 9PGTelephone: 020 7485 1550 or 020 8679 8000

Provides advice and fact sheets for the elderly.

Help the Aged207221 Pentonville Road, London N1 9UZTelephone: 0207 278 1114

Fax: 0207 278 1116Email: [email protected]

Website: http://www.helptheaged.org.ukFreephone advice line: 0808 800 6565

A national charity dedicated to improving the

quality of life for older people in need of help inthe United Kingdom.


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The Elderly Accommodation Counsel46a Chiswick High, London W4 1SZ

Telephone: 0208 742 1182 or 0208 995 8320Produce booklets and provide advice onaccommodation for the elderly.

The Relatives and Residents Association

5 Tavistock Place, London, WC1H 9SNTelephone: 0207 692 4302Information and advice line: 0207 916 6055(Monday to Friday 10.00am12.30pm and1.305.00pm)

Practical advice and local groups for anyone withan elderly relative or friend receiving residentialor nursing home care. Membership is available toall relatives.

The Stroke Association

Stroke HouseWhitecross StreetLondon EC1Y 8JJTelephone: 0207 566 0300

Website: http://www.stroke.org.uk


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The National Care Standards Commission(Various offices countrywide)

A national organisation responsible for settingminimum standards that apply to care homes andfor monitoring their achievement. Fullyoperational from April 2002.

Further information:

Older People as Consumers in Care Homes.An Office of Fair Trading factsheet aimed atpeople thinking of moving into a care home isavailable by writing to the Office of Fair Trading,Fleetbank House, 26 Salisbury Square, London

EC4Y 8JX (Tel: 0207 211 8000 or 0870 60 60321 for orders of 10 or more)

Moving into a Care Home. A leaflet availablefrom the Department of Health, PO Box 777,London SE1 6XH or fax 01623 724 524


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The National Service Framework for OlderPeople, Department of Health, 2001, available on

the Departments website:http://www.doh.gov.uk/nsf/olderpeople.htm

Better Care, Higher Standards A charter forlong term care available from Department ofHealth, PO BOX 777, London SE1 6XH. Each

health authority and local council has a localcharter on long term care that you can obtaindirect from them.

Documents

Funded Nursing Care