Guide to Funding of Care and Welfare Benefits
Acute healthcare in hospital
Following a severe brain injury, it is likely that you or your loved one will have undergone hospital treatment immediately following the injury. Following a relatively short period of rehabilitation, the options available to patients depend on a number of different circumstances. We hope this short guide will provide you with some information to help you navigate the next part of your journey.
Continuing NHS Healthcare in England
The NHS has a statutory obligation to provide (and fund) ongoing health needs to those brain injured individuals with on-going healthcare needs. These needs will be assessed according to a national framework of criteria. The assessment will usually be carried out by the multi-disciplinary team involved in the care of the patient as part of the discharge planning process. The team will consider the patient’s healthcare needs by reference to the Checklist Tool which scores the patient against various criteria: behaviour, cognition, psychological/emotional difficulties, communication, mobility, nutritional needs, continence, skin integrity, breathing difficulties, medication needs, level of consciousness, and other deficits. The team will discuss each of these areas and agree scoring which forms part of the Decision Support Tool. The scoring takes account of the nature of the deficit and its intensity, its complexity and unpredictability. If the patient meets the required level of need, then the NHS will have to fund ongoing medical care for the patient. While the funding is provided by the local CCG (Clinical Commissioning Group), the criteria set are nationally set- not local standards.
As with all NHS Care, Continuing Healthcare funding is NOT means tested.
A patient is entitled to be present at the MDT meeting when this assessment is carried out and you may wish to attend to ensure that the healthcare professionals have as much information as possible.
These rules apply in England. Slightly different rules apply to patients in Wales, Scotland and Northern Ireland.
What does Continuing Care Funding Provide?
Funding will often provide a placement at a specialist neurological rehabilitation centre or care home. Your CCG will have contracts with local care homes but will try to accommodate the wishes of the family if possible. The funding will meet the care home costs and the therapies that are needed such as physiotherapy, occupational therapy and speech and language therapy. As with all NHS services, resources are stretched so often the therapy is less intensive than it was while the patient was in hospital.
Appeals against Refused NHS Continuing Care
The CCG will notify you of the decision as to whether ongoing care will be funded. If the patient is deemed to not meet the required criteria for continuing healthcare funding, it is possible to appeal that decision. Upon being notified of the refusal, you are entitled be provided with the reasons for the decision. If you disagree with the decision and feel that the criteria have not been correctly assessed against the checklist, then you should ask the CCG to reconsider the case. If they still refuse to provide funding, you are entitled to have the matter adjudicated by the Parliamentary and Health Service Ombudsman whose website is at: https://www.ombudsman.org.uk/
Local Authority (Council) Funded Care (Social Care)
If you/your loved one does not meet the criteria for NHS Continuing Care, the council for the area where the brain injured person lives may provide care and support if they have a limited ability to pay for the services themselves.
As some of the services are means-tested, the local authority will carry out a financial assessment to determine whether any contribution has to be made. This assessment looks at income (including some benefits) and capital (including the value of the equity in the home owned by the applicant). Here, the council can consider any capital that has been spent or given away if it was done to avoid it being taken into account for the purposes of financial assessment.
The financial assessment depends on whether you are going into a care home or receiving care in your own home. If you are going into residential care, the local authority must ensure you have enough spare money (known as a Personal Expenses Allowance) to pay for essential personal items (toiletries, clothes etc); whereas if you are going to be receiving care at home; you are allowed sufficient income to cover your living expenses as well (this is known as the MIG- Minimum Income Guarantee).
If you believe that your financial assessment is wrong, you can challenge the means test method using the council’s complaints process.
If you meet the financial criteria, for some or all of your care, you will be given a Personal Budget. Here there are two options:
1. The council provides and pays for a care package directly to you, (either by using its own staff or by contracting with a care agency); or
2. Pays money directly to you in the form of Direct Payments – to enable you to purchase a care package.
Freedom of Choice- Do I have to go to a particular care home chosen by the council?
This is a very common question, we often hear at Brain Injury is BIG. Yes: you do have a freedom of choice.
Firstly, it is important to consider whether you need to rely on state funding at all. If you have a compensation claim, it may well be that the claim can include the cost of care (which could be a care package at home). Please see our guide to compensation claims.
If, however, you are dependent on local authority funding, the council must give you at least one option (usually more than one) that is covered by your personal budget. If you don’t like the recommendation made by the council and you have a different preference, ask you council to see whether this is possible (as quotes given by care homes are often negotiable).
If you still prefer a care home that is more expensive than your personal budget and you are willing and able to pay the difference by what is known as Top Up Payments, then this is possible. But remember that the local authority can never require you to pay a top-up payment and must give you at least one choice within the amount set in your personal budget.
Free support from the local authority
In addition to funding care, subject to need, the council must also provide for community equipment, minor adaptations to your home and reablement without charge.
Community equipment means items specifically designed to make daily life easier for you examples include communication aids or special equipment to help you feed yourself. It does not usually include “ordinary equipment” that non-disabled people may use but each case is assessed on its own merit.
Minor adaptations to the home costing less than £1,000 are provided by local authorities at no charge. Examples might include grab rails to make it safer to get in and out of a bath, raised toilet seats or adaptations to make the bed easier to get on and off. If the adaptation will cost more than £1,000, you may be eligible for a Disabled Facilities Grant (see below)
Reablement services are meant to help people adapt to a recent illness or disability by learning or relearning the skills necessary for independent daily living at home This can include the training and support of relatives or carers to help you live more independently and is usually free for the first 6 weeks.
Entitlement to state benefits for disability is both complex and forever changing. The following information should serve as a guide only but you will need to seek advice on your own individual circumstances.
The first question to consider is the applicants age:
• Children under 16 are entitled to claim Disability Living Allowance
• Adults 16-64 are entitled to claim Personal Independence Payments
• Adults 65+ are entitled to claim Attendance Allowance
Personal Independence Payments
PIP is made up of two components:
1. Difficulties with activities of daily living; and
2. Difficulties with mobility
You may be entitled to the daily living component if you have difficulties with things like: preparing or eating food
• washing, bathing and using the toilet
• dressing and undressing
• reading and communicating
• managing your medicines or treatments
• making decisions about money
• engaging with other people
There are 2 rates depending on the severity of impairment. The current weekly rates are £55.65 (standard rate) or £83.10 (enhanced rate)
You may be entitled to the mobility component if you have difficulties with getting about such as walking or transferring into and out of a chair. The current weekly rates are £22 (standard rate) or £58 (enhanced rate).
A claim for PIP is made to the DWP (Department for Work and Pensions) and is subject to a medical assessment.
Disabled Facilities Grant
If you need major adaptations to your property which exceed the £1,000 limit of minor adaptations, you may apply to your local authority for a Disabled Facilities Grant (DFG). This might cover work such as widening doorways, installing ramps, a stairlift, or downstairs wet room. A Disabled Facilities Grant won’t affect any benefits you get. Grants are means-tested but can be up to £30,000 in England so are worth considering. If you live in rented accommodation either you or your landlord can apply on your behalf. Your council will arrange for an occupational therapist to visit you at home to assess the merits of the application.
Employment Support Allowance
If you are unable to work by reason of your disability, you may be entitled to ESA. This is a means-tested benefit and will take account of your capital savings and yours and your partner’s income. There is no entitlement to ESA if you have capital savings of £6,000 or more (but note that certain capital is disregarded -including compensation monies that have been put into a personal injury trust). The application process involves a Work Capability Assessment to ensure that you are incapable of working.
The amount you are entitled to claim changes after the first 13 weeks and then depends on whether you are in the work-related group or support group, whether you are additionally entitled to the enhanced disability premium or severe disability premium.
If you care for someone (who is in receipt of the daily living component of PIP, or certain other benefits) for at least 35 hours a week then a claim for carer’s allowance (currently £62.70 per week) may be claimed. You do not have to live with the person you care for nor be related to them. A claim could affect the other benefits that you or the person you claim for get (including ESA) and your receipt of carers allowance is treated as income for tax purposes.
Vehicles and Transport Benefits
We draw your attention to the following:
• Blue Badge Parking Scheme – this is not just limited to drivers but applies to disabled passengers with severe walking difficulties. The scheme details are at: www.gov.uk/apply-blue-badge
• Motability Car Leasing Scheme -. If you are in receipt of the enhanced rate of mobility component of PIP (or equivalent) , you may be able to use this to lease a car under the Motability Scheme – go to www.motability,co,uk
• Vehicle tax exemption – You can apply for exemption from paying vehicle tax if you get the higher rate mobility component of Disability Living Allowance or enhanced rate of PIP. If you are on the lower rates, you can apply for a 50% reduction.
• Dial a Ride and public transport– Your local council may operate a taxi scheme for disabled people. Check you own local authority’s website as services vary from one council to the next. You might also qualify for a bus pass or disabled person’s rail card – go to: https://www.disabledpersons-railcard.co.uk/
You may not have to pay VAT on products designed or adapted for your own personal or domestic use. Also, you won’t be charged VAT on the installation and any extra work needed as part of this, repairs or maintenance and spare parts or accessories. This includes having a vehicle adapted to suit your condition, or on the lease of a Motability vehicle. Make sure your supplier knows that you are disabled so this can relief can be claimed.
Brain Injury is BIG Grant Scheme
Don’t forget to check out our own grant scheme which may provide some financial assistance.