Assessments for NHS-funded nursing care
People with dementia living in nursing homes should have their nursing care provided by a registered nurse free of charge by the NHS, through funding known as the registered nursing care contribution (RNCC). This factsheet looks at eligibilty for RNCC and addresses frequently asked questions on the topic. This information applies to people receiving care in England. Different arrangements apply in Wales, Northern Ireland and Scotland.
Since 2001, people receiving nursing care in a care home have been entitled to the registered nursing care contribution (RNCC); a sum of money paid by the NHS to the care home for the care provided by a registered nurse.
The RNCC is only used to pay for nursing care. The person is still responsible for paying the cost of their accommodation, board and personal care, although people with limited income and capital may be entitled to financial support from social services.
Until 30 September 2007, the RNCC was paid according to the level of a person's nursing care needs; referred to as high, medium or low needs. The higher the need, the higher the sum paid. Since 1 October 2007, a single rate of payment RNCC has replaced the three bands.
People who were categorised in low and medium bands prior to 1 October 2007 were moved immediately onto the standard weekly payment. Any person who was receiving high-band funding continues to receive this higher level of payment until their case is fully reviewed. If, on review, the person:
- has needs that would have previously been medium (stable and predictable) or low, they will move on to the new, flat-rate payment
is eligible for NHS continuing healthcare (fully funded NHS care) then the RNCC payment will cease.
The National Framework
Since 1 October 2007, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care has been implemented. The national framework simplifies the interaction between the process for the assessment of NHS continuing healthcare (fully funded NHS care) and the RNCC assessment. In all cases, a decision about eligibility for NHS continuing healthcare must be made before considering the need for the RNCC.
If a person does not qualify for NHS continuing healthcare, the need for care from a registered nurse should be considered. The assessment should consider whether the person's needs would be most appropriately met in a care home providing nursing care (and, therefore, if they are eligible for NHS-funded nursing care).
Frequently asked questions
What is the difference between NHS continuing healthcare and NHS-funded nursing care?
NHS continuing healthcare is a complete package of ongoing care arranged and funded solely by the NHS, for those assessed as eligible. It can be provided in any setting. If the person lives in their own home, the NHS will fund all the care and support that they have been assessed as needing. The care may be provided in the person's home or not, depending on what has been decided to be most appropriate in the care plan. If the person lives in a care home, the NHS will make a contract with the care home and will pay the full fees, including for accommodation and care.
NHS-funded nursing care is the funding provided by the NHS to care homes providing nursing, for the provision of nursing care by a registered nurse.
How is a decision made about NHS-funded nursing care?
When a person is in a care home which provides nursing care, or about to move into such a home, they should be assessed for their nursing care needs. The assessor must first consider whether the person has a primary health care need and would be eligible for NHS continuing health care (fully funded NHS care). If they conclude the person is not eligible, the assessor should then decide whether registered nursing care in a care home providing nursing is the best option.
The assessor will be a registered nurse and will try to answer the following questions:
- Does the person have registered nursing needs at a level where they require a care home providing a nursing care environment?
- Do they want or need to be in a residential setting, or is another option more appropriate?
A nurse making this decision should take into account all the individual's nursing needs, based on what is known about their condition and their usual behaviour over the course of a week, or a number of weeks. They should also consider the potential outcomes if support were not provided, or were provided in different ways, and should focus on the impact of any decisions on the person's independence, and risks involved for the person, their family and others close to them. This should be recorded in a care plan. Once the person is assessed as eligible, the home will start to receive the RNCC from the NHS.
What is the difference between a care home registered to provide personal care and a care home registered to provide nursing care?
Care homes registered to provide nursing have a registered nurse present at all times. This is not required for care homes which provide personal care only. Ask the manager of the home what kind of care they are registered to provide. Dual-registered homes no longer exist, but homes registered to provide nursing may accept people with personal care needs who may need nursing care in the future.
The nursing care assessments are not carried out in care homes registered to provide personal care only, because people in these homes should have their nursing needs met by the NHS through a visiting district or community nurse and GP service.
How is 'nursing care' defined?
Rather narrowly. It is defined as 'care provided, delegated, monitored or supervised by a registered nurse'. This does not include the care provided by a nursing or care assistant, even if that care is delegated or supervised by the registered nurse. In this context, it is the act of supervision or delegation that is classed as 'nursing', rather than the care itself. Personal care is not defined.
What impact does this assessment have on attendance allowance and disability living allowance?
The introduction of the RNCC in care homes does not affect the level of attendance allowance received by residents if they are funding their own care, but if they receive public financial support, such as from social services, attendance allowance or disability living allowance will stop after 28 days.
Will anything else be taken into account when assessing the registered nursing care contribution?
Yes. The results of other care or needs assessments and the care plan will be taken into account, and the nurse carrying out the assessment may also talk to other professionals involved.
Do I have to arrange the assessment?
No. The NHS will automatically arrange an assessment. The money will be paid straight to the care home.
Will I see a reduction in my fee if I am self-funding?
When a person moves into a care home they should be given a contract setting out the terms and conditions. This would show:
- the cost of accommodation, board and personal care
- the cost of nursing care by a registered nurse.
If the contract includes the RNCC element, the amount payable by the resident is reduced, as the NHS pays that element. However, some care homes contract with the resident only for the cost of accommodation, board and personal care and have another contract with the NHS for the RNCC so there will be no financial benefit for the resident.
What if I am partly self-funding?
Very few people who are partly self-funding are likely to see a reduction in their fee. Where the fee is split between the resident and social services it is likely that social services, and not the resident, will have its fee reduced.
What if I'm unhappy with the assessment of the registered nursing care contribution for my care?
Challenges to decisions about eligibility for NHS-funded nursing care will be dealt with by the local primary care trust according to their local disputes process in the first instance. The individual's rights under the existing NHS complaints procedure remain unaltered.
Last updated: November 2010
Last reviewed: November 2010
Reviewed by: Caroline Beilanska, Director, Solicitors for the Elderly
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