Confusion over NHS funding eligibility for dementia care

Recent adverts and media reports about being able to get NHS continuing healthcare funding have left many people confused about their eligibility. Helpline Adviser Jack Gillis explains the facts. 

'I saw a television advert saying that people with dementia are entitled to an automatic care home fee refund. Is this true?'

The helpline has received a lot of questions like this recently. Although some people may be eligible for NHS funding, there is no automatic entitlement to a care home fee refund.

New deadlines were announced earlier this year for people to appeal against decisions about their entitlement to NHS continuing healthcare funding. A number of companies have been advertising legal and financial services to help make a claim, but many people have been left with the wrong impression after seeing these adverts and associated coverage.

Not automatic

NHS continuing healthcare funding is complicated. It is provided if you are considered to have a 'primary need' for health care and this relies on the distinction between social care and health care. Social care is funded by individuals or social services, while health care should be funded by the NHS. Individuals may be awarded NHS funding when they are considered to have an 'overall need' for health care.

People with dementia are not automatically entitled to NHS funding. Although some people may be eligible, a large number will not be - this is why some people may have found the adverts and media reports to be misleading.

Continuing healthcare funding is given when people meet criteria set by the NHS and undergo an individual assessment. In the past some people with dementia have not been assessed when they should have been or have been assessed incorrectly.

Making a claim

People can make a claim for NHS continuing healthcare funding without any legal assistance. It's important to remember that companies advertising their services are businesses and will charge a fee.

Anyone concerned about this subject should have a look at the Society's information in the first instance.

In some cases we can also help by putting people in touch with our specialist support group of volunteers, who are often successful in supporting people to appeal to the NHS when funding has been withheld or withdrawn.

Readers beware

Coverage of dementia in the media can be misleading at times. Newspapers can gloss over an issue or overemphasise some aspects to be more appealing to their readers.

Our aim on the National Dementia Helpline is to give clear and honest information in a safe and supportive way.

You can find out more about eligibility for NHS continuing healthcare funding and appealing a decision, and you can download our leaflet When does the NHS pay for care? To order a free copy of the leaflet, please email [email protected].