Providing bespoke care nationwide for clients with spinal injuries and neurological conditions
What are the different types of funding available for spinal injury and neurological care, and what’s the best way to get funding?
Spinal injury, neurological rehab and ongoing care and support are extremely specialist, complex and multi-faceted. No two people are the same, and everyone has their own priorities and their own ways of living their life. When it comes to making decisions about ongoing support, choice is key.
Having choice over the way you are helped to live your life is such a basic and fundamental need that it is essential that funding shouldn’t restrict the way you live your life but rather enhance it. There’s a lot of information out there detailing the kinds of funding available, but it can seem daunting and complicated, right at a time when things need to go smoothly.
Here at Total Community Care (TCC) we want to ensure you’re getting the right funding to help you get the support you need to live the life you want. These are uncertain times, as political priorities realign and budgets for health and care are under scrutiny. The opportunities for funding are not always guaranteed to stay the same and we will always endeavour to be abreast of the changes to point our current and future clients toward the best financial advice for their needs.
From a pragmatic point of view, getting the right funding in place will allow for the best package of care in your own home. This should cover the whole 24 hours and all of your identified care and rehab needs. Such packages not only enhance your life and independence, but also reduce the likelihood of unnecessary admissions to hospital or extended stays within them.
The extent of your needs will influence the kind of help and care you are entitled to. The presentation of your needs is crucial in accessing the correct funding. Accessing all the funding that you’re entitled to can give you the freedom to make choices – to choose care coordinators with experience in your condition, to choose your own priorities, to choose the people you’re comfortable with allowing into your home, to choose the opportunities you follow.
The routes for funding ongoing care needs can seem complicated; there is a mixture of resources available from different authorities – local government, various NHS initiatives, personal health insurance and more. Everyone should be able to request an assessment for care funding and have the ultimate decision regarding the direction their funding takes them and the care they receive.
The current opportunities for help towards funding are, in a nutshell:
Statutory funding can come out of one of two state budgets – the budget for health, and the budget for social care. Obtaining funding involves an assessment of your needs before a decision on the level of funding you are eligible to receive can be calculated.
Specific complex and long-term health needs are met by NHS funding, whereas social care needs may be funded by local authorities. It is important to note a vital distinction in that NHS funding is free whilst that which comes from Local Authorities (most often Social Services Department) is means tested. It is entirely possible to receive a jointly funded package to provide for both your health and social care needs.
Some individuals who receive only social care funding might receive it through Direct Payments. This again intends to allow the individual as much flexibility as possibility in choosing the right care for themselves.
Statutory health funding may be accessed through the Clinical Commissioning Group (CCG) through Continuing Healthcare (CHC). Eligibility for this type of funding is based on specific objective criteria relating to the intensity, nature, complexity, and unpredictability of your condition and needs. At some stage there is an assessment process involving a Decision Support Tool (DST) which looks at your needs in a range of areas or domains.
Ongoing basic care needs which are considered out of the remit of NHS funding for nursing and specific or complex health care are met by a social care budget, and can include help with things like looking after your home, cleaning, shopping and cooking, as well as personal care and other aspects of supported living. These costs are met by your local authority, and local council websites can offer some specific guidance for your area.
A health and social care assessment can be daunting, and it is likely to lead to a decision that impacts significantly on your life and health. It is possible to challenge any decision that you feel is unfair or wrong, and there are clear routes in place for you to do this.
Statutory funding can help meet any needs either at home or, if it is more appropriate, in an assisted living or care facility. There has been a huge drive towards holistic, individualised care and flexibility in the services offered by care managers, teams and organisations.
Many individuals can find the process of accessing the correct funding for themselves, or a loved one, a daunting process. There are a range of advocacy services that exist to support people through this process and it might well be useful to consider using their services.
A Personal Health Budget (PHB) is an NHS initiative to use the money needed for care in a different way, giving the individual far greater control over the care they receive. This control is largely based upon the freedom and flexibility in how to spend the funding in an agreed way that is best suited to your individual circumstances.
The individual should be central to development of care plans in any situation and all decisions should be led by the person needing support. Good care is well planned, goal-oriented and adaptable, and a thorough appraisal of both needs and desires should inform plans. Care managers and teams are there to ensure that the individual understands all the options available, how they can be tailored to their needs, and how their PHB can be used to best achieve realistic goals and desired lifestyles.
Everyone who has ongoing health care needs which are eligible for CHC funding should now be offered a PHB. In exceptional circumstances, where people are unable to make clear choices for themselves, their care budget can still be met with a PHB through a third party.
There may be limits to the statutory funding you receive that mean you have a shortfall in some care or treatment you want. In theory, any real care needs should be met by statutory funding and the proforma for making these decisions should not allow for interpretation on the part of the assessors. If funding covers, for example, your social care needs but does not stretch to an aspect of rehab or treatment, it may be possible to self-fund for that part of your care. Experienced TCC advisors are available to discuss your care needs wherever your funding comes from, and offer a wide range of services and links to the appropriate specialists for you.
For some individuals with injuries arising from an accident, legal action may be appropriate resulting in a settlement or payment covering costs of ongoing health and social care needs, as well as loss of income, adaptations to your home or accessible housing, and other financial impacts. Where your care needs are met through a legal or insurance settlement, this will be treated by CCGs as self-funding.
There may be other additional funding still due to those with ongoing care needs; so there’s no need to compromise on your quality of life. TCC has a great deal of experience working with individuals who have sustained such an injury wherein there might be a compensation claim. TCC has a close working relationship with a number of expert case managers and legal firms in assisting the injured individual getting the correct amount of financial compensation for their future care,
An initial assessment for eligibility for statutory funding can be completed by a healthcare professional or social worker involved in your care. Often this is done in hospital or another care facility, and can be arranged by the staff there. There is often a delay between being medically fit for discharge and having appropriate care in place to go home with, and it is in everyone’s best interests to keep this delay to a minimum. This initial appraisal will trigger eligibility assessment for Continuing Healthcare, NHS funded nursing care, or local authority funded social care.
If the initial assessment finds that the person may be eligible for care funding, a secondary assessment is undertaken, with a more complete picture gained of the person’s needs. At this stage, a local authority care manager with a background in health or social care will become involved and can begin to help make arrangements for the most appropriate package of care to enable a timely discharge from hospital.
If the individual who may be eligible for funded care is already living at home – with or without care – or in a nursing home or other care facility, their GP or social worker, can start the assessment process, or anyone can contact their local CCG directly to ask for an assessment. Guidelines state that the assessments should be performed as soon as possible, and a decision made within 28 days.
Being assessed as eligible for a larger care package or being entitled to more funding towards care should not negatively impact on the care already being received. Having a PHB means that care can come from the same providers, just with a different funding stream.
Personal Independence Payments (PIP), which replace the Disability Living Allowance (DLA) are not designed to cover care needs and are an entirely separate assessment and undertaking to the funding for care needs. PIP is, however, another state allowance designed to make life easier for people with extra needs, and so it is worth bearing it in mind when accessing the help available to you. PIP requires a separate assessment arranged by your local benefits office and entitles you to support with costs for travel, council tax and more. Being eligible for care funding does not automatically make you eligible for PIP, or vice versa.
Having the funds to get the care and support you’ll need going forward means that you can choose the right care.
TCC is a specialist care provider with a great wealth of experience in providing bespoke complex care packages, often of a health nature, to support individuals in their own homes. All of our individuals have access to registered nurses employed by TCC to ensure that its staff is fully competent in meeting a range of needs including ventilatory care. All staff receive highly evaluated training specific to the individual needs of the client they are contracted to work with.
TCC , if appropriate to your situation, can help by assigning you a personal care manager who will help you to assemble a team of specialists and carers to best suit your needs. We take pride in ensuring that everyone we work with is well trained, experienced, and actively interested in their specialty, and in enabling our clients to take an active role in choosing their own team.
Getting you home or to the most appropriate place of care should be the priority of everyone involved in this process, and we believe that arranging a safe, specialist care team is the most important part of that.
TCC helps people living in England, Scotland or Wales to make informed decisions about their care and choose the team that’s right for them. We believe that people should have choices over who they welcome into their homes and about the partnerships they create to cover their care needs, which can be intimate and all-encompassing. TCC are proud of the fact that its services have only ever been evaluated as good or outstanding by the Care Quality Commission (CQC).
We value our employees and have stringent recruitment and training process to ensure we only provide the absolute best care. We offer solutions to cover all the hours you may need care, including on holidays and throughout hospital stays. It’s your life, so you take the lead.
Choosing the right care provider is one of the most important decisions you can make, and our advisors are on hand to answer any of your questions and make every part of your journey as smooth as possible.