Family of 82-year-old woman overpaid £6,300 to care homes, despite her receiving NHS CHC funding

The family of an 82-year-old woman with dementia has received a refund from her health care bills after paying unnecessarily £80 a month in additional benefits for six years.

Rosemary Hanlon, who lives at the Anchorage Nursing Home in Hoylake, Wirral, was eligible for full NHS funding due to her deteriorating health in 2016.

Before that, she was funded by her local government, and paid extra to fill a gap the council wouldn’t fund, even though she didn’t get an upgrade to her room or services.

After that, her family continued to pay the supplements on her behalf without realizing that the NHS would cover the bills for every aspect of her care that she had judged to be necessary.

The discrepancy was discovered by the new owner of the care home after it changed hands earlier in the year, and for the past month Ms Hanlon’s family has been trying to recover money on her behalf.

Her daughter, Annabel Collins, got in touch with This is Money after new owner RSJB Quality Care Homes immediately agreed to refund £320 but said it had only been responsible for overpayments since it was taken over in April.

Meanwhile, the previous owner, whose current business is called The Old Garden in Hoylake, Wirral, had replied that she was on vacation and would contact her when she returned.

After asking both care home owners for comment, The Old Garden paid Mrs Hanlon £6,000 but did not respond to us. RSJB’s statement is below.

The case highlights the need for families of those receiving full NHS care funding to ensure they don’t pay for something already covered – an issue Mrs Hanlon’s family told us they want to report in case it helps others .

“We feel like we had to fight and fight for my mother’s best interests throughout her illness. A fight that shouldn’t happen,” said Ms Collins, whose mother was diagnosed with early-onset dementia at age 64.

Paying tribute to her, she said, “My mother is a very special person. I know a lot of people say that about their mothers. This time it really is a true reflection of her. She raised four children when our father left her with four children under six.

“Why did we choose to challenge the system on her behalf, you may ask? We do it for our mother who is still physically with us, but whose love, support and true self for us were lost when this cruel disease took hold of her. We know she knows how much she is loved.’

Ms Collins says her family wanted to publish their story to warn people with relatives receiving NHS care who may not know what this funding should cover and needlessly top up.

About the reimbursement rules, she says, “Someone should have told us this years ago.”

Ms Collins and her family have complained to NHS Cheshire and Merseyside saying they had not informed them of the fees she would pay in the future if NHS CHC was awarded.

In their complaint they say: ‘We have not been discussed with us about the financing and care package of our mother. Also no recommendations were made to us as to what she was and was not responsible for paying.

“If an assessment had been made, it would have been noted that she paid a top-up fee that violates the National Framework.”

People in severe ill health can receive health care benefits 100 per cent funded by the NHS, although the assessments and bureaucracy can be challenging.

James Urquhart-Burton, partner at Ridley & Hall Solicitors and an expert in healthcare financing, explains how to apply for NHS CHC here and how to appeal here if you are rejected.

He says of Ms Hanlon’s case: ‘NHS CHC should be provided free of charge and it is legally the responsibility of the NHS body in question.

‘The demand for supplements usually arises when a person wants to move to (or already live in a care home) which is more expensive than the NHS deems necessary to meet the individual’s needs.

“The National Framework for NHS Continuing Healthcare does say that ‘top up’ CHC funding is not allowed to meet an individual’s assessed needs.”

He continued: ‘The care service contract should confirm the care home’s obligations to the service user, but in my view the Integrated Care Board (which was, of course, the Clinical Commissioning Group in 2016) was responsible for a) the decision of eligibility , b) take over the financing and c) deal with any financial implications with Rosemary and/or her representative.

‘It is unknown to what extent the ICB considered fully reimbursing healthcare in 2016 and further research is needed.’

>>>Read more comments from James Urquhart-Burton about healthcare financing and upgrades below

RSJB Executive Chairman Bernie Suresparan said: “RSJB Quality Care Homes Ltd acquired The Anchorage Nursing Home in April 2022.

“As soon as we learned that the family overpaid, we agreed to refund the overpayments from April 2022.

“We have requested bank account information from the family so that we can refund these payments to resolve the issue as quickly as possible.”

Mr Suresparan added: ‘As we did not take over the house until April 2022, it is unfair and unreasonable to expect RSJB Quality Care Homes Ltd to refund payments to the previous owner as we are not liable for these overpayments .’

An NHS Cheshire and Merseyside spokesperson said: ‘We have received Ms Collins’ concerns regarding Rosemary Hanlon’s funding and care package payments and will respond in accordance with the NHS’s complaints procedures.’