Can care home fees already paid be recovered?

Potentially. Where a past period should have been NHS-funded under NHS Continuing Healthcare, eligible fees may be reimbursed. The assessment history, care period and available evidence all matter.

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Solicitor service · retrospective NHS CHC

Paid care home fees? We check whether the NHS may have been responsible.

Some past care periods can be reviewed where NHS Continuing Healthcare may not have been properly considered. The correct route depends on whether the period was genuinely unassessed, previously assessed and refused, or affected by another decision that should be reviewed.

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Start with the route, not the refund figure. We first establish whether the period was unassessed, already assessed or subject to another CHC decision, because that determines the proper NHS process.

When might care-home fee recovery be relevant?

A retrospective review may be relevant where care was privately funded and there is evidence that NHS Continuing Healthcare should have been considered or awarded for all or part of the period. Current DHSC/NHS England guidance provides a route for genuinely previously unassessed periods of care from 1 April 2012 onwards in England.

A PUPoC request is not a second appeal

If a full CHC assessment already decided the person was not eligible for the same period, that period should not simply be presented as “previously unassessed”. The appeal, complaint or review route may be the correct route instead.

What evidence do we look for?

Care-home records, GP and hospital records, social-care assessments, clinical notes, invoices and payment evidence can all matter. The aim is to reconstruct the person’s needs over the relevant period and compare them with the CHC framework.

What happens if eligibility is established retrospectively?

Current government guidance says reimbursement should restore the person to the financial position they would have been in if CHC eligibility had been agreed at the appropriate time. The relevant care costs and interest may therefore need to be addressed, depending on the decision and period.

Can an estate pursue the issue after death?

Yes, retrospective CHC issues can remain relevant after death. The person acting for the estate will need the appropriate authority, and any reimbursement due to the deceased person is dealt with through the estate.

Choose the correct route

The care-fee recovery cluster

Reclaim care home fees
Unassessed periods, reimbursement and evidence →Retrospective CHC claims
PUPoC and past care periods →Claiming after death
What happens when the person has died →Who qualifies
The eligibility test that still applies retrospectively →Primary health need
The core CHC test →CHC already refused?
Use the appeal route where appropriate →