Frail elderly people are being forced to sell their homes because the NHS is taking years to pay them vital cash to fund their care bills.
A Money Mail investigation found officials are taking up to five years to process claims for funding.
In some cases, families are having to wait two years even after the NHS has agreed to pay up.
Currently, you have to finance your own care bills if you have assets of more than £23,250. This includes your home.
Ordeal: Kenneth and Betty Hayes had to pay up for care for several years before moving into an care home when their fees should have been covered by the NHS
However, people with complex, severe or unpredictable health needs should have the costs met by the NHS.
These so-called Continuing Healthcare rules apply to both nursing home residents and those who receive home help for physical or mental needs.
Money Mail found so little is known about this vital funding that some families are unnecessarily paying up to £70,000 in care fees.
Experts say the NHS rarely tells families about Continuing Healthcare because it costs the authorities a lot of money. And when families do apply, they are being hit by unfair rejections and lengthy delays.
In one case, a family who claimed for the funding in 2012 were finally approved in 2015 — but are still awaiting payment.
Another widow told Money Mail she had been left exhausted by the four-year process to hear if her claim would be met.
Lisa Morgan, a solicitor for law firm Hugh James, which has helped clients win back £100 million over unfair care bills, says: ‘There is such a backlog of cases that families are waiting years rather than months for a decision or payment, which just isn’t fair on those struggling financially.
‘All too often individuals and their families are needlessly forced to sell their homes and other assets to pay for care.’
In 2015-16, almost 160,000 people were deemed eligible for Continuing Healthcare funding, at a cost of £3.1 billion.
But a damning report by the National Audit Office (NAO) found there was ‘significant’ variation across the country in the number of people being approved for this cash and the eligibility criteria used.
Experts say the NHS rarely tells families about Continuing Healthcare because it costs the authorities a lot of money
It said common complaints included NHS assessors playing down care needs or ignoring relevant evidence.
It also said that while decisions on eligibility should be made within a month, one in ten applicants were waiting three months or more.
To be eligible, an individual’s primary need must be healthcare, rather than social. For example, this might include round-the-clock help controlling a disability or illness, rather than getting dressed or washing.
However, the rules are extremely vague and no specific conditions automatically qualify. That means the decision often comes down to the opinions of local clinical group assessors.
Kevin Hayes, a surveyor, has been battling to recover cash for his father Kenneth’s estate since 2012. Kenneth died in July 2011, aged 85, from Alzheimer’s, and his wife Betty died a year later.
He’d paid privately for carers at home for several years before moving into an Oxfordshire care home in 2010 after a fall. The family was forced to sell the parents’ £400,000 house to fund Kenneth’s bills, which exceeded £70,000.
It was only after his death that Kevin’s friend, a nurse, told him his father may have been entitled to Continuing Healthcare funding.
Kevin, 66, tried to apply retrospectively. He says the forms were extensive, delving deep into his father’s level of communication, cognitive function and medication.
‘The process is so long,’ Kevin says. ‘It is almost as if the NHS has made it like an obstacle course to make it as difficult as possible to obtain the funding.’
The family launched a claim with Hugh James in 2012 and it took three years, until 2015, to learn they were eligible for funding — but only for part of their claim. This included 18 months of home care and five months of nursing home care between 2008 and 2010.
Yet the family have so far been paid only £11,000 for the five months of nursing home care. They are still owed around £35,260 (which includes interest going back to 2008) for the home care.
They were initially refused funding for the last 13 months of his father’s life because his deterioration meant his needs were by then deemed ‘less complicated’. However, after a lengthy appeal, they have since been granted another seven months of payments.
Yet, they are still waiting for the extra £27,830, as well as an appeal decision from NHS England on the final five months of Kenneth’s life.
Kevin has complained to the Parliamentary and Health Service Ombudsman about the two-year delay in getting the cash paid.
‘The NHS has never explained to us why the money has not been paid yet,’ he says.
‘It has been exhausting and stressful dealing with this for so long but, as the executors of dad’s estate, we feel a responsibility to be careful with his money, so we keep fighting it.’
The Oxfordshire Clinical Commissioning Group said it was aware of the claim and ‘was processing it in line with the national guidance’.
Complaints about Continuing Healthcare to the ombudsman hit a record high of 628 in the 12 months to April — double the 319 figure for five years ago.
Diana Hodgkinson has suffered years of stress waiting for a payout — and it may all be in vain.
Her husband John died in 2008, aged 74, after suffering from Parkinson’s Disease and Lewy Body dementia. He spent the last six years of his life in a care home at a cost of £33,000 to the couple.
Four years after his death, Diana read about Continuing Healthcare and applied, believing John was eligible. It took another four years for NHS Mansfield and Ashfield Clinical Commissioning Group to reach a decision.
Her claim was rejected and she appealed against the decision in February 2016. That claim was refused last week, 17 months on.
She has now been told she can go to the ombudsman, but she desperately wants an end to the drawn-out process.
Diana, of Selston, Notts, says: ‘The waiting and appeals have been very stressful. I’ll have a big bonfire for all the paperwork I’ve been holding on to.’
Mansfield and Ashfield Clinical Commissioning Group apologised for ‘the distress caused to the family during the time taken to complete the review’.
An NHS England spokesman says: ‘Taxpayers rightly expect that care is taken before handing out public funds and, while some cases are incredibly complex, the majority that need it get an independent review within six months.’