turned down for nhs continuing care, any point fighting the decision

markymark10_2 · 10 February 2008 at 12:20PM

Hi Fellow savers

Having posted to this board before and found so many helpful posters I hope that you may be able to help me with my mums current predicament.

She has been in hospital for 3 months now with a severe stroke which has left her unable to move her right hand side & unable to talk or read & write.

The Hospital appointed a social worker 3 weeks ago & advised me to start looking for a care home as their assessment is that she was not making much progress & was not likely to improve significantly in the future.

Her continuing care needs checklist reads like this.

A= exceeds the described need b= borderline c=doesnt meet required need

Mum scored A in cognition & communication as she has no way of communicating other than shaking or nodding her head & due to dyspraxia her responses are sometimes inappropriate & she also in the nurses opinion has poor cognition.

She also scored B in mobility as she cannot move or dress/toilet herself & aneeds an encore machine to move her off of the bed although she can feed with her one good arm. She must also be placed carefully due to muscle tension in her right arm & leg which causes her much pain if she is pilled or jolted.

B in nutrition as she is on soft smooth diet & needs supervision when eating in case she over feeds herself.

B in continence as she requires help in toileting & accidents sometimes occur.

B in drug therapies as she is on several medications.

This according to the list would have been enough to qualify my mum for continuing care, but when she was assessed one week later by whoever makes the recommendations she was disqualified from continuing care.

In his opinion her drugs can be administered by care home staff.

She can communicate enough to be considered capable of making her own decisions (although the speech therapist wouldnt let me bring in power of attourney consent forms as she doesnt consider my mums responses as being consistant enough to be sure that she is giving the ok to this.

That she could be hoisted at a care home without any problem (despite her pain from her bad arm & leg and the need to be placed carefully) They have also in hospital reported that she has now improved well enough to use the rotunda, however when I visited yesterday staff were still using the encore machine to move her.

And that her toileting is adequate despite the fact that I still bring home soiled underwear & she cannot transfer to toilet without the help of 2 nurses & a hoist.

An amazing improvement in 10 days overall considering that the hospital had stated that further improvement was not expected although to be honest it seems that the assessor has deliberately downgraded as many catagories as possible to exempt the nhs from providing any further support.

All this disqualifies her from any sort of nhs support & leaves her funding her own care with the help of the local council for the first 12 weeks.

Is there any way that I can appeal this decision & exactly how in need of care do you need to be before you are considered worthy of support through the nhs.

I did ask her social worker about an appeal & she seemed to think that there was no point & seems more interested in getting my mum to sign forms giving the council permission to look into her finances.

Any help/advice would be greatly appreciated.

chesky369 · 10 February 2008 at 12:33PM

go to your local citizens' advice bureau - they will be totally on your side and if they think you have the ghost of a chance with an appeal, they will help you.

Mojisola · 10 February 2008 at 2:43PM

markymark10 wrote: »

Hi Fellow savers
the speech therapist wouldnt let me bring in power of attourney consent forms as she doesnt consider my mums responses as being consistant enough to be sure that she is giving the ok to this.

******

I did ask her social worker about an appeal & she seemed to think that there was no point & seems more interested in getting my mum to sign forms giving the council permission to look into her finances.

I'm horrified at the way you and your mother are being treated. Apart from everything else how could your mother sign a consent form for the social worker if her therapist won't let you sort out legal stuff?

Good luck with the appeal.

Coupon-mad · 10 February 2008 at 2:54PM

Just want to say best of luck with this, if it were me I think I would appeal. I have read of appeals being accepted & NHS funding decisions overturned, and from the info you have given surely there are some grounds.

I agree with another poster who said contact the CAB. What about contacting your local MP as well, they should hold weekly surgeries that you may be able to get good info from (i.e. who to contact at the very least). If you are fortunate, your MP might even take a personal interest with your appeal which always helps.

saving-grace · 12 February 2008 at 6:14PM

Marky mark try this link.
http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=75

I know your mother is suffering the effects of a stroke, not Alzheimers, but I think you may find this useful as it tells you how to go about making an appeal if you have been turned down for NHS continuing healthcare. It gives advice on how to word a letter to request a review, who to contact etc, lots of step by step info.

getting-sorted-sarah · 12 February 2008 at 6:30PM

saving-grace - quite right, the Alzheimers Society are at the forefront of challenging these sorts of decisions.
OP - yes appeal, in my experience both the NHS and Social Services will do their utmost not to pay for anything.
Isn't is usually 6 months before a long term prognosis can be made after a stroke?

GrannyKate · 12 February 2008 at 8:41PM

Yes do appeal

Recommend the following sites for advice

The office of the Public Guardian - explains all about different Powers of Attorney, the new Mental Capacity Act etc

http://www.publicguardian.gov.uk/index.htm

Also Age Concern

http://www.ageconcern.org.uk/AgeConcern/Documents/fs20.pdf

The Primary Care Trust (PCT) concerned will also have a PALS team/office who should be able to offer support and advice with the process.

poet123 · 12 February 2008 at 9:30PM

I really feel for you,this happened to me and my mum was terminally ill! I fought (not an official appeal but a reprieve) and won but it was a pyrric victory as she died shortly afterwards and so I had spent her last days fighting the system instead of concentrating on her. BUT that said, I would do it again because it was a disgrace that they could say she wasn't eligible.

In my experience once you begin the process they will back off a bit,as theyreally dont want to take you on.....this will give you breathing space,also play for time by saying you are "looking into care homes".

Good luck.

Biggles · 12 February 2008 at 10:11PM

markymark10 wrote: »

She can communicate enough to be considered capable of making her own decisions (although the speech therapist wouldnt let me bring in power of attourney consent forms as she doesnt consider my mums responses as being consistant enough to be sure that she is giving the ok to this.

Never mind the speech therapist(!), bring the forms in while you have your mother's doctor with her and see what he/she thinks to her mental capacity. Though if she scored poorly on cognition, it could be doubtful.

And I agree with Mojisola, there's no way she should be allowed to sign forms allowing the council to 'look into her finances' (what on earth does that mean?) if she can't sign an LPA.

markymark10_2 · 13 February 2008 at 12:23AM

Thanks for all your advice & support. I am going to go to citizens advice next Monday as unfortunately due to work commitments I cant get there any earlier.

I'm going to have a word with the ward staff tomorrow to get a conclusive opinion on whether mum is fit to sign the poa forms & also to find out how to get a copy of the final report which resulted in my mum being turned down for continuing care, I know her social worker has a copy but trying to get her to send a copy to me is proving difficult.

It has been 3 weeks since mum was referred to her & I have still to meet her social worker in person & other than sending me a booklet & advising me that I need to find her a care home in the councils area & requesting details about finance (the council will pay for the first 12 weeks as mum has little capital other that her bungalow which she owns jointly with me but they seem to insist that the care home must be in their area) she seems to be doing very little in terms of support for my mum or me.

Should she be doing more to aid us in this or is it the norm that the social worker is more interested in making sure that the council arent shortchanged than providing help & support in making sure that we get the best possible care for our loved ones.

markymark10_2 · 13 February 2008 at 12:42AM

And I agree with Mojisola, there's no way she should be allowed to sign forms allowing the council to 'look into her finances' (what on earth does that mean?) if she can't sign an LPA.[/quote]

As I understand it because mum cant talk or write coherently & I have informed the social worker that my mum has very little savings & that the only other capital she has is a half share in her house which we jointly own, then the council need to run a check to prove that I am telling the truth & there is no hidden fortune which she can use to pay for her care over the first 12 weeks when she is being supported by the council.

After this they will place a charge for her care against the land registry of the house until it can be sold (which will be very difficult if I cannot get p.o.a). So I assume that once again they need to check if I am telling the truth about the houses value, the joint ownership & the mortgage left to pay so that they know how much money my mum has in capital that can be used to pay for her self funded care.

Sadly it seems that in the case of the elderly & unwell the general attitude of both the NHS & the social services is that they will try their best first & foremost to make sure that they avoid paying the cost of care especially if the patient can afford to pay for it themselves.

turned down for nhs continuing care, any point fighting the decision

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