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  • redsquirrelsuk
    Give it a try
    I don't know the full in's and out's but my Grandma suffered from Dementia and Alzheimer 's which got worse over the years. She was admitted to Hospital and then discharged straight into a Nursing Home as she could no longer care for herself. She was ringing the Police as she was convinced there were boy's and girls in her house taunting her. Her condition deteriorated quite quickly and I think she was in nursing home that specialised in Dementia patients for approx 18 months. My mum became POA and looked after her affairs. My mum was told as my Grandmother had money she had to pay for her own nursing home fee's which were i think around £800 p\w which then increased considerably as her condition deteriorated.

    My Grandmother died in 2008 and i have mentioned this post to my mum but am wondering if anyone has an opinion on whether we would be eligible for a claim as my Grandmother has passed away and we no longer have any paperwork for the nursing home fee's/bank statements.

    Many thanks
    Originally posted by ladybrady
    Don't worry about technicalities at the moment, if you and your Mum think she should have been eligible (which it certainly sounds like she would have been) put in a claim via your PCT. The nursing home should have records going back to then (they are obliged by law to keep records for a minimum of 6 years). The PCT will want to know which nursing home she was in and what date she went into the nursing home and the date of her death (and date of birth). Also visit the Alzheimer Society's web site, they have very good info on there.
    • woolly_wombat
    • By woolly_wombat 29th Aug 12, 12:10 PM
    • 453 Posts
    • 265 Thanks
    woolly_wombat
    .

    For more personal experience see this MSE thread which has been running for some years. http://forums.moneysavingexpert.com/showthread.php?t=800521&highlight=chc
    Originally posted by monkeyspanner
    Thank you monkeyspanner from a beneficiary of you long running thread. Your original plea for help with applying for nhs continuing healthcare for a member of you own family has morphed into a fantastic source of help and advice for the rest of us.

    A big thank you to MSE for highlighting the recently introduced deadline and for ensuring that far more people are aware of their rights.
    • hellenjc
    • By hellenjc 29th Aug 12, 1:45 PM
    • 452 Posts
    • 3,882 Thanks
    hellenjc
    I am a Social Worker working with Older People and have attended many Multi-Disciplinary meetings to assess for Continuing Health Care funding. Obviously I can only speak from my own experience but during a full assessment Social Services ( who are often, but not always, already involved) should be asked to do a Social Care assessment - different from a nursing assessment which will often be done by a District Nurse if the person is at home or by a nurse in hospital. Following completion of assessments the meeting itself should include family members, other professionals involved and the individual themselves if they are able to attend.
    Each of the criteria will be gone through and everyone has the opportunity for input at this point and a "meeting " decision is taken.The meetings look at the nature, intensity, complexity or unpredictability of the individualís needs when making a decision.
    If their condition is very unstable and unpredictable CHC is more likely to be approved.
    It is not unusual for there to be joint funding between Health and Social Care, where the person clearly has a health need but also social care needs and the decision is always reviewed regularly because as someone has already mentioned if the health need resolves then Continuing Health Care will often no longer fund.. However what I have also found is that if it is considered that the only reason the health need has lessened is because of the quality of the nursing care then they will often continue to fund if that argument can be made.
    Also if the individual is turned down but their condition substantially deteriorates then a new nursing assessment checklist can be asked for.
    I think you should definitely read the Decision Support Tool before any meetings and good practice would say this should be gone through with family members/carers before the meeting. I have certainly done this many times myself.. Don't be afraid to ask for this to be done.
    Hope this helps a bit

    Ps I'm not saying I agree with all this but just telling it as it is !
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 2:00 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Thank you MSE for picking up this issue and highlighting the governments attempt to continue to keep the possibility of NHS funding out of the publics view. These deadlines are an attempt to limit the retrospective liability for funding which was not brought to the attention of those who might be entitled. This was often with the knowing conivance or ignorance of NHS and Social Services staff.

    The MSE guide implies at its start that this funding was available for 2007 in England this ,however. is just when the new suposedly universal assessment system based around the DST (decision support tool) was introduced. Prior to that all PCTs ran their own individual CHC funding process. This led to a postcode lottery which was supposed to have been solved with the introduction of the DST based system. However neither the DST or National Framework documents spell out to individual PCTs what scores are necessary to get CHC funding. Therefore there are still large discrepancies in award rates between PCTs.

    Please note the basis of NHS CHC funding goes back to JULY 1999 in a court of appeal judgement in the case of Coughlan vs North and East Devon Health Authority. Here is a link if anyone would like to read the basis of the appeal decision. http://www.sochealth.co.uk/health-law/r-v-north-and-east-devon-ha-ex-parte-coughlan-1999-payment-for-nursing-care/
  • Brookebaloo
    Deadline help
    Hi,

    This was my Nan's situation and my Dad had to be a lot of money for her care, including selling her house well below the value. It was 70K but because it wasn't selling he had to accept the lowest offer to satisfy the council, so sold it for 23K!!!! Still a sore point in our house.

    Anyways is the deadline strictly 2004 onwards as my Nan died in 2003 after 10 years inside a care facility for her alzehimers - any help appreciated

    Caroline xx
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 2:11 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi,

    This was my Nan's situation and my Dad had to be a lot of money for her care, including selling her house well below the value. It was 70K but because it wasn't selling he had to accept the lowest offer to satisfy the council, so sold it for 23K!!!! Still a sore point in our house.

    Anyways is the deadline strictly 2004 onwards as my Nan died in 2003 after 10 years inside a care facility for her alzehimers - any help appreciated

    Caroline xx
    Originally posted by Brookebaloo
    Have a look at Coughlan vs NE Devon Health authority July 1999.
    You would also need to check if there is a statute of limitation on cases like this.
  • Brookebaloo
    Have a look at Coughlan vs NE Devon Health authority July 1999.
    You would also need to check if there is a statute of limitation on cases like this.
    Originally posted by monkeyspanner
    Hi -Many Thanks for your reply.... what does a 'statue of limitation' mean?? I want to tell my Dad about this reclaiming, but don't want to get his hopes up if we are outside of the deadline. As I mentioned earlier, its still a touchy subject the way the council and care trust bullied him for costs etc. One day she was in the local hospital for 2 weeks rest bite care, the next she was never allowed home again and into full time care.

    Thanks xx
  • SocialCare
    Continuing Healthcare
    my mother entered a privately paid for care home in 2002 and died there in 2010. She suffered from Dementia from the start which gradually got worse and she paid for care out her own pocket for the whole time. One month before she died she went into hospital and was formally assessed as qualifying for free care due to her condition.
    I am wondering if I can make a claim as she had been in that qualifying condition for some time (maybe a year or more) prior to being assessed but she wasn't formally assessed as I didn't know you could be.
    I had POA but this ceased on her death. Will I be able to claim any money back for her estate?
    Any help appreciated.
    Originally posted by arhodes
    Hi, you can ask for a retrospective assessment. the PCT will collect the evidence (care plans, assessments, etc.) for the time period you feel that your mother may be eligible and make a decision based upon the available evidence. Phone your local PCT and ask the continuing healthcare department for details about how to make a retrospective application for continuing healthcare funding. You've nothing to loose and it won't affect any of the money you have received already.

    Very best wishes.
  • Mags609
    Care, resedential/dementia Home
    Hi, can anyone help with this question? my dad was assessed with dementia and could only leave Hospital to go to a residentail home that was dementia registered, this was arranged and he had around a year before he passed away. He had to pay for himself as he had savings, does this quailify for repayment? when I enquired for nuring care the home said he would not qualify so never did it, though he was receiving total care, feeding, incontinence, bathing etc. I am new to this and could not find the Post option so have used reply to thread
  • SOLITAIRE
    Confused!
    Hi just joined this forum. I'm rather confused and frightened by all of this. My Mother sadly had a severe stroke just over eight years ago. She was in hospital for a few weeks and then six weeks in a stroke rehab hospital in Wales. We then moved her to a nursing home near us in England. We had to sell her home in North Wales to help fund the fees. All this money and all her savings have now gone. She was initially in Barchester private home but following various thefts (of which the police were not interested) we moved her to a Bupa nursing home. She has been there over six years now and she is partially funded now.
    Just how complicated and difficult is this claiming process? I do have POA. There is no way my Mother could have stayed in her own home. She is paralysed fully down one side. She has lost her left sided vision in both eyes. Her speech is not effected. However, certainly not out of choice would my Mother be in a nursing home. She was only a young 72 when she suffered this stroke and she is one of the youngest in the home. I am worried that 'rocking the boat' might upset the home and also effect the financial help we already get - could they ask us to move Mother? The home is far from perfect but to have move would be too upsetting for Mother.
  • missiemoo
    We, my sister and I, fought our local PCT successfully regarding our father who was in late stage vascular dementia, bedridden, doubly incontinent, unable to feed himself, bullous pemphigoid skin condition, bed sores etc etc. He had his first CC Assessment whilst in hospital February 2009 and the decision was made there and then that he did not qualify for full funding but was granted the nursing aspect of his care paid directly to the care home, which in itself implies that there is a medical need. His follow up assessment should have taken 3 months after the first, according to the NHS Guidelines, but we had to make several phone calls and send begging letters before they would re-assess and this took place in October 2009, 8 months after his initial assessment. Even though dad's condition had deteriorated the same decision was made - does not qualify. However, after much persistence and dogged determination we managed to set up a meeting with the lead nurse of our PCT and a decision was made in our favour, back paid to the original assessment, we feel sure that the initial decision was overturned as the MDT did not follow the correct procedure. I say don't give up and don't allow people to assume that's it's all about the money when the principle far outweighs that!
    Last edited by missiemoo; 29-08-2012 at 2:56 PM.
  • SocialCare
    CHC Deadline
    Hi,

    This was my Nan's situation and my Dad had to be a lot of money for her care, including selling her house well below the value. It was 70K but because it wasn't selling he had to accept the lowest offer to satisfy the council, so sold it for 23K!!!! Still a sore point in our house.

    Anyways is the deadline strictly 2004 onwards as my Nan died in 2003 after 10 years inside a care facility for her alzehimers - any help appreciated

    Caroline xx
    Originally posted by Brookebaloo
    Hi. A report by the Health Service Ombudsman in 2003, prompted a major review of cases going back to 1996. In July 2007 the NHS chief executive wrote to PCTs explaining a desire to bring the review process to a close. He asked PCTs, using appropriate awareness-raising initiatives, to encourage local people who wanted to request a review of a case that involved care provided mainly before April 2004 to raise it with them
    before November 2007. However, you can still ask the PCT to review such a case, indicating why you have not raised it before. The PCT has a duty to ensure that no one with a legitimate claim to a review misses out.

    Don't worry about the legal jargon in the proposed reading of the Coughlan case. The case is helpful in that it sets the benchmark for the primary health need that MSE mention in the relted article.

    Write to your local PCT and ask for a review of the case and just explain why you haven't asked before. Probably likely that the reason being you weren't aware of the potential eligibility for CHC funding.

    Very best wishes.
  • SocialCare
    CHC funding
    Hi just joined this forum. I'm rather confused and frightened by all of this. My Mother sadly had a severe stroke just over eight years ago. She was in hospital for a few weeks and then six weeks in a stroke rehab hospital in Wales. We then moved her to a nursing home near us in England. We had to sell her home in North Wales to help fund the fees. All this money and all her savings have now gone. She was initially in Barchester private home but following various thefts (of which the police were not interested) we moved her to a Bupa nursing home. She has been there over six years now and she is partially funded now.
    Just how complicated and difficult is this claiming process? I do have POA. There is no way my Mother could have stayed in her own home. She is paralysed fully down one side. She has lost her left sided vision in both eyes. Her speech is not effected. However, certainly not out of choice would my Mother be in a nursing home. She was only a young 72 when she suffered this stroke and she is one of the youngest in the home. I am worried that 'rocking the boat' might upset the home and also effect the financial help we already get - could they ask us to move Mother? The home is far from perfect but to have move would be too upsetting for Mother.
    Originally posted by SOLITAIRE
    Don't worry about how the home will react to CHC funding - most are happier for CHC funding than the local authority to be funding / part funding your mother's care because the PCT's funding limits are usually higher than local authorities. What I mean by that is when the local authority pay for someones care (which sounds to be your case) they will limit their funding - for instance they might pay a maximum of £470 for a nursing placement whilst the PCT might pay a maximum of £650.

    If your mother's placement costs £600 as an example, the local authority will still only pay up to their limit and a third party (usually family) will need to top up the remainder.

    That said, it sounds as though the local authority are already part-funding her placement so I would assume that they agree to the level of fees and the placement will remain.

    The application process for CHC funding should not take more than 28 days from checklist to you being informed of the decision. Appeals can take considerable time depending upon the level of appeal.

    Very Best Wishes.
  • SocialCare
    CHC funding
    Hi, can anyone help with this question? my dad was assessed with dementia and could only leave Hospital to go to a residentail home that was dementia registered, this was arranged and he had around a year before he passed away. He had to pay for himself as he had savings, does this quailify for repayment? when I enquired for nuring care the home said he would not qualify so never did it, though he was receiving total care, feeding, incontinence, bathing etc. I am new to this and could not find the Post option so have used reply to thread
    Originally posted by Mags609
    Hi. Unfortunately the home offered advice that they shouldn't have although I'm sure it was done with the best of intentions. You can ask your local primary care trust for a retrospective decision about whether your Dad was eligible for CHC funding. Phone the continuing healthcare department of your local PCT, explain the situation and ask to make a retrospective application for CHC funding.

    A good idea is to search on the internet for "Coughlan Judgement". It explains a case which has set the benchmark for CHC funding. Compare the needs of your Dad against Pmela's (Coughlan). If they're simmilar, you have a chance of Success.

    Very Best Wishes.
  • SocialCare
    CHC funding
    I wish it was as simple as this is portrayed. If it was then we would not have had six years of problems over nursing home fees for a relative who initially suffered a series of strokes, and is now said (by social services) to have advanced dementia.

    I have boxes and boxes and boxes of paperwork, hospital and nursing home records, copies of PCT assessments etc etc. but we have repeatedly been turned down for funding, although it was granted once, because her condition was unpredictable. We then spent four years in the appeal system being bounced about between the PCT and SHA while the PCT did its best to remove funding.

    At that stage the PCT decided to close the appeal (they paid while it was in progress) so from summer 2011 my relative has been paying £3,300 a month and this particular nursing home has 13 months in the year!

    I'm at a loss to know how to progress this further. If social services say that someone has advanced dementia, and the doctor also believes so, what can people do if they are refused funding on appeal? We have found the assessments are disgustingly underscored but unless the process is flawed you can't complain to the ombudsman because they don't investigate anything other than procedures.

    Hardly anyone ever manages to get money back and refusing to pay is advocated by another website but is very bad advice, in my opinion.
    Thanks
    Originally posted by newsgirl
    Hi. It sounds as though your relative was eligible for CHC funding and it was withdrawn upon review. A CHC review should be just that, a review of the personís needs. If the needs havenít changed then nor should the organisation with funding responsibility. At review, the assessors shouldn't complete a new decision support tool (DST) in isolation. Instead, they should review the original DST. However, the important fact is if the needs haven't changed then the PCT should continue funding. If this is in fact the case, phone the CHC department at the local PCT and ask for them to identify how their needs have decreased.

    Very best Wishes.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 3:58 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi -Many Thanks for your reply.... what does a 'statue of limitation' mean?? I want to tell my Dad about this reclaiming, but don't want to get his hopes up if we are outside of the deadline. As I mentioned earlier, its still a touchy subject the way the council and care trust bullied him for costs etc. One day she was in the local hospital for 2 weeks rest bite care, the next she was never allowed home again and into full time care.

    Thanks xx
    Originally posted by Brookebaloo
    Statute of limitations is a time limit applied to different types of legal cases in which a case can be started. This differs in different types of litigation. Unfortunately I am not familiar with what limit would apply in this case. You may be able to get clarification from www.counselandcare.org.uk they run a free helpline regarding care home funding.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 4:05 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi just joined this forum. I'm rather confused and frightened by all of this. My Mother sadly had a severe stroke just over eight years ago. She was in hospital for a few weeks and then six weeks in a stroke rehab hospital in Wales. We then moved her to a nursing home near us in England. We had to sell her home in North Wales to help fund the fees. All this money and all her savings have now gone. She was initially in Barchester private home but following various thefts (of which the police were not interested) we moved her to a Bupa nursing home. She has been there over six years now and she is partially funded now.
    Just how complicated and difficult is this claiming process? I do have POA. There is no way my Mother could have stayed in her own home. She is paralysed fully down one side. She has lost her left sided vision in both eyes. Her speech is not effected. However, certainly not out of choice would my Mother be in a nursing home. She was only a young 72 when she suffered this stroke and she is one of the youngest in the home. I am worried that 'rocking the boat' might upset the home and also effect the financial help we already get - could they ask us to move Mother? The home is far from perfect but to have move would be too upsetting for Mother.
    Originally posted by SOLITAIRE
    The care home my MIL was in was run by an ex-nursing sister who thought we had no chance of obtaining CHC funding. After our success she was converted and encouraged other residents to apply. I believe they were sucessful in another 3 cases which as it was a small care home was 25% of their residents.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 4:21 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    I wish it was as simple as this is portrayed. If it was then we would not have had six years of problems over nursing home fees for a relative who initially suffered a series of strokes, and is now said (by social services) to have advanced dementia.

    I have boxes and boxes and boxes of paperwork, hospital and nursing home records, copies of PCT assessments etc etc. but we have repeatedly been turned down for funding, although it was granted once, because her condition was unpredictable. We then spent four years in the appeal system being bounced about between the PCT and SHA while the PCT did its best to remove funding.

    At that stage the PCT decided to close the appeal (they paid while it was in progress) so from summer 2011 my relative has been paying £3,300 a month and this particular nursing home has 13 months in the year!

    I'm at a loss to know how to progress this further. If social services say that someone has advanced dementia, and the doctor also believes so, what can people do if they are refused funding on appeal? We have found the assessments are disgustingly underscored but unless the process is flawed you can't complain to the ombudsman because they don't investigate anything other than procedures.

    Hardly anyone ever manages to get money back and refusing to pay is advocated by another website but is very bad advice, in my opinion.
    Thanks
    Originally posted by newsgirl
    Sorry to hear you have come to an impass with the PCT/SHA.

    Although I applaud MSE for raising this as an issue I was concerned with their overly optomistic approach. They have presented this issue in typical Martin style but I would have emphasised this is for anyone an uphill fight against faceless NHS officials who are doing their job which is to minimise claims however legitimate they may be.

    If you have got to the point that you do not know where to try next. I would seriously consider using one of the solicitors specialising in this area. Even if you have to sign away some of any award to get a no-win no-fee arrangement. Or if they say no you know you have done your best for your relative.

    One of the areas where CHC funding is particularly bad is related to dementia which seems to be regarded by many NHS staff as a social effect of old age rather than a degenerative medical condition. The same PCTs will often award CHC funding if a patient has a stroke but someone with similar symtoms arising from dementia will be denied.

    Good luck and please ask if you have specific queries.

    I agree with you refusing payments simply damages your relationship with the care provider and is not a sensible course of action.
    Last edited by monkeyspanner; 29-08-2012 at 4:25 PM.
  • hannahjsmith
    Does anyone have a link to the one in Wales, I can't seem to find anything current. Thank you!
  • Splatman
    My Father died just over a year ago now after spending a couple of years in a nursing home with many different medical conditions. He was admitted to hospital as he had a couple of falls at home but then he was sent straight from hospital to the nursing home. he was unable to do anything for himself so we asked for a continuing care assessment to be carried out however when we went through this process it was quite obvious that the NHS trust were looking for any loophole or excuse not to grant it. Suffice to say, the claim was rejected and we had to pay for all of the care and accommodation from the sale of my fathers house.

    As I mentioned, my father is sadly no longer with us but i was wondering if you could tell me who I should now make a claim to as we have already been refused the continuing care assistance.

    Many thanks for your help
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