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    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 4:34 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    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
    It sounds like your Mum might have had a fast track award for end of life care. This should not stop you requesting a retrospective review if you believe her care was primarily due to medical needs for some time prior to the award.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 4:36 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    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
    Originally posted by Splatman
    I would have thought a close relative such as yourself could make that request or if you would like to make it more formal it could come from the executor of his estate(if he had one).
  • SocialCare
    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 individual’s 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 !
    Originally posted by hellenjc
    The national framework is very clear about health and social care needs. If there is a primary health need it doesn't matter what social care needs there are; the PCT should pay 100%. Joint packages should only be agreed in certain situations.

    With kind Regards.
    • Allan87
    • By Allan87 29th Aug 12, 5:10 PM
    • 450 Posts
    • 44 Thanks
    Allan87
    My family have just appointed a solicitor to chase this up for us, the solicitors seem to think we have a "reasonable chance of success" based on the evidence provided so just have to see what happens - nothing ventured, nothing gained.
  • grandmabirch
    Does care in your own home count (live in carer)?
    My Grandma was cared for in her own home (she had severe Parkinsons). My Grandparents were told that because they had savings, they would have to pay for the entire costs themselves. Can these costs of a live in carer be reclaimed?
    Many thanks.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 5:51 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    My Grandma was cared for in her own home (she had severe Parkinsons). My Grandparents were told that because they had savings, they would have to pay for the entire costs themselves. Can these costs of a live in carer be reclaimed?
    Many thanks.
    Originally posted by grandmabirch
    Yes any setting including own home. In fact the original legal case on which these payments are based involved home care.
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 6:09 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Does anyone have a link to the one in Wales, I can't seem to find anything current. Thank you!
    Originally posted by hannahjsmith
    Here are some links you may find useful, WAG (Welsh assembly Government) has adopted a similar system to England but as is their usual practice needed to spend almost 3 years making it slightly different.

    http://www.wales.nhs.uk/continuingnhshealthcare
    http://www.wales.nhs.uk/sitesplus/documents/867/F244_NHS_e_WEB.pdf
    http://www.cardiffandvaleuhb.wales.nhs.uk/opendoc/182911
    http://wales.gov.uk/docs/dhss/publications/100614chcframeworken.pdf
    http://wales.gov.uk/publications/accessinfo/drnewhomepage/dr2012/julsep/health/lg1995/?lang=en
    http://www.wales.nhs.uk/documents/continuingnhshealthcarecommunicationtoolv1.pdf
  • hopeful21
    Not an easy task
    I have been reading all this with great interest. I have recently submitted a claim to my PCT for a retrospective claim for my late husband.
    I won't know the outcome until the end of year but I would hate to think that anyone thinking of doing a claim can just write a letter or make a few phone calls.
    I have spent 4 months going through care plans, medical records,social service reports (all bringing back bad memories) reading long documents from the Dept of Health on criteria, eligibility etc. Lots of research was done so I fully understood the procedure. Documents have to be scrutinised so you don't miss a scape of evidence. Lots of internet search on the illness's he had and the drugs taken so I could strengthen my case.
    I submitted a 20 page report to the PCT....it was a tremendous amount of hard work. I would say this is not for the feint hearted but if you have the determination, go for it and be prepared to fight.
  • grandmabirch
    Yes any setting including own home. In fact the original legal case on which these payments are based involved home care.
    Originally posted by monkeyspanner

    Thank you very much and fingers crossed!
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 10:14 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    I have been reading all this with great interest. I have recently submitted a claim to my PCT for a retrospective claim for my late husband.
    I won't know the outcome until the end of year but I would hate to think that anyone thinking of doing a claim can just write a letter or make a few phone calls.
    I have spent 4 months going through care plans, medical records,social service reports (all bringing back bad memories) reading long documents from the Dept of Health on criteria, eligibility etc. Lots of research was done so I fully understood the procedure. Documents have to be scrutinised so you don't miss a scape of evidence. Lots of internet search on the illness's he had and the drugs taken so I could strengthen my case.
    I submitted a 20 page report to the PCT....it was a tremendous amount of hard work. I would say this is not for the feint hearted but if you have the determination, go for it and be prepared to fight.
    Originally posted by hopeful21
    Your approach which is presumeably based on experience of dealing with the NHS is typical of those going through the process.

    This is not like reclaiming PPI and cannot be approached in the same way. The NHS have not rolled over and capitulated like the banks

    We have to accept that very few applicants will find this an easy process and whilst some will succeed after a long proceess many will fail. Also, many will undertake the task with the backdrop of taking care of a relative during declining health or the actual loss of that relative.

    The process is confrontational because it is an all or nothing decision. This is an idiotic system because a persons needs cannot be 100% medical or !00% domestic. There will always be elements of both. However, it is the system both sides have to deal with until the government actually gets to grips with the issue of funding elderly care.

    I wish you Good Luck.
  • ajax1n
    I appreciate that the original guide refers to England but does anyone know if a similar system operates in Scotland?
  • Claim Winner
    Winning Cases
    Hi, before embarking on a claim is it worth doing your homework to ensure that you have a case. It can be a long and frustrating process and you need to be realistic which means knowing the criteria. Look at a Decision Support Tool, look at the domains and see where your relative may score on the level of need - the more Moderate/High/Severe/Priority they have the more likely they are to meet. It is not disease related and every case will be assessed on its own merits. You need to look at the nature of the need and show that it was intense, complex and unpredictable. Look at the Assessed Level of Needs page and mark where you think your relative may score. Be armed with the facts, the PCT's are strapped for cash and will not fund unless there is a strong case. If it is a current assessment you need to be involved and be aware that funding can be withdrawn on review. You need to make sure that care plans are updated, that care needs are documented as with all cases it is evidence that will prove it. You may be asked for input so make sure you keep a diary so you are sure of your facts. If you are self funding you need to be especially vigilent with regard to CHC, you will probably be paying more for your care than either Social Services or CHC will fund and this may have financial implications for care providers. You may be asked to top up the fees as more PCTs set contract prices for beds. Retrospective cases for those now deceased can take years to come to panel (am waiting for a case which was started over 2 years ago!). You do not want it to go to appeal as this will take even more time so make sure you have a robust case first time around as the NHS is going through a huge change, cutting staff and the PCT's are inundated with cases - both current and retrospective. They will be working on many cases and are under pressure to move them on, you will only be working on one so spend time on it, get the evidence and if you are sure of your case, do not take no for an answer!
  • hedgie
    Should I try a reclaim?
    Hi, I am unsure whther to attempt to reclaim fees. My mother was funded by the NHS for £101 a month for most of her 3 year stay at a nursing home, for the last 1 to 2 months of her life she was assessed and fully funded, by this time she was seriously ill. She was discharged straight from hospital to the home (she was at home prior to this) as she had a leg amputated. She was in a wheelchair, doubley incontinent had dementia and was on several medications including warfarin. I find the thought of trying to make a claim quite daunting and wasn't sure if the fact that she had some funding and then full funding later would mean I wouldn't stand a chance. My local primary care trust is apparently very strict on funding and I was told she would keep being assessed every 3 months and could lose the funding if she improved at all. She passed away last year. Thanks
    • 111KAB
    • By 111KAB 30th Aug 12, 9:01 AM
    • 3,632 Posts
    • 1,477 Thanks
    111KAB
    My situation is similar to 'hedgie' insofar as my mother receives a nominal amount of funding from her PCT of £100 pm but her nursing home fees are £2,700 pm on top of this. She has been in a nursing home since 1998 so obviously the costs have been high (nearly £300k to date!) - I am unsure, as she already receives a 'contribution' from her PCT if she is entitled to make a claim??? Thanks
  • pat47uk
    my grandfather was diagnosed with dementia in 2006 [he started to go walkabout on his own and didnt know how to get home etc]
    he was put in a "hospital" for a short while, the doctor and social worker assessed[sp?]him and said that there was noway he was allowed to go home so he was put into a residential nursing home, at no time was pct mentioned to us, the local council took his pension weekly to pay for the home [we got an invoice once a month saying his pension paid his home fees].....
    he was left with nothing each week so we had to pay for everyday items for him [hair cuts ,soap, razors etc]..he died from vascular dementia in 2010..
    we put in a claim and we have now been told that his claim was rejected!!!!
    He matched the criteria and everything, for pct paying for his care home fees, but it was still rejected!!!
    • monkeyspanner
    • By monkeyspanner 30th Aug 12, 2:21 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi, I am unsure whther to attempt to reclaim fees. My mother was funded by the NHS for £101 a month for most of her 3 year stay at a nursing home, for the last 1 to 2 months of her life she was assessed and fully funded, by this time she was seriously ill. She was discharged straight from hospital to the home (she was at home prior to this) as she had a leg amputated. She was in a wheelchair, doubley incontinent had dementia and was on several medications including warfarin. I find the thought of trying to make a claim quite daunting and wasn't sure if the fact that she had some funding and then full funding later would mean I wouldn't stand a chance. My local primary care trust is apparently very strict on funding and I was told she would keep being assessed every 3 months and could lose the funding if she improved at all. She passed away last year. Thanks
    Originally posted by hedgie
    My situation is similar to 'hedgie' insofar as my mother receives a nominal amount of funding from her PCT of £100 pm but her nursing home fees are £2,700 pm on top of this. She has been in a nursing home since 1998 so obviously the costs have been high (nearly £300k to date!) - I am unsure, as she already receives a 'contribution' from her PCT if she is entitled to make a claim??? Thanks
    Originally posted by 111KAB
    Similar answer for both of you.
    The contribution of £100/£101 is probably a nursing supplement. If that is the case the supplement is the fall back position if CHC is not given. Receipt of the nursing supplement does not exclude a CHC assessment.

    Hedgie As your mother had been in a care home for three years a sucessful retrospective claim would depend largely on the evidence you could gather regarding her medical condition during the 3 years. Depending on the extent of her contact with medical staff the day to day evidence would be mostly from the care home. So it would depend on how good their record keeping was. If I have calculated correctly she would have been discharged from hospital to the care home sometime in 2008. If this is the case it would have been covered by the new CHC system introduced in 2007. As a minimum, the discharge team should have carried out an initial CHC checklist and provided your mother or her carers with their findings. Perhaps your first question of the PCT should be was this carried and what were the results. If it wasn't carried out then they failed to follow proceedure. If it was carried out and they did not give the family the results this was bad practice and they failed to give you the opportunity to challenge the results. Both would in my view be grounds for asking for a retrospective review

    111KAB As your mother has been in a nursing home since 1998 she may never have had a CHC assessment but my comments above to 111Kab also apply.
    Last edited by monkeyspanner; 30-08-2012 at 2:42 PM. Reason: Added joint answer
    • monkeyspanner
    • By monkeyspanner 30th Aug 12, 2:54 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    my grandfather was diagnosed with dementia in 2006 [he started to go walkabout on his own and didnt know how to get home etc]
    he was put in a "hospital" for a short while, the doctor and social worker assessed[sp?]him and said that there was noway he was allowed to go home so he was put into a residential nursing home, at no time was pct mentioned to us, the local council took his pension weekly to pay for the home [we got an invoice once a month saying his pension paid his home fees].....
    he was left with nothing each week so we had to pay for everyday items for him [hair cuts ,soap, razors etc]..he died from vascular dementia in 2010..
    we put in a claim and we have now been told that his claim was rejected!!!!
    He matched the criteria and everything, for pct paying for his care home fees, but it was still rejected!!!
    Originally posted by pat47uk
    There are a number of issues here.
    In 2006 CHC funding was covered by individual PCT rules. It does not surprise me that the PCT and CHC funding was not mentioned to you as there was a practice at the time of not bringing this up with patients and families.

    You mention that you Grandfathers pension was taken so I assume the council assessed him as liable to contribute towards his fees. Under this arrangement a weekly allowance (at present this is about £20) should have been disregarded from the assessment and left for personal expenses. I have heard of cases where this has not been done and families have had to insist. If this was not done you could go back to the council and ask for the assessments to be reviewed.

    In terms of the CHC review how far did you get with the claim. Did you lodge an objection to their decision? Did you get as far as an IRP (independant review panel)?
  • pat47uk
    There are a number of issues here.
    In terms of the CHC review how far did you get with the claim. Did you lodge an objection to their decision? Did you get as far as an IRP (independant review panel)?
    Originally posted by monkeyspanner
    we sent off the questionaire with carehomeclaims, had a call from them saying they had passed it to the medical assessment team, heard nothing so contacted them this morning to be told claim was rejected and I would be getting a letter explaining why??!!
    • monkeyspanner
    • By monkeyspanner 30th Aug 12, 7:26 PM
    • 2,118 Posts
    • 1,933 Thanks
    monkeyspanner
    we sent off the questionaire with carehomeclaims, had a call from them saying they had passed it to the medical assessment team, heard nothing so contacted them this morning to be told claim was rejected and I would be getting a letter explaining why??!!
    Originally posted by pat47uk
    Would I be correct thinking that CareHomeClaims is a company which offers to assist reclaiming care home fees? If it is, they are not prepared to assist you on a no-win no-fee basis and you will need to wait to see what reasons they have. This does not mean you cannot apply directly to your local PCT or approach a different specialist company. The MSE guide outlines how you can do this yourself.
  • hendo1000
    hi can anyone tell me if this applies to scotland as well as it cost me £55000 for my mothers nursing home care
    thanks for any replies
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