Eligibility to NHS Continuing Care Funding?

Spruance

Thanks again.

It is so sad because in his rare semi-lucid moments we think he is begiinning to realise that this time is growing ever nearer. Last night his sister visited him and she said that he mentioned something about 'funeral' and 'wooden box', but it is so difficult to interpret what he is saying and in what context that we cannot be absolutely sure what he is thinking.

Today the hospital say that he has to them not to make any further attempts to insert a cannula, presumably because of the pain and discomfort that this causes him. Obviously the hospital are obliged to respect his wishes but this in turn means that he is only able to accept fluids and medication by mouth which he is also struggling with.

It is just so unfair and I feel so desperately helpless at being unable to help him, except by visiting.

On top of that I have just found out a few minutes ago, that Barclays have renewed his car insurance for another year - goodness knows why or indeed how. I have just spoken to them but they can't do anything without uncle's permission. Honestly you couldn't make it up, so that will be another thread shortly elsewhere on this forum.

Spruance

Savvy_Sue

It would be worth asking the hospital about their 'end of life pathway', which may have a different name.

Dad pulled a cannula out of his hand in the early hours of the morning of the day before he died, and it was not immediately replaced. 12 hours later, a junior doctor was called to try to re-insert it so that he could be given further doses of antibiotics. When we found out we asked what they were hoping to achieve, given that he'd already had several massive doses which had clearly been ineffective; his blood pressure was rock bottom so he had no veins to speak of; and we'd all been called to his bedside because he was 'very poorly' the day before that!

Anyway, after consulting with his registrar, this jd agreed that there was no point trying to do more, so he was moved onto their 'end of life pathway' making Dad comfortable was the main aim. He did become lucid briefly before he died and seemed to know who was with him: I'd stayed with him through one night and I think he knew I was there.

Spruance wrote: »

On top of that I have just found out a few minutes ago, that Barclays have renewed his car insurance for another year - goodness knows why or indeed how. I have just spoken to them but they can't do anything without uncle's permission. Honestly you couldn't make it up, so that will be another thread shortly elsewhere on this forum.

It's possible that he had it on a DD with them. We do, with a different company, which means that if we don't find a better quote it is renewed automatically. I know, it's not as Expert as it might be, but that's the way we do it, and if / when we change, we know we need to cancel the DD!

On a practical note, is the car parked on the road? If it is, can you get it off the road, on someone else's insurance if necessary? Because I have a nasty feeling that car insurance may lapse on death - may be worth posting that question on the insurance board when you have a moment to draw breath!

beverly_hills

Hi Spruance, have moved here from the insurance site, so sorry your uncle is so ill.
Re the MRSA, I would have thought that was primarily due to their incompetence in caring for his personal hygene. I understand you said things are moving quickly, and of course we don't know what you're going through at this moment, but if it should happen that you're still having problems with administration, it may be worth considering Power of Attorney, continuing and welfare. Contact your local court - it's the Sherrif Court in Scotland, don't know what the English equivilent is, also the Office of the Public Guardian are very helpful and able to give advice. I found both excellent in getting things done quickly. Just tell them you need help and advice, and explain the situation as briefly and calmly as you can, perhaps write it in letter form as your notes so you do miss out or duplicate anything.
My thoughts are with you and your family.

Spruance

Sadly my uncle passed away at 3am on Saturday 31st July 2010 since when it has been something of an emotional rollercoaster ride whilst at the same time trying to keep a handle on all of the paperwork and organisation.

I have had a long chat with the Coroner this afternoon (who became involved due to uncle having surgery twice over a short period) but he is happy that it was death by natural causes, and thus there will be no need for a post mortem and so that side of things can proceed as normal. On the other hand he was very supportive of my position regarding the claim against the hospital and social services and having been filled in on the background he advised me to definitely pursue it as it might just make them rethink their procedures and spare anyone else the ordeal that our family and my uncle had to go through over the last ten days.

Savvy Sue - As regards the car insurance, yes it does lapse on death but since uncle didn't even own the car, a fact which seemed to escape Barclays attention, that is immaterial as it was insured by the new owner in April 2010. The hospital consultant drafted out a suitably worded letter on Friday 30th July 2010 which I understand makes it abundantly clear to Barclays what was going on. It was handed to me sealed with tape and I sent it on Barclays by recorded mail. In any case I will have access to the death certificate in the next few days so if I haven't heard back by then I will get in touch again and then they will have no choice but to comply with my cancellation request.

Beverly Hills - Thanks for the advice. Sadly it no longer applies but I will bear that in mind should I find myself in this situation again.

What was even more shocking about the MRSA situation is when we went to collect uncle's possessions from the care home on Saturday afternoon, they mentioned that he had been sent to them not alone in an emergency ambulance, but in a passenger ambulance with other people.:eek:

When he was readmitted to hospital we were first asked if we were in good health and then required to wear latex gloves, disposable plastic gowns and had to wash our hands/arms in hot water with special soap before leaving the room. I just cannot believe that the hospital would be so negligent as to put other people's health at risk in this way.

Anyway, I have been keeping notes along the way and my mum also keeps a daily diary which has chapter and verse on uncle's treatment so once things settle down, I will start on my official complaint. I should perhaps say that I have already hand delivered to the hospital a notice of intention to complain, with a request that my uncle's notes be preserved. In addition the coroner said that we are entitled (on payment of a nominal fee) to have copies of my uncle's medical records and to question his doctors should the need arise.

I will be looking for reimbursement of care home feeds but my main focus is to try to stop this happening ever again, and will take this all the way to the top if necessary. "Hell hath no fury etc."

Thanks again to everyone for their support. It is very much appreciated.

Spruance

beaujolais-nouveau

Spruance wrote: »

Sadly my uncle passed away at 3am on Saturday 31st July 2010 ... What was even more shocking about the MRSA situation is when we went to collect uncle's possessions from the care home on Saturday afternoon, they mentioned that he had been sent to them not alone in an emergency ambulance, but in a passenger ambulance with other people.:eek: ... I just cannot believe that the hospital would be so negligent as to put other people's health at risk in this way.

I just wanted to say how sorry I am that your uncle's last days and hours were so bad for everyone. The Pilgrim Hospital sounds out of control. Letting someone with MRSA travel with other vulnerable people - words bl**dy well fail me. Good luck with your official complaint.

Spruance wrote: »

my main focus is to try to stop this happening ever again, and will take this all the way to the top if necessary. "Hell hath no fury etc."

I can identify with that. I am beginning to wonder how many NHS PCTs actually "plan out" medical/clinical lead/oversight when dealing with the elderly. Ie deliberately scope procedures so that clinical judgement is absent, leaving Social Services to play at being doctors and nurses. Which is definitely what happened in my mother's case.

monkeyspanner

The treatment of your uncle was extremely cruel and the Hospital and Social Services should be ashamed. I am so sorry for your loss in such horrible circumstances.

The NHS unfortunately has a propensity to hide problems like these and would rather spend money on gagging employees who speak out than rectifying their systemic problems.
http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-trust-tried-to-gag-doctor-who-spoke-out-1810515.html

I wish you good luck in your efforts to confront them. I suspect it will be a long hard campaign.

margaretclare

I am sorry about your poor uncle. We all hope that the end of life will be as peaceful as possible, and this did not happen. I hope that he was mercifully not aware of much that was going on around him.

He would not have been in a fit state to sit in the ambulance transporting him back to the care home. I know from my DH's experience how they stop and start, drop people off along a planned route and are more like a bus service than what we think of as 'ambulance'. That journey alone was extremely cruel.

The MRSA may not have been directly transmissable to other people as long as no one came into direct contact with his wounds, blood or any other body fluids. But that's not the point. It shouldn't have happened!

Commiserations to you and the family.

Gillingham

I am so sorry about your uncle's death and about the apalling treatment he suffered. I can really relate to this as my uncle is currently in a similar position. He has Parkinsons disease with Lewy Body dementia. He was in a care home but his behaviour became unpredictable and aggressive so he was sectioned under the mental health act and spent four months in a local mental health unit. He is doubly incontinent and can't feed himself, can't communicate and has several open pressure sores. However we were told his condition was stabilised and he was well enough to be transferred to a nursing home. He moved three weeks ago and his condition continued to deteriorate. He could not move and was being turned in his bed every hour. He contracted a chest infection and the local GP gave him anitbiotics. He refused to eat or drink and eventually the home called in the GP again and he is now in a side ward at our local General Hospital. He has pneumonia and several other chest and urinary problems. He still can't eat or drink and when I visited yesterday there was an untouched meal of pasty, peas and potatoe sitting on his table. I just got blank looks when I asked if they realised he couldn't even feed himself, let alone that he wasn't eating anything at all. The doctor told us his condition was improving and he might be going back to the nursing home soon. He is being barrier nursed, but no one told us about it! On admission I was told he was 'very, very poorly' and it was possible he would not last the night. Now, in less than a week, it looks like they want him out. He has no children and my Mam (93yrs) is his next of kin. Obviously she can't do anything so I am having to deal with this myself. He is 'almost' self funded as he has several very good pensions which leave him just short of the £650 a week nursing home fees. He doesn't have any capital, but I still feel decisions are going to be made on a financial, not need, basis. I am going to do my best to get him the best possible care, but I feel that I am being ignored as I am only a neice. Heaven help anyone who doesn't have a family to fight for them. If social services were footing the nursing home bill I feel that the position might be somewhat different. He is just lying there, unable to move, eat, drink or communicate. His breathing is awful. He now has even more pressure sores. It is a dreadfull way to be. It is terrible for us knowing that finances are playing such a hugh part in his care.

Mojisola

Gillingham wrote: »

Heaven help anyone who doesn't have a family to fight for them.

It sounds awful but I don't think people without family last very long.

It's appalling that anyone is treated in the ways described. Don't the nurses and social workers ever think "What if this was my relative?"

I'm in similar position to Gillingham but my uncle is well enough to do the hospital paperwork and has named me as next of kin so I will have some say when things get worse for him.

monkeyspanner

Gillingham wrote: »

I am so sorry about your uncle's death and about the apalling treatment he suffered. I can really relate to this as my uncle is currently in a similar position. He has Parkinsons disease with Lewy Body dementia. He was in a care home but his behaviour became unpredictable and aggressive so he was sectioned under the mental health act and spent four months in a local mental health unit. He is doubly incontinent and can't feed himself, can't communicate and has several open pressure sores. However we were told his condition was stabilised and he was well enough to be transferred to a nursing home. He moved three weeks ago and his condition continued to deteriorate. He could not move and was being turned in his bed every hour. He contracted a chest infection and the local GP gave him anitbiotics. He refused to eat or drink and eventually the home called in the GP again and he is now in a side ward at our local General Hospital. He has pneumonia and several other chest and urinary problems. He still can't eat or drink and when I visited yesterday there was an untouched meal of pasty, peas and potatoe sitting on his table. I just got blank looks when I asked if they realised he couldn't even feed himself, let alone that he wasn't eating anything at all. The doctor told us his condition was improving and he might be going back to the nursing home soon. He is being barrier nursed, but no one told us about it! On admission I was told he was 'very, very poorly' and it was possible he would not last the night. Now, in less than a week, it looks like they want him out. He has no children and my Mam (93yrs) is his next of kin. Obviously she can't do anything so I am having to deal with this myself. He is 'almost' self funded as he has several very good pensions which leave him just short of the £650 a week nursing home fees. He doesn't have any capital, but I still feel decisions are going to be made on a financial, not need, basis. I am going to do my best to get him the best possible care, but I feel that I am being ignored as I am only a neice. Heaven help anyone who doesn't have a family to fight for them. If social services were footing the nursing home bill I feel that the position might be somewhat different. He is just lying there, unable to move, eat, drink or communicate. His breathing is awful. He now has even more pressure sores. It is a dreadfull way to be. It is terrible for us knowing that finances are playing such a hugh part in his care.

Sorry to hear about your uncle. Judging on what you have said about his conditions he should not be self-funding his care home fees and maybe should not have been for some time. These fees should be picked up by NHS Continuing Healthcare funding. You could ask for a fast track assessment from the PCT CHC assessment team and in any case the hospital have to at least do an initial CHC checklist assessment (under CRAG rules) for this funding prior to discharge. This checklist assessment is supposed to be weighted on the generous side in order to catch all patients who should have a full CHC funding assessment. Don't be put off, their attitude may change if they realise you are aware of the possibility of this funding. I believe as he has been previously sectioned he should score highly in at least one domain of the full assessment.

One aspect of the CHC assessment you should be aware of is that even if a condition is under control though medication e.g. your uncles behavioural disturbance it must still be assessed as a medical need. For more information if you do an MSE forum search for CHC you should find at least a couple of threads.