Reclaim Care Home Costs for Free- New MSE guide

monkeyspanner

megansden wrote: »

Since contacting the PCT it appears that my mother was only on CHC for 1 week which seems bizzaar as she has ongoing clinical problems for at least 2 years (dementia, incontinence and constantly falling over) I am wondering if there is a case for compensation given the circumstances:mad:

If your Mums medical problems (or part of them) were from Oct 2007 have a look at the DST and do your own assessment. If there are in your opinion a couple of severes and a couple of highs and you have the stamina for a fight, then its worth considering asking for a retrospective review. When doing your assessment remember that if any of your mum's conditions were managed well then you shouls assess as though they were not managed. "A well managed need is still a need".

Here is a link to the DST http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103329.pdf

tinkerbellkirst

monkeyspanner wrote: »

I was a little concerned that you mention your grandmother is funding your granfather from presumeably joint savings. Only your grandfathers savings should be used for funding his care. Your grandmother is not under any obligation to fund his care from her savings. So if their saving were say £60,000 in joint accounts £30,000 of that is your grandmothers leaving £30000 to be assessed. The first £23,250 is the lower savings limit leaving £6,750 for use against the care home fees. Once your grandfathers savings reach the lower savings limit the council must assist with his fees. This means that a means test is made of your grandfathers income including state and other pensions and any other capital. The means test should take account of your grandmothers needs and property should be excluded from the assessment if your grandmothers is still living there. The situation could get more complicated if the savings were in an account in your grandfathers name only.

The hospital records should show if any CHC checklists have been carried out. This is a requirement on disccharge from hospital and the results should be communicated by the discharge team to the patient or their representative.

If you believe that your grandfathers needs are now primarily health related then a CHC assessment should be requested asap.

Thankyou for your reply,

All the assumptions you made regarding the savings etc are correct and i think their savings are nearing the lower limit now (well my grandads half) or may have already reached this. Its a bit of an ongoing issue with my grandma as SS should probably now be funding towards his care, but as they would then lose his pension/attendance allowance etc trying to get my grandma to see she would still be better off is a bit of a... erm challenge! So i am concerned she will just continue to fund his care until all savings are gone and then i dont know what she will do. Anyhow thats a different matter altogether!

My mum is coming to look over the criteria with me and the tools and guidelines etc as she knows my grandad best so can see where she thinks he should score and we will work out before proceeding whether we think we have a case. I may in the mean time though get his records to see the copies of any assessments and what he scored.

My mum has been present every time he has been dishcharged from hospital to return with him to the care home and no results have ever been communicated with her.

Thankyou again

monkeyspanner

tinkerbellkirst wrote: »

Thankyou for your reply,

All the assumptions you made regarding the savings etc are correct and i think their savings are nearing the lower limit now (well my grandads half) or may have already reached this. Its a bit of an ongoing issue with my grandma as SS should probably now be funding towards his care, but as they would then lose his pension/attendance allowance etc trying to get my grandma to see she would still be better off is a bit of a... erm challenge! So i am concerned she will just continue to fund his care until all savings are gone and then i dont know what she will do. Anyhow thats a different matter altogether!

My mum is coming to look over the criteria with me and the tools and guidelines etc as she knows my grandad best so can see where she thinks he should score and we will work out before proceeding whether we think we have a case. I may in the mean time though get his records to see the copies of any assessments and what he scored.

My mum has been present every time he has been dishcharged from hospital to return with him to the care home and no results have ever been communicated with her.

Thankyou again

Good luck with persuading your grandmother. Although the attendance allowance would stop after the first 28days of the council assisting with funding she would not necessarily lose all your grandfathers pension particarly if this was their only source of income and used jointly for household expenses.

And good luck with following up the CHC assessments.

hollyhocks123

Hi, bit late to the forum here but there was something that bugged me on the page, and it asked for any errors to be flagged up.
I do work for the NHS (the 'other side, I know!).

But maybe I can offer a different perspective, who knows - i have worked with both the IRP's and the Ombudsman's office so I wanted to share what little I know:)



''What is a "primary health need"?
Instead, eligibility is based on your 'score' (from the highest 'priority' need, to severe need, low need), in 12 'care domains' (such as mobility, continence and breathing). If you had one 'priority' or two 'severe' needs, there's a decent chance you were eligible.

To keep it simple, ask yourself whether a reasonable person, who wasn't emotionally involved in this would say whether health needs - physical or mental, caused by disability, accident or illness - are the main reason for care being needed.'


The first statement about 2 Severe's or 1 Priorty having a decent chance - it's more of a 99% chance, I'd have said 100% but can't say what other PCT's do but if anyone was given this and didn't get CHC, you'd have a very good case by the time you got to IRP.


Re The second statment - I do object to this, it's about the health needs, not the cause (the wording is 'not diagnosis led') so someone might have high health needs due to old age for example,and no illness. It's really got nothing to do with someones illness (it sounds awful I know, you don't have to agree with the system to work in it!). You have to take a really clinical / cold view and look at how much nurse intervention or skilled equivalent someone is receiving and needs.


As another note the National Framework and DST is only from October 2007 - but the policies for your local area for the time prior to this should be available online, a google search should find them.


I could give all sorts of advice and hints on here, but I don't want to go on, sorry if I already have, but if anyone wants know more, let me know, I'm happy to share what I do and what I know

monkeyspanner

hollyhocks123 wrote: »

Hi, bit late to the forum here but there was something that bugged me on the page, and it asked for any errors to be flagged up.
I do work for the NHS (the 'other side, I know!).

But maybe I can offer a different perspective, who knows - i have worked with both the IRP's and the Ombudsman's office so I wanted to share what little I know:)



''What is a "primary health need"?
Instead, eligibility is based on your 'score' (from the highest 'priority' need, to severe need, low need), in 12 'care domains' (such as mobility, continence and breathing). If you had one 'priority' or two 'severe' needs, there's a decent chance you were eligible.

To keep it simple, ask yourself whether a reasonable person, who wasn't emotionally involved in this would say whether health needs - physical or mental, caused by disability, accident or illness - are the main reason for care being needed.'


The first statement about 2 Severe's or 1 Priorty having a decent chance - it's more of a 99% chance, I'd have said 100% but can't say what other PCT's do but if anyone was given this and didn't get CHC, you'd have a very good case by the time you got to IRP.


Re The second statment - I do object to this, it's about the health needs, not the cause (the wording is 'not diagnosis led') so someone might have high health needs due to old age for example,and no illness. It's really got nothing to do with someones illness (it sounds awful I know, you don't have to agree with the system to work in it!). You have to take a really clinical / cold view and look at how much nurse intervention or skilled equivalent someone is receiving and needs.


As another note the National Framework and DST is only from October 2007 - but the policies for your local area for the time prior to this should be available online, a google search should find them.


I could give all sorts of advice and hints on here, but I don't want to go on, sorry if I already have, but if anyone wants know more, let me know, I'm happy to share what I do and what I know

Thanks for your input. Perhaps you could comment on why some PCTs deny CHC to patients with dementia of various types whilst providing CHC funding to stroke patients with similar symptoms. Thanks

DeeBeeBedford

Hi All, sorry if I'm doing this the wrong way, my first post to this forum, just wondering if anyone can help me? My father went into a care home for respite care at the end of 2010, he'd been having carers 4x daily to his warden assisted flat for approx a year after his health deteriorated. He was diagnosed with 'suspected MS', became bedbound and doubly incontinent and lost a dramatic amount of weight leading to him going to the care home for respite, which he then has remained in ever since, all the while his health deteriorating, he can't talk/communicate very well at all, has to be fed pureed food as he is at risk of choking and never leaves his room except for when they weigh him. He has full funding from the CHC but only since January 2012. I have a current dispute with the local Chief Executive of the Council as when he was first admitted social services failed to carry out a full assessment and the Care Home billed us for his care (which was part funded due to nursing costs) and we got asked to complete the required assessment (of which we weren't aware) at the end of 2011 - long story short - they then billed my dad for an underpayment of almost £10k!! We'd been paying a monthly amount that the care home had billed us for! Our argument with the Chief Exec is that Dad didn't have a choice to turn down their costs and his alternative would've been to live with us and have carers attend him in our home, so a retrospective charge seems immoral and against his human right to choose! They are taking their time to resolve this issue and I'm wondering if it's because they are aware of this issue where he basically should've been assessed for CHC funding from day 1 of being admitted for respite or even prior to that in his warden assisted flat when carers were arranged to visit 4 times a day! I've only become aware of this thread due to being sent emails for MSE! So my question is basically, do people think as dad has been assessed and has been accepted as needing the CHC funding, what about the amount he has paid prior to January 2012 and the 'debt' they say he owes due to their mistake. By the way, their written response has said we should have known his monthly payments were an 'interim payment' despite not having experience with putting a loved one into a care home before or knowledge of what assessments were required by social services other than being sent a bill from the care home and paying it on a monthly basis!!! Our last letter to the Chief Exec mentioned we would take the matter to the Ombudsman but they are 'investigating' to 'be thorough' as they have made quite a few mistakes along the way (ie, overcharges for care when dad was living in his flat therefore being owed money so they have to calculate how much he is actually 'in debt' for, but the 'financial' person is 'on holiday'!) so it's as though their last correspondence to us is asking us to wait a bit longer......maybe until after 30th September? I have POA. Any advice or opinions on what to do would be greatly, greatly appreciated! I do believe it's not the money here and the principle, they have apologised for taking so long to do the financial assessment (15months!) but, as I said, their whole argument is based on that they think we should've known and were told by a social worker who visited my dad when I was there, not so! Thanks in advance.

monkeyspanner

Hi Dee
Your story sounds very familiar. Social services tend to railroad relatives into situations which are unfamilar and take advantage of patients and relatives lack of knowledge.

I think you should think about this as two separate issues.

The first is NHS CHC funding. As far as I am aware unlike discharge from hospital to a care home there is no obligation on social services to arrange a CHC assessment although in my opinion this would have been good practice as soon as it became apparent your father would need long term care. It is of course possible that as your fathers condition has deteriorated over time that he would not have qualified for funding.at the start of his stay in care home. Could I ask what prompted the CHC funding that was granted from Jan 2012 and as far as you are aware was any retrospective review of your fathers condition carried out at the time? If not I would lodge a request for a retrospective review prior to any deadline that might apply. (see the MSE guide for details).

The second issue is your dispute with the council. If I have understood your dispute this revovles around you as POA not having been given accurate costs of your father's care in good time after his move to the care home. I think it would have been reasonable for you to expect a timely financial assessment to have been carried out and for you to be given this information as his POA. It would seem a substantial miscalculation to accumulate £10000 underpayment over 15 months. Both the lack of information and the time delay in providing accurate information are in my opinion unreasonable. Unfortunately I can't think of any regulation they have infringed as I am not familiar with local government regulations. I wish you luck with your dispute.

hollyhocks123

monkeyspanner wrote: »

Thanks for your input. Perhaps you could comment on why some PCTs deny CHC to patients with dementia of various types whilst providing CHC funding to stroke patients with similar symptoms. Thanks

Hiya, it's never about 'denying' anything, nurses / MDT's go out to see what the evidence finds someone to be eligible for, it's a health assessment the problem comes because the outcome of the assessment is related to finance, but nurses don't go out to 'deny' someone something or 'take away' funding (I hear that one a lot), they just look at eligibility.

With regard to the dementia vs stroke, there could be many explanations; patients are never compared, so it's not -P1 needs more help than P2 so therefore should get CHC, it depends what the need is, one may have increased needs but the increased needs may be social in nature, whereas the other one may be more health needs; without knowing the specifics I can't really say why but I can't stress enough how much it is not diagnosis led, the 'root cause' stroke or dementia, is irrelevant.

I'll give an example in case it helps - I'll use 2 people in a nursing home and I'll generalise.
You could have 2 very simlar cases, they have impaired cognition (High or Severe on a DST), maybe be a bit resistive to care (Low or Moderate depending) be immobile (High), no verbal or non verbal communication (High), needs feeding (Low) so very similar needs and they'r likely to be eligible for FNC, but one patient could have lost a lot of weight in the last 3 months (a high percentage of their weight) and it's not looking like it's settling or improving, this may have led to pressure sores and all of a sudden you client needs the nurse on durty to be thinking and checking a whole lot more, the needs are interacting and causing an increase to the nursing input required (immobile plus low weight increases bed sores and it's harder for them to heal etc) this would suggest CHC. - like I said this is a very simple general example - It actually could be FNC or CHC, it would depend on how much weight loss etc and the impact of it and if it was an acute episode like an infection involved, but it also shows that for DST's - anything post Oct 2007 - it's all about the 4 key indicators, the 'scorings' of High, Severe etc, don't matter so much after the 1 Priority, 2 Severe's. 2 people could have exactly the same 'scoring' and have different eligibility.

There is always subjectivity involved, nurses have to make an assessment, however PCT's have panels and checks and training and forums which remove as much of this as possible (at least I hope all the PCT's do) .

I hope this helps, again, I've gone on a lot.

hollyhocks123

In response to Dee,

I agree with everything Monkeyspanner has put, look at what prompted the January 2012 DST, if there was a step change or a hospital visit for example this would explain it, a checklist would have been done and someone would have decided on that nurse in the home, social worker, district nurse - would be worth seeing what made them decide that - call the home and see if they know or speak to one of the homes nurses, but if nothing changed you should either apply for a retro or call / write to the PCT and ask them what they think. It would be sensible for a PCT to send a nurse to look over the care home notes for the few months prior to the DST being completed in January and see if they can see a step change or if they feel it was CHC then as well. It depends on both you and the PCT, you may want to follow all the official steps in which case a retrospective review is the only option, the other one is slightly more informal but I know quite a few PCT's who do that as for some families that's all they want, to know someone has looked at the records and are given the reason why a decision was made.

Good luck with both the council and the PCT

alicebean

Hoping someone can advise. My nan has been in a residential home for 10 years. My concern is that if I start this process and she turns out to be eligible for CHC will that trigger or give evidence to the home to ask for to be moved to a nursing place. As this is not an option - when she stopped be privately funded and the local authority had to step in we had a big fight to keep her where she was.