Reclaim Care Home Costs for Free- New MSE guide

Doc_N

I'm finding the advice on here very helpful - thanks to monkeyspanner in particular.

Money Box (Radio 4, Saturday, noon) is, I believe, doing a piece on this issue, and with their track record it's likely to be useful listening.

With a relative, now deceased, who spent several years in a care home at her own expense I've a personal interest in this. She ended up there because the hospital said that her dementia made it impossible for her to carry on living at home. That was certainly the case, and two fractured hips just compounded things. She was totally unable to take her many medications, thanks to the dementia, and that was the root cause of the problems. On top of that she was unable to care for her colostomy.

I'm getting the impression from the very helpful posts in here that dementia is not being seen as a health/medical issue - more a social one, with the outcome that it isn't funded by the NHS, and isn't therefore something that can form the basis of a valid back-claim.

This seems illogical, in that dementia creates just as many issues for the patient as a physical ailment (probably more so) and does lead to the situation that my relative found herself in - a complete inability to look after herself which would have led, inevitably, to an early death.

Have I perhaps misunderstood the position here?

Chesty434

I could not agree more - the PCT reviews seem to be based on the fact that if your are physically unable to do certain things, or in simple terms, have medication issues, incontinence, drips etc, then you qualify.

The simple truth is, if at the age of 52 you are struck down with a brain injury that leaves you completely unable to lead a normal life and will always need monitoring and assistance to carry out what was once before something you took for granted - the PCT do not think this is a need that applies to be funded - because you appear 'normal'

Since this time the family have sold our mothers house, and with the aid of disability allowances, widows pensions and an annuity purchased from funds paid to our mother when our father died of cancer, has all added up to be able to afford fees which at one time reached £55,000 per year. Our mother needs a secure unit (which in itself is an indicator of her needs).

Furthermore, social services visited a few years back and were even trying to take away her standard monthly allowance everybody gets. Told them a few home truths and never heard from them since!

The system leaves us totally frustrated and disgusted at the treatment and total disregard to what has been for 20 years, very very difficult.

The fact is because our mother can walk around and seemingly appear 'normal' she does not qualify - take away the care and support and she would not be able to cope. She could meet you and chat to you and within 5 minutes of you leaving have no idea who you were.

She did not ask to be ill - but as a result lost everything she and my father ever worked for!

Doc_N

There's a piece now on Radio 4 - You and Yours.

Available later online:

http://www.bbc.co.uk/programmes/b006qps9

purepink

This is something I have been considering for sometime, but have avoided because event thinking about it makes me quite upset :-(
One of my dearest friends developed Alzheimers and discussed POA with me. I had young children at the time and she wasn't sure whether I could cope with the additional work involved, or whether to give it to her solicitor. It wasn't the volume of work I was concerned about - it was that I like transparency, so naively I thought the solicitor would be a better choice. How wrong I was. As she deteriorated, she was put in a care-home. Her property was left empty. The beautifully landscaped gardens became overgrown. I tried to have an 'input' but I was firmly put in my place - I wasn't a relative! (She barely had any releatives!) The house was sold for what I believe to be less than market value. She was moved around care homes and then placed in a nursing home. Eventually, she died. There is so much more I could say! BUT I doubt the solicitor ever looked into the nursing home fees being paid! I was one of the beneficiaries of her estate. I have recently asked her solicitors (the one who had POA is no longer there) to look at her file, to see whether an application to cover the nursing home fees was ever made. The clock is ticking (end Sept deadline). She was SO careful with her money when she was alive, that I feel it is my duty to make sure that the solicitor took equal care when they had POA, but even writing this is making me feel sick to the pit of my stomach. I do feel she was wronged in so many ways and need to detach myself, I know. But as far as reclaiming the fees (in this long and sorry story) please does anyone have any advice for me?

monkeyspanner

Doc_N wrote: »

I'm finding the advice on here very helpful - thanks to monkeyspanner in particular.

Money Box (Radio 4, Saturday, noon) is, I believe, doing a piece on this issue, and with their track record it's likely to be useful listening.

With a relative, now deceased, who spent several years in a care home at her own expense I've a personal interest in this. She ended up there because the hospital said that her dementia made it impossible for her to carry on living at home. That was certainly the case, and two fractured hips just compounded things. She was totally unable to take her many medications, thanks to the dementia, and that was the root cause of the problems. On top of that she was unable to care for her colostomy.

I'm getting the impression from the very helpful posts in here that dementia is not being seen as a health/medical issue - more a social one, with the outcome that it isn't funded by the NHS, and isn't therefore something that can form the basis of a valid back-claim.

This seems illogical, in that dementia creates just as many issues for the patient as a physical ailment (probably more so) and does lead to the situation that my relative found herself in - a complete inability to look after herself which would have led, inevitably, to an early death.

Have I perhaps misunderstood the position here?

Yes it is illogical and just plain wrong that degenerative illnesses of the brain are seen in some areas as a "normal" consequence of old age. If my understanding of the National Framework and DST assessment is correct there is no reason why these illnesses cannot be included in the medical needs and they are not an inevitable consequence of old age.

As you have pointed out it was as a direct consequence of your relatives dementia that she was no longer able to live at home. This of course does not necessarily mean she should have received CHC funding as there is a requirement for needs to be both complex and severe but on the basis of the other medical needs you outline I think there is sufficient to ask for a retrospective review.

monkeyspanner

skintwellie wrote: »

Wonder if anyone is able to help - my mum went into hospital February 2011 following yet another fall and consequent fracture of her femur. My sister and I pushed for nursing home care but her assessment decided that she required an EMI home for her worsening dementia. Mum had very little in the way of savings and we had a choice of several homes where she could go using her pension/pension credit topped up by social services.
Mum sadly passed away last month, I was wondering if we are able to make a claim based upon the fact that she used her state pension payments to pay towards her care.

Any advice greatly appreciated, Thanks.

Sorry to hear of your recent loss.

Yes you could ask for a review but you may wish to consider the amount of money you may recover against the time and effort required to make a claim. Another point to consider is that cases where there is no pressing need to complete a review will be the lowest priority and another poster has already been given a time scale of 12months before the PCT look at their case. However you may want to lodge a request prior to any deadline so that at least you have put the case on the waiting list.

monkeyspanner

purepink wrote: »

This is something I have been considering for sometime, but have avoided because event thinking about it makes me quite upset :-(
One of my dearest friends developed Alzheimers and discussed POA with me. I had young children at the time and she wasn't sure whether I could cope with the additional work involved, or whether to give it to her solicitor. It wasn't the volume of work I was concerned about - it was that I like transparency, so naively I thought the solicitor would be a better choice. How wrong I was. As she deteriorated, she was put in a care-home. Her property was left empty. The beautifully landscaped gardens became overgrown. I tried to have an 'input' but I was firmly put in my place - I wasn't a relative! (She barely had any releatives!) The house was sold for what I believe to be less than market value. She was moved around care homes and then placed in a nursing home. Eventually, she died. There is so much more I could say! BUT I doubt the solicitor ever looked into the nursing home fees being paid! I was one of the beneficiaries of her estate. I have recently asked her solicitors (the one who had POA is no longer there) to look at her file, to see whether an application to cover the nursing home fees was ever made. The clock is ticking (end Sept deadline). She was SO careful with her money when she was alive, that I feel it is my duty to make sure that the solicitor took equal care when they had POA, but even writing this is making me feel sick to the pit of my stomach. I do feel she was wronged in so many ways and need to detach myself, I know. But as far as reclaiming the fees (in this long and sorry story) please does anyone have any advice for me?

That is very sad and understandably you are upset. You should not blame yourself as it was the solicitor's responsibility to look after your friends assets as her POA, and they were receiving payment for that duty.

There may be an added degree of difficulty in processing a claim as you were not POA but being a beneficiary may help. Have you spoken to the other beneficiaries or would that be difficult? Also you might wish to approach the executor of your friends estate (or was this the same solicitor?).

I would not wish to put you off but you are obviously affected by the treatment of your friend and in order to follow up a claim yourself it will require substantial involvement over a period of months if not years. In your case I think I would advise finding a sympathic solicitor that has experience in this type of case. I would also advise caution in finding a solicitor as there are a large amount of claims chasers advertising heavily on various media at the moment because of the deadlines.

I hope this assists you.

mjk_2

hollyhocks123 wrote: »

Ask for a copy of the DST, if totality of need was considered there is no grounds for a retrospective (look to see if the 4 key indicators were used, is usually a good sign the totality was considered) if not then you should apply for a retro.
Just my opinion, but from what you've written there's nothing there to indicate CHC to me, so sounds like DST may have been right, however without seeing the whole DST it's obviously not definative, just a view also worth noting how close that DST was done towards the end, if not done close but there was a rapid deterioration (i.e. went downhill very fast - 4 weeksish) then may have been eligible for fast track funding.

GRRR just typed long post and it's disappeared!! Thanks for your reply Hollyhocks. What are the "4 key indicators"? Are they the 4 domains with the possibility of a "Priority" grading?

So, shorter version... Mum had DST applied twice.

First time (approx 10 months before death):
Severe: Cognition
High: Behaviour
Moderate: Psychological, Nutrition, Continence, Skin, Drugs
No needs: All other domains

Second time (approx 4 months before death):
Severe: Cognition
High: Communication, Mobility,
Moderate: Psychological, Nutrition, Continence, Skin, Drugs
No need: All other domains

According to DST notes: "one domain recorded as severe, together with needs in a number of other domains may well also indicate a primary health need". So Mum's case fell into this rather woolly area where the decision depends on the "complexity, intensity or unpredicatability of the needs"... so we were turned down.

Not sure whether it's worth revisiting this whole thing - at the moment it's just bringing back bad memories. On the otherhand as a long-term MSE'er I don't like to leave any stones unturned!

monkeyspanner

mjk wrote: »

GRRR just typed long post and it's disappeared!! Thanks for your reply Hollyhocks. What are the "4 key indicators"? Are they the 4 domains with the possibility of a "Priority" grading?

So, shorter version... Mum had DST applied twice.

First time (approx 10 months before death):
Severe: Cognition
High: Behaviour
Moderate: Psychological, Nutrition, Continence, Skin, Drugs
No needs: All other domains

Second time (approx 4 months before death):
Severe: Cognition
High: Communication, Mobility,
Moderate: Psychological, Nutrition, Continence, Skin, Drugs
No need: All other domains

According to DST notes: "one domain recorded as severe, together with needs in a number of other domains may well also indicate a primary health need". So Mum's case fell into this rather woolly area where the decision depends on the "complexity, intensity or unpredicatability of the needs"... so we were turned down.

Not sure whether it's worth revisiting this whole thing - at the moment it's just bringing back bad memories. On the otherhand as a long-term MSE'er I don't like to leave any stones unturned!

In your opinion do these DST results reflect your mother's condition at the time?

purepink

monkeyspanner wrote: »

That is very sad and understandably you are upset. You should not blame yourself as it was the solicitor's responsibility to look after your friends assets as her POA, and they were receiving payment for that duty.

There may be an added degree of difficulty in processing a claim as you were not POA but being a beneficiary may help. Have you spoken to the other beneficiaries or would that be difficult? Also you might wish to approach the executor of your friends estate (or was this the same solicitor?).

I would not wish to put you off but you are obviously affected by the treatment of your friend and in order to follow up a claim yourself it will require substantial involvement over a period of months if not years. In your case I think I would advise finding a sympathic solicitor that has experience in this type of case. I would also advise caution in finding a solicitor as there are a large amount of claims chasers advertising heavily on various media at the moment because of the deadlines.

I hope this assists you.

Thank you very much and yes, it does help :-)
The other beneficiaries were as upset as I was, so would support any action. In fact, I originally said I would do something, but it was all too raw. The executor was.... the solicitor. The estate agent was.... the solicitor, or at least the estate agency branch! I had considered going through Hugh James, but then thought I would just see what was being avised on here. Originally there was another executor, but the will was changed (I believe it was changed AFTER the diagnosis) and in fact, there was an amount left to the solicitor who had POA. It would probably be easier to let sleeping dogs lie, but I don't feel I have 'done right' by my friend. Perhaps I should add (I don't think I mentioned it before) but after not allowing me to be involved with my friend's care (because I wasn't a relative) once she had died I was invited to liaise with the undertaker and the vicar, over the funeral arrangements, order of service etc., and I scattered her ashes, because I knew where she wanted them scattered :-( So I guess the best way forward is to put it through Hugh James (or similar)?