Reclaim Care Home Costs for Free- New MSE guide

mjk_2

monkeyspanner wrote: »

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

I pretty much agree with the individual "scores". I think I would have scored her "high" for psychological needs at both times (though for different problems).

During the last few weeks of her life (no DST assessment) when she lost the ability to swallow, I guess her Nutrition score would have moved to "high", and also for Drugs.

jackjackrabbit

I maybe stating the obvious as I haven't read all the responses so apologies if this has already been said, and it may well fall outside of the current discussions, but I thought it worth stating that although the title of this forum is ‘Reclaim Care Costs' and the word Caring is used throughout, the word that should be emphasised here is NURSING. The costs are only covered if the claimant requires full time Nursing Care. I now know this as a friend whose wife requires fulltime care at home, with four visits per day from carers, contacted his local PCT and they confirmed that this was the case and that he could not make a claim. The original article may not have made this clear.

monkeyspanner

jackjackrabbit wrote: »

I maybe stating the obvious as I haven't read all the responses so apologies if this has already been said, and it may well fall outside of the current discussions, but I thought it worth stating that although the title of this forum is ‘Reclaim Care Costs' and the word Caring is used throughout, the word that should be emphasised here is NURSING. The costs are only covered if the claimant requires full time Nursing Care. I now know this as a friend whose wife requires fulltime care at home, with four visits per day from carers, contacted his local PCT and they confirmed that this was the case and that he could not make a claim. The original article may not have made this clear.

This is not strictly the case. It was at one time limited to nursing care by qualified medical staff but this was widened some time ago to include non-medical staff administering care. CHC funding is available in any setting including patients own home and care homes that do not have nursing facilities. The relevant 2009 National framework clause is:

47.NHS continuing healthcare may be provided by PCTs in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility for NHS continuing healthcare is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care. The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have a bearing on NHS continuing healthcare eligibility.

This was also included in the 2007 National Framework document.

monkeyspanner

purepink wrote: »

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)?

That sounds like a good plan. If you wanted to make sure you meet the deadline you could notify the PCT and then approach a solicitor. Perhaps a letter to the PCT signed jointly by the beneficiaries would be appropriate. Good luck if you decide to proceed.

hollyhocks123

jackjackrabbit wrote: »

I maybe stating the obvious as I haven't read all the responses so apologies if this has already been said, and it may well fall outside of the current discussions, but I thought it worth stating that although the title of this forum is ‘Reclaim Care Costs' and the word Caring is used throughout, the word that should be emphasised here is NURSING. The costs are only covered if the claimant requires full time Nursing Care. I now know this as a friend whose wife requires fulltime care at home, with four visits per day from carers, contacted his local PCT and they confirmed that this was the case and that he could not make a claim. The original article may not have made this clear.

You have no idea how glad I was to read this! At least to see someone else objecting to the title 'Reclaiming Care Costs'. I will go on about this in every post, it is about someones health needs, nothing to do with finance or claiming costs back, yes the outcome can be financial, but the retrospective is still about eligibility.

To clarify it used to be about nursing need only, and by that I do mean direct nurse intervention, but since the framework (and I want to say the revised one of 2009, but it might be in the 2007 one, can't remember off the top of my head) it includes 'skilled intervention' too, which is nursing equivalent, it doesn't mean carers in a nursing home for example. But a personal assistant or family member may be trained in say tracheotomy clearing/ care, and that counts as a 'skilled intervention' which is nurse equivalent.

hollyhocks123

mjk wrote: »

I pretty much agree with the individual "scores". I think I would have scored her "high" for psychological needs at both times (though for different problems).

During the last few weeks of her life (no DST assessment) when she lost the ability to swallow, I guess her Nutrition score would have moved to "high", and also for Drugs.

I didn't want to quote all your posts so just picked the last one!
I'm glad you agree with most of the weightings, families often disagree but the nurses assessing are qualified and train for that job, everyone is entitled to their view but families are part of the evidence not of the MDT (I have sat in many an IRP where this has been at the crux of the matter), so I am glad you also agreed with the majority of the weightings.
To refer to an earlier questions the four key indicators are the complexity, intensity etc bit. From the looks of the weightings (and as I've said before it is about the 4 key indicators not the weightings for the most, but the do give a hint when you've seen enough) I would have said definately FNC, and only CHC if the 4 key indicators demonstrated it, I've seen many cases go to IRP with one severe and 4 highs and still not be found to be a primary health need as there was minimal complexity and minimal intensity for example.

So, again without seeing the records, I would say the PCT's outcome is sound, especially as 2 DST's were done with similar outcomes. However, I would contact your PCT to enquire if anyone would look at the last 4 weeks again to see if there should have been a fast track, if the reduced swallow led to loss of weight and medication began to be refused (due to no swallow) then may be have been eligible for palliative care, if the GP put her on a palliative pathway, your in with a high chance of it being fast track eligible. Do note this is at the PCT's choice, there's no policy on it as 4 weeks is too small a timeframe to claim as a retro but I'd hope they would look into it and see that a) perhaps there should have been an assessment and if so you should get those 4 weeks.

The other way, if your up for it, is to ask for a retro for the whole time, or 6 months +, if they accepted, and they may not due to the 2 DST's being done, then they would have to look at the whole time even if you're only thinking the last bit was eligible, and they may find eligibility for PHN for the last 4 weeks. It's a convaluted way but I've seen it before.

hollyhocks123

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?

Hi, the dementia shouldn't be seen as anything in an assessment, it will be noted in the DST and likely have a large need in the cognitive domain and therefore be mentioned there and 'weighted' there. But, and I can't stress this enough, it isn't to do with diagnosis. it will be around the needs, if someone has dememntia, and it has caused social needs, then that would not be CHC, but where the dementia has led to health needs it may be FNC or CHC, again, health needs - in a nuring home are about the registered nurse involvement, in other environments it includes skilled equivalent care also.

It does seem incredibly unfair, that someone can be struck with a dreadful illness or disease or accident and have all the needs created, such as needing help with washing and dressing and feeding, and still not be classed as anywhere near eligible for health funding.

So if your going to apply for a retrospective, in the simplest terms, forget the diagnosis, look at the needs, were there swallowing issues, did the behaviour stop care being given regularly or require extra intervention, were there pressure sores, skin tares etc, was a hoist needed for transfers and could she assist (use her arms to hold on) at all etc. That sort of thing.

It's the framework and policies we've got to work in, we don't have to like them but it's what we've got. Hope I've been of some use, or at the very least, not offensive or upsetting, it's always hard when it's personal.

monkeyspanner

hollyhocks123 wrote: »

It does seem incredibly unfair, that someone can be struck with a dreadful illness or disease or accident and have all the needs created, such as needing help with washing and dressing and feeding, and still not be classed as anywhere near eligible for health funding.
.

So are you saying that needing help with feeding as a result of a degenerative condition is purely a social need?

monkeyspanner

hollyhocks123 wrote: »

You have no idea how glad I was to read this! At least to see someone else objecting to the title 'Reclaiming Care Costs'. I will go on about this in every post, it is about someones health needs, nothing to do with finance or claiming costs back, yes the outcome can be financial, but the retrospective is still about eligibility.

To clarify it used to be about nursing need only, and by that I do mean direct nurse intervention, but since the framework (and I want to say the revised one of 2009, but it might be in the 2007 one, can't remember off the top of my head) it includes 'skilled intervention' too, which is nursing equivalent, it doesn't mean carers in a nursing home for example. But a personal assistant or family member may be trained in say tracheotomy clearing/ care, and that counts as a 'skilled intervention' which is nurse equivalent.

It is in both the original 2007 National Framework and the revised 2009 National Framework.

2007 Wording
37. NHS Continuing Healthcare may be provided by PCTs in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility for NHS Continuing Healthcare is therefore not determined or influenced by either the setting where the care is provided nor by the characteristics of the person who delivers the care. The decision-making rationale should not marginalise a need because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have a bearing on NHS Continuing Healthcare eligibility.

2009 Wording
47. NHS continuing healthcare may be provided by PCTs in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility for NHS continuing healthcare is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care. The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have a bearing on NHS continuing healthcare eligibility.

The wording is identical apart from the clause number. The framework document clause is quite clear and uses the words "healthcare" and "care" not "nursing". I am unsure where the "skilled intervention" is in the National Framework. Is this possibly an "interpretation" of the Framework document?

hollyhocks123

monkeyspanner wrote: »

So are you saying that needing help with feeding as a result of a degenerative condition is purely a social need?

I'm saying the point is it doesn't matter what it is a result of and with regard to the feeding specifically, yes it can be social only, if it is just feeding then it is, if there is SALT involvement or swallowing issues, for example, then it becomes more of a health need, if someone needs a carer to feed them it is mainly a social need, but it depends, it is all about the need - for example some people have swallowing issues even with thickened fluids, pureed diet etc, and need special positioning as per SALT guidelines, that would be more of a health need. Again, this alone wouldn't be a Primary health need, but there are likely to be more needs going on.

In response to your other post I used skilled intervention as my wording in order to explain (it's wording from the continuing health care guidance, around joint packages), I find practicle examples etc easier to explain, and for majority of people to understand.

The clearest place where registered nurses are mentioned specifically is the FNC guidance who make it clear the differenence between the nurses and carers in a care home, also around joint packages. CHC pre national framework (in my previous message I wasn't 2009 change or the pre framework) it used to defined as nursing but they expanded it as the wanted to acknowledge the skilled care that a lot of carers and family gave that would normally need to be given by a nurse.

If written this whilst my computer is going a bit odd, so if there are random words all over the show I apologise!:)