Reclaim Care Home Costs for Free- New MSE guide

monkeyspanner

Hollyhocks
Thanks for your explanation. I understand the distnction that you are explaining but I have to say I don't agree with this interpretation of the National Framework.

If as a result of an illness a patient is unable to feed themselves either physically or because of lack of motivation then being fed or encouraged to eat is one of their most basic and essential health needs. Without feeding (including more importantly the provision of liquids) a patient's overall health will deteriorate more rapidly than other factors you have identified as a health need. The need to be fed is just as much a health need as for instance being assisted out of bed which could score as severe on the DST assessment.

Of course the need for feeding on its own would be insufficient to demonstrate an overiding healthcare need.

I appreciate you taking the time to expand on the medical approach to CHC assessments but hope you will understand that to the general population this seems like splitting hairs and overcomplicating what would appear to be straightforward issues of healthcare. There also appears to be an underlying judgement by the NHS that if a task is not one which a nurse would carry out then the reason for carrying out that task is not a health need. This judgement would I believe be contrary to the spirit and letter of the National Framework document.

monkeyspanner

mjk wrote: »

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!

Thanks for your reply indicating you largely agree with the asessments.
I have had another look at the summary above and one point does occur to me.

In the first asessment "behaviour" is assessed as a high need but does not appear in the second assessment. Is this because the behaviour problems were resolved or were they controlled by medication. If they were controlled by medication then they should still be classed as a need in the second assessment. The National Framework is clear on this point.
The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. (Extract of clause 47 National Framework document 2009)

metron

My elderly aunt found herself discharged from hospital several years back, with the family being told that she needed to go into a care home because her dementia made it impossible for her to feed herself, or take the medications she needed to take simply to stay alive.

It cost around £100,000 whilst she was in the care home, and without the care she received there’s no doubt at all that she’d have died at home within weeks (or been taken back into hospital) because none of the family lived near enough to be able to help.
This wasn’t a ‘care’ issue as I see it – it arose directly as a result of her dementia. I’m inclined towards making a claim, but the work involved looks daunting, particularly if there’s little prospect of success.

I’d appreciate any thoughts from someone with better knowledge of this than I have.

monkeyspanner

metron wrote: »

My elderly aunt found herself discharged from hospital several years back, with the family being told that she needed to go into a care home because her dementia made it impossible for her to feed herself, or take the medications she needed to take simply to stay alive.

It cost around £100,000 whilst she was in the care home, and without the care she received there’s no doubt at all that she’d have died at home within weeks (or been taken back into hospital) because none of the family lived near enough to be able to help.
This wasn’t a ‘care’ issue as I see it – it arose directly as a result of her dementia. I’m inclined towards making a claim, but the work involved looks daunting, particularly if there’s little prospect of success.

I’d appreciate any thoughts from someone with better knowledge of this than I have.

Yes it does involve a lot of work but this is likely to be spread over a period of months or possibly years. If you take on the process yourself you will need to read and reread various official documents and be able to put together information to support any appeals. The best attributes you could have would be persistence and ability to compartmentalise this process from the rest of your life. If you let your thoughts dwell on the process it can take over your life. There will be periods when you are very busy and then long periods where nothing happens.

metron

monkeyspanner wrote: »

Yes it does involve a lot of work but this is likely to be spread over a period of months or possibly years. If you take on the process yourself you will need to read and reread various official documents and be able to put together information to support any appeals. The best attributes you could have would be persistence and ability to compartmentalise this process from the rest of your life. If you let your thoughts dwell on the process it can take over your life. There will be periods when you are very busy and then long periods where nothing happens.

Thank you. You feel that there's a possible case, then?

monkeyspanner

metron wrote: »

Thank you. You feel that there's a possible case, then?

Sorry I really can't tell you what your chance of success may be. Your best course is to look at the DST assessment documents and work through them yourself. There are a number of domains and there would have to be high to severe scores in several domains. You would need to ask the PCT for a retrospective review and demonstrate medical needs which are complex and unpredictable. A good start is to read the MSE guide carefully and then look at the DST.

realshannon

Just a quick update from me and also which may help people, albeit a little late for the looming deadline, but it is possible. I saw an advert in our local paper for a local firm of solicitors I had heard of, and I contacted them. They have acted very quickly and have visited us at home at the weekend, they have accepted the case on a no win no fee. I am told they can cover any part of the country, not sure about Scotland with different rules but just ask them, and their details are, if anyone wants to chat to them or look on the website - Mike Rice , Nash and Co, Plymouth tel 01752 827048 email [EMAIL="mrice@nash.co.uk"]mrice@nash.co.uk[/EMAIL], website will come up with just nash and co plymouth - for me, even having the files out of the house, and there were alot, has made me feel better - I fel totally defeated before, it may not come to anything, but the fact that an experienced team of lawyers will look at everything for me and take the strain is just great. The PCT lead me a merry dance as did social workers, district nurses and the like. I would also state that Hugh James wouldnt take the case as I had too much input and had done almost too much! I can appreciate alot would like a blank canvass to deal with but just so you know, if one turns you down, another may not. they have said it could take 12 months, but thats fine, whatever the result it will be final and at least the NHS and PCT will know they can walk over people and their feelings and, most importantly, I am doing this for my MIL, its a matter of principle not money. will post back as and when I hear more - good luck to everyone!

Doc_N

realshannon wrote: »

Just a quick update from me and also which may help people, albeit a little late for the looming deadline, but it is possible. I saw an advert in our local paper for a local firm of solicitors I had heard of, and I contacted them. They have acted very quickly and have visited us at home at the weekend, they have accepted the case on a no win no fee.

That's very interesting, and certainly a route I'm considering - possibly using Hugh James. I've had positive dealings with them before, and they're certainly well geared up to handling these claims.

Would you mind sharing with us, please, the percentage of the total recovered that Nash & Co are taking on a no win/no fee basis?

Come to think of it, it might be helpful to those of us considering using solicitors if we share information on the sort of legal charges which are being sought by different firms.

Information is power.....:)

birdsnest_2

Just heard about this and am so short of time to get into it before the deadline. Any opinions that might discourage or encourage would be really helpful please. My mum went into a care home in 2006 and passed away in 2009. She was not officially assessed as needing care, although it was clear to the family that she was a danger in her own home and had numerous falls. Her mobility was deteriorating, although she was just managing to get around the house with sticks or a frame. She was diagnosed with dementia and had suffered a mild stroke. I was due to move 250 miles away from her home, and we therefore decided on a private care home close to me. We sold her house for funds and my sister and I had Power of Attorney. Which PCT would I need to contact? The one near her old home or the one in the area of the care home? A year or so before her death she was assessed as needing nursing care and this increase was covered by Social Services, although we continued to pay for the residential care as before.

monkeyspanner

birdsnest wrote: »

Just heard about this and am so short of time to get into it before the deadline. Any opinions that might discourage or encourage would be really helpful please. My mum went into a care home in 2006 and passed away in 2009. She was not officially assessed as needing care, although it was clear to the family that she was a danger in her own home and had numerous falls. Her mobility was deteriorating, although she was just managing to get around the house with sticks or a frame. She was diagnosed with dementia and had suffered a mild stroke. I was due to move 250 miles away from her home, and we therefore decided on a private care home close to me. We sold her house for funds and my sister and I had Power of Attorney. Which PCT would I need to contact? The one near her old home or the one in the area of the care home? A year or so before her death she was assessed as needing nursing care and this increase was covered by Social Services, although we continued to pay for the residential care as before.

Initially the relevant PCT would hve been the one that covered her home area or if she was in hospital the PCT that covered that hospital. However, if she received a nursing supplement from 2008 it could be that the PCT would have been the one that covered the care home area.

The nursing supplement is a fall back position if CHC funding is not granted. So it is likely a CHC assessment or checklist was carried out for the nursing supplement to be awarded. The results of any assessment should have been communicated to a carer or family member.

I know time is short prior to the deadline but you can lodge a request for a review. You do not have to prepare a case prior to lodging the request. As you are uncertain of the PCT it may be adviseable to ask them to confirm you have the correct area. It is likely to be some time (months) before anything is done by the PCT as reviews will be low priority.