Reclaim Care Home Costs for Free- New MSE guide

margf

omnirife wrote: »

Hello,

I'm a social services operator at a County Council, so I take a huge number of calls from the children, relatives and registered Power of Attorneys of people in care homes or receiving other care services. Just thought I'd chime in with a perspective on making the initial contact to the relevant department, because it might save people time.

I'm pleased to see that the article is directing people to the Primary Care Trusts however we are receiving a high volume of calls from people wanting to "claim back care home fees" having read this article, and we are directing people wanting to claim for CHC to their local PCT. I realise that it can be difficult to navigate your way through the public services, especially when it involves anything financial, however please try not to get angry with us when you are re-directed to the correct number. The article does quite clearly state that people need to contact the PCT.

This is because social services don't own the CHC process. You may want to contact the social worker if you know that the person concerned has an active social worker already involved, in which case you might ask the social worker if they will contact the PCT on your behalf. However I would personally simply contact the PCT myself rather than the social worker because this way it won't sit on a social worker's to do list for a few days or weeks before anything happens. The social worker does not follow any different a process than a member of the public for requesting a CHC assessment for someone. There is no "back door" or hidden phone line for a speedier assessment process accessible by social services staff (at least in our area..!)

The CHC process does involve a social worker if a person has passed the initial screening tool, because a social worker is involved in the next stage of the assessment - however the allocation of a social worker will be arranged by the PCT automatically at this stage, so families don't need to arrange this for themselves. So overall best thing to do is contact PCT yourself and see if you can back get the money that you might very correctly be entitled to. Far easier this way rather than phoning up social services, where you will only be re-directed to the correct line.

Thank you for this information, but we are now even more confused, as after contacting our local PCT, they advised us to write to The Continuing Health Team and the address they gave us was our Social Services Department.

We will have to ring again tomorrow as from this it looks like our letter of intent could have been sent to the wrong address.

We do re-call that an assessment was carried out but dont really know what this was for and having dug out the invoices from our local borough council they do state 'your contribution for Nursing'. Can anyone advise if this means we are entitled to a refund?

Thanks
Marg

monkeyspanner

margf wrote: »

Thank you for this information, but we are now even more confused, as after contacting our local PCT, they advised us to write to The Continuing Health Team and the address they gave us was our Social Services Department.

We will have to ring again tomorrow as from this it looks like our letter of intent could have been sent to the wrong address.

We do re-call that an assessment was carried out but dont really know what this was for and having dug out the invoices from our local borough council they do state 'your contribution for Nursing'. Can anyone advise if this means we are entitled to a refund?

Thanks
Marg

If you post the area you are in I will try to find an address for you.

If I recall correctly you were contributing the bulk of the state pension. If found eligable for CHC funding you would be entitled to a refund. However this does depend on having complex and unpredictable health needs. You would have been dealing with council social services as a council supported care home resident but the CHC funding is assessed and administered by the CHC team in the local PCT.

monkeyspanner

Came across this document which people may find useful and it also contains some useful links.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131085.pdf

It seems to be aimed at people administering the CHC system rather than us plebs. But some interesting points if you are already up to speed with the CHC system. If you are just beginning read the MSE guide, DST and National Framework documents first.

margf

Hi

Thank you so much for your help Monkeyspanner, you are correct we did deal with the Council Social Services, but the Nursing Home was a Private one, which is Warrington.
The needs were in my opinion complex and unpredictable health needs as she was unable to anything for herself the first diagnosis many years before was the onset of Alzhiemers, but it was later found to be an in-operable brain tumour and she was discharged from a Hospital to the Nursing home as she was so ill.
What is your interpretation of complex and upredicatable and can you give me some examples please?

Thanks once again for all your input into this thread.:T

Marg

noelphobic

My mum died 2 year ago after 1 year in a residential home (EMI) and 5 years in a nursing home. Soon after her death I notified the PCT that I was claiming the full cost of her fees back from them. At the time I was informed that it would be approximately 18 months until the case went to panel. The most recent communication from them advised that they had to deal with more recent cases first (which is obviously nonsensical and implies misinterpretation of DOH guidelines). They said that our case would be heard by April 2013.

For various reasons I am now considering putting the case in the hands of solicitors. This would have to be on a no win no fee basis. I wondered how many other people have done this, what the fees were, and whether the outcome was successful.

I did look at the MSE info which suggested that it would be best to find someone who would not take any more than 20%. I could live with that if it meant that the case was more likely to be successful than if I did it myself. I feel that, because of other problems in my life, doing it myself would lead to serious health problems for me which would be exacerbated if the case was not upheld.

Any advice on using solicitors would be greatly appreciated.

noelphobic

redsquirrelsuk wrote: »

The nursing home should have records going back to then (they are obliged by law to keep records for a minimum of 6 years). .

When we decided to apply for CHC we asked the first home that my mum had been in to provide a copy of her records. They replied and said that the records had been shredded after 3 years and quoted some so called rule that directed them to do this (can't remember the exact wording and don't have the paperwork to hand at the moment).

At the time that we requested the records it was around 6 years since my mum had first been in that home but less than 6 years since she had left. If the home was breaching DPA by not keeping the records for 6 years can any action be taken against them?

noelphobic

Allan87 wrote: »

My family have just appointed a solicitor to chase this up for us, the solicitors seem to think we have a "reasonable chance of success" based on the evidence provided so just have to see what happens - nothing ventured, nothing gained.

is this being done on a no win no fee basis? If so, what percentage would the solicitors take from any settlement?

monkeyspanner

noelphobic wrote: »

My mum died 2 year ago after 1 year in a residential home (EMI) and 5 years in a nursing home. Soon after her death I notified the PCT that I was claiming the full cost of her fees back from them. At the time I was informed that it would be approximately 18 months until the case went to panel. The most recent communication from them advised that they had to deal with more recent cases first (which is obviously nonsensical and implies misinterpretation of DOH guidelines). They said that our case would be heard by April 2013.

For various reasons I am now considering putting the case in the hands of solicitors. This would have to be on a no win no fee basis. I wondered how many other people have done this, what the fees were, and whether the outcome was successful.

I did look at the MSE info which suggested that it would be best to find someone who would not take any more than 20%. I could live with that if it meant that the case was more likely to be successful than if I did it myself. I feel that, because of other problems in my life, doing it myself would lead to serious health problems for me which would be exacerbated if the case was not upheld.

Any advice on using solicitors would be greatly appreciated.

Because of the deadline there are a number of companies advertising heavily for this kind of business. I may be wrong but my advice would be not to take any of these offerings too seriously. I believe they represent the same style of business which calls me repeatedly saying I should reclaim PPI which I have never had. When you look at these web sites if you cannot see a contact telephone number and a real postal address and look like actual solicitors I would not consider them. Many are merely call centres whipping up enquiries which they then will farm out to willing solicitors who may or may not have a track record in this area.

It would seem contrary but look for solicitors who are not advertising who have been successful in this area previously. One such company has been mentioned several times in this thread they have won 5 and 6 figure cases in the past.

noelphobic wrote: »

When we decided to apply for CHC we asked the first home that my mum had been in to provide a copy of her records. They replied and said that the records had been shredded after 3 years and quoted some so called rule that directed them to do this (can't remember the exact wording and don't have the paperwork to hand at the moment).

At the time that we requested the records it was around 6 years since my mum had first been in that home but less than 6 years since she had left. If the home was breaching DPA by not keeping the records for 6 years can any action be taken against them?

Not sure about the 6 years but the 2001 Care Home Regulations require that records are kept for a minimum of 3 years.

Records17.—(1) The registered person shall—
(a)maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user;
(b)ensure that the record referred to in sub-paragraph (a) is kept securely in the care home.
(2) The registered person shall maintain in the care home the records specified in Schedule 4.
(3) The registered person shall ensure that the records referred to in paragraphs (1) and (2)—
(a)are kept up to date; and
(b)are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home.
(4) The records referred to in paragraphs (1) and (2) shall be retained for not less than three years from the date of the last entry.

Here is a link to the regulations. http://www.legislation.gov.uk/uksi/2001/3965/regulation/17/made

monkeyspanner

margf wrote: »

Hi

Thank you so much for your help Monkeyspanner, you are correct we did deal with the Council Social Services, but the Nursing Home was a Private one, which is Warrington.
The needs were in my opinion complex and unpredictable health needs as she was unable to anything for herself the first diagnosis many years before was the onset of Alzhiemers, but it was later found to be an in-operable brain tumour and she was discharged from a Hospital to the Nursing home as she was so ill.
What is your interpretation of complex and upredicatable and can you give me some examples please?

Thanks once again for all your input into this thread.:T

Marg

I think you have identified the most difficult area of the CHC system. Although the DST should standardise the assessment system over the various domains there is no set standard of what DST scores will result in a CHC award. As the FAQ document above says.

2.15 Is there a combination of highs and moderates that guarantees eligibility for NHS Continuing Healthcare?
There is no specific combination of highs and moderates that would ‘guarantee’ eligibility. The user notes for the DST state:
• one domain recorded as severe, together with needs in a number of other domains, or
• a number of domains with high and/or moderate needs, .... may well also indicate a primary health need. In these cases, the overall need, the interactions between needs in different care domains, and the evidence from risk assessments should be taken into account in deciding whether a recommendation of eligibility for NHS continuing healthcare should be made.

So the best a layperson can do is to work their way through the DST document and if their relative scores High or Severe in a number of different domains there is a possibility (not guarantee) that an award will be made. Although it must be possible I have never heard of a CHC award being made for medium scores only.

You should concentrate on assessing the patient's actual health needs as a diagnosis of a disease does not mean there is a need. It is possible that needs may interact and increase the complexity. For instance if a medication used to control one disease causes an unwanted side effect or worsens the symtoms of another condition. You should also rate a need as if it was not managed as the national framework accepts that a well managed need is still a need.

Cognition and altered states of mind is an example of a side affect of dementia but it could be either fairly benign or dangerous for the patient and carers. I have heard of dementia patients in care homes varying from someone who believed they were in a hotel in the south of France and loved it to someone who thought they were being held captive by an evil force, hated their situation and as a result was medicated to control their violent outbursts. Somewhere in the middle would be the lady who thought her Mum and Dad were coming to fetch her, who was upset but not violent and could be distracted with care but was prone to wander if able to do so. Each of these would probably score high or severe on cognition but their behaviour scores would differ widely.

Willowgill

Hi - I've been urged to look at this by Martin's repeated reminders aboutthe 30th Sept deadline but am totally confused and could do with some adviseplease.

My mother went into hospital in July 2009 after a fall - she had beenincreasingly immobile at home and after several weeks SS decided she was indanger at home and insisted she went into care. At the time she was assessedand they determined she should be funded 50% by NHS and 50% by the council lessher pension which was also taken. Myfather was still living at home at the time - they had both been diagnosed withAlzheimers the year before but were both still able to function at home withour help and some private carers. Over the next year she quickly deterioratedboth mentally and physically – she became incontinent, incapable of standingunaided and increasingly confused. She was very deaf and communication was alsobecoming a problem as speech started to go. Jun 2010 my father also fell andwas also taken into hospital. By the time he had been assessed some 6 weekslater he had stopped eating, losing over 2 stone, became aggressive and challengingwith staff and very confused. My husband and I had been his sole carers andrealised we had no choice (well were told this too) but for him to join my mumin the care home. He went in fully funded by the NHS but died just 6 weekslater in Aug 2010. Once Dad had left the house Mum’s care was no longer part fundedby the council and half her fees were accrued against their property which wehad put up for sale. She also continued to contribute her pension less £20 aweek spending money and by Sept 2011 the fees had wracked up to £11000 against thehouse. She had another assessment Sept 2010 but despite my insistence that shereally did need 24 hour nursing care they decided she still would only get 50%funding. By Sept 2011 she had no quality of life whatsoever being totallyincapable of moving, speaking or eating unaided and the PCT panel finallyallowed her 24 hour funding. The council then gave us the choice of continuingwith the monthly direct debit from her pension which they then deducted fromthe accrual against the property or we could pay the full balance on the salewhen it finally took place. I chose the former option. She died Jun this year,coincidentally the same week the house sale was going through and we paid thecouncil £7500 to settle the fees. My dilemma now is do I try to reclaim the 50%from from July 2010 to Sept 2011 when she was paying 50% herself? There is nodoubt in my mind that from the second assessment to the third she needed fullnursing care but how do I prove that? I believe if she had had this during thattime then the £11k accrued initially against the house would not have happened.At the end of the day it’s now over and thankfully my parents are at peace butI know they would have been horrified at the way things turned out - it wasalways a worry to them that just such a scenario would happen and I know theywould want me to fight for whatever they should have had but I really don’tknow how to go about this in retrospect. Any advice would be very welcome. Myapologies for the length of this post!