Reclaim Care Home Costs for Free- New MSE guide

sunsetboulevard

Thanks everybody for your replies.

sunsetboulevard

I've been filling in the Questionnaire recently trying to reclaim my aunt's care home costs.

I really feel like just giving up now. I'm still on the question about whether her needs were complex, intense or unpredictable. monkeyspanner kindly gave me an explanation of what this meant but seriously, I just haven't got a clue how to answer this question.

It's made harder still by the fact that the care home destroyed all of her notes (she was in there in 2005) and I just don't know the answer to the above question. I'm almost tempted to put 'I don't know' as the answer. But, in reality, I think I know that if I do put that it'll just give them the excuse they need to turn my application down.

What do you think cos I'm completely stumped!

Thanks.

beaujolais-nouveau

monkeyspanner wrote: »

The CHC system stems from the Coughlan case so it isn't necessary. The fact that you have found the existence of continuing healthcare funding means you are well inforrmed. You might want to look at the national framework document and quote from that if appropriate to your aunt's case

I think Coughlan does have to be mentioned, if it applies here. In my experience of two PCTs (Suffolk and Somerset), if you don't mention Coughlan it will just help the PCTs ignore Coughlan. With my mother's case, both Somerset and Suffolk behaved exactly as if the Coughlan decision never happened - and I believe them to be in contempt of court - and both breached their own operational policies.

beaujolais-nouveau

Jo101 wrote: »

I contacted the care home who told me they no longer have her notes and that they are sitting in an airplane hangar waiting for destruction. That's really great, how am I supposed to know what her daily routine and care needs were in the care home without the notes! ...

Not that there is a lot to say about her daily routine. She had had a fall at her home, resulting in a stroke and had been brain damaged as a result of banging her head on the floor. From the time she was initially admitted into hospital until the day she died in the care home (it was only about 5 months in total), her daily routine consisted of bed baths, being PEG fed, no mobility at all, totally unaware of where she was and being hoisted from her bed to a chair. She required total care, as she wasn't able to do anything for herself. She didn't communicate with or acknowledge us, her family, for the whole time she was in the hospital and care home.

I have no idea what medication the care home were given her, maybe it was the same as the hospital gave her.

Do you have a copy of the Decision Support Tool document that should have been completed when your mother was discharged from hospital?

sunsetboulevard

I'm just going to double-check now. Is it actually a form headed 'Decision support tool'? Just so that I look for the right thing. Thanks.


EDIT: Just finished checking. Definitely no Decision Support Tool.

monkeyspanner

Jo101 wrote: »

I've been filling in the Questionnaire recently trying to reclaim my aunt's care home costs.

I really feel like just giving up now. I'm still on the question about whether her needs were complex, intense or unpredictable. monkeyspanner kindly gave me an explanation of what this meant but seriously, I just haven't got a clue how to answer this question.

It's made harder still by the fact that the care home destroyed all of her notes (she was in there in 2005) and I just don't know the answer to the above question. I'm almost tempted to put 'I don't know' as the answer. But, in reality, I think I know that if I do put that it'll just give them the excuse they need to turn my application down.

What do you think cos I'm completely stumped!

Thanks.

I have gone back to your previous post where you detail your Aunts medical problems and I don't think you are wasting your time. There are however a number of practical considerations you might want to consider before you embark on what could be a very lengthy and time consuming process.

Firstly there was a deadline for retropective consideration of older CHC claims. Did you manage to lodge your request prior to the deadline?

Secondly you mention that there was a period of 5 months of hospital and care home. It is probably a lot of money but this is a relatively short period and you might want to make a pragmatic consideration of what sum of money you may recover if successful.

As your aunts case predates (2005) the introduction of the CHC National Framework and the use of the standard DST (decision support tool) any assessment that was carried out would have been covered by whatever local PCT (primary care trust) rules that were in place at the time. Knowledge and implementation of CHC assessments at the time was patchy and I would not be surprised if no assessments werre carried out.

As regards filling in the form and identifying if your aunts needs were complex intense and unpredictable it would probably help you to look at the DST which is currently used to assess CHC eligability and work through allocating scores based on what you saw of your aunt's condition.
Here is a link to the current documents.
https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

The DST looks at a number of care domains and categorises the severity of the patients condition in each domain.
1. Behaviour - Your brief decription of self harm would indicate a high or severe score.
2. Cognition - If your aunt was unaware of her surroundings and did not recognise family members a severe score would be indicated.
3. Psychological or emotional need - The highest category here is high and it sounds as though your aunts needs in the category would be high.
4. Communication - You mention there was no communication so again the hihest scorre is indicated.
5. Mobility - As your aunt still had some mobility e.g. head banging a high rrather than severre score may be indicated but have a look at the descriptions.
6 Feeding - At least a high score.
7 Continence - No information in your decription but I would envisage there were needs in this area.
8 Skin (tissue viability)- No information
9 Breathing - No information
10 Drug therapies - No information
11 Alterred states of consciousness - No information but if a severe stoke patient I would envisge some needs in this area.
12 Other issues.

Unfortunately there is no set combination of DST scores that will determine if CHC was payable but if your aunt would have scored severe or high in a number of domains that would be a positive indication. Of course as the DST was not in use in 2005 it will probably be deemed irelevant but the domains may give you assistance to marshall your thoughts.

It is essential that you explain why you believe your aunts needs were complex etc as this is the basic criteria for deciding if CHC is payable.

Hope this helps.

sunsetboulevard

Hi monkeyspanner, thanks very much for your detailed reply.

This is how I think she would have scored on the DST:-

1. No needs (sorry monkeyspanner, I think the wording I used on my earlier post about my aunt being brain damaged after 'banging' her head on the floor may not have been the most appropriate word to use. What I meant was she was brain damaged after 'hitting' her head on the floor. Sorry for confusion caused.

2. Severe

3. Moderate

4. High

5. High/Severe

6. High/Severe

7. Moderate/High

8. Moderate

9. No needs

10. Moderate

11. High - I may need to think about this one - she just seemed to be either sleeping (eyes closed), or awake but in a trance-like state (eyes open, not speaking, not acknowledging us). I don't know if that's what they mean by altered state of consciousness?

I think I will need to look through the DST again at some stage because there may be areas that I have not scored her highly enough. I know how bad she really was but I think this form has been designed and worded in such a way that it deliberately downplays the severity of a person's condition.

How could I be expected to know what her psychological and emotional needs were when she couldn't talk or express herself?

monkeyspanner

Altered state of consciousness is normally explained as:
-Displaced in time.
-Displaced in place.
-Seeing or experiencing things that are not reality.

It would seem that your aunt had little consiousness or could not demonstrate that she was aware of her surrroundings on any level. So that would seem to qualify as significantly "altered".

I understand what you mean about the DST and it is the experience of many relatives when trying to assist at assessments. Our experience was that assessors also tried to assign different meanings than normal to some words or terms in the DST.

hopeful21

Having submitted a retrospective claim last year for my late husband, I have recently had my panel meeting and have been awarded full CHC for the period claimed. I did it all on my own, without a solicitor or claim company. It was a lot of hard work, getting facts and acquitting myself with the procedures but it paid off as I believed in what I was doing.
If anyone needs some tips I'm happy to give some pointers...

rubrenus

Well I got my claim in in time. Just a tip that may help. I got copies of my mother's medical records, and amongst them was a letter from a consultant stating that in his opinion she needed nursing care. Let's see them dodge that one!