Reclaim Care Home Costs for Free- New MSE guide

ratty2601

I need some more info on this! How do you instigate a claim and to who exactly? PCT/Care Home?? What do you do when the relative in question is deceased? How quickly can NHS provide records for an individual? Time is ticking away and I have until the 29th Sept before I decide to go to one of these companies that take 30% plus VAT of money received! HELPPPPP!

Doc_N

Very interesting piece on this in today's Money Box (Radio 4):

http://www.bbc.co.uk/programmes/b006qjnv

Well worth listening to if you're considering a claim, as I am.

margf

Hi

Please can anyone advise me if reclaiming applies to payments made from a persons pension ie my friends mother had no assets so she had to pay over her pension and was left around £15 a week for personal items.
Her mother was suffering from Dementia amongst other medial conditions (brain tumour).

Thanks

monkeyspanner

2274 wrote: »

Hi after a bit advice please.
I have just applied to the pct for a retrospective claim for my late grandmother.Even before there has been public knowledge about reclaiming care home fees being advertised everywhere I thought I had been unfairly treated by the authorities.My grandmother went into hospital and got transfered to a nursing home.against her wishes.She inially was in the hospital part of the home.Cut a very long story short it was such a traumatic experience it was quite unbelievable.the social services, the care home and the council it is all a big fix,they were all in together.the place should have been closed down for neglect anf employee exploitation.They just took over and never explained anything to me even though I had power of attourney.Didnt even mention CHC.However they did explain how much money they wanted with the charge they put on my grandmothers property.They took her full pension and placed a charge on the property.i was living there at the time and it had to be sold because when they took my grandmothers pension we could not afford the morgage so it had to be sold.If it is the law and you have to pay thats fair! In the case of my grandmother she was in there for health care not social she could not stand because of fluid on her legs.there was a district nurse coming in to treat her.She was in a wheel chair.The weight loss was unreal.she had toilet issues and didnt even know where she was.she thought she was living in some posh appartment that she had bought (had serious dementia issues.) just wanting to know what the procedure is for reclaim.its all like a different language for me.I cant be bothered with any stress from it all. any help would be appreciated.thanx

To proceed with a retrospective claim you will need as much information as you can gather about your grandmothers physical and metal condition. Also you will need details of any fees paid for care.

The purpose of the retrospective review will be to assertain if at any time during her stay in care she would have qualified for CHC funding. If any CHC checklists or assessments were carried out these will also form an important part of the review. You don't detail any dates for these events so I am not able to tell you what should have been done.

The files should be reviewed by someone with medical knowledge normally a Nurse Practioner or similar who is familiar with the CHC system.

The CHC assessment system in England is based around a Decision Support Tool (DST) this enables assessment of a number of medical criteria. I would strongly advise that you familiarise yourself with the DST and try to do your own scoring for your Grandmothers condition at critical points. e.g. Hospital discharge, major medical changes.

The scoring is in terms of Low, Medium, High, Severe, Critical and the DST sets out in fairly straightforward terms how to classify each criteria.

Unfortunately there is no clearly defined boundary beyond which a patient would be entitled to CHC funding. But as a guide a patient would be unlikely to get CHC if they did not score high or above in a number of criteria and perhaps a minimum a couple of severes. There is a heavy emphasis on severity and complexity of the medical conditions.

I am concerned that you can't deal with stress. This is likely to be a lengthy and possibly stressful process which at best will take months and can take years. You will need to be patient and persistent. If you feel this is beyond your resources I would approach a specialist claims company to see if they can take this matter forward. You will need to give them clear and detailed information in order to decide if your grandmothers case is worth persuing.

I hope I have managed to make things a little clearer.

monkeyspanner

margf wrote: »

Hi

Please can anyone advise me if reclaiming applies to payments made from a persons pension ie my friends mother had no assets so she had to pay over her pension and was left around £15 a week for personal items.
Her mother was suffering from Dementia amongst other medial conditions (brain tumour).

Thanks

Yes it does apply to any payments for care including pensions.

monkeyspanner

ratty2601 wrote: »

I need some more info on this! How do you instigate a claim and to who exactly? PCT/Care Home?? What do you do when the relative in question is deceased? How quickly can NHS provide records for an individual? Time is ticking away and I have until the 29th Sept before I decide to go to one of these companies that take 30% plus VAT of money received! HELPPPPP!

You would need to notify the Continuing Healthcare Team within the relevant PCT. Initially you need to lodge the intention letter prior to the deadlin. If a relative is deceased then you would need to ask for a retrospective review. Normally the NHS is reasonably quick with providing records but can make reasonable charges for this service. I believe £50 is typical.

monkeyspanner

megansden wrote: »

My mother was in a the same position with council social services making a deferred arrangement, whilst in the assisted care home the property became unfit to live in and after lots of break-ins it was decided to demolish it. Mother still had to pay fees to the home from her attendance allowance since she has died the land was sold to pay for bills etc but not the care home fees and indeed I still have some outstanding fees to pay at the moment, she suffered the same as this the above have. I think I shall start a claim (but who with?) is it the PCT? Alittle help to start would be great by the way I had POA on her estate

Thanks in advance

Your mother should only have been self-funding in the care home if her assets were higher than the lower savings limit. (currently around £23500). You mention fees outstanding will her estate cover these fees?
Yes it is the PCT you should approach if you think her primary needs were medical rather than social.

monkeyspanner

Gold_Star wrote: »

Hello..

My father (74yrs) had a stroke in Feb 2011 and was in hospital until July 2011 where he was admitted straight to a nursing care home for approximately one month. He had has a left sided weakness, speech difficulties, poor mobility co-ordination and diabetes. He required help with bathing, dressing, walking, sometimes feeding and administering his medication and insulin. He came home in September 2011 and tended to by carers through the Council to whom my mother (74yrs) the main carer is paying. The invoice costs vary from £1000.00 - £3000.00 at irregular periods from the time he came home in September. He has been assessed by a social worker at Leeds City Council at home. What position are we in to make a claim?

Was a CHC checklist performed for your father at discharge from hospital? (or prior to going home). If not the PCT have not followed proceedure. The care being provided for your father sounds like at home care organised by the local council social services department. There are no country wide rules for charges levied by individual councils for these services. However there is no reason why CHC funding cannot be assessed for at home care but this is unlikely to be suggested by social services as the CHC funding is provided by the NHS via your local PCT.

monkeyspanner

MSE_Martin wrote: »

Thank you for all the feedback above. We are working through it.

I wanted to get this article on the site, as it is an important issue that's not covered, and not enough people know about their rights under Continuing Health needs with the NHS.

The team and I have worked hard to get this out quickly, and in a way people understand (which I think is one of the difficulties with this issue) but we make no bones about the fact it is a new subject for us and a learning experience.

To those of you who have been through this process (or are going through it) do let us know your feedback and suggestions for improvement on the guide - we're more than happy to have them.

I've already made a few tweaks after checking up things mentioned here.

Thanks

Martin

How about some resources to answer some of the queries the MSE guide has generated on this thread?

2274

monkeyspanner wrote: »

To proceed with a retrospective claim you will need as much information as you can gather about your grandmothers physical and metal condition. Also you will need details of any fees paid for care.

The purpose of the retrospective review will be to assertain if at any time during her stay in care she would have qualified for CHC funding. If any CHC checklists or assessments were carried out these will also form an important part of the review. You don't detail any dates for these events so I am not able to tell you what should have been done.

The files should be reviewed by someone with medical knowledge normally a Nurse Practioner or similar who is familiar with the CHC system.

The CHC assessment system in England is based around a Decision Support Tool (DST) this enables assessment of a number of medical criteria. I would strongly advise that you familiarise yourself with the DST and try to do your own scoring for your Grandmothers condition at critical points. e.g. Hospital discharge, major medical changes.

The scoring is in terms of Low, Medium, High, Severe, Critical and the DST sets out in fairly straightforward terms how to classify each criteria.

Unfortunately there is no clearly defined boundary beyond which a patient would be entitled to CHC funding. But as a guide a patient would be unlikely to get CHC if they did not score high or above in a number of criteria and perhaps a minimum a couple of severes. There is a heavy emphasis on severity and complexity of the medical conditions.

I am concerned that you can't deal with stress. This is likely to be a lengthy and possibly stressful process which at best will take months and can take years. You will need to be patient and persistent. If you feel this is beyond your resources I would approach a specialist claims company to see if they can take this matter forward. You will need to give them clear and detailed information in order to decide if your grandmothers case is worth persuing.

I hope I have managed to make things a little clearer.

THANX money spanner.
my grandmother went into the care home in August 04 and sadly passed away July 06.I am aware that she could be entitled for a reclaim from April 04 until she passed away in July 06. You mentioned that I need as much information as possible.Where do I get that from? I have applied to the PCT for a reclaim,they sent out a form asking for confirmation of her will and permission to get all the relevant care details ,hospital etc...records!! I have corresponded with the info they required.I sent my signature so they can get the relevant documents. I have went through the DST criteria and to my knowledge my grandmother certainly scored 2 severes im my oppinion.If possible could you inform me what I need to do with regards to my next step.Do I have to prepare a defense? Where do and how do I get all my evidence? I am not wanting to get back fees what has been paid if it is the law,however I sincerely believe that the more I have learnt about these CHC assesments I am sure my grandmother should of not paid for her care....My experience was that the social services just took over..i didnt sense any compassion on there behalf.It was terrible.Any more help would be greatly appreciated..
thanx paul