Reclaim Care Home Costs for Free- New MSE guide

monkeyspanner

2274 wrote: »

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

Your experience is not unusual and my experience is that if Social Services see personal assets they will latch onto that as the easiest way of funding care. During the period you mention CHC would have been governed by CHC rules imposed by individual PCTs as the harmonised English system was not introduced until 2007. So the DST would probably not apply although some areas were trialing it earlier than its official introduction in Oct 2007. Now that you have given permission the PCT will gather the medical evidence review the case and give you their decision. If you want to challenge the decision you may need more information dependant on their grounds for refusal. I am not sure if you could ask them to release the information they have used.

If you want to get prepared in advance you can approach individual hospitals, GPs and care homes and ask for copies of the records. They will probably charge. This can be time consuming. You would also need the CHC rules and assessment process documents for the relevant period and the PCT should be able to provide that.

It is likely that the PCT could take a long time to consider the case as it is retrospective and normally current assessments take priority. So be prepared for long periods of activity followed by short bursts of activity.

2274

monkeyspanner wrote: »

Your experience is not unusual and my experience is that if Social Services see personal assets they will latch onto that as the easiest way of funding care. During the period you mention CHC would have been governed by CHC rules imposed by individual PCTs as the harmonised English system was not introduced until 2007. So the DST would probably not apply although some areas were trialing it earlier than its official introduction in Oct 2007. Now that you have given permission the PCT will gather the medical evidence review the case and give you their decision. If you want to challenge the decision you may need more information dependant on their grounds for refusal. I am not sure if you could ask them to release the information they have used.

If you want to get prepared in advance you can approach individual hospitals, GPs and care homes and ask for copies of the records. They will probably charge. This can be time consuming. You would also need the CHC rules and assessment process documents for the relevant period and the PCT should be able to provide that.

It is likely that the PCT could take a long time to consider the case as it is retrospective and normally current assessments take priority. So be prepared for long periods of activity followed by short bursts of activity.

Thanx monkeyspanner. your advise is very interesting.I would very much think that the reply from the PCT will be a guarunteed refusal.If that is the case I would be suprised if they would release all their evidence that they have gathered to a claimant.Is there any law that states NHS or care homes have to release info? I will not be fobbed off !! Also who would have the CHC rules and assesment documents for the period grandmother was in care? who would have the results of the assesment? My grandmother was in there nearly 3 year,how many assesments would they have done? or is there a law for a certain amount? I know I have loads of questions but would appreciate any answers and then I Know exactly what I am up against. I also ticked the box for an independant review on the letter I recieved from the PCT. Was that wise? Who are they? Is it possible I could have a favourable decision from the PCT reassesment without a load of hassle?

thanx paul

monkeyspanner

2274 wrote: »

Thanx monkeyspanner. your advise is very interesting.I would very much think that the reply from the PCT will be a guarunteed refusal.If that is the case I would be suprised if they would release all their evidence that they have gathered to a claimant.Is there any law that states NHS or care homes have to release info? I will not be fobbed off !! Also who would have the CHC rules and assesment documents for the period grandmother was in care? who would have the results of the assesment? My grandmother was in there nearly 3 year,how many assesments would they have done? or is there a law for a certain amount? I know I have loads of questions but would appreciate any answers and then I Know exactly what I am up against. I also ticked the box for an independant review on the letter I recieved from the PCT. Was that wise? Who are they? Is it possible I could have a favourable decision from the PCT reassesment without a load of hassle?

thanx paul

There should not be a problem obtaining records from the NHS. Not so sure if the care home has the same obligation.

It is possible that there were no CHC funding assessments carried out during the 3 years. During the period in question the onus was very much on the patient or their family to push for an assessment. Of course this was difficult as no-one was told about CHC.

The PCT will be able to provide the rules at the time and the results of any assessments carried out.

An independant review panel is essentially people who are not involved with the PCT concerned. In my MIL's case there was a non-medically train chair who had worked within the NHS, a senior nurse practitioner from another area and a retired social worker. This should thoeretically provide an unbiased view so your decision is fine.

I think it is unlikely you would get a hassle free process but this will depend largely on the amount of evidence presented and the severity of the conditions uncovered.

2274

monkeyspanner wrote: »

There should not be a problem obtaining records from the NHS. Not so sure if the care home has the same obligation.

It is possible that there were no CHC funding assessments carried out during the 3 years. During the period in question the onus was very much on the patient or their family to push for an assessment. Of course this was difficult as no-one was told about CHC.

The PCT will be able to provide the rules at the time and the results of any assessments carried out.

An independant review panel is essentially people who are not involved with the PCT concerned. In my MIL's case there was a non-medically train chair who had worked within the NHS, a senior nurse practitioner from another area and a retired social worker. This should thoeretically provide an unbiased view so your decision is fine.

I think it is unlikely you would get a hassle free process but this will depend largely on the amount of evidence presented and the severity of the conditions uncovered.

thanx for all your help monkeyspanner:):):)

megansden

Hi All

Further to my recent emails, I have sent a retrospective letter into my local PCLs and have a reply QUOTE: PALs are unable to help in reclaiming my mothers home care fees I have to go to the NHS Business Services Authority for help on which I found out is wrong so now I am trying the social services in the hospital where she was staying, I will let you know if this is correct way forward

Elf1972

Hi everyone i a new to forums so please accuse any mistakes I make also all help and advice will be gratefully received. My partner recently had to put his beloved uncle into a nursing home he is 93 and has Alzheimer's. We discovered recently that he loses his AA allowance and pension including his war pension to pay for the nursing home! Is there any other help financially or is this all correct we still have to buy aloof his clothes toiletries and general comforts for him including any larger purchases that are needed for him plus days out with us etc..... He is my partners only living relative and vice versa, the property he lived in was not owned by him, it was owned by distant relatives from his deceased wife's family they live over in Canada and have since sold the property. My partner has power of attorney can anyone advise me of help etc out there for him? Thank you so much. Emma x:)

desklass

Hi

I'd be grateful for any help as to whether it's worth applying for my late grandfather's fees. He was discharged from hospital straight to a nursing home after having a stroke and having terminal cancer in Dec 2006. From then to March 2007 he forfeited his personal pension and state pension towards the cost of his care. Is this the same thing as paying for care costs? Also as my grandfather has since died can his daughter claim on his behalf. Unfortunately we don't have any records of amounts forfeited etc. I've had a look at the templates but nothing seems to cover this situation and would like some guidance as what, if any, is the best way to go about this.

Thanks in advance.

monkeyspanner

megansden wrote: »

Hi All

Further to my recent emails, I have sent a retrospective letter into my local PCLs and have a reply QUOTE: PALs are unable to help in reclaiming my mothers home care fees I have to go to the NHS Business Services Authority for help on which I found out is wrong so now I am trying the social services in the hospital where she was staying, I will let you know if this is correct way forward

If you are in England you should approch the local PCT primary care trust.

monkeyspanner

Elf1972 wrote: »

Hi everyone i a new to forums so please accuse any mistakes I make also all help and advice will be gratefully received. My partner recently had to put his beloved uncle into a nursing home he is 93 and has Alzheimer's. We discovered recently that he loses his AA allowance and pension including his war pension to pay for the nursing home! Is there any other help financially or is this all correct we still have to buy aloof his clothes toiletries and general comforts for him including any larger purchases that are needed for him plus days out with us etc..... He is my partners only living relative and vice versa, the property he lived in was not owned by him, it was owned by distant relatives from his deceased wife's family they live over in Canada and have since sold the property. My partner has power of attorney can anyone advise me of help etc out there for him? Thank you so much. Emma x:)

Hi Emma
Sorry to hear about your partners uncle.
Briefly if someone has less than £23250 in savings or other assets their care home fees will be assited by the local councils social services department. They do however as you say expect the resident to contribute the majority of their income including any pensions. There should have been a small allowance of about £20/week excluded from his assessed income to pay personal expenses. The council should have assessed his care needs in order to set the level of funding they are prepared to support.

If he has extra medical needs he may be entitled to a nursing supplement of around £100/week funded by the NHS. This will normally be paid directly to the nursing home and will not reduce the amount he contributes from his pension.

If his medical needs are complex and severe he may be entitled to NHS funded continuing healthcare (CHC) funding. This is not means tested and if granted he would not have to contribute from his pensions. If you believe he may fall into this category you should contact his local PCT to arrange for an assessment.

Attendance allowance is not payable to council assisted residents or to those in receipt of CHC funding after the first 28days of care home residence or receipt of CHC.

If you would like more detail about care home funding in England have a look at guide No:16 in this list.
http://www.independentage.org/help-and-advice/guides-and-factsheets/guide-and-factsheet-topics/care-funding.aspx

Hope this helps.

monkeyspanner

desklass wrote: »

Hi

I'd be grateful for any help as to whether it's worth applying for my late grandfather's fees. He was discharged from hospital straight to a nursing home after having a stroke and having terminal cancer in Dec 2006. From then to March 2007 he forfeited his personal pension and state pension towards the cost of his care. Is this the same thing as paying for care costs? Also as my grandfather has since died can his daughter claim on his behalf. Unfortunately we don't have any records of amounts forfeited etc. I've had a look at the templates but nothing seems to cover this situation and would like some guidance as what, if any, is the best way to go about this.

Thanks in advance.

Although your grandfather was council assisted he would have still contributed the majority of his pension towards his care home fees. If he had been CHC funded he would not have paid these amounts towards his fees. Under CHC rules there is currently arrangements for fast track assessments for end of life care and there would probably have been an equivalent system in place at the time of your grandfathers illness. The amounts contributed from a state pension by your grandfather for the 3 months Dec 2006 to Mar 2007 at a rough estimate would have been about £1000.