Care Home fees

lozzark

My dad was admitted to hospital after breaking his hip at home. The op went fine, but a few days into recovery something went wrong with his swallowing. He recovered from several bouts of aspirate pneumonia and was eventually fitted with a PEG so that he could be fed directly into his stomach. Things seemed to be going fine and the hospital social services rep formulated a plan to move him to a care home. His main issue was that after many months in a hospital bed, his muscles had weakened. He could get up, but need help to move about. He'd been receiving physio at the hospital for a while. The rep convinced him to move to a care home on a trial basis for 4 weeks and that he would not have to pay. He wanted to return home with a care package. At home he cared for my mum who had Alzheimer's. My mum did not need physical help, more supervision to stop her wandering off, so the plan was potentially viable provided that a suitable care package was in place. I agreed to pay top-up fees. These were only £20/week, so not really an issue for 4 weeks.
The transfer was made, but 3 days later he contracted aspirate pneumonia. The probable reason for this is that the care home did not receive feeding instructions on the transfer. They probably overfed him and caused reflux. I know he suffered reflux, but just one episode was enough to trigger aspirate pneumonia. He never recovered to the level he was at when he transferred to the care home. I kept asking the rep about the care home fees and she replied that the "protocol" was that they were paid while the client was in hospital. I wasn't happy about it because I was paying the top up fees. Two days after the 4 weeks had run its course, my dad died. He was recovering from about his tenth bout of aspirate pneumonia.
During the period of his illness the local authority had sent me an assessment form. I asked the rep what to do with this and she said "burn it". I said goodbye and she said we would not meet again "unless I received a very big bill".
The local authority pressed me after that and I had to admit my dad had means above the upper threshold (which I believed he kept quiet about). I am the executor of his estate and cannot lie about his assets. So they sent me a bill for the full cost of the 4 weeks he did not spend at the care home, coming to around £2,000.
I questioned this because I looked on the ageUK facts sheets and found that my dad should have been eligible for "intermediate" care.
This is where the client is going to the care home for a short period in order to recover before going home. He had been told at the time he would not have to pay (at least for the first 4 weeks). I don't know if "intermediate" care is what was agreed at the time, but certainly the plan sounded very much like it.
I received a reply saying that my dad had been asked to contribute to his care costs (note not agree to pay them) and the local authority wanted to recover the cost against the estate. "Intermediate" care is not means tested.
So has the local authority a valid claim? If so it is easy, I just charge against the estate and pay at probate, but why should I if he was not liable. If he was not liable how to I approach obtaining a resolution? If no-one knows here I guess I need to speak to a solicitor. Thanks in advance for any comments.

Gingernutty

lozzark wrote: »

My dad was admitted to hospital after breaking his hip at home.

The op went fine, but a few days into recovery something went wrong with his swallowing.

He recovered from several bouts of aspirate pneumonia and was eventually fitted with a PEG so that he could be fed directly into his stomach. Things seemed to be going fine and the hospital social services rep formulated a plan to move him to a care home.

His main issue was that after many months in a hospital bed, his muscles had weakened. He could get up, but need help to move about. He'd been receiving physio at the hospital for a while.

The rep convinced him to move to a care home on a trial basis for 4 weeks and that he would not have to pay. He wanted to return home with a care package. At home he cared for my mum who had Alzheimer's.

My mum did not need physical help, more supervision to stop her wandering off, so the plan was potentially viable provided that a suitable care package was in place.

I agreed to pay top-up fees. These were only £20/week, so not really an issue for 4 weeks.

The transfer was made, but 3 days later he contracted aspirate pneumonia. The probable reason for this is that the care home did not receive feeding instructions on the transfer.

They probably overfed him and caused reflux. I know he suffered reflux, but just one episode was enough to trigger aspirate pneumonia.

He never recovered to the level he was at when he transferred to the care home. I kept asking the rep about the care home fees and she replied that the "protocol" was that they were paid while the client was in hospital.I wasn't happy about it because I was paying the top up fees.

Two days after the 4 weeks had run its course, my dad died. He was recovering from about his tenth bout of aspirate pneumonia. During the period of his illness the local authority had sent me an assessment form. I asked the rep what to do with this and she said "burn it". I said goodbye and she said we would not meet again "unless I received a very big bill".

The local authority pressed me after that and I had to admit my dad had means above the upper threshold (which I believed he kept quiet about). I am the executor of his estate and cannot lie about his assets. So they sent me a bill for the full cost of the 4 weeks he did not spend at the care home, coming to around £2,000.

I questioned this because I looked on the ageUK facts sheets and found that my dad should have been eligible for "intermediate" care. This is where the client is going to the care home for a short period in order to recover before going home.

He had been told at the time he would not have to pay (at least for the first 4 weeks). I don't know if "intermediate" care is what was agreed at the time, but certainly the plan sounded very much like it.

I received a reply saying that my dad had been asked to contribute to his care costs (note not agree to pay them) and the local authority wanted to recover the cost against the estate. "Intermediate" care is not means tested.

So has the local authority a valid claim?

If so it is easy, I just charge against the estate and pay at probate, but why should I if he was not liable.

If he was not liable how to I approach obtaining a resolution?

If no-one knows here I guess I need to speak to a solicitor.

Thanks in advance for any comments.

Hi Lozzark. HTH.

suki1001

That sounds a lot of times for that to have happened. Did he use his peg at night, or during the day. the machine should give a specific dose, so in theory it shouldn't be possible to overfeed someone. However if someone isn't trained properly it can be unsafe.

If someone is fed at night they must be kept at an angle of at least 45 degrees or they're at risk of choking. I can't believe they didn't receive the correct information, it sounds very negligent to me, but that is just my opinion and maybe there was another reason he was prone to the aspirate pnemonia. I've looked after people who've had peg feeds and your dad's experience doesn't sit comfortably with me, but like I say it's only on the peg itself and not medical conditions.

In regards to the fees, it does sound odd you were told 2 different things, especially when your dad wasn't given a choice. Can you speak to social services again?

Torry_Quine

suki1001 wrote: »

That sounds a lot of times for that to have happened. Did he use his peg at night, or during the day. the machine should give a specific dose, so in theory it shouldn't be possible to overfeed someone. However if someone isn't trained properly it can be unsafe.

If someone is fed at night they must be kept at an angle of at least 45 degrees or they're at risk of choking. I can't believe they didn't receive the correct information, it sounds very negligent to me, but that is just my opinion and maybe there was another reason he was prone to the aspirate pnemonia. I've looked after people who've had peg feeds and your dad's experience doesn't sit comfortably with me, but like I say it's only on the peg itself and not medical conditions.

In regards to the fees, it does sound odd you were told 2 different things, especially when your dad wasn't given a choice. Can you speak to social services again?

On the peg feeding my great-aunt had one for over seven years following aspiration pneumonia. She was never given instructions on what position to be and was fed at night and always ended up at the bottom of the bed no matter how she started off. Never had any choking and she couldn't swallow anything at all.

OP On the fees was anything signed saying that fees were payable?

Pee

Get a Solicitors for the Elderly Solicitor.

suki1001

Torry_Quine wrote: »

On the peg feeding my great-aunt had one for over seven years following aspiration pneumonia. She was never given instructions on what position to be and was fed at night and always ended up at the bottom of the bed no matter how she started off. Never had any choking and she couldn't swallow anything at all.

OP On the fees was anything signed saying that fees were payable?

I'm only going on what I was trained to follow and that was for everyone I looked after, I would have been shot otherwise. I actually remember now it was at least 30degrees. I've seen complications from peg feeding and so I wouldn't have done it any other way - otherwise I would have been negligent. I'd have thought the care home would have had to have followed the same criteria.

Torry_Quine

suki1001 wrote: »

I'm only going on what I was trained to follow and that was for everyone I looked after, I would have been shot otherwise. I actually remember now it was at least 30degrees. I've seen complications from peg feeding and so I wouldn't have done it any other way - otherwise I would have been negligent. I'd have thought the care home would have had to have followed the same criteria.

No the care home were never told about the position and I doubt very much she would have listened if they had tried to tell her to be in a specific position. Her feed was connected, started up and that was all until it finished and the reverse was done. I'm somewhat puzzled as to how you can get aspiration from a peg feed.:o

suki1001

Torry_Quine wrote: »

No the care home were never told about the position and I doubt very much she would have listened if they had tried to tell her to be in a specific position. Her feed was connected, started up and that was all until it finished and the reverse was done. I'm somewhat puzzled as to how you can get aspiration from a peg feed.:o

If you are lying flat and you don't have muscle control or it's weakened especially if you cough, you're at risk of bringing the feed back up when it's going straight into your stomach at night and the nearest place it's going to go is straight into your lungs. You're literally breathing in fluid and that's what causes it. If you have a peg feed it makes you much more at risk of. It was one of the first things I was told. the company who make the feed had specialist nurses who came in and trained me. If you are lying at an angle the risk is reduced.

Sorry op - it's gone a bit off topic, but it still concerns me.

Torry_Quine

suki1001 wrote: »

If you are lying flat and you don't have muscle control or it's weakened especially if you cough, you're at risk of bringing the feed back up when it's going straight into your stomach at night and the nearest place it's going to go is straight into your lungs. You're literally breathing in fluid and that's what causes it. If you have a peg feed it makes you much more at risk of. It was one of the first things I was told. the company who make the feed had specialist nurses who came in and trained me.

Sorry op - it's gone a bit off topic, but it still concerns me.

Yes we have gone off topic so I will end here.

I totally see what you're saying but I would have thought that just not sleeping totally flat would be enough. I can honestly say there were never any problems and she had no muscle control at all on one side, actually it was totally paralysed. In fact for a short while she did everything herself with no input from care staff.

suki1001

Torry_Quine wrote: »

Yes we have gone off topic so I will end here.

I totally see what you're saying but I would have thought that just not sleeping totally flat would be enough. I can honestly say there were never any problems and she had no muscle control at all on one side, actually it was totally paralysed. In fact for a short while she did everything herself with no input from care staff.

Sorry just a little extra thing, the people I worked with were paralysed, so maybe that's why, but still for me I should imagine I would have been sacked for putting someone at risk if I'd have laid them flat.

Torry_Quine

suki1001 wrote: »

Sorry just a little extra thing, the people I worked with were paralysed, so maybe that's why, but still for me I should imagine I would have been sacked for putting someone at risk if I'd have laid them flat.

Now that would make a difference. My relative was able to move around although she never lay completely flat .