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CHC dementure care assesment... any advice please?

I have had a bit a kick in this direction to ask for advice regarding my father's funding for ongoing residential demeture care.

He has been cared for at home by my mum for nine years since his diagnosis, but earlier this years things became unmanageable and almost dangerous with dad being admitted into respite that day. Mum really did not want dad in full time care and still now speaks of wanting to bring in home occasionally. Towards the end of respite, we were strongly encouraged by the psychiatrist and respite staff to consider a nursing home.

The funding for the nursing him is split between my dads financial reserves, pensions etc, and the local council. Dad is paying the greater part of his fees. An assesment took place this week, involving a care home nurse, a carer, and an NHS nurse, there should have also been a social worker present but she didn't make it. The nature of the meeting was to decide if the NHS should be paying a greater contribution as dad's needs escalate. Dad's contribution is expected to stay the same, it is about the split of the remainder between council and NHS.

Mum had to sit through this meeting detailing every aspect of dad's health and behaviour, many things had happend which the care staff had not told us. The NHS nurse assessed him and was pretty much spot on with her findings, exactly how we had seen it. Dad really does need full time nursing care, there is no way we could do this at home even if we adapted the house etc.
Briefly, the dementure has reached a stage where he can longer remember his name, date of birth, home or former workplace for most of his life. Family members are either forgotton, or mixed up in terms of names and relationship position. He is active and walks around a lot, meal times and toilet stops can be awkward, requiring two carers to assist. Something like a chest infection really makes these effects worse.

Physically, he is generally OK for his age, but has been treated for skin cancer, has rhumatoid arthrisis, diabetes and only one kidney is functional.

As I say, there is no way he can be cared for at home, my mum would love to, and the professionals seem to agree. However, the recent bill was huge and there is obviously no way to tell how long this may continue for, leaving the risk mum will be left with nothing. We have also recently heard that should the MHA be needed to be applied to a patient/resident the care fees are covered by the state.

To cut a long story short, I am wondering if there is a provision to reduce dad's financial contributions towards his own care when it is obvious he cannot be cared for by himself or his, very willing, family.
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Replies

  • You mean 'dementia', don't you?

    It is possible to get the NHS to pick up the whole bill, but from experience of people who post on here, it can be difficult. What you describe is an 'illness', an organic disease which has affected your Dad's brain and is causing these changes in his behaviour. That comes under the NHS. It's not just 'oh he's got a bit older and needs care'. The difference between the need for the NHS and the need for the 'care' system is not well-defined.

    I knew a man who developed this disease and he was treated totally under the mental health system. At no time was there any question of 'paying for his care'. He started going to day-stay at the local MH unit, then as his condition worsened he went into an NHS elderly mentally infirm unit.

    It's encouraging that you're got the NHS involved. There will be others coming along who have much more personal experience of this type of situation.

    Good luck!
    [FONT=Times New Roman, serif]Æ[/FONT]r ic wisdom funde, [FONT=Times New Roman, serif]æ[/FONT]r wear[FONT=Times New Roman, serif]ð[/FONT] ic eald.
    Before I found wisdom, I became old.
  • Sorry, it is dementia, isn't it? I think....

    NHS have really only been drawn in since the council want to offload more of his fees, which the home want to increase as the level of care required has increased. As far as we are aware, it will just mean the split between council and NHS funding may alter, the contribution my mum is expected to pay will remain the same. The NHS nurse just said it would be decided by the board, no suggestion was made that mums bill may be reduced.

    I would have thought the need for care might have been identified since every professional who has met him since the morning he was admitted to respite has indicated the need for him to live in a dementia specialist nursing home, and that 'home' would no longer be a suitable environment.
  • uknickuknick Forumite
    1.3K Posts
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    Try this website. Their forum is extremely useful in advising what you can and can't get on the NHS/state.

    http://www.alzheimers.org.uk/

    My mother-in-law was in the same condition as your father with regard to her mental state. She was a danger to herself if left to live alone so social services unilaterally decreed she needed to live in a care home. This was despite her wishes to stay in her home. As time progressed her physical health also deteriorated to the point she could barely see and walk. But, despite it being the council's decision, as she had savings and a house her care was completely paid for from her own assets.

    It was only after her death we found out about some solicitors who specialise in recovering incorrectly paid for care home fees.
  • essentially the only way your fathers contribution could be reduced is if his care needs were such that they could only be met by a registered nurse, as opposed to a trained carer, in which case the NHS would pay the whole cost of care and your fathers income and savings would be totally ignored. By the sound of it, it would appear that the meeting was about a change in his needs that mean he requires a nursing home rather than a residential home, in which case health will contribute the extra costs (around £109 per week- if in England). Your mothers income or savings should not be taken into account, nor their home. In terms of any government benefits, i.e. council tax, pension credits etc. your mother will be treated as a single person and qualify for the single persons discount etc.
  • converted wrote: »
    essentially the only way your fathers contribution could be reduced is if his care needs were such that they could only be met by a registered nurse, as opposed to a trained carer, in which case the NHS would pay the whole cost of care and your fathers income and savings would be totally ignored. By the sound of it, it would appear that the meeting was about a change in his needs that mean he requires a nursing home rather than a residential home, in which case health will contribute the extra costs (around £109 per week- if in England). Your mothers income or savings should not be taken into account, nor their home. In terms of any government benefits, i.e. council tax, pension credits etc. your mother will be treated as a single person and qualify for the single persons discount etc.

    The requirement that CHC funded care needed to be provided by a registered nurse was discontinued some time ago. Care can be provided by any suitable carer in any environment including own home. The requirement is that the primary need is medical rather than domestic. Unfortunately many NHS areas still treat dementia as a unavoidable consequence of old age rather than a degenerative illness that only some people suffer from. The OP will need to push for a full assessment for Continuing healthcare funding. The assessment is normally performed by the NHS team and the overall responsibility for this funding in England has been transferred to the local NHS GP commissioning boards after being handed over by the old PCT (Primary Care Trusts).
  • I think it is more that since my mum was never in a position to build a full pension, dad's pension was used between them to keep the house going, which is now taken for his care.

    He already is in a dementia specialist nursing home.

    I think what took place was a full CHC assesment recently, but the only financail factors to be considered were what portion the council should pay, and what the NHS should pay. The third component of the fee payment, his own, apparantly will stay the same regardless.

    Is it worth contacting the psychiatrist? I'm sure she already knows it is not just old age.

    Do the solicitors that claim to recover fees tend to be a good option?
  • If awarded CHC funding your Dad woud not be paying any fees. It sounds like CHC was not awarded but the NHS are paying a nursing supplement which is the fall back position if a CHC award is not made but the patient need additional care.

    It is unlikely that the psychiatrist woud have any impact on the CHC award but it may be worth a try.

    The solicitors normally have a free initial screening of each case. It may be worth trying them but you may wish to look at the DST based CHC assessment process yourself to see what you think your Dad might score. The solicitors went through a stage of being snowed under because the government set a deadline for retrospective claims prior to a certain date and this created a large demand for their services. I am not sure if the situation is better now.
  • I think that you need to speak to a social worker, as it is their role to make sure all the financial aspects are straight. Especially as they didn't attend the meeting.
    Your dad's contribution is partly based upon his income & savings, which must surely be dwindling by now & will only continue to do so. What I mean is, if they had worked out a contribution based upon that originally, now they have to do it again as they are working with a different (smaller) figure.

    I have been through this process & it is complex, confusing and takes a long time. But find out who the social worker assigned to your Dad is & speak to them as soon as possible. Tell them that you want a new financial assessment. It may be that this is already in hand, but at least you'll know & the social worker should keep you/your Mum fully informed.
  • theoss wrote: »
    I think it is more that since my mum was never in a position to build a full pension, dad's pension was used between them to keep the house going, which is now taken for his care.

    He already is in a dementia specialist nursing home.

    I think what took place was a full CHC assesment recently, but the only financail factors to be considered were what portion the council should pay, and what the NHS should pay. The third component of the fee payment, his own, apparantly will stay the same regardless.

    Is it worth contacting the psychiatrist? I'm sure she already knows it is not just old age.

    Do the solicitors that claim to recover fees tend to be a good option?

    No, the house can't be taken for his care, since your Mum needs it to live in - it has to be disregarded.
    [FONT=Times New Roman, serif]Æ[/FONT]r ic wisdom funde, [FONT=Times New Roman, serif]æ[/FONT]r wear[FONT=Times New Roman, serif]ð[/FONT] ic eald.
    Before I found wisdom, I became old.
  • It sounds like you attended an assessment to see if dad was still entitled to the funded nursing care (FNC) element of his care which is the £120 a week that is paid for by the NHS. You couldn't have attended a CHC assessment without a social worker present. In order to undetake a Chc assessment you have to by law at least have a nurse, doctor and social worker present at the meeting.

    The care home fees that dad is paying is means tested back on his savings and if he has a property. The threshold in Wales is anyone Who has over £23,500 in savings pays full charge for their care package/care home fees.

    I wouldn't bother going to a solicitor as they will just tell you what you want to hear, take your money for the privilege than turn around and tell you that dad is not entitled to anything. Best thing to do is speak to the professionals involved in dads care to see if they feel there are any triggers to complete a CHC assessment. The complex care nurse that would have assessed for the FNC element of your dads care would have stated if she felt there were triggers to complete a CHC assessment.

    If you feel that dad should not be paying full charge for his care home fees then contact the social services finance team who can complete a financial reassessment.
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