turned down for nhs continuing care, any point fighting the decision

Biggles

markymark10 wrote: »

As I understand it because mum cant talk or write coherently & I have informed the social worker that my mum has very little savings & that the only other capital she has is a half share in her house which we jointly own, then the council need to run a check to prove that I am telling the truth & there is no hidden fortune which she can use to pay for her care over the first 12 weeks when she is being supported by the council.

I understand that, Mark, but who is going to give authority for the check?

The Council say your Mum can sign to give authority, the speech therapist says she can't sign anything.

If she's going to sign anything at all, it should be the PoA.

vikki_louise

Hello, I hope the CAB can help you fight this, it seems very much pot luck as to whether you get continuing care, one of the asssessments made about my Nan talked half way through about a compleatly different lady, and had a drastic change in her condition in about 2 weeks which strangely enough no one but the person who filled in the paper could see! Anyway she has it now, so at last they don't have to pay for carers (and the DNs which they never had to pay for).

good luck with it,

Viks

frannyann

Yes you can appeal and there is a formal process for this, I am surprised the social worker is not fighting it as councils are trying to get nhs funded care for most of their clients. Also I would ask what the hospital policy is for time from referral to social services to assessment is, most hospitals will have a discharge policy for reimbursement reasons, it sounds as though social worker has taken far too long to do the assessment.

A financal assessment is done for everyone recieving any type of care and if money is not disclosed then it is assumed to be self funded care. But if she is self funding then there is not the force of social services pushing the CC judgement. I would contact the continuing care team at the local PCT and ask to see the "decision tool" and ask for a copy of the joint assessment, then talk through it with nurses to see how it compares to the care mum gets on the ward, if it differs greatly explain you would like to formally appeal against the decision, they then have to explain the process to you. Good Luck

soolin

I have been referred to this thread and have bookmarked it for reference. Markymark I am so sorry to hear about your mother, the last thing anyone needs at a time like this is to have to battle with the powers that be as well.

I am likely to be in the same situation and will know more tomorrow. I have relied over the past few months since my father had a stroke on the great support from some very knowledgeable people on here and it has definitely seemed at time as though they knew more than social services who just kept trying to push everything back on me. I also agree that Alzheimers society is a great place for honest and immediate advice, they have a solicitor on the phone some afternoons and just knowing what to say and what to ask for when you meet with the social services was very supportive.

markymark10_2

Hi There

Once again thanks for all the help & support. With help from mums social worker & the CIB I have a team meeting with the hospital tomorrow where I will be able to meet with all the medical team including the person who made mums reassessment.

I will be able to challenge the team on my mums nursing needs & hopefully get some insight into exactly what criteria has to be met in order for them to be prepared to pay. I will post the outcome & any helpful advice when this has happened as hopefully this will benefit anyone else who reads these forums.

Thanks again for everyones help & advice

smartarse

It's important to be clear about what is "nursing" and what is "personal care". I hope it went well for you.

monkeyspanner

!!!!!! wrote: »

It's important to be clear about what is "nursing" and what is "personal care". I hope it went well for you.

Second that. Hope you got somewhere.

Despite the new assessment tool being introduced in October it is still no clearer where the decision boundary is, and nobody seems prepared to explain how decisions about CC are made.

There seems to be an assuption with medical staff that if someone is in or about to go live in a care home then their need is domestic and therefore they automatically don't qualify for continuing care. Despite the fact that the regulations say CC is available in all settings including home care.

We were also asked 'Is your Mum going to be self funding?'. I have no idea why that should be relevant to a decision on health needs other than if I let myself be cynical when the relevance becomes blindingly obvious.

morganlefay

markymark, just keep fighting...your Mum is ILL and several cases have now been determined which say that the NHS ought to be caring for ill people, yet they still don't. I fought and fought to have my severely demented and disabled mother cared for under Continuing Care. Don't let any feelings of not wanting to offend them, or be a nuisance stop you. Actually the people who make the decisions are sometimes quite OK, but they don't make the rules. Just keep at them, because your mother should be getting CC funding. In the end, after my mother died, the assessors went back to the Home she was in and looked again at her notes. They said that they had perhaps been mistaken (ha ha) and she should have had the highest RNCC banding (but still not CC funding) and gave me some money back. That was no consolation and I am left with an abiding feeling of fury and of my mother being let down by the NHS when she most needed care. Tony Blair, shortly after his election, said that he didn't want pensioners to have to sell their homes to fund their medical care, and what difference did he make ? None. And still it goes on. Keep at them, it's tiring and time consuming but if we all give in and roll over they will continue to pursue this approach which is illegal. I wish you tremendously good luck, and a lot of energy to battle with them.
Morgan

Primrose

Picked the follow info up from a community newsletter recently. Don't know whether these people could help you.

"The fight for continuing care fees to be paid by the NHS or a Local Authority remains a consuming nightmare for thousands of families. Everything hinges on the definition and interpretation of the ruling as to whether the primary need for care is a health need.It becomes a matter of expert evidence and application – and many
families are left floundering and bemused by delay, intransigence and complexity. It can be costing them many thousands of pounds. Challenging denial, securing eligibility

Robert Campbell & Company is a specialist legal practice handling continuing care cases for a wide range of clients all around the UK. One recent case, involved a son whose father, an Alzheimers sufferer, was prevented from returning home after hospitalisation. For over a year, the son and daughter challenged the denial of NHS continuing care for their father – without any success. Robert Campbell & Co. was asked to take on the case and, in a relatively short time, was able to establish a report reflecting the seriousness of the father's condition and secure an agreement that he was eligible for fully funded NHS continuing care. The father eventually was able to move into a nursing home paid for by the NHS. Delighted at this outcome, grateful son Chris Leeds, said: “I do not believe we would have achieved this highly satisfactory outcome without Robert Campbell's involvement – and I am very happy to recommend Robert's services to anyone. He is highly efficient, focused and good to deal with. At crucial points in the process, he gave us extremely good advice.” The success almost certainly saved the family tens of thousands of pounds in care costs without, in any way, compromising the father’s care. Robert Campbell & Co. offer a free on line assessment of a person's potential to achieve Continuing Care eligibility. You can access this now by going to: http://www.carelaw.co.uk/nursing-care-assessment.html. Robert Campbell & Co will then offer a 'Capped Fee Scheme' to
clients, at £595 plus VAT. Full details of this scheme can be viewed athttp://www.carelaw.co.uk/capped_fee_scheme.html

monkeyspanner

Anyone know anything more about Robert Cambell & co and carelaw?