Continuing Health Care - Preparing to fight PCT's decision

malid

monkeyspanner wrote: »

Hi Beryl
I would avoid transferring assets especially if your mum is not capable of making her own financial decisions. I assume as you are just doing a POA it will be a Lasting POA and these have to be registered with the public guardian prior to use. Once registered there are pretty strict guidlines about keeping financial records. Rules for the old style EPA are slightly different and they don't need to be registered until the donors mental capability is in question.

Beryltheperil
It is no longer possible to apply for an EPA (Enduring Power of Attorney); you mus tgo for the LPA (Pasting Power of Attorney). You say you are in the process of doing this; please be confident that you can go through this process yourself and you do not need to use a solicitor. I filled all the appropriate forms and followed the procedures for my uncle. It was all approved by the office of the Public Guardian but unfortunately my uncle passed away before it commenced. The important point to note is that you need to do this whilst your mum is still able to understand what is happening. The POA is then registered when you feel your mum is lon longer able to deal with her affairs (health care of financial).

Monkeyspanner is correct, you need to be careful about depravation of assets but it isn't clear what mental capacity your mum has to make decisions. By the way, she doesn't need to be incapable in order to have a POA. The POA allows someone to administer her affairs on her behalf - you and your brother could be attorneys.

Whilst she is in receipt of CHC, her assets are safe but clearly you need to watch out for the reviews. Remember, she can gift up to £3000 (I thinK) every financial year. Perhaps there is another forum which can give more detailed information on this.

monkeyspanner

I think Malid is thinking about gift allowances in relation to IHT. There are several exemptions.
-Small gift allowance £250 per year each to as many people as you like is exempt. (The £250 has to be the total of all gifts to that person in the year)
-General allowance of £3000 per year and unused general allowances may be carried forward one tax year. So if no gift last year a total of £6000 this year.
-Marriage gift allowances(not sure of the limits).

I am not sure the council would recognise those gifting levels in relation to deprivation of assets and unless your mum has a substantial estate in excess of £316000 IHT probably need not be considered unless substantial transfers of assets have taken place in the previous 7 years.

Errata

Beryltheperil - I agree with Malid, but would like to point out that the LPA needs a Certificate Provider. If your mum has some degree of confusion and short term memory loss you will need to understand the role of the Certificate Provider and what Public Guardianship means. HTH

Beryltheperil_2

Hi all

I do have some knowledge of IHT. I have 25 years of banking experience. It may of interest to some that the LA did a financial review of my mum's affairs in order to pay the fees pending POA. The seven year rule is only for tax purposes if your assets will be in excess of 600k and you have been widowed/married. This is because the allowance is now shared between husband and wife. My dad died 4 years ago and his allowance has now passed to my mum. She could now leave over 600k without family paying IHT. Her assets are actually no where near that figure but it may be of interest to some. The LA told us that as my mum was previously in good health and was not in receipt of AA she could have transferred her assets to us the day before her stroke and it would not have been deemed to be deprivation of assets.

I am not exactly sure which POA we are going for but it is very long winded now and has to be registered with the court. Our mum is mentally capable but suffers from some mild short term memory loss. Physically she is very disabled, hence the POA.

malid

Beryltheperil wrote: »

Hi all



I am not exactly sure which POA we are going for but it is very long winded now and has to be registered with the court. Our mum is mentally capable but suffers from some mild short term memory loss. Physically she is very disabled, hence the POA.

Hi, I went for the financial POA. To be honest, I think it's a bit of a con having to do two separate ones for care and financial matters at £250 each. I made the decision that a POA over fiancial matters would influence/be relevant to care issues. As your mum is still of sound mind generally, the form filling shouldn't be too difficult but I agree, it is long winded. Completing and registering it immediately is not an issue although cearly in some circumstances, there is no need to register immediately.

Cheers

mar1e

I have read most of these posts withh great interest and do understand the frustrations people go through trying to get relatives and sometimes themselves through the Continuing Health Care process. I am a SW for adults with disabilities and have been involved in a number of successful CHC applications over the last few years and some unsuccessful ones.

In my opinion there is a bigger drive from the councils for people to become chc funded due to public demands on its purse strings. All SW in my authority recieved training in CHC applications and training was updated in line with the new national guidance that came out in October 2007.

However it would still appear that health professional are still not truly up to speed with CHC and I believe that this is because traditionally health staff priority and rightly so is to nurse people back to full health as is possible not too chase around for funding. Where as within SW it is sadly usually the 1st thing we have to think of is 'right how are we going to pay for this'. So this is where I think CHC is failing. I do not want to offend any health care professionals out there because you do do a sterling job, however you do have to admit funding isnt always your priority and to be fair if it was my mum or dad I would want your priority to be making them better.

CHC should be health led as it is a pot of money held by the PCT and all assessments should have at least a nurse a medic and a sw to input. To be fair as many health professionals as possible but this is the very least an application is required to have.
CHC in my authority is normally reviewed after the first 12 weeks then again at 6mths depending on individual case it may not be reviewed for a further 12mths.
If a person does recieve CHC and is going to go to a nursing home and are in reciept of DLA CC then they will loose this but you would loose this if the placement was funded by the local authority.

The way I personally look at CHC is complex and unpreditable but also does the person who is administering the care and or medication do they need to be a health professional if a health professional didnt deliver that care what would happen, and yes every need is a need even if it is being managed.

The key is if you arent happy with the assessment then you should ask for this to be done as far as I am aware all PCT now have a CHC team if not they should have at the very least a funded nursing care team.

Even though the National guidance brought in in October 2007 was meant to bring all PCTs into line it sadly didnt and as a SW who sometimes has to do CHC across different PCTs this can be frustrating.

The above is my personal experience as a SW inputting into the continuing Health care process sometimes smoothly and sometimes with sheer frustration

Marie

monkeyspanner

Thanks for the insider's view mar1e.

Picking up on a couple of your points.

At the point of discharge from hospital the patient's prognosis must be to some degree apparent to the medical professionals. Therefore the priority at that point should be to assess (together with the SW and patient's family) a suitable ongoing living arrangement for that patient which provides a proper level of care. Unfortunately the usual priority of the hospital discharge team is to find out when the patient can be discharged. This results in a discontinuity of care and in our case the discharge proceedures for my MIL were not followed in relation to CHC assessment.

The NHS CHC funding is not well known by the public and patient's family are not routinely informed of this and other funding alternatives. It should not be up to the family to research the options available and insist that proceedures are followed. In our case we had to do all the funding research and we did not discover the CHC funding system until after my MIL was discharged from hospital. It then took us several weeks to find out how this system should work and who was responsible for running assessments. It is unfortunate that this diversion of effort inevitably detracted from the level of emotional and physical support we could give my MIL at a stressful time for her.

The increased attention being paid to CHC funding by Social Services departments should be welcomed. Many may be inappropriately funding residents in care homes who should be in receipt of NHS CHC funding.

There is a great deal of misunderstanding of the CHC system within the NHS and SS. The off the cuff advice to us was that CHC funding is so difficult to obtain it is not worth trying. The phrase 'you have to be at death's door to get CHC funding' was used. Hopefully things will improve as the new CHC framework and staff training make an impact. I do feel that CHC needs to be seen as an integral part of the care provision system not just something that has to be done if the patient's family insist, or as a Social Services department manager said to us 'now you have cottoned-on'!

Beryltheperil_2

Hi monkeyspanner

Been away on holiday. You are absolutely correct in what you say. We were told by a social worker that "you have to be dieing in order to get CHC". I appreciate the contribution from someone with a Social Services background and understand their position. However in our area we felt that the Social Services had or preferred to have little knowledge of CHC. We felt that they were "all in it together". In our area there is, interestingly, an advocacy service for CHC and the advocates posts are funded by the Local Authority.

Biggles

My mother deteriorated towards the end of last year and, early this year, I got my sister (who lives locally, so is the normal contact for the home) to ask about NHSCC. My sister is not very assertive (understatement!) and said she was told the last assessment had been in May 08, so did we want to appeal against that? This was the first we'd heard of an assessment in '08, so I said a) we couldn't appeal unless we were told what the grounds were for any decision, in writing, and b) we probably had no grounds as at that date and were more concerned about her current situation. I was up there on 9 Jan and was given the impression by the care home staff that, in her condition, this was likely to be a formality, though the question of the effective date was left in the air.

Eventually, we got the message over and an assessment was arranged for 14 Jan, which my sister was going to attend. Sadly Mum died on 11 January. I suggested to my sister that she should still attend the meeting (as we were seeking retrospective CC) but it was cancelled without consultation.

Finally she was visited by the person from the PCT, who said they had discussed it with the care home staff and agreed CC for the last two weeks of her life. My sister was told if we wished to seek further backdating, we have to appeal the decision. But we have nothing in writing, and no notice of the grounds on which the decision is based, therefore no grounds to appeal.

Is it normal for relatives not to be notified of an assessment and, when they enquire, to only be given it verbally? Surely the PCT must be required to give details in writing?

malid

Hi Biggles

So sorry to learn about your mum; my sympathies to you and your family.

I'm no expert but I would certainly appeal. Read through the posts on this forum and you'll get loads of information. It may be time consuming but well worth it - for personal if not financial satisfaction and in pursuit of fairness.

Good luck!