Continuing Health Care - Preparing to fight PCT's decision

monkeyspanner

atoneswitsend wrote: »

I am much obliged to all the help and advice received via this forum which has assisted in my succeeding to obtain CHC funding for my SiL. From my army background this is merely the first battle. The war has yet to be won.
Now I wish to turn to making a retrospective claim. However I am uncertain how to progress this. Any advice or guidance would be much appreciated.

We had this situation with my MIL. You should inform the PCT you want a retrospective review for the relevant period. Essentially your problem will be gathering sufficient evidence to convince assessors and more probably an Independant Review Panel (convened by PCT) that at any particular time CHC funding should have been awarded. So my advice is gather as much medical evidence from hospital, GP and if relevant care home before it "disappears". We then persuaded the PCT to have a lead assessor go over all the medical history and make a report for use at panel. Surprisingly the two IRP meetings we attended were never given sight of this report, and we were never given an explanation of the reason it was not presented for consideration. The chair of the IRP then we assume gave the PCT a nudge and told them they were not following proceedure and that the SHA if involved would not be happy, and the manager of the CHC section simply awarded a CHC retrospectively for the relatively short period the IRP felt they had insufficient evidence upon which to make an award. It seems a strange way to run a department but by that time we were just relieved to have won and did not persue the missing report.

So in summary evidence, persistance and pressure may win through in the end. Failing that a review by the SHA almost inevitably will find proceedural errors. And your final option is judicial review but you will need a specialist legal team for that.

atoneswitsend

Thank you Monkeyspanner. I appreciate your assistance.
I have downloaded the CHC guidelines etc available online to help me in my claim todate. Are there any similar notes/guidelines I can access online relating to a retrospective claim?

monkeyspanner

atoneswitsend wrote: »

Thank you Monkeyspanner. I appreciate your assistance.
I have downloaded the CHC guidelines etc available online to help me in my claim todate. Are there any similar notes/guidelines I can access online relating to a retrospective claim?

I am not aware of any specific guidelines regarding retrospective awards but you may find relevant information in the National Framework regarding the proceedure followed in your SIL's case.

Normally retrospective awards involve around the period between hospital discharge (with a negative initial checklist) and the patients representatives persuading the PCT to carry out a full DST based assessment. For the purposes of this post I will assume your SIL's award has been made from the date of the DST assessment.

I have briefly gone back over your initial posts and see your SIL was not expected to survive and that the initial checklist with negative result was done 3 weeks prior to discharge.

I believe this could be grounds for challenge as if your SIL was not expected to survive then she should have been assessed under the fast track process and I would have thought that at least another checklist should have been completed nearer discharge. The initial checklist should also be completed so that all possible candidates for full assessment receive one and looking briefly at your SIL's medical condition it seems impossible that a full assessment was not recommended. The other area you should consider how your SIL's condition changed between discharge and assessment. I suspect that she may have improved or stayed much the same in either case there is a strong argument for backdating the claim to discharge.

If you study the framework you will probably find that proper proceedure was not followed and there will be many reasons for you to refer any decision to the SHA for review of the PCT's proceedure in this case if the PCT do not agree to retrospective CHC payment. Normally PCT's do not act in a timely manner, and overlook their obligations to communicate their decisions effectively and fail to give opportunity for challenges to be made. Part of the reason for this is because the initial checklist is delegated to hospital staff who are under pressure to discharge patients quickly and are poorly trained in regard to the checklist and National Framework. Drawing up a timeline of all relevant events may help to highlight problem areas.

I hope this helps.

Katykat

Digger, just to put you in the picture, the PCT, LA and care homes do not play fair when it comes to Joint packages. My mum was self funding in a residential unit of a home ( we are fighting the CHC refusal) She was paying £395 pw at that time. When her condition deteriorated they transferred her to the nursing unit and the PCT magnanimously awarded her funded nursing care of £101 pw. I ( mistakenly ) thought that this £101 was to cover the services of the registered nurse and that the £395 would remain the same, as she ws still using the same amount of carer time, food, water, heating etc. But no- the fees went up to £450 pw. So now the home was receiving £551 pw in total. When i quieried this figuire, I was told that the room she had in the residential unit was a block booking room ( the LA pay for a number of beds in certain homes at a reduced rate, this guarantees an income for the home even if the bed is unoccupied ) Even though the LA then pass this fee on to the resident. When she was transferred to the nursing unit ( same home, just turn right out of the lift intead of left), this wasn't a block booking so we were charged the full room rate. I have no way of proving that this was or wasn't a block booking room, I just have to take their word for it.
Incidentally, read the national Framework, not sure which part but you can google it. It states that all asessments have to be carried out with the full involvment of either the person concerned or the representative. It doesn't have to be a family member or even the person who has POA, but obviously it would be better if the person had POA as they can be awkward enough dealing with POA. i hope someone has POA for both her in laws. The other point I'd mention is you dont have to take a back seat here. She obviously has a lot on her plate at the moment and its great that you are there in the background providing advice and support, but you can play a more active part if its better for her. You would be acting as an advocate for your sister ( rather like a solicitor but without the stinging fees) Believe me, you and your sister need as much advice, and support as possible.

monkeyspanner

weanie wrote: »

I have been 'lurking' amongst this thread off and on for some time. My mother has Vascular Dementia and a range of other needs which now seem to be 'relatively' insignificant in comparison to the speed that Dementia has taken over.
At our wits end over ayear ago, we gave up trying ot care for Mum within the family and she moved to a Care Home where she had spent some respite weeks during our care.
Mum's home has been sold and she has funded [we had the 12 week disregard and we managed her payments for her]. Her bank account has now reached the critical less than £23000 and we were obliged to contact the finance team and they in turn contacted Social Services and eventually there was a review with a social worker. The decision for PCT advice was reached during this meeting and we waited and waited for the PCT nurse to make an appointment. We had stressed to the social worker that we were quite insistent upon being invited to the assessment whenever it should be and we have waited over a month to be told that the waiting was to continue as they were busy. After a bit of a rant and a visit to see Mum I discovered quite by chance that an appointment had been made and that we had not been invited. We turned up anyway and it was obvious that the nurse thought that there was no need for PCT involvement and funding but as we assisted with the answers to the pre assessment, it was clear that there WAS a need to apply the Decision Support Tool. Apparently this will be during a multi disciplinary meeting and at a date unknown.
It seems so rude and dismissive to ignore our request for an invitiation and given the attitude of the nurse [appeared to think it was not a necessary visit at first and certainly not a priority], we wonder how many scores of A or B, Mum would have achieved without our input.
I found the whole process disturbing and stressful and wonder what is ahead for us all.
As Mum's money is practically gone, it may seem that we are wasting our time but if she were to receive PCT funding, then we/she could top up a better placement [or even the one she is in now] with her weekly pension. For this reason, we wll press on.

I am glad you managed to be an advocate for your Mum and you were sucessful with the initial checklist. Many PCT's do not think it is necessary for the patients representatives to be present at assessments and see them as a nuisance. I wish you luck with the full DST assessment and hope the PCT has the courtesy to inform you of the date. When we were in this situation with my MIL we informed the care home that no one from the NHS was to visit her without our prior knowledge so that one of us could always be present at all assessments.

If successful with CHC funding you will be able to retain and use your Mum's income incuding state pension for her benefit as all care home costs should be covered by the NHS and there should be no need to make top-up payments. If unsuccessful your mum will have to contribute the majority of her income including state pension towards her care and as she is on the minimum savings limit will not be allowed to make top-up payments herself so any top-up payments will be down to your family. As she is transfering from fully self-funding to Social Services supported (if no CHC funding) the SS will need to do a care needs assessment which will determine their maximum support funding level (part of which will be your mum's income). The difference between this support level and the care home fees will determine the top-up required. It may be adviseable to assertain the support level and fees so you know what might be required.

heartfield

First time on site.

I am a full time carer for one parent terminally ill with cancer.

The other parent had a fall and has now got vascular dementia, and needs full time care.

The above pages have been invaluable to me. As in 'Dont settle for just anything'.

Since asking for everything to be put in writing, the powers that be have started to take notice.

I am still battling on and hope to get my parent into a home of MY choice with THEM paying the full cost.

Will let you know how I get on.

Heartfield.

DiggerUK

No news yet about MIL's (Wendy), CHC; but they are going to fast track FIL's (Barry) home care package. Sister reckons she may be getting extra cover so she can get some time off for herself.
We even joked that she could come over and visit us for a change!

Any advice on what to watch out for with the fast tracking?

Sister is a bit despondent about whole process; but I feel if we can get a success under her belt with Barry's fast tracking, then she may find that bit extra to push for Wendy's CHC package.

Nearly forgot, SW said they can fund 450??? any idea how high the LA can go. Sister seems to be getting sucked in with a bribe in my opinion, then she gets angry because they didn't offer this in first place.

Thanks to all so far.

monkeyspanner

DiggerUK wrote: »

No news yet about MIL's (Wendy), CHC; but they are going to fast track FIL's (Barry) home care package. Sister reckons she may be getting extra cover so she can get some time off for herself.
We even joked that she could come over and visit us for a change!

Any advice on what to watch out for with the fast tracking?

Sister is a bit despondent about whole process; but I feel if we can get a success under her belt with Barry's fast tracking, then she may find that bit extra to push for Wendy's CHC package.

Nearly forgot, SW said they can fund 450??? any idea how high the LA can go. Sister seems to be getting sucked in with a bribe in my opinion, then she gets angry because they didn't offer this in first place.

Thanks to all so far.

LA maximums differ from area to area. You may be able to find published figures if you search the LA SS webpages. It would actually be in the SS financial interest to support efforts to get CHC funding as they would then not have to make any contribution. Many SS departments are reluctant to help as it upsets their cozy relationship with local NHS trusts.

atoneswitsend

Thank you Monkeyspanner. Most useful advice as always. I am photocopying all the records I can lay my hands on.
The CHC was awarded to my SiL wef 1 November so there will be a review early next year.
This is now top of my priority list, above the retrospective claim. What has happened will not change so I think that can wait whilst I turn my attention to the review assessment.
So any advice would be welcome. All I know is that this will be dealt with by the specialist nurse asessor. but I do not know what is involved.

[Deleted User]

Does the NHS funded care also apply to 24 hour care in a persons own home? Or is it only for those who go into a care home?