Continuing Health Care - Preparing to fight PCT's decision

monkeyspanner

DiggerUK wrote: »

Update 2.
Sister finds that the visiting nurses are better informed than her about her FIL's (Barry) fast tracked help, they are now providing night cover 5 nights a week, she is also getting some weekly allowance of hours that mean she can get about 10 days holiday a year, plus they are sending more day nurses in to wash and clean Barry. This allows her about 4/5 hours on two mornings a week so she can go and do whatever.
When she phones the powers that be, it turns out they made these decisions days ago.....and "can't understand why nobody informed you."

If you think that is weird, the hospital phoned late this afternoon to ask her to get some clothes ready for her MIL (Wendy)....she goes in to a fully funded care home tomorrow. And again...... "nobody knows why" she wasn't informed!!!

Does this sound fishy, or normal. Do they have different teams of people not talking to each other. Thankfully I prefer c0ck up to conspiracy theories.

It sounds like your sister has a positive result. Ineffective communication is perfectly normal but don't assume it is not part of the conspiracy to reduce the release of information. If your sister does not know what has been awarded and why then if it is withdrawn later it is more difficult to challenge.

DiggerUK

monkeyspanner wrote: »

It sounds like your sister has a positive result.......

Are you well seasoned at this god awful game, or just a realist.
I will advise my sister to get copies of everything, so she knows why she has got, what she has got.

To all lurkers...don't be intimidated.
To all who have advised...many, many thanks. My sister seems human again.

Love to all. Mr. & Mrs. Digger.

tubsmacker

Katykat wrote: »

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.

I remember reading a lawyers opinion about the legality of shared accommodation in care homes.

The issue is that it is apparently unlawful for a home that is part funded by a public body (such as the Local Authority) to amortise it's overheads disproportionately. In other words the home is charging you, the private client more for heating lighting, staff costs etc etc than it is for the block booking clients or maybe those that are not self funders.

You could consider a legal challenge to determine that you and your mum's self funding cohabitants have been unlawfully levied.

The prospect of a successful case would possibly frighten the relevant authorities somewhat, as the current trend is for the NHS and the LA's to secure better 'deals' by block booking as depicted by the NHS Chief Executives conference at the Wirral.

monkeyspanner

tubsmacker wrote: »

I remember reading a lawyers opinion about the legality of shared accommodation in care homes.

The issue is that it is apparently unlawful for a home that is part funded by a public body (such as the Local Authority) to amortise it's overheads disproportionately. In other words the home is charging you, the private client more for heating lighting, staff costs etc etc than it is for the block booking clients or maybe those that are not self funders.

You could consider a legal challenge to determine that you and your mum's self funding cohabitants have been unlawfully levied.

The prospect of a successful case would possibly frighten the relevant authorities somewhat, as the current trend is for the NHS and the LA's to secure better 'deals' by block booking as depicted by the NHS Chief Executives conference at the Wirral.

That's a very interesting point. Perhaps it would be worth starting with a self-funder who has reached the lower savings limit and is now council supported but has to continue paying the self-funders rate and needs 3rd party top-up. However, I would not want to be the resident caught up in a legal battle whilst still living in the care home.

There was also a recent case in Wales where a number of care homes were challenging their local council support funding levels as inadequate. I believe the court found that the council's calculations had been flawed. http://www.westerntelegraph.co.uk/news/8625197.Threatened_care_homes_await_key_court_ruling_on_council_fees/

monkeyspanner

DiggerUK wrote: »

Are you well seasoned at this god awful game, or just a realist.
I will advise my sister to get copies of everything, so she knows why she has got, what she has got.

To all lurkers...don't be intimidated.
To all who have advised...many, many thanks. My sister seems human again.

Love to all. Mr. & Mrs. Digger.

If I haven't experienced the tatics personally I will usually have read about it on this thread. The whole experience has I am afraid increased my cynical nature.

I am very glad to hear that your sister feels a bit more in control.

Katykat

Tubsmacker, I understand what you mean, however I'm pretty sure that the care home would turn this argument on its head. Their reasoning is that the LA pay for these beds whether they are occupied or not. This allows them to give the LA a discount on their standard rates. A bit like BOGOF- buy one get one free-. The LA would then argue that they are passing this saving on to their client. It a bit of Heads you lose, Tails you lose really. You are correct in that it would be interesting to see what happens if this method is challenged, but I'm not the one to do it I'm afraid. I ( & I'm sure almost everyone that this fiasco affects) have enough of a fight going on trying to get funding. I just couldn't take on any more. But I'm sure someone will one day.

soolin

I'm just joining this thread so I can bookmark it. Dad is being moved from his current residential home to a nursing home (assuming I can find one!) and I am determined to try and get some help with his funding.

I fear though that his needs will be assessed as social only, even though the residnetial home have said they can no longer meet his needs due to the fact that he needs nursing care.

Wish me luck, I can't even find a home with a vacant bed that can cope with nursing needs and dementia and the hospital want his out 'now'.

Savvy_Sue

soolin, what the hospital wants and what they can do are two separate things.

they cannot discharge him until a suitable place has been identified. and I'd say do not be rushed. ask them how you are supposed to identify somewhere before he's had his full assessment, and if they say it's happened ask why you weren't invited to be there, and where are the results.

I'm sure one of the experts will be along soon to tell me if I'm wrong about this!

soolin

Savvy_Sue wrote: »

soolin, what the hospital wants and what they can do are two separate things.

they cannot discharge him until a suitable place has been identified. and I'd say do not be rushed. ask them how you are supposed to identify somewhere before he's had his full assessment, and if they say it's happened ask why you weren't invited to be there, and where are the results.

I'm sure one of the experts will be along soon to tell me if I'm wrong about this!

Thanks Savvy_Sue, the care needs assessment is being done today and I am going along shortly to 'help'. Have been phoning round homes locally that can cope with severe dementia and can't find any (apart from 1* ones) with a bed, have a tentative arrangement to view one tomorrow although there is someone already interested in it apparently.

The home i really really want never has any vacancies, which suggests the high level rating it has is justified as they even have a waiting list!

tubsmacker

soolin wrote: »

I'm just joining this thread so I can bookmark it. Dad is being moved from his current residential home to a nursing home (assuming I can find one!) and I am determined to try and get some help with his funding.

I fear though that his needs will be assessed as social only, even though the residnetial home have said they can no longer meet his needs due to the fact that he needs nursing care.

Wish me luck, I can't even find a home with a vacant bed that can cope with nursing needs and dementia and the hospital want his out 'now'.

The problem here is that your Dad has a worsening condition which the care home have said they can no longer manage. This would arguably demonstrate the presence of a Primary Health need.

My advice (which you may not like) is not to move your dad to a NH but to get the NHS to conduct a full Continuing Healthcare assessment where he is. The care home want him out so will probably side with your assessment that he has a Primary health Need. Social Services will want to push you to moving him to a Nursing Home for fear of them getting involved financially as will the NHS.

Once you move your Dad and continue paying, that's how it will stay for a very long time whilst you go blue in the face chasing the PCT (NHS) appeals process.

If the NHS won't play ball. write to the PCT telling them that you have instructed the home to transfer your dad to the NHS hospital for an assessment as it is not possible for them to legally continue to look after him. You believe he is entitled to Continuing care and demand a full assessment.

The objective here is to cease paying on transfer and not to sign anything whatsoever. A battle lies ahead if you choose this route but a battle also awaits if you conduct a transfer and continue paying anyway.

You must choose what you think your Dad would want you to do really.