Continuing Health Care - Preparing to fight PCT's decision

tubsmacker

Katykat wrote: »

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.

My argument isn't directed at the Care Home. As far as I'm concerned they can do as they please with '2 for 1' offers etc. I'm focussing on the legality of a public body amortising it's residential accommodation overheads disproportionately in a building occupied by both private and state funded residents. In other words, the LA are breaking the law by negotiating lower fees than private clients have access to.

This argument would put the fear of God into Local Authorities :eek: because their focus,and that of the NHS is to bully care homes into giving them a 'better deal' for block bookings

Meanwhile, Joe Soap is pushed against the wall for £700 a week or whatever.

So why not stop paying your fees on the grounds that unfairness prevails as the LA is forcing you to subsidise it's publicly funded clients and needs sorting in a court of law?

Any takers?

realshannon

Well, I have finally read all the pages of this extremely interesting blog. I have cut and paste pages of information. Can I briefly ask for any views etc before I start next week with my letter writing?
My mother in law is 92 - extremely strong willed and independant lady, broke her hip a few years ago and her husbands funeral, never been right since. Fell last year, knocked her head and arm but luckily no broken bones. Occ Health at hospital insistent she needed help at home. We tried and tried but she wasnt having any of it, but did agree to an assessment of her home for extra support gadgets, like extra handrail and a bath lift. she did try meals on meals but within 2 weeks we found she was putting them in the bin or down the loo so that didnt work! tablets were the same, found in pockets or down the side of her chair. Her daughter has been marvellous helping with everything, luckily retired early but had her own health issues. We dont live local so couldnt help on a daily basis. We managed to get a friend of the family that she liked to come in and help with cleaning, what there was, shopping etc. that worked well. we had a 24 hr alarm installed. This year despite all our worries about her, she couldnt be dissuaded from any further help etc, daughter was on the verge of a breakdown with caring etc for many years. Before a decision could be made, she fell again and broke her pubic rami. Didnt use her alarm as she didnt want to upset anyone. In hospital we are told she will be kept there until stable then transferred to rehab hospital for approx 5 weeks, great, we thought this is the opportunity if you can make a good thing out of something bad! we can get her more help etc etc etc. In the 2nd week of her stay we had a call from the hospital to say that she was being discharged back home, we couldnt believe it. It was actually quite aggressive, we need the bed either today or tomorrow. we explained we didnt agree she wasnt anyway near capable of coping without alot of help, she couldnt hardly walk and had become confused. We are now told she has vasculr dementia as well as heart problems, she has a pacemaker. As with most people on this link, we had no knowledge of continued care, felt pressured and stressed with everything. They kept ringing and hassling, and said they had 2 homes which could take her, in the end it as only one home, a residential home. It was lovely but we had no knowledge of the OT assessment which we had specifically asked to be told about as we wanted to be present in lieu of her deterioration. After weeks of self funding at this home, many falls and accidents later, they advise they cant cope. Many doctors visits later a consultant attended and said she had deteriorated following her dementia assessment at hospital. we had no idea that she had it or that she was suffering in that way. we just thought it was old age but everything then slipped into place with all the things she used to say. The home then gave us notice but very luckily we did find another, meanwhile, we had heard of continuing care. The social worker had become involved. she was specifically told not to deal with sis in law due to her mental state, but she asked her to sign a contract, which she did. when we werent there, now we are being pressed to do a financial assessment. One checklist was done before xmas, was positive and we were told an assessment would follow. Mum in laws health was poor for a while, during which time the SW did the checklist she was actually in bed. Meanwhile the district nurse became involved and told us the score was too high. instead of having the full assessment what actualy happened was another checklist with both of them in attendance and surprise surprise she failed. We have now complained to the hospital and wait for documents so we can appeal. is there anything else we can do in the meanwhile? apart from refusing to supply any financial information to SW who is pressing for this - any guidance appreciated. thank you very much (this is a very shortened version of events!)

Katykat

Realshannnon, there are a few things you cab do. Firstly, someone has to be appointed as Power of attorney if not already done. Unfortunately as MiL has alreeady been diagnosed with dementia she can not appoint someone of her choice. as a family you should discuss who you want to be appointed. You can have more than one attorney. You will have to apply to the court of Protection. You dont have to consult a solicitor, its easy enough to do yourself. the forms are availableonthislinkhttp://www.publicguardian.gov.uk/forms/Making-an-LPA.htm
Next, you need to read through the National Framework ( yawn!, but important) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103162
Both the checklists done were illegal, they did not conform to the N Framework. Family are supposed to be consulted and encouraged to participate, so I would imediately complain to the PCT and demand a new checklist done in your ( or another representative) preesence and to make sure that it is scored correctly. At least 1 A score qualifies for a full assessment which also should be done with full participation of the family. Has your SiL been diagnosed with a condition that would normally render her incapable of taking responsibility? If so, the SW was completely out of order asking her to sign anything and as such any document may be rendered invalid. DO NOT LET SOCIAL SERVICES BECOME ANY MORE INVOLVED UNTIL FUNDING HAS BEEN DENIED. It will be, but that is when the fight really begins. Register with the freenursingcare forum and you will reieve lots of help and advice from people like yourself and also specialists. One other things, be very wary about consulting solicitors. Only if you absolutely feel you cannot fight the authorities, but then you must be prepared to PAY. A LOT.
I'm not going to pretend that its easy, its most defintaly not. I've been fighting for 3 yrs now and I've spent hundreds of hours researching, going to meetings, liasing with leal experts & others, writing letters reading documents. And I'm still not there yet. Be strong, if you have the guts, you can do it. Just a shame tht you HAVE to do it.

monkeyspanner

I am afraid this sounds all too familiar. SS always pile on the pressure and do not represent their client's interest. Hospitals are IMHO worse and act often entirely against the CHC National framework.

It may be splitting hairs but did your SIL have a power of attorney to act on behalf of your MIL financially if not whatever she signed could be meaningless. You could complain to the SS but I rather doubt you will make any progress.

It sounds as though the proceedures have been almost totally ignored. You need to press as you are doing for a full assessment. It may be worth approaching the SHA (strategic health authority) who have the power to review proceedure but not officially until all steps have been followed with the PCT. If you approach them they may apply pressure to the PCT behind the scenes.

If your SIL does not feel able to resist providing the financial information and start self-funding on behalf of your MIL all is not lost but she will have to demonstrate your MIL's health condition retrospectively in order to recover the payments. We managed to get retrospective payments for 9 months care for my MIL. Yes that is how long it took to get through the process and that I understand was relatively quick.

Good luck anyway.

realshannon

Thank you. My Husband and sister in law have power of attorney and have dealt with her affairs for years. I have offered to help because my sister in law just wasnt in a good place and couldnt cope and I could see it all crashing down around us. My Husband works very long hours and I actually like a challenge anyway! I have consulted alot of the documents already but need to now revisit them and to be blunt kick some butt - I certainly feel like sister in law has been taken advantage of and she was gutted when she finally confessed what had happened, she was embarrassed to say. I told the SW but she originally denied it and then reneged and agreed we had had the conversation several times. We have just wasted 2 months now from them messing around. we have to pay the hospital £50 for documents, and we have a cracking letter from the consultant who saw MIL at the 1st home so I am confident we will get there but after this, I think I will put my "sort this out" boots away and have a well earned rest! thanks again, will post update

monkeyspanner

Here is a link to the ADASS (Association of Directors of Adult Social Services) CHC web links page. All the latest guidance notes, National framework, CHC checklist, DST, Fast track assessment, statistics for award rates across PCT's and SHA's and a comparison of the differences between 2007 and 2009 framework.

http://www.adass.org.uk/index.php?option=com_content&view=article&id=510&Itemid=390

Some interesting figures in the stats particularly the reduction in CHC award rates in some areas over a year.

angie1965

My mam has dementia and 5 weeks ago was coping pretty well until she developed anemia ans was admitted to hospital, she has been in 6 weeks being treated for that aswell as her diet needs as she wasnt a great eater, the problem i am up against is simply this, a meeting was called to acess her needs, i was informed she will need 24 hr care as she has become incontinent (i feel this is bcos she was told she couldnt get up) without permission so she has to rely on staff who are mostly busy.......I want a full care package in mams home rather than her go into nursing home which they are pushing for, in this meeting they were adamant that she needs 24 hr care which surprised me, as 5 weeks ago she didnt! I felt bullied in that room, social worker giving me stinkers when i said your making choices for my mam knowing that a nursing home isnt what she wants........not only that they can only fund 4 hrs a day care which im sure isnt right........they also said she wd be required to sell her home to fund the care home fees, even tho mam as under 1000 in savings, is this right and if not what do i do to protect not only her wishes but her home..........she, they say, is incapable of making decisions omg that made me so angry, please please someone help, i asked mam about a care home and she cried please dont put me in there......i am DESPERATE for the right advice where do i begin. :(:(:(

malid

Angie 1965 I was so sorry to read your predicament. I know this is a long thread but you need to read it carefully. There is a lot of great advice. Many have given good advice but Monkeyspanner's posts are a must for you to read.

It looks to me as the issue is are they saying 24 hour care or 24 hour nursing care? Subtle but key difference to the funding. However the assessment for CHC is on specified criteria and not dependent on it being 24. I may be wrong here. This thread will give you an insight into CHC and the funding issues and when a person has to 'fund' him/herself.

It is possible to have a care package set up for an individual to stay ay home, I expect it's more hassle for those sorting it out but don't be put off or bullied into accepting something you and your mam don't want.

Please please read the pages here. I know it looks daunting but you need to get a clearer picture of potential issues and what you can do.

All the best and if you have a question, post it here so that the great people who use this can try to help. I have certainly valued advice and information given here.

monkeyspanner

Angie I too was so sorry to hear you are being put in this position by people who are being paid to act in your Mum's best interest but are actually representing their organisations best interests. The hospital staff want to clear the bed and the fastest way of doing that is to persuade you to take over and move your Mum to a care home. The social services are mainly interested in minimising their workload and if there is access to funds they will go the route of self-funding again in a care home. The PCT will be interested in minimising their financial liability and although their own medical staff are saying your Mum needs certain care you will have to fight to get funding from them.

My advice here is to try to resist being rushed into a decision but that does not mean I am definitely saying don't consider a care home. My MIL was adamant she did not want to go into a care home. She struggled at home in her ex-council house with at home care then when this got too much went into sheltered accommodation with their own carers. After a medical collapse she finally moved to a care home much against her wishes which was a terrible time for her family. Within a few days she was the happiest we had seen her for years and she spent the last few months of her life in a caring environment which provided all the support she needed. Her health substantially improved because she was taking her medication on time supervised by the carers.

If you want to carry out your Mum's wishes and resist the care home route I think you may find the NHS CHC Practice Guidance Notes document informative, here is a link.

http://www.adass.org.uk/images/stori...77%20final.pdf

The relevant sections start at section 11.7 and it appears there may be some case law to support a patient's wishes to remain at home (see Gunter case) but the circumstances are different in that Gunter was a young patient who could still express a wish to remain at home. Of course you need to get CHC funding first.

On the practical side prior to discharge to hospital must carry out a CHC checklist this is designed to assess medical needs and see if a full CHC assessment is required. Ask about the checklist and say you want to attend they may refuse but it will be difficult for them if you seem to know the proceedure. You should be informed of the result of the checklist and if negative you should challenge any part of the decision you disagree with. If positive a full assessment using the DST (decision support tool) should follow but not necessarily very quickly or prior to a move.

You could try asking if your Mum is suitable for rehab this is usually a lesser hospital where they try to get patients to a condition where they are more able to look after themselves. The PCT/NHS should fund this. This will give you a breathing space to see what is best.

As your Mum has so little in cash savings if it does come to a care home placement you can ask for a 12 week disregard period this allows 12 weeks where the value of the house is disregarded from any financial assessment. Also you should ask for deferred payment this will mean that a financial charge is put against the house but your Mum would retain ownership until the house is sold. There are several financial advantages to this. I know that your Mum will be worried about losing her house but the financial status this will provide will allow her to buy a better level of care than council assisted
residents.

It will not be an easy time for you but try to inform yourself of the process as any knowledge will help you fight your Mum's corner. If you don't understand what you are being told don't be frightened to ask for a proper explanation, you will often find that the staff using the jergon don't actually understand the process themselves and cannot explain it to you. This in itself will put you in a better position. We found that the way to survive this and prioritise looking after my MIL was to compartmentalise dealing with the authorities into a specific time slot each day. You also need to set aside some time for yourself or it will take over your life.

Good Luck.

angie1965

Thank you so so much for that great prompt advice, im going to approch the hospital discharge nurse who has pushed for residential/nursing home care from the beginning and ask her about a CHC checklist although im not too sure wot it means.......Legally id like to know where we stand if i decide to take my mam home to live with me, can they refuse, the social worker frowned at me during the meeting and said this isnt only your decision (meaning they can override and bully me) i felt so intimidated you would not believe........will keep u posted guys and THANK YOU xx