Continuing Health Care - Preparing to fight PCT's decision

monkeyspanner

ajd1301 wrote: »

hi there, my father has been in a carehome for the last year paying 2,000 a month. he was diagnosed as suffering with early stages of cenile dimentia. if i have read the thread correctly, he may have been assessed incorrectly. is this correct.

if so, how can I attempt to get the money he has spent back and prove he was assessed wrong. because his money is now down to the 21k threshold they have picked up the tab.

is this correct. if so how do i start claiming it back or attempt to .

help!!!!!

regards ajd1301

You would need to demonstrate that your dad's primary need for some or all of the time he has been in a care home was medical in order to obtain a retrospective award of CHC funding. It is unlikely that early stage dementia on its own would be sufficient to get an award of CHC funding.

My first advice would be for you to try to find out if and when any CHC assessments have been carried out. If your dad was discharged from hospital to a care home he should have had as a minimum an initial CHC checklist carried out. This woiuld normally be carried out by the hospital discharge team and would have indicated at that time if a full CHC assessment should be carried out. Full CHC assessments based on a DST(decision support tool) are the responsibilty of the PCT (primary care trust) in England. The DST sets out a number of domains for assessment. If your dad was moved from home to a care home it may be that there was no attempt to make any form of CHC assessment particularly as he had some financial means.

Although your dad is now down to the minimum savings limit he will still be contributing his pension and a tariff income based on some of his savings so potentially there are still some financial savings to be made by a successful CHC assessment.

Do you have any form of power of attorney? Dealing with your dad's financial affairs could prove difficult if you don't. Does he have sufficient mental capacity to give you a POA and would he be willing to do that?

As an aside is he being charged the standard council supported rate by the care home or are they continuing to charge a self-funded rate? Have you been asked to provide a 3rd party top-up?

lauhar2010

I have just been reading some of the stories on here and i two have been and seen the hell that is gone through via nursing home fees.

My grandmother went into residentual care 5 years ago we sold her house and used all what was hardly any savings to pay for care in her residentual home.
Sadly arounf two years later she stopped eating and vastly deteriated badly she ended up in hospital and was hours from death. They managed to get her sorted as best you can with someone who cant talk walk. feed themself cant swollow and is doubly encontetent. She was then entitled to continueing health care via the NHS. She was placed into care and improved a little by that i mean she gained 7KG over 18months. Now we are being told she is no longer entitled to this and now we are once again going through finances after finance to place her in anaother home because we cant afford where she was placed via the nhs. She is also very vocal.

an 86 years old later being forced to move home because the NHS will no longer pay simple because she has gained weight.

This story i feel is a disgrace to society there are so many people out there in the same boat i for one would like to unite and make a stand and help more people who are being treated in this disgusting manner.

Why should prisoners recieve treatment of a new house etc when they have commited crime yet elderly people give up every penny because they cant get funding.

If anyone is with me please email me i have plenty of video's of my nan in her state to show people her condition.

This condition has not only destroyed my once happy nan but it has stressed my family to the core and i dont think people know the impact these condition have on the lives of the elderly and the carers and families who have to stand by and watch them treated this way.

Bakewell54

To all who are posting here in the early stages of beginning 'the fight'. Good luck!
My advice is to be resolute, get everything in writing (as opposed to telephone conversations) and log it all meticulously with dates/times.
This excellent thread will help you through, but you have to be prepared to do some very hard work yourself.
I made such a nuisance of myself that my mother died still not having achieved CHC (I think they were determined that she should not have it) - but her care was NHS funded because of the resoluteness of our fight. The SS never were allowed to assess her funds. Our PCT was/is rubbish and their paperwork was thrown out by the SHA's (Strategic Health Authority) IRP (Independent Review Panel).
I fought for mum's case from when she became very ill in May 2008 until she passed away in March 2011, and I am now taking it to the Ombudsman.
By the way I too was 'threatened' with the Public Guardian!

jonnyfan

Hello. New to posting although I have read through the thread. My mother was self funding in a residential home until six weeks ago when she had a haemorragic stroke. She is 95, and was previously fit although frail and walking with a frame. She is now unable to walk, or stand and has to be moved with a hoist. She has problems swallowing and has to have liquidised foods and thickened fluids. She is fed with a spoon and has lost weight whilst in hospital (although she has not been weighed while in hospital as the scales are broken on the ward). Although she can speak reasonably clearly she is very confused and has gone back in time about 80 years. She has had three falls in hospital as she has managed to work her way out of bed.
She has now been assessed for CHC and refused, as her needs are "social", rather than "nursing" needs.
Does this sound right? Is there any point in fighting?
We were told that if we appeal, she would be placed in a home of their choice. None of the homes mentioned are anywhere near where she is now; the one "with a bed" is over 40 minutes drive away.
Any advice, anyone?

jonnyfan

Shoula have also said she has vascular dementia and her skin is at risk as she score 19 on the scale I believe 20 is the threshold- surprise! She is doubly incontinent.

gingerfox

jonnyfan wrote: »

Hello. New to posting although I have read through the thread. My mother was self funding in a residential home until six weeks ago when she had a haemorragic stroke. She is 95, and was previously fit although frail and walking with a frame. She is now unable to walk, or stand and has to be moved with a hoist. She has problems swallowing and has to have liquidised foods and thickened fluids. She is fed with a spoon and has lost weight whilst in hospital (although she has not been weighed while in hospital as the scales are broken on the ward). Although she can speak reasonably clearly she is very confused and has gone back in time about 80 years. She has had three falls in hospital as she has managed to work her way out of bed.
She has now been assessed for CHC and refused, as her needs are "social", rather than "nursing" needs.
Does this sound right? Is there any point in fighting?
We were told that if we appeal, she would be placed in a home of their choice. None of the homes mentioned are anywhere near where she is now; the one "with a bed" is over 40 minutes drive away.
Any advice, anyone?

Were you at the meeting when this was decided? You can download the Decision Making Tool and go through the domains yourself to see how highly she scores. You can see then on which basis you can appeal - and yes, it's always worth appealing. It does sound as if you have a case, as her needs have changed since the stroke and she may well deteriorate. Read the domains very carefully - as some of her difficulties may fit into only one of the categories because of the wording. eg if she no long term memory she would score a 'severe'.

Why will she be moved? She doesn't necessarily need a nursing home if she is under CHC - as long as the home can satisfy the LA that they can meet her needs. If it is more expensive and it's your choice, then under CHC you would pay the 'top-up', but if she NEEDS that place, you wouldn't.

I'm afraid you may be a victim of the bullying tactics employed by some - don't let it put you off.

Read the information on the Age UK website and contact them for advice.

weanie

Advice please
My mother died on Christmas Eve in 2009. I had cared fro her for some years and hs ehad lived in a residential home for barely the last two of her life. Just prior to her death, we had an initial CHC assessment and this assessment flagged up the need for further actions.
In March of last year, a |full CHC funding review was held to see if Mum should have been eligible for funding during the last months of her life. The result was that funding was denied and I decided to seek to appeal.
I wrote a letter in August to this effect and received no reply. I approached one of the 'lead nurses' by email and she acknowledged that the letter had been received. No reply to date! Yesterday I wrote to ask if i might have a reply to my letter of early August and this moring a phone call from the original nurse saying she knew nothing of either letter but was ringing [coincidentally] to request my permission for documents from the home to be released and to see if I was still interested in an appeal.
Can any one give me soe advice and perhaps explain what has been boing on? did they expect me to disappear?
I feel quite shaken by this and am not sure what happens next.
Many thanks in anticipation

monkeyspanner

jonnyfan wrote: »

Hello. New to posting although I have read through the thread. My mother was self funding in a residential home until six weeks ago when she had a haemorragic stroke. She is 95, and was previously fit although frail and walking with a frame. She is now unable to walk, or stand and has to be moved with a hoist. She has problems swallowing and has to have liquidised foods and thickened fluids. She is fed with a spoon and has lost weight whilst in hospital (although she has not been weighed while in hospital as the scales are broken on the ward). Although she can speak reasonably clearly she is very confused and has gone back in time about 80 years. She has had three falls in hospital as she has managed to work her way out of bed.
She has now been assessed for CHC and refused, as her needs are "social", rather than "nursing" needs.
Does this sound right? Is there any point in fighting?
We were told that if we appeal, she would be placed in a home of their choice. None of the homes mentioned are anywhere near where she is now; the one "with a bed" is over 40 minutes drive away.
Any advice, anyone?

Sounds like your mums needs are far from social and the comment about an enforced move is a threat with the aim of putting you off making an appeal. Who issued this theat? Ask for it in letter form.

My advice would be to appeal and if there is any repitition of the threat say you will be making an official complaint to the SHA (strategic health authority). If you don't want to escalate to that extent any move to another care home should be preceeded by a risk assessment. This has to take into account your mums well being and part of that will be contact with her immediate family.

Good luck and don't let them grind you down.

monkeyspanner

weanie wrote: »

Advice please
My mother died on Christmas Eve in 2009. I had cared fro her for some years and hs ehad lived in a residential home for barely the last two of her life. Just prior to her death, we had an initial CHC assessment and this assessment flagged up the need for further actions.
In March of last year, a |full CHC funding review was held to see if Mum should have been eligible for funding during the last months of her life. The result was that funding was denied and I decided to seek to appeal.
I wrote a letter in August to this effect and received no reply. I approached one of the 'lead nurses' by email and she acknowledged that the letter had been received. No reply to date! Yesterday I wrote to ask if i might have a reply to my letter of early August and this moring a phone call from the original nurse saying she knew nothing of either letter but was ringing [coincidentally] to request my permission for documents from the home to be released and to see if I was still interested in an appeal.
Can any one give me soe advice and perhaps explain what has been boing on? did they expect me to disappear?
I feel quite shaken by this and am not sure what happens next.
Many thanks in anticipation

I think I would be asking for the SHA to review the PCTs handling of your mums case.

weanie

Having re-read my own post I note an error - Mum died in December '10 not '09. Does this alter the advice Monkeyspanner? Upon what basis could I criticise the handling of the case? lso i wonder if I could request that any documents given over to the PCT should also be orovided to myself from the home - it seems unbalanced otherwise. Do you thinkj I should approach a solicitor for legal advise? I want to make the best job I can of this as I feel that my mother has been disrespected by various parties here and her interests given little priority. thanks for the advice