Continuing Health Care - Preparing to fight PCT's decision

Jays

Does the relative living in the house have to be over 60?

My brother who is in his 40s still lives with my mum, and I do wonder what would happen if she needs to go into some sort of care. He could not afford to live anyway else.

Thanks for your answers.

monkeyspanner

The only other circumstances for disregarding the value of the house are if there is a dependant child under 16 or if there is a close relative who is incapacitated (in receipt of disability allowance).

At the discretion of the Council the house value can be disregarded if a relative gave up their own property to move into the house to care for the relative who is now moving to a care home.

If a younger relative is still living in the house the council may at their discretion allow the relative to continue living there and place a financial charge over the value of the house. Interest cannot be levied on the amount set against the house until the death of the owner.

If your Mum has no immediate prospect of needing to move to a care home then it may be worth her considering gifting a part share of the house to your brother. She would need to take advice from a solicitor as there are some legal issues about the advantages of using Joint ownership or tenants in common. This would make your brothers right to live in the house stronger. The council may take the view that your mother was deliberately depriving herself of assets if she needed to move to a care home in the next few years. Technically the council can go back as far as they like in your mum's financial affairs looking for deprivation of assets but would have difficulty in proving that this was the motivation if some time had passed prior to needing a care home. The other aspect to this is that if your brother contributes financially to the purchase or upkeep of the house he could argue that your mum is not the beneficial owner of the whole house but again she would need to consult a solicitor.

I hope this helps.

malid

allthatmularky wrote: »

Just come across this thread - when looking for details of power of attorney.

A bit of background - I have an uncle who has advanced Parkinson's and is currently in hospital but has been assessed as needing nursing care in a nursing home.
He was previously looked after by his sister - with various helpers from the local authority - his sister is now too unwell to look after him, and we have been advised by the nursing staff/social workers that he now requires 24 hr nursing help.

Just starting to look into homes/finances etc and all a little confusing - the social worker tells me that his DLA would no longer be available and since he has above the £22250 in savings he would be expected to fund his care.

I presume because of his medical needs the PCT would fund the proportion deemed necessary for his nursing needs.

Any information on the CHC (if he might be eligible for any funding) and the power of attorney procedures would be most help - I've just 'skimmed' this thread as yet - will read it in more detail when I get a chance.

Hi Allthatmularky

The key point in your message is:
'he now requires 24 hour nursing help'. I can't stress enough how important it is to get the CHc assessment before he is discharged from hospital to a nursing home. If this assessment has taken place, as your post seems to suggest, ask exactly what the outcome was and if he does not meet the CHc criteria, ask why. The hospital staff will always want to have any discussion with the next of kin; is this his sister? Also, it is important to understand that if your uncle is capable, all discussions should be with him and if required, a representative(s) of his choice which could be you and his sister.

My uncle had advance Parkinson's which brought on Parkinson's Dementia. He was not capable of any discussion let alone making decisions. Whilst my aunt was his next of kin, I was acting on their behalf (albeit without the necessary 'official' in instrument of the POA as registration had not come through). You will have to push hard possibly but do not give up and try to remain pleasant and courteous but assertive even though you may be frustrated and angry.

On the funding issue, the fact that your uncle has more than £22,000 is wholly irrelevant when looking at the issue of NHS nursing care and entitlement. I was fortunate not to have the self funding issue to deal with but I think it would be useful to keep these issues separate:

1. Entitlement to CHc funding
2. Payment of fees if self funding (with a proportion of NHS care funding)
3. POA - if your uncle is still capable you need to do this a.s.a.p. You can down load the necessary forms and follow the instructions (there is one form for dealing with health and care and another for financial affairs. It costs £150 each to register these when you think it is relevant - again I assume a.s.a.p. - and registration from my experience will take 8 weeks). As long as you read them and fill it in carefully, there is no need to have a solicitor do it for you.

There is extremely valuable information in this thread and the links provided by Monkeyspanner in particular were invaluable to me. The Law Society's point about access to nursing care as a general rule as opposed to entitlement to CHc is very interesting and useful.

Hope this helps and good luck!

monkeyspanner

malid wrote: »

Hi Allthatmularky

On the funding issue, the fact that your uncle has more than £22,000 is wholly irrelevant when looking at the issue of NHS nursing care and entitlement. I was fortunate not to have the self funding issue to deal with but I think it would be useful to keep these issues separate:.

Hope this helps and good luck!

This is absolutely true but unfortunately it does seem to affect the way that the gatekeepers of the Continuing Healthcare funding system view the patient and assessment.

The worst offenders from our experience were social services who could not disengage fast enough when they found out my MIL had some savings. This ranged from complete lack of assistance in finding a care home, through no advice on the care home funding system, to being downright obstructive when we eventually stumbled across the possibility of CHC funding.

But even a lead nurse assessor performing a CHC assessment stated we had damaged our case by finding my MIL a care home. It is difficult to do otherwise when the hospital pressuring for an early discharge and you have no knowledge of the funding options other than 'if you have savings over £21500 - you pay'. (£21500 was the savings limit for 2007-8)

My advice would be if any of these bodies asks about savings, do not volunteer that you believe your relative will be self funding, particularly if you have not been informed of the system. I would now turn the question around and ask about the options for funding.

greenflamingo_2

From our own experience in April my FIL had a CHC done on him whilst in hospital - we were not informed and received no paperwork or anything about it at all. Pressure was put on us by the hospital social worker to get him a place in a nursing home so that the bed could be freed up. My FIL will keep on telling people that he fine and needs no assistance despite now being totally immobile and bed bound. He looks severely malnourished and wasted and his ribs are very apparent.Whilst he was in hospital he was asked to bring in his own walking frame, which was by the side of his bed. During the month he was in there he was unable to use it but was assessed as having some mobility i..e using a walking frame!

We have now instructed a specialist solicitor who offers a capped rate so we are sending all the paperwork we have managed to obtain off to him. His nursing specialist has assessed my FIL as having nursing needs.

malid

Hi Greenflamingo

It is time-consuming and frustrating but I was determined to get as much understanding as possible of the CHc process and related matters. Once you do this, in my view you do not need a solicitor but obviously this is a matter of personal choice.

Although you have chosen to use a solicitor, I would certainly recommend that you familiarise yourself with the Decision Support Tool which is used to assess the patient. You should ask for details of the assessment that took place in August and request a further assessment and ask to participate in the review. Make sure you know what medication your FIL is on and familiarise yourself with what they are for. (I guess these are all things what the solicitor will now do on your behalf).

I see two issues here:

1. Original discharge from hospital and CHc assessment - were protocols followed?
2. Ongoing PTC assessment for CHc and challenges

I would query:

Subsequently the PCT board duly overruled all the recommendations from the framework tool.

At the risk of repetition, there is a wealth of information and invaluable links on pages 1 and 2 of this thread.

Please make sure that your solicitor understands and is competent in this area. I raise this as one post in this thread reports POA forms being incorrectly completed by solicitors thus leading to delays.

Monkeyspanner, you are spot on about not disclosing any financial information. Excellent advice for everyone reading this thread.

Best of luck.

greenflamingo_2

Well here we go again!
Now received Form F1 "Personal Financial Statement - Application for Assistance with fees". As we are appealling refusal of CHC we ignored the previous one but now have two weeks in which to response and fill in the full details of my FIL's income, savings, house etc. At the moment my father has been in the nursing home since mid April - he didnt pay anything for 12 weeks but after that has been paying invoices sent to us for £400 per month (I guess this is being subsidised by the Adult Care Services). We have been told in the covering letter that if we do not reply within 14 days he will have to pay the full fees (around £500 per week !). We havent applied for Attendance Allowance as we are awaiting the POA from his solicitor and there is a 6 month waiting limit anyway.

Should we write back toAdult Care Services to say there is an appeal underway for CHC or should we complete the form? He only has around £10K in savings so I guess the longer the PCT drag their feet the more likely his savings are to be eaten away. We were hoping to use this money to carry out major improvements on his house (unsaleable as in a very poor condition) so that at least he might get £600 per month in rental towards fees whilst awaiting the outcome of the appeal. If we take out the money would this be viewed as deprivation of income by the authorities? A bit of a chicken and egg situation! Advice desperately needed.

monkeyspanner

I would fill out the form. When my MIL was suceessful with a retrospective CHC award we recovered all money paid by MIL to the care home plus expenses minus contributions paid by the Social Services and attendance allowance. As I mentioned before you will be expected to contribute the bulk of your relatives pension/income towards the 12 week disregard period less a weekly pocket money allowance of around £21. You also need to make it clear that your relative only has limited savings apart from the property and that you wish consideration be made to the council making provision for defered payments. If you are successful the council will continue to pay the care home but place a financial charge over the property. Interest is not charged on defered payments whilst your relative is alive. In the meantime I would make an attendance allowance claim.

For more advice on paying for care homes see
www.counselandcare.org.uk

malid

greenflamingo wrote: »

Well here we go again!
We havent applied for Attendance Allowance as we are awaiting the POA from his solicitor and there is a 6 month waiting limit anyway.

Not sure what 6 month waiting limit you are referring to. I have recently successfully applied for AA for a friend's mother. The form was received by DWP on 22nd Sept; acknowledgement sent by DWP on 30th Sept and confirmation of lower amount of AA payment received 8th October. This has been backdated to 22nd September - date of receipt of form. As your FIL is currently self funding by the looks of it, you need to apply for the AA as soon as possible.

From my experience, registration of POA takes 8 weeks.

JuneBow

Greenflamingo, you should certainly apply for attandance allowance now.
To be eligable you FIL should have needed care for 6 months or more. Registration of POA should not take 6 months, so I imagine that is what the solicitor is referring to.
The award can normally be backdated for 3 months. However, there are certain circumstances which will allow you to have to award backdated more than 3 months. One of them can be inability to apply, because you are waiting registration of POA documents. Another, is misdirection. (ie you have been told by DSS/DWP you cannot have it)
However, lack of knowledge about eligibility is NOT classed as "good cause".
You will be aware, I think another poster has mentioned this, that AA will have to be repaid if you later become eligible for NHS continuing care. I am sure that this would not bother you as you would be better off anyway.
Essential improvements to the home would not be classed as deprivation of assets.

margaretclare wrote: »

I shall insist that DH applies for AA once this crisis situation for him in hospital is over, because he is going to have a stiff left leg, no knee joint, and therefore will need help with e.g. dressing. Also he would certainly have been dead last Monday night if I hadn't been here because he was slipping into a hyperglycaemic coma, so the criteria about 'needing someone there during the night' will be fulfilled. This infection came absolutely out of nowhere and there is no guarantee that it won't come back again, so all the criteria will be fulfilled. Also we may even need to replace furniture, chairs that he can get in and out of more easily with a stiff leg, so any extra money is always welcome.

These conditions do not in themselves make anyone eligible for attendance allowance. Attendance allowance is for those that need help for a substantial part of the day (usually about 5 hours per day)
Diabetes in itself, is not sufficient to be awarded at the 24 hour rate. To be awarded at the 24 hour rate, you need to have an severely unpredicable condition that would require someonw to be AWAKE for a substantial part of the night. There is sufficient case law within the archives to show that diabetes is not one of these conditions. There are other features of diabetes which would however, make an inidvidual eligable for the benefit, particularly how an individual can come with these features. For example one person could be very able, and intelligent, and would be able to cope, and another not so able.

I am sure that you would find the money useful, but to legally claim this benefit, you would need to demonstrate something other than that which you have outlined.
If you are finding things so tight, then have you tried Pension Credit?