Care / nursing home fees

dreamon100

Hi,
My 88year old uncle has been in a care home (alzheimers) for several months now. His health has deteriorated and he is at present in hospital. It has been proposed that he will have to go to a nursing home.

My aunt has been paying the care home fees, someone has told her that she will not be liable to pay the nursing home fees. Is this correct?

regards Dreamon100

minimadtrix

Yet again, as with so many things in life, it all comes down to how much they have. My best advice is that you ring your local social services. They maybe able to give you better advice as to how else it could be funded.

purple12

I presume if she has been paying residential fees, she would be liable at the same level for nursing fees

EXCEPT

If your uncle needs what is classed as 'Continuing Care' which can be provided in a nursing home. Continuing care is paid by the NHS and is therefore free. It has very tight criteria though and is used rarely even in nursing home placements. There has to be some pretty major medical issues going on - for example, (and I'm just thinking of some of the people I've worked with because this is my job.. ) alzheimers but where there are major behavioural issues like violence, aggression. Trachotemy care. Very high level nursing support, basically.
Nursing care will though have a component paid by the NHS regardless but this won't make up the difference in cost between residential homes and nursing homes.
The key is the Continuing Care criteria. It might be worth having a search on google for that for more detailed information.

finlaybaby

The criteria for Continuing Care is complex, intense, unpredictable healthcare needs. I'm a Clinical Review Sister and am happy to give advice if needed.

Behaviour carries a priority and if your uncle met the described need, he would automatically be referred for full consideration of Continuing Healthcare.

monkeyspanner

finlaybaby wrote: »

The criteria for Continuing Care is complex, intense, unpredictable healthcare needs. I'm a Clinical Review Sister and am happy to give advice if needed.

Behaviour carries a priority and if your uncle met the described need, he would automatically be referred for full consideration of Continuing Healthcare.

Unfortunately not all healthcare trusts follow the guidelines. It may be up to you as the family to ensure that a proper assessment is done prior to discharge from hospital. Don't let the hospital fob you off, they should do an initial CHC checklist assessment and inform you of the result. If they say your relative is not eligable for a full continuing healthcare assessment then insist on a full assessment. Do not allow them to discharge your relative into a care home/nursing home setting at your expense during a convalescent period prior to a full assessment, it is the health authorities responsibility to fund this recovery period.

The rules for assessment changed in Oct 2007 to a standard nationwide Decision support tool. This assesses the patient in a number of key areas. The guidelines say that if an assessor is in doubt over any area then they should take the worst case, but often they do the opposite and are over optomistic in their assessment. One of the key factors is that if a health need is well managed it is still a need and should be assessed as such. So for instance if the patient had been suffering from behavioural problems due to dementia but this is under control by the use of drugs this need is well managed but still should be assessed as a need. Essentially you need to demonstrate that the patients needs for care are primarily health and that domestic needs are ancilliary to the health needs.

Although the Decision support tool was introduced in October with the aim of eliminating postcode lottery in the allocation of Continuing health care funding there is no consistency across authorities as to how to make the decision. For instance how many severe/high/medium ratings on the DST and in what combination does the patient need to be successful.

My advice would be to inform yourself as to the assessment process, ensure you are involved at each stage (not all PCT's will volunteer this), don't take no for an answer and appeal any negative decision, ask for a decision panel made up of independant individuals who have no employment connection with the health authority or associated social services department, and make sure you are invited to the panel meeting, we have found that you may be given little notice of assessments and/or meetings and will be expected to drop everything to suit their convenience. If necessary you can appeal the panel's decision to the SHA (strategic health authority) and if that fails go for a judicial review. Be prepared for the long haul you will probably be resisted at every stage. We are just finally getting somewhere in this process after 8 months of letter writing, 2 assessments, a retrospective review, 2 panel meetings with another panel meeting pending.

If you would like pointers to where you can find information please PM me. Good Luck.

As regards finance if your uncle is not successful in getting CHc funding then he will be liable for his own care fees if he has more than around £22,000 in assets including property. Under that limit the social services have to assist in funding but the patient is still expected to contibute the majority of their income/benefits except a derisory weekly allowance of around £20. I think your aunt should take specialised advice on funding because the teatment of joint and separate assets for a married couple are complicated and the treatment of the value of the home will differ dependant on how the home is owned (joint ownership/tenants in common). A good source of advice in this area is www.counselandcare.org.uk .
If it turns out that your uncle is liable for the cost of his care it may be worth looking at a care anuity where a capital sum is exchanged for a guaranteed income for life. Obviouusly the downside of this is that the capital sum is spent irrespective of how long the income is needed. This is a specialist area and one organisation that can give advice is https://www.hsbcpensions.co.uk/nhfa/pages/index.asp there have been a number of threads on this subject in the past with one contributer being edinvestor

If your uncle requires a nursing home then he may be entitled to a weekly nursing allowance of £101(may have risen in April) this used to be one of three funding bands but was standardised as one band in October.

Your Uncle should be eligable for attendance allowance which is not means tested and is payable at one of two levels dependant on the level of care needs. The higher level is £64.50/week (may have risen in April). This is not payable after the first 4weeks of a hospital stay or CHC provision.

Dependant on circumstances your uncle may also be eligable for pension credit.

dreamon100

Hi, I will pass this info on to my cousins, hopefully they can make sense of the system.

monkeyspanner

Info from another thread. If the patient's spouse over age 60 is living in the home the value of that property is not taken into account when assessing the self funding of care home fees.

monkeyspanner

finlaybaby wrote: »

The criteria for Continuing Care is complex, intense, unpredictable healthcare needs. I'm a Clinical Review Sister and am happy to give advice if needed.

Behaviour carries a priority and if your uncle met the described need, he would automatically be referred for full consideration of Continuing Healthcare.

Partial Success with Continuing Healthcare Funding
We have been informed that my MIL has been awarded Nation Health CHc funding from 7 months after being discharged from hospital.

The CHc Panel decided there was insufficient evidence to award for the first seven months of MIL's residence in a care home. The primary reasons for the lack of evidence was.

-3 months delay to an initial assessment due to being passed around the system and discharge priceedures not being followed.
-We appealled the first assessment as it was inaccurate and did not reflect MIL's medical condition, and a reassessment did not take place for a further 3 months.
-A retrospective review of MIL's medical status for the first 3 months after discharge was carried out but not submitted to the CHc panel.
-Our submissions to the assessment process were either ignored or not taken into account.

We will now have to appeal the decision re the first 7 months based on the fact that proceedure has not been followed in a timely and open manner. But at least we have an award ongoing until the next CHc reassessment.

Finlaybaby have you any advice?

finlaybaby

Congratulations on being awarded CHC funding, albeit not from date of discharge.

I would ask the trust to review her healthcare needs retrospectively and to consider eligibility for NHS national framework continuing healthcare funding under the strategic health authority's criteria. This will involve gathering all health and social care records so that an informed decision can be made.

Information was missing from a recent case that I worked on and the family were persistent and did not accept the date for backpayments. This case was then sent to the SHA and the family received a cheque for £85000!!! Not bad for the price of a stamp.

Hope this helps and good luck.