Reclaim Care Home Costs for Free- New MSE guide
Comments
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Brookebaloo wrote: »Hi,
This was my Nan's situation and my Dad had to be a lot of money for her care, including selling her house well below the value. It was 70K but because it wasn't selling he had to accept the lowest offer to satisfy the council, so sold it for 23K!!!! Still a sore point in our house.
Anyways is the deadline strictly 2004 onwards as my Nan died in 2003 after 10 years inside a care facility for her alzehimers - any help appreciated
Caroline xx
Hi. A report by the Health Service Ombudsman in 2003, prompted a major review of cases going back to 1996. In July 2007 the NHS chief executive wrote to PCTs explaining a desire to bring the review process to a close. He asked PCTs, using appropriate awareness-raising initiatives, to encourage local people who wanted to request a review of a case that involved care provided mainly before April 2004 to raise it with them
before November 2007. However, you can still ask the PCT to review such a case, indicating why you have not raised it before. The PCT has a duty to ensure that no one with a legitimate claim to a review misses out.
Don't worry about the legal jargon in the proposed reading of the Coughlan case. The case is helpful in that it sets the benchmark for the primary health need that MSE mention in the relted article.
Write to your local PCT and ask for a review of the case and just explain why you haven't asked before. Probably likely that the reason being you weren't aware of the potential eligibility for CHC funding.
Very best wishes.0 -
Hi just joined this forum. I'm rather confused and frightened by all of this. My Mother sadly had a severe stroke just over eight years ago. She was in hospital for a few weeks and then six weeks in a stroke rehab hospital in Wales. We then moved her to a nursing home near us in England. We had to sell her home in North Wales to help fund the fees. All this money and all her savings have now gone. She was initially in Barchester private home but following various thefts (of which the police were not interested) we moved her to a Bupa nursing home. She has been there over six years now and she is partially funded now.
Just how complicated and difficult is this claiming process? I do have POA. There is no way my Mother could have stayed in her own home. She is paralysed fully down one side. She has lost her left sided vision in both eyes. Her speech is not effected. However, certainly not out of choice would my Mother be in a nursing home. She was only a young 72 when she suffered this stroke and she is one of the youngest in the home. I am worried that 'rocking the boat' might upset the home and also effect the financial help we already get - could they ask us to move Mother? The home is far from perfect but to have move would be too upsetting for Mother.
Don't worry about how the home will react to CHC funding - most are happier for CHC funding than the local authority to be funding / part funding your mother's care because the PCT's funding limits are usually higher than local authorities. What I mean by that is when the local authority pay for someones care (which sounds to be your case) they will limit their funding - for instance they might pay a maximum of £470 for a nursing placement whilst the PCT might pay a maximum of £650.
If your mother's placement costs £600 as an example, the local authority will still only pay up to their limit and a third party (usually family) will need to top up the remainder.
That said, it sounds as though the local authority are already part-funding her placement so I would assume that they agree to the level of fees and the placement will remain.
The application process for CHC funding should not take more than 28 days from checklist to you being informed of the decision. Appeals can take considerable time depending upon the level of appeal.
Very Best Wishes.0 -
Hi, can anyone help with this question? my dad was assessed with dementia and could only leave Hospital to go to a residentail home that was dementia registered, this was arranged and he had around a year before he passed away. He had to pay for himself as he had savings, does this quailify for repayment? when I enquired for nuring care the home said he would not qualify so never did it, though he was receiving total care, feeding, incontinence, bathing etc. I am new to this and could not find the Post option so have used reply to thread
Hi. Unfortunately the home offered advice that they shouldn't have although I'm sure it was done with the best of intentions. You can ask your local primary care trust for a retrospective decision about whether your Dad was eligible for CHC funding. Phone the continuing healthcare department of your local PCT, explain the situation and ask to make a retrospective application for CHC funding.
A good idea is to search on the internet for "Coughlan Judgement". It explains a case which has set the benchmark for CHC funding. Compare the needs of your Dad against Pmela's (Coughlan). If they're simmilar, you have a chance of Success.
Very Best Wishes.0 -
I wish it was as simple as this is portrayed. If it was then we would not have had six years of problems over nursing home fees for a relative who initially suffered a series of strokes, and is now said (by social services) to have advanced dementia.
I have boxes and boxes and boxes of paperwork, hospital and nursing home records, copies of PCT assessments etc etc. but we have repeatedly been turned down for funding, although it was granted once, because her condition was unpredictable. We then spent four years in the appeal system being bounced about between the PCT and SHA while the PCT did its best to remove funding.
At that stage the PCT decided to close the appeal (they paid while it was in progress) so from summer 2011 my relative has been paying £3,300 a month and this particular nursing home has 13 months in the year!
I'm at a loss to know how to progress this further. If social services say that someone has advanced dementia, and the doctor also believes so, what can people do if they are refused funding on appeal? We have found the assessments are disgustingly underscored but unless the process is flawed you can't complain to the ombudsman because they don't investigate anything other than procedures.
Hardly anyone ever manages to get money back and refusing to pay is advocated by another website but is very bad advice, in my opinion.
Thanks
Hi. It sounds as though your relative was eligible for CHC funding and it was withdrawn upon review. A CHC review should be just that, a review of the person’s needs. If the needs haven’t changed then nor should the organisation with funding responsibility. At review, the assessors shouldn't complete a new decision support tool (DST) in isolation. Instead, they should review the original DST. However, the important fact is if the needs haven't changed then the PCT should continue funding. If this is in fact the case, phone the CHC department at the local PCT and ask for them to identify how their needs have decreased.
Very best Wishes.0 -
Brookebaloo wrote: »Hi -Many Thanks for your reply.... what does a 'statue of limitation' mean?? I want to tell my Dad about this reclaiming, but don't want to get his hopes up if we are outside of the deadline. As I mentioned earlier, its still a touchy subject the way the council and care trust bullied him for costs etc. One day she was in the local hospital for 2 weeks rest bite care, the next she was never allowed home again and into full time care.
Thanks xx
Statute of limitations is a time limit applied to different types of legal cases in which a case can be started. This differs in different types of litigation. Unfortunately I am not familiar with what limit would apply in this case. You may be able to get clarification from https://www.counselandcare.org.uk they run a free helpline regarding care home funding.0 -
Hi just joined this forum. I'm rather confused and frightened by all of this. My Mother sadly had a severe stroke just over eight years ago. She was in hospital for a few weeks and then six weeks in a stroke rehab hospital in Wales. We then moved her to a nursing home near us in England. We had to sell her home in North Wales to help fund the fees. All this money and all her savings have now gone. She was initially in Barchester private home but following various thefts (of which the police were not interested) we moved her to a Bupa nursing home. She has been there over six years now and she is partially funded now.
Just how complicated and difficult is this claiming process? I do have POA. There is no way my Mother could have stayed in her own home. She is paralysed fully down one side. She has lost her left sided vision in both eyes. Her speech is not effected. However, certainly not out of choice would my Mother be in a nursing home. She was only a young 72 when she suffered this stroke and she is one of the youngest in the home. I am worried that 'rocking the boat' might upset the home and also effect the financial help we already get - could they ask us to move Mother? The home is far from perfect but to have move would be too upsetting for Mother.
The care home my MIL was in was run by an ex-nursing sister who thought we had no chance of obtaining CHC funding. After our success she was converted and encouraged other residents to apply. I believe they were sucessful in another 3 cases which as it was a small care home was 25% of their residents.0 -
I wish it was as simple as this is portrayed. If it was then we would not have had six years of problems over nursing home fees for a relative who initially suffered a series of strokes, and is now said (by social services) to have advanced dementia.
I have boxes and boxes and boxes of paperwork, hospital and nursing home records, copies of PCT assessments etc etc. but we have repeatedly been turned down for funding, although it was granted once, because her condition was unpredictable. We then spent four years in the appeal system being bounced about between the PCT and SHA while the PCT did its best to remove funding.
At that stage the PCT decided to close the appeal (they paid while it was in progress) so from summer 2011 my relative has been paying £3,300 a month and this particular nursing home has 13 months in the year!
I'm at a loss to know how to progress this further. If social services say that someone has advanced dementia, and the doctor also believes so, what can people do if they are refused funding on appeal? We have found the assessments are disgustingly underscored but unless the process is flawed you can't complain to the ombudsman because they don't investigate anything other than procedures.
Hardly anyone ever manages to get money back and refusing to pay is advocated by another website but is very bad advice, in my opinion.
Thanks
Sorry to hear you have come to an impass with the PCT/SHA.
Although I applaud MSE for raising this as an issue I was concerned with their overly optomistic approach. They have presented this issue in typical Martin style but I would have emphasised this is for anyone an uphill fight against faceless NHS officials who are doing their job which is to minimise claims however legitimate they may be.
If you have got to the point that you do not know where to try next. I would seriously consider using one of the solicitors specialising in this area. Even if you have to sign away some of any award to get a no-win no-fee arrangement. Or if they say no you know you have done your best for your relative.
One of the areas where CHC funding is particularly bad is related to dementia which seems to be regarded by many NHS staff as a social effect of old age rather than a degenerative medical condition. The same PCTs will often award CHC funding if a patient has a stroke but someone with similar symtoms arising from dementia will be denied.
Good luck and please ask if you have specific queries.
I agree with you refusing payments simply damages your relationship with the care provider and is not a sensible course of action.0 -
Does anyone have a link to the one in Wales, I can't seem to find anything current. Thank you!0
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My Father died just over a year ago now after spending a couple of years in a nursing home with many different medical conditions. He was admitted to hospital as he had a couple of falls at home but then he was sent straight from hospital to the nursing home. he was unable to do anything for himself so we asked for a continuing care assessment to be carried out however when we went through this process it was quite obvious that the NHS trust were looking for any loophole or excuse not to grant it. Suffice to say, the claim was rejected and we had to pay for all of the care and accommodation from the sale of my fathers house.
As I mentioned, my father is sadly no longer with us but i was wondering if you could tell me who I should now make a claim to as we have already been refused the continuing care assistance.
Many thanks for your help0 -
my mother entered a privately paid for care home in 2002 and died there in 2010. She suffered from Dementia from the start which gradually got worse and she paid for care out her own pocket for the whole time. One month before she died she went into hospital and was formally assessed as qualifying for free care due to her condition.
I am wondering if I can make a claim as she had been in that qualifying condition for some time (maybe a year or more) prior to being assessed but she wasn't formally assessed as I didn't know you could be.
I had POA but this ceased on her death. Will I be able to claim any money back for her estate?
Any help appreciated.
It sounds like your Mum might have had a fast track award for end of life care. This should not stop you requesting a retrospective review if you believe her care was primarily due to medical needs for some time prior to the award.0
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