Reclaim Care Home Costs for Free- New MSE guide

Former_MSE_Dan · 28 August 2012 at 9:37PM

Hi all,

We've put together the first incarnation of a guide to reclaiming wrongly paid care home costs. Since 2004, the NHS should have paid for all care where the 'primary need' was a health need.

The DEADLINE for these reclaims is 30 September 2012 - so we have put together a guide to help people claim by themselves for free. Please read and let us know any questions, feedback, potential errors and hopefully success stories. Thanks!

Reclaim Care Home Costs for Free

Also see this thread detailing one MoneySaver's experiences in reclaiming care costs

Continuous Healthcare Reclaiming

arhodes_2 · 29 August 2012 at 12:03AM

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.

stargrazer10 · 29 August 2012 at 6:26AM

Hi
My father had parkinsons and dementia and paid in full his nursing home fees until he died in 2005. I recently saw an advert on tv re the reclaiming of nursing home fees. I contacted the company and they were very helpful and they sent me a claim pack. The claim pack had a tick list of all the health problems that my father may have had. I realised that I could claim the possible refund myself, and used the tick sheet to help compose a letter to the primary care trust. I also phoned the relevent pct and spoke to a nurse ( they seem to have allocated a specialist nurse to deal with such claims) After discussing my fathers' case with her she was not at all discouraging in the possibility of a claim. I suggest you contact the pct concerned, and if you need help composing a letter ask for an info pack from one of the many companies dealing with refund claims - you dont have to use them, and their info packs are very useful!! ( I have had only one reminder email from the company since getting their pack in June)

arhodes_2 · 29 August 2012 at 7:27AM

Stargazer10,

Thanks for the reply. My only problem is that my mum was in a rest home not a nursing home and therefore I'm not clear if she would have a case. It was only at the end of her illness that she deteriorated to the point where she was assessed as needing nursing care and I may be wrong but I thought that until she needed nursing care she had to pay. When exactly she crossed that line would be hard to say as she is no longer alive.
I will investigate though. thanks for the help.

Spent_Up · 29 August 2012 at 8:20AM

Hello

My Mum has been in a care home for 8 years. She suffers from Alzheimers and is also incontinent. In April 2011 she was hospitalised and had a pacemaker fitted. She receives no financial help other than receipt of Attendance allowance. She has been assessed but we were told that she would only receive the difference between care home fees and nursing home fees and her attendance allowance would be stopped. Also that if we applied for the nursing home fees then the authority would require her to be placed in a nursing home. We do not want her to be moved, she is happy where she is, the staff know her and understand her moods and is feels this is her home. Can we claim or will this result in her being moved? We have had to sell her home to fund her care.

auntiepam · 29 August 2012 at 8:40AM

I guess this is a partial success story, I was successful in getting costs paid under continuing health care for my mother when she went into a dementia care home due to needing terminal care because of brain cancer. However, my father went into the same home at the same time as he has alzheimers, ( my mother was his carer) and currently I am not going to attempt to reclaim as I know, despite being told by a GP that he must not be left on his own, he is no where near being as bad as he needs to be to qualify.
I think my mother was fast tracked as she was terminally ill, and it all happened quite fast so I did not have time to familiarise myself with all the criteria, but the meeting where the decision was made was horrid - I disagree with martins article, I think you do need to read the decision support tool - just to see how poorly someone needs to be - otherwise you could do a lot of work when the criteria might not be meet - they are looking at the nature,
intensity, complexity or unpredictability of the individual’s needs. I found myself having to argue each point that she was worse than than the health professionals said she was -because that is what I thought and in the knowledge that if she was not deemed that bad, ie did not score highly enough, she would meet the criteria. This was all happening as the hospital wanted her out of the bed because they were not treating her and so she was a blocker.
At some point I may think again about my father - but it was stressful especially as you are having to do it for someone who you care about, so will not do it until I am pretty sure of succeeding.

monkeyspanner · 29 August 2012 at 8:43AM

Spent_Up wrote: »

Hello

My Mum has been in a care home for 8 years. She suffers from Alzheimers and is also incontinent. In April 2011 she was hospitalised and had a pacemaker fitted. She receives no financial help other than receipt of Attendance allowance. She has been assessed but we were told that she would only receive the difference between care home fees and nursing home fees and her attendance allowance would be stopped. Also that if we applied for the nursing home fees then the authority would require her to be placed in a nursing home. We do not want her to be moved, she is happy where she is, the staff know her and understand her moods and is feels this is her home. Can we claim or will this result in her being moved? We have had to sell her home to fund her care.

Continuing healthcare funding is available in any setting including own home. I am not sure about the nursing supplement but the threat to move her sounds like a way to make you back off in your claim.

monkeyspanner · 29 August 2012 at 8:50AM

auntiepam wrote: »

I guess this is a partial success story, I was successful in getting costs paid under continuing health care for my mother when she went into a dementia care home due to needing terminal care because of brain cancer. However, my father went into the same home at the same time as he has alzheimers, ( my mother was his carer) and currently I am not going to attempt to reclaim as I know, despite being told by a GP that he must not be left on his own, he is no where near being as bad as he needs to be to qualify.
I think my mother was fast tracked as she was terminally ill, and it all happened quite fast so I did not have time to familiarise myself with all the criteria, but the meeting where the decision was made was horrid - I disagree with martins article, I think you do need to read the decision support tool - just to see how poorly someone needs to be - otherwise you could do a lot of work when the criteria might not be meet - they are looking at the nature,
intensity, complexity or unpredictability of the individual’s needs. I found myself having to argue each point that she was worse than than the health professionals said she was -because that is what I thought and in the knowledge that if she was not deemed that bad, ie did not score highly enough, she would meet the criteria. This was all happening as the hospital wanted her out of the bed because they were not treating her and so she was a blocker.
At some point I may think again about my father - but it was stressful especially as you are having to do it for someone who you care about, so will not do it until I am pretty sure of succeeding.

I agree with this completely. Read the DST and be prepared to argue each criteria or the assessment will downplay the seriousness of your relatives condition. Also read the National Framework document to see if the PCT is following proceedure. You will have to fight each step of the process and it is not a simple process even down to having to argue the meaning of individual words on the DST.

For more personal experience see this MSE thread which has been running for some years. http://forums.moneysavingexpert.com/showthread.php?t=800521&highlight=chc

auntiepam · 29 August 2012 at 8:53AM

Spent_Up wrote: »

Hello

My Mum has been in a care home for 8 years. She suffers from Alzheimers and is also incontinent. In April 2011 she was hospitalised and had a pacemaker fitted. She receives no financial help other than receipt of Attendance allowance. She has been assessed but we were told that she would only receive the difference between care home fees and nursing home fees and her attendance allowance would be stopped. Also that if we applied for the nursing home fees then the authority would require her to be placed in a nursing home. We do not want her to be moved, she is happy where she is, the staff know her and understand her moods and is feels this is her home. Can we claim or will this result in her being moved? We have had to sell her home to fund her care.

I would suggest you go through this check-list first http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103328.pdf. to see if she meets the requirements for a full assessment.

DaisyHawkins · 29 August 2012 at 9:41AM

monkeyspanner wrote: »

I agree with this completely. Read the DST and be prepared to argue each criteria or the assessment will downplay the seriousness of your relatives condition. Also read the National Framework document to see if the PCT is following proceedure. You will have to fight each step of the process and it is not a simple process even down to having to argue the meaning of individual words on the DST.

For more personal experience see this MSE thread which has been running for some years.

Thanks for this link which I will read with interest. Our experience is one of failure.
My mother-in-law has MS. She is incontinent, immobile, bedbound and nearly blind. Her hands are badly deformed to the extent that she can only feed herself with finger food and needs to be assisted with her meals. She frequently suffers from urinary tract infections which make her delirious and at worst comatose. She has been paying for her own care at home for a number of years and was admitted to hospital when her bedsores became infected. On discharge she went into a nursing home andher care was being paid for by continuing health care. This year she was reassessed and the funding has been terminated because her bedsores have cleared up and there is no longer a medical need for her care. We appealed but to no avail. She is currently paying for her care which approx. £800/week and we are in the process of selling her house.

in_need_of_help_2 · 29 August 2012 at 10:19AM

I saw the link today on the weekly email, well done to all of you who have put this together and to those who have been sucessfull.
My mum has had a bad stroke and after the main hospital was discharged to a community hospital where she could stay for only 6 weeks, we manage 7 weeks and 3days! She was given the assessemnt for care by the staff nurse, they went over this with me but i do not have a copy of it, but it was to assist with transfering her to an interim care home, to prove she needed assistance. She was transferred, and now needs to undergo a Financial Assmt which by all accounts will mean she is to pay for her care. This interim care home is inorder for use to convert our gargage to accomodation and wet room for mum to move in with us as they have said she cannot live independently, perhaps i can claim back the costs for this too....
However after reading todays link, i believe she has a need for continuing health care something the NHS keep close so we the general public do not know about it!!
So any ideas on how i should tackle this, do i argue now with the nhs, pct or ......
Thanks in advance for your help.
p.s. will have power of att in the next 2 weeks.

Reclaim Care Home Costs for Free- New MSE guide

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