Reclaim Care Home Costs for Free- New MSE guide

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  • monkeyspanner
    monkeyspanner Posts: 2,124 Forumite
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    Splatman wrote: »
    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 help

    I would have thought a close relative such as yourself could make that request or if you would like to make it more formal it could come from the executor of his estate(if he had one).
  • SocialCare
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    hellenjc wrote: »
    I am a Social Worker working with Older People and have attended many Multi-Disciplinary meetings to assess for Continuing Health Care funding. Obviously I can only speak from my own experience but during a full assessment Social Services ( who are often, but not always, already involved) should be asked to do a Social Care assessment - different from a nursing assessment which will often be done by a District Nurse if the person is at home or by a nurse in hospital. Following completion of assessments the meeting itself should include family members, other professionals involved and the individual themselves if they are able to attend.
    Each of the criteria will be gone through and everyone has the opportunity for input at this point and a "meeting " decision is taken.The meetings look at the nature, intensity, complexity or unpredictability of the individual’s needs when making a decision.
    If their condition is very unstable and unpredictable CHC is more likely to be approved.
    It is not unusual for there to be joint funding between Health and Social Care, where the person clearly has a health need but also social care needs and the decision is always reviewed regularly because as someone has already mentioned if the health need resolves then Continuing Health Care will often no longer fund.. However what I have also found is that if it is considered that the only reason the health need has lessened is because of the quality of the nursing care then they will often continue to fund if that argument can be made.
    Also if the individual is turned down but their condition substantially deteriorates then a new nursing assessment checklist can be asked for.
    I think you should definitely read the Decision Support Tool before any meetings and good practice would say this should be gone through with family members/carers before the meeting. I have certainly done this many times myself.. Don't be afraid to ask for this to be done.
    Hope this helps a bit

    Ps I'm not saying I agree with all this but just telling it as it is !

    The national framework is very clear about health and social care needs. If there is a primary health need it doesn't matter what social care needs there are; the PCT should pay 100%. Joint packages should only be agreed in certain situations.

    With kind Regards.
  • Allan87
    Allan87 Posts: 465 Forumite
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    My family have just appointed a solicitor to chase this up for us, the solicitors seem to think we have a "reasonable chance of success" based on the evidence provided so just have to see what happens - nothing ventured, nothing gained.
  • grandmabirch
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    My Grandma was cared for in her own home (she had severe Parkinsons). My Grandparents were told that because they had savings, they would have to pay for the entire costs themselves. Can these costs of a live in carer be reclaimed?
    Many thanks.
  • monkeyspanner
    monkeyspanner Posts: 2,124 Forumite
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    My Grandma was cared for in her own home (she had severe Parkinsons). My Grandparents were told that because they had savings, they would have to pay for the entire costs themselves. Can these costs of a live in carer be reclaimed?
    Many thanks.

    Yes any setting including own home. In fact the original legal case on which these payments are based involved home care.
  • monkeyspanner
    monkeyspanner Posts: 2,124 Forumite
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    Does anyone have a link to the one in Wales, I can't seem to find anything current. Thank you!

    Here are some links you may find useful, WAG (Welsh assembly Government) has adopted a similar system to England but as is their usual practice needed to spend almost 3 years making it slightly different.

    http://www.wales.nhs.uk/continuingnhshealthcare
    http://www.wales.nhs.uk/sitesplus/documents/867/F244_NHS_e_WEB.pdf
    http://www.cardiffandvaleuhb.wales.nhs.uk/opendoc/182911
    http://wales.gov.uk/docs/dhss/publications/100614chcframeworken.pdf
    http://wales.gov.uk/publications/accessinfo/drnewhomepage/dr2012/julsep/health/lg1995/?lang=en
    http://www.wales.nhs.uk/documents/continuingnhshealthcarecommunicationtoolv1.pdf
  • hopeful21
    hopeful21 Posts: 13 Forumite
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    I have been reading all this with great interest. I have recently submitted a claim to my PCT for a retrospective claim for my late husband.
    I won't know the outcome until the end of year but I would hate to think that anyone thinking of doing a claim can just write a letter or make a few phone calls.
    I have spent 4 months going through care plans, medical records,social service reports (all bringing back bad memories) reading long documents from the Dept of Health on criteria, eligibility etc. Lots of research was done so I fully understood the procedure. Documents have to be scrutinised so you don't miss a scape of evidence. Lots of internet search on the illness's he had and the drugs taken so I could strengthen my case.
    I submitted a 20 page report to the PCT....it was a tremendous amount of hard work. I would say this is not for the feint hearted but if you have the determination, go for it and be prepared to fight.
  • grandmabirch
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    Yes any setting including own home. In fact the original legal case on which these payments are based involved home care.


    Thank you very much and fingers crossed!
  • monkeyspanner
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    hopeful21 wrote: »
    I have been reading all this with great interest. I have recently submitted a claim to my PCT for a retrospective claim for my late husband.
    I won't know the outcome until the end of year but I would hate to think that anyone thinking of doing a claim can just write a letter or make a few phone calls.
    I have spent 4 months going through care plans, medical records,social service reports (all bringing back bad memories) reading long documents from the Dept of Health on criteria, eligibility etc. Lots of research was done so I fully understood the procedure. Documents have to be scrutinised so you don't miss a scape of evidence. Lots of internet search on the illness's he had and the drugs taken so I could strengthen my case.
    I submitted a 20 page report to the PCT....it was a tremendous amount of hard work. I would say this is not for the feint hearted but if you have the determination, go for it and be prepared to fight.

    Your approach which is presumeably based on experience of dealing with the NHS is typical of those going through the process.

    This is not like reclaiming PPI and cannot be approached in the same way. The NHS have not rolled over and capitulated like the banks

    We have to accept that very few applicants will find this an easy process and whilst some will succeed after a long proceess many will fail. Also, many will undertake the task with the backdrop of taking care of a relative during declining health or the actual loss of that relative.

    The process is confrontational because it is an all or nothing decision. This is an idiotic system because a persons needs cannot be 100% medical or !00% domestic. There will always be elements of both. However, it is the system both sides have to deal with until the government actually gets to grips with the issue of funding elderly care.

    I wish you Good Luck.
  • ajax1n
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    I appreciate that the original guide refers to England but does anyone know if a similar system operates in Scotland?
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