Reclaim Care Home Costs for Free- New MSE guide
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Hi, before embarking on a claim is it worth doing your homework to ensure that you have a case. It can be a long and frustrating process and you need to be realistic which means knowing the criteria. Look at a Decision Support Tool, look at the domains and see where your relative may score on the level of need - the more Moderate/High/Severe/Priority they have the more likely they are to meet. It is not disease related and every case will be assessed on its own merits. You need to look at the nature of the need and show that it was intense, complex and unpredictable. Look at the Assessed Level of Needs page and mark where you think your relative may score. Be armed with the facts, the PCT's are strapped for cash and will not fund unless there is a strong case. If it is a current assessment you need to be involved and be aware that funding can be withdrawn on review. You need to make sure that care plans are updated, that care needs are documented as with all cases it is evidence that will prove it. You may be asked for input so make sure you keep a diary so you are sure of your facts. If you are self funding you need to be especially vigilent with regard to CHC, you will probably be paying more for your care than either Social Services or CHC will fund and this may have financial implications for care providers. You may be asked to top up the fees as more PCTs set contract prices for beds. Retrospective cases for those now deceased can take years to come to panel (am waiting for a case which was started over 2 years ago!). You do not want it to go to appeal as this will take even more time so make sure you have a robust case first time around as the NHS is going through a huge change, cutting staff and the PCT's are inundated with cases - both current and retrospective. They will be working on many cases and are under pressure to move them on, you will only be working on one so spend time on it, get the evidence and if you are sure of your case, do not take no for an answer!0
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Hi, I am unsure whther to attempt to reclaim fees. My mother was funded by the NHS for £101 a month for most of her 3 year stay at a nursing home, for the last 1 to 2 months of her life she was assessed and fully funded, by this time she was seriously ill. She was discharged straight from hospital to the home (she was at home prior to this) as she had a leg amputated. She was in a wheelchair, doubley incontinent had dementia and was on several medications including warfarin. I find the thought of trying to make a claim quite daunting and wasn't sure if the fact that she had some funding and then full funding later would mean I wouldn't stand a chance. My local primary care trust is apparently very strict on funding and I was told she would keep being assessed every 3 months and could lose the funding if she improved at all. She passed away last year. Thanks0
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My situation is similar to 'hedgie' insofar as my mother receives a nominal amount of funding from her PCT of £100 pm but her nursing home fees are £2,700 pm on top of this. She has been in a nursing home since 1998 so obviously the costs have been high (nearly £300k to date!) - I am unsure, as she already receives a 'contribution' from her PCT if she is entitled to make a claim??? Thanks0
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my grandfather was diagnosed with dementia in 2006 [he started to go walkabout on his own and didnt know how to get home etc]
he was put in a "hospital" for a short while, the doctor and social worker assessed[sp?]him and said that there was noway he was allowed to go home so he was put into a residential nursing home, at no time was pct mentioned to us, the local council took his pension weekly to pay for the home [we got an invoice once a month saying his pension paid his home fees].....
he was left with nothing each week so we had to pay for everyday items for him [hair cuts ,soap, razors etc]..he died from vascular dementia in 2010..
we put in a claim and we have now been told that his claim was rejected!!!!
He matched the criteria and everything, for pct paying for his care home fees, but it was still rejected!!!0 -
Hi, I am unsure whther to attempt to reclaim fees. My mother was funded by the NHS for £101 a month for most of her 3 year stay at a nursing home, for the last 1 to 2 months of her life she was assessed and fully funded, by this time she was seriously ill. She was discharged straight from hospital to the home (she was at home prior to this) as she had a leg amputated. She was in a wheelchair, doubley incontinent had dementia and was on several medications including warfarin. I find the thought of trying to make a claim quite daunting and wasn't sure if the fact that she had some funding and then full funding later would mean I wouldn't stand a chance. My local primary care trust is apparently very strict on funding and I was told she would keep being assessed every 3 months and could lose the funding if she improved at all. She passed away last year. ThanksMy situation is similar to 'hedgie' insofar as my mother receives a nominal amount of funding from her PCT of £100 pm but her nursing home fees are £2,700 pm on top of this. She has been in a nursing home since 1998 so obviously the costs have been high (nearly £300k to date!) - I am unsure, as she already receives a 'contribution' from her PCT if she is entitled to make a claim??? Thanks
Similar answer for both of you.
The contribution of £100/£101 is probably a nursing supplement. If that is the case the supplement is the fall back position if CHC is not given. Receipt of the nursing supplement does not exclude a CHC assessment.
Hedgie As your mother had been in a care home for three years a sucessful retrospective claim would depend largely on the evidence you could gather regarding her medical condition during the 3 years. Depending on the extent of her contact with medical staff the day to day evidence would be mostly from the care home. So it would depend on how good their record keeping was. If I have calculated correctly she would have been discharged from hospital to the care home sometime in 2008. If this is the case it would have been covered by the new CHC system introduced in 2007. As a minimum, the discharge team should have carried out an initial CHC checklist and provided your mother or her carers with their findings. Perhaps your first question of the PCT should be was this carried and what were the results. If it wasn't carried out then they failed to follow proceedure. If it was carried out and they did not give the family the results this was bad practice and they failed to give you the opportunity to challenge the results. Both would in my view be grounds for asking for a retrospective review
111KAB As your mother has been in a nursing home since 1998 she may never have had a CHC assessment but my comments above to 111Kab also apply.0 -
my grandfather was diagnosed with dementia in 2006 [he started to go walkabout on his own and didnt know how to get home etc]
he was put in a "hospital" for a short while, the doctor and social worker assessed[sp?]him and said that there was noway he was allowed to go home so he was put into a residential nursing home, at no time was pct mentioned to us, the local council took his pension weekly to pay for the home [we got an invoice once a month saying his pension paid his home fees].....
he was left with nothing each week so we had to pay for everyday items for him [hair cuts ,soap, razors etc]..he died from vascular dementia in 2010..
we put in a claim and we have now been told that his claim was rejected!!!!
He matched the criteria and everything, for pct paying for his care home fees, but it was still rejected!!!
There are a number of issues here.
In 2006 CHC funding was covered by individual PCT rules. It does not surprise me that the PCT and CHC funding was not mentioned to you as there was a practice at the time of not bringing this up with patients and families.
You mention that you Grandfathers pension was taken so I assume the council assessed him as liable to contribute towards his fees. Under this arrangement a weekly allowance (at present this is about £20) should have been disregarded from the assessment and left for personal expenses. I have heard of cases where this has not been done and families have had to insist. If this was not done you could go back to the council and ask for the assessments to be reviewed.
In terms of the CHC review how far did you get with the claim. Did you lodge an objection to their decision? Did you get as far as an IRP (independant review panel)?0 -
monkeyspanner wrote: »There are a number of issues here.
In terms of the CHC review how far did you get with the claim. Did you lodge an objection to their decision? Did you get as far as an IRP (independant review panel)?
we sent off the questionaire with carehomeclaims, had a call from them saying they had passed it to the medical assessment team, heard nothing so contacted them this morning to be told claim was rejected and I would be getting a letter explaining why??!!0 -
we sent off the questionaire with carehomeclaims, had a call from them saying they had passed it to the medical assessment team, heard nothing so contacted them this morning to be told claim was rejected and I would be getting a letter explaining why??!!
Would I be correct thinking that CareHomeClaims is a company which offers to assist reclaiming care home fees? If it is, they are not prepared to assist you on a no-win no-fee basis and you will need to wait to see what reasons they have. This does not mean you cannot apply directly to your local PCT or approach a different specialist company. The MSE guide outlines how you can do this yourself.0 -
hi can anyone tell me if this applies to scotland as well as it cost me £55000 for my mothers nursing home care
thanks for any replies0 -
hi can anyone tell me if this applies to scotland as well as it cost me £55000 for my mothers nursing home care
thanks for any repliesI appreciate that the original guide refers to England but does anyone know if a similar system operates in Scotland?
Yes there is a CHC funding system in Scotland but it differs from England.
Here is a starting point for you.
http://www.careinfoscotland.co.uk/how-do-i-pay-for-care/nhs-continuing-health-care.aspx
Hope this helps.0
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