Retrospective Continuing Health Care

[Worrywart]

Hi all,
My mother died in August in a care home, she’d been there 5 years following a brain injury. She had detiorated massively in last two years , doubly incontinent, bed bound, no communication, totally reliant on Carers for everything. She was hospitalised Feb 20 and when she was discharged in March we were told she had weeks to live. She was so frail ( 5 stone - her normal weight was about 12 stone , very tall lady). Asked about nursing care and CHC bit was told there was no point as she was at end of life and woild survive a few weeks. She survived 6 months in a care home and died alone in lockdown. On the day she died the GP refused to come out to provide palliative drugs ( as he didn’t have them he said , they admit this was an error and they have apologised) he also said she should have been in a nursing home .
I am so incensed, I’ve just received a £35,000 bill for her care, her small terraced cottage will have to be sold, she had left it to her precious grandchildren. I’ve looked into CHC - I need to read up on it and was wondering if anyone had any good resources to read as there is so much on line.
I’ve been told that if the care home could manage her she wouldn’t get CHC but they are bound to say that aren’t they. They certainly didn’t manage the palliative drugs as she died a horrible death, I don’t know what else went on as we were in lockdown for the last 6 months of her life.
I’m seriously unwell myself, a hysterectomy went wrong, I have 3 stoma bags. I want to make sure though my mother gets What she was entitled to, if of course that is possible.
Thank you

[sunnydisposition]

Condolences

I just had a google search and I don't know if this link with help...

https://www.carehome.co.uk/advice/can-i ... -home-fees

From the web site


If they pass away, their estate will be liable to pay for outstanding fees
When a person dies, the care home will issue an invoice for any outstanding fees. This is not for the family to pay, it will be taken from their estate, such as remaining money in their bank account.

Don’t rely on transferring your property to your family or trust companies
Ms Charlton advises: “Some people think that transferring their property to their children may prevent it being taken into consideration when their assets are being considered for the payment of care home fees.

“The risk of this is not only transferring the property out of your name and running the risk of falling out with your children and being asked to leave the house but if your child goes through divorce or bankruptcy, that asset would be taken into consideration. A local authority may also look at this transaction too and find that it was transferred meaning there was deliberate deprivation of assets.

“Trust companies also advertise property trusts which guarantee to protect properties from being taken in payment of care fees however, these companies are usually unregulated and cost thousands of pounds. If a local authority again believes the property was put into a trust as a means of deliberate deprivation of assets the trust could be forced to wind up and the property would still be taken into consideration.”

Care home fee planning trusts can be a waste of money. Ms Charlton emphasises: “They aren’t concrete, because if a local authority believes that the house was put into a trust purposely to prevent it being used for care fees, they may deem this to be deliberate deprivation of assets and reverse the long and very often expensive process of setting up the trust and the property could still be taken into consideration.”

[Pennie]

Unless I'm missing something obvious, I would have thought that your mother would have been eligible for fast-track CHC when she was discharged from hospital in March. The fact that her doctor declared her end-of-life and that she possibly only had a few weeks to live would definitely lend weight to this and just don't understand why it wasn't even considered.

[Worrywart]

Unless I'm missing something obvious, I would have thought that your mother would have been eligible for fast-track CHC when she was discharged from hospital in March. The fact that her doctor declared her end-of-life and that she possibly only had a few weeks to live would definitely lend weight to this and just don't understand why it wasn't even considered.

Thank you Pennie. I did ask repeatedly and was just told if the care home will accept her back and can manage her then there was no need for CHC. I asked for a meeting with the consultant and he said she had weeks and did I really want her moved, I was worried about her going back to the care home as I knew there were no trained staff there, I’d worried about it for years but I was seriously ill myself and thought the authorities must now what they were doing . I have considered making a retrospective claim via a solicitor as I’m so angry about it all but I’m not sure I am up to it. So Pennie if someone is on a plaintive pathway does that increase their chances of receiving CHC?

[Worrywart]

Unless I'm missing something obvious, I would have thought that your mother would have been eligible for fast-track CHC when she was discharged from hospital in March. The fact that her doctor declared her end-of-life and that she possibly only had a few weeks to live would definitely lend weight to this and just don't understand why it wasn't even considered.

Thank you Pennie. I did ask repeatedly and was just told if the care home will accept her back and can manage her then there was no need for CHC. I asked for a meeting with the consultant and he said she had weeks and did I really want her moved, I was worried about her going back to the care home as I knew there were no trained staff there, I’d worried about it for years but I was seriously ill myself and thought the authorities must now what they were doing . I have considered making a retrospective claim via a solicitor as I’m so angry about it all but I’m not sure I am up to it. So Pennie if someone is on a plaintive pathway does that increase their chances of receiving CHC?

[Worrywart]

Condolences

I just had a google search and I don't know if this link with help...

https://www.carehome.co.uk/advice/can-i ... -home-fees

From the web site


If they pass away, their estate will be liable to pay for outstanding fees
When a person dies, the care home will issue an invoice for any outstanding fees. This is not for the family to pay, it will be taken from their estate, such as remaining money in their bank account.

Don’t rely on transferring your property to your family or trust companies
Ms Charlton advises: “Some people think that transferring their property to their children may prevent it being taken into consideration when their assets are being considered for the payment of care home fees.

“The risk of this is not only transferring the property out of your name and running the risk of falling out with your children and being asked to leave the house but if your child goes through divorce or bankruptcy, that asset would be taken into consideration. A local authority may also look at this transaction too and find that it was transferred meaning there was deliberate deprivation of assets.

“Trust companies also advertise property trusts which guarantee to protect properties from being taken in payment of care fees however, these companies are usually unregulated and cost thousands of pounds. If a local authority again believes the property was put into a trust as a means of deliberate deprivation of assets the trust could be forced to wind up and the property would still be taken into consideration.”

Care home fee planning trusts can be a waste of money. Ms Charlton emphasises: “They aren’t concrete, because if a local authority believes that the house was put into a trust purposely to prevent it being used for care fees, they may deem this to be deliberate deprivation of assets and reverse the long and very often expensive process of setting up the trust and the property could still be taken into consideration.”

Thank you very much I will look into what you have said

[Pennie]

This is taken from the "Care to be Different" website (I have highlighted in bold):


Fast Track funding is not only for end of life. Many families are wrongly told that NHS Continuing Healthcare funding is only available for people who are at the end of their life. Not only is this incorrect, it often means that elderly people with significant health needs are wrongly denied the free NHS care they are entitled to in law.

Continuing Healthcare funding for care fees depends on the extent of your relative’s health needs, not what stage of your life they’re at. Assessments are supposed to be carried out swiftly, no matter what your relative’s degree of health needs. There is, however, a special process that should be used in emergency situations when a person is in a period of rapid deterioration or when a person is in ‘terminal decline’ at the end of their life.

National Framework guidelines, page 32, paragraph 97:

“Individuals with a rapidly deteriorating condition that may be entering a terminal phase, may require ‘fast tracking’ for immediate provision of NHS continuing healthcare.”

Nursing care is provided by the NHS, and NHS care is free – in law. The Continuing Healthcare eligibility criteria are based purely on care needs and NOT on a person’s money, and by looking at the criteria – and at the local authority legal limit for means tested care – it will be clear whether or not a person should receive full NHS funding for their care.

If your relative is in terminal decline at the end of their life or in a period of rapid deterioration, you can insist on them having an urgent Continuing Healthcare assessment. This is done using the NHS Continuing Healthcare Fast Track process (‘Fast Track Pathway Tool for NHS Continuing Healthcare’). Essentially, it’s a fast assessment to get NHS funding in place as quickly as possible.

Here are some of the key points to keep in mind about this NHS Continuing Healthcare Fast Track process:

It is used if your relative has urgent health needs and/or nursing needs and is rapidly deteriorating and/or in a terminal phase of life. It is also used if your relative’s health is likely to deteriorate rapidly before the next routine Continuing Healthcare review. It is not only for people at end of life.
It allows a quick decision to be made about Continuing Healthcare funding. As part of this, it allows appropriate end of life support to be put in place quickly by the NHS – free of charge – and it means your relative can have care provided in their preferred location, including at home.
The Fast Track assessment should be carried out by a registered medical practitioner (the ‘assessor’), such as a GP, consultant, registered nurse, hospice clinician, etc – but this person must have detailed knowledge of your relative’s needs. Unfortunately, families report that GPs and other medics often have little (if any) knowledge of the Continuing Healthcare assessment process, and it can fall to the family to ‘educate’ them in this respect. This can be immensely frustrating for the family at a time when urgent action is required.
In the Fast Track assessment the assessor makes the decision that person is in a rapidly deteriorating state and/or in a terminal phase and with an increasing level of dependency. This decision should be accepted and acted upon immediately by the NHS.
There should be no delay in providing free NHS Continuing Healthcare funding just because NHS or local authority staff are arguing or debating how the Fast Track should be used.
Your relative should be moved to his/her preferred place of care and have funding immediately put in place without having to go through the long-drawn-out ‘full’ multidisciplinary team Continuing Healthcare assessment process. The NHS is responsible for this. If your relative is already in a care home, and no longer owns their own home, it may be that the care home will be the best place in which to remain.
Once Fast Track Continuing Healthcare funding is in place, it should never removed without the NHS going through the proper review process, i.e. a full assessment process carried out by a multi-disciplinary team (MDT). This ‘full’ assessment process uses a form called the ‘Decision Support Tool’ (DST). Only once the Fast Track assessment is complete and funding is put in place should an MDT review process ever be started – and only if this MDT assessment is really necessary. This full MDT assessment process should never delay urgent Fast Track end-of-life funding and care.
If parts of the Fast Track form have not been completed, or if the assessor does not know how to complete it, or the patient cannot assist in completing it, this should never delay a decision about funding or delay NHS care being put in place.
Essentially, the Fast Track allows for a decision to be made quickly that your relative has a ‘primary health need’, that they have a rapidly deteriorating condition or are in the terminal phase of life, that their needs are more than ancillary to the provisions of accommodation by a local authority, i.e. the care they need is beyond the legal remit of Social Services.

Remember, ask for a Fast Track assessment if you feel your relative should have one. If this is declined, and yet it’s clear that your relative is declining rapidly, put your concerns in writing to the Chief Executive of your relative’s local NHS (Clinical Commissioning Group) and copy it to the Continuing Healthcare Team, the GP, all appropriate consultants, nurses, medics, clinicians, carers and the care home manager (if relevant).

If necessary write to your MP.

If it’s obvious that your relative needs urgent nursing care, you could also refuse to pay (or continue to pay) care fees at this point.

This does, of course, raise a further question: If a rapid decision can be made using the Fast Track process, why can’t all NHS Continuing Healthcare assessments be as quick?

It may also be useful to read the comments at the bottom - maybe some more "ammunition" there? Unfortunately, I don't have any direct experience of CHC (fast-track or otherwise) - well, not yet anyway!

[Penny]

Worrywort .... you need to be looking at getting retrospective claims. Care To Be Different is the best site for this and they are really helpful.

I used them recently to read up all about Fast Track CHC for my Mum. She died a few weeks ago from Alzheimers and had been in care for 4 years funding it all herself. When she really started deteriorating in September I printed off the forms, completed what I could and asked the GP (who I have never met) to do his part. he admitted to me that he knew very little about this so I printed off more stuff for him to read and left it for him. Within a week the local CCG approved it and we got it for approx the last 2.5 months of her life which amounted to approx £7,000.

When my head is straight again I plan to see if I can get CHC for further back than this because Mum was discharged from hospital 3 years ago and I feel she should have been entitled to it even back then.

Let us know how you get on.

By the way, 3 stoma bags? How the heck do you manage? Mum had just one for the last 20+ years and that was bad enough. She had bowel cancer twice.

[Worrywart]

Thank you . I wish I hadn’t instructed solicitor now, they aren’t being that helpful and I’m having to fill the forms in myself so not sure why I bothered ! Too late now thiugh as I’m tied into contract - it’s no win no fee.

Re the bags. I’ve had an ileostomy 35 years and it’s fine. 5 years ago a hysterectomy perforated my bowel so I have a fistula so that’s why I need the extra bags, somedays I cope, somedays I could scream , my husband is my carer which doesn’t work too well, on saying that I’m lucky as many people with my condition can’t eat or drink and are vein fed , I can eat and drink but my life is compromised.

I better read up some more on CHC as it seems I have to do the work, the solicitor seems to be doing very little at the moment

Thank you x