Care Home Funding Case Studies
CASE STUDY 1
Mrs P’s family approached us to look at their Mother’s situation as the cost of funding her care was putting a great strain on their finances, and they didn’t want to move her to a cheaper care home as she had been in the current one for 4 years and was settled there. Also it was within easy reach of her daughter and two sons.
Our nursing experts studied the information that was provided on our questionnaire, and as a result we felt that Mrs P qualified for Continuing Health Care funding (CHC), and in particular we pointed out to the NHS that they had failed in their statutory duty to carry out a CHC assessment “at least annually” as stipulated by the NHS guidelines. Mrs P had not been assessed for 3 years.
It is a sad but true fact that the health of elderly patients in care homes does not tend to improve, so we demanded that the Clinical Commissioning Group (CCG) with responsibility for the patient carry out an assessment. After much dragging of the feet the CCG agreed to do so.
Initially Mrs P was denied funding, but once again we were able to submit a very strong case on her behalf, and we were successful on appeal.
Full funding was granted, but unfortunately a week later Mrs P passed away.
However the patient’s health needs did not just suddenly change overnight, her condition had been worsening for quite some time, and we were able to get the funding backdated for 10 months.
We obtained a rebate for Mrs P’s estate that came to over £42,000 including interest.
CASE STUDY 2
Mr H’s daughter contacted us as her Father had been consistently denied CHC funding by the NHS. She had come to realise that the system for claiming funding is not at all user friendly, is overly complicated, and found a lack of continuity in the answers to her questions that she received (too often staff handling CHC claims have not been adequately trained. These are highly technical cases and need to be assessed by experienced personnel ).
We presented our case to the CCG and after 8 months they agreed to carry out an assessment. The claim was turned down, but when we looked at their report we found it hard to believe that the correct person had been assessed. Their report contained a frightening numbers of factual errors.
We asked for a Multi-Disciplinary Team panel to be convened which we attended in person with Mr H’s daughter. At the appeal one of our nursing experts pointed out several glaring errors, one of which prompted one of the physicians on the panel to interrupt proceedings stating that “if he is on that medication his level of need goes straight to level A”. Ordinarily the panel prefer to confer in private, but we were pleasantly surprised by this reaction.
As a result a second assessment was carried out. Mr H now receives £3,000 per month in funding, leaving his daughter to find just £200 per month. Mr H also received a rebate amounting to just over £16,000 including interest.
The family were relieved that Mr H's home was no longer going have to be sold.
CASE STUDY 3
We were successful in obtaining funding for Mrs C from Brent CCG backdated to September 30th 2013. This was great for the family as they were now saving £850 per week. However we believed that Mrs C qualified for funding much earlier than Brent were prepared to pay. The CCG refused our appeal so we took the claim to the next stage and insisted upon an Independent Review Panel being convened by NHS England to hear our argument.
The Panel disagreed with Brent's decision and backdated the funding to February 1st 2012. With interest added Mrs C received a further rebate of £60,000.
Claiming successfully for CHC funding is not easy,
it takes a long time, but it can be done.