Betty was in hospital following a stroke that left her with a number of disabling conditions. Before the stroke, she had lived in her own home and had paid for carers to look after her during the day. Most of her care needs related to her dementia.
Betty’s family and health and social care professionals all agreed that she now required a 24-hour nursing home placement. A nurse assessor from the primary care trust (PCT) applied the NHS continuing healthcare needs checklist to Betty’s case. She decided Betty’s needs were stable and predictable and that she did not meet the criteria for NHS Continuing Healthcare Funding (fully funded care).
Betty and her daughter Rachel were told Betty would get a payment of £106.30 funded nursing care contribution from the NHS towards her fees if she moved to a nursing home. The home Rachel found for her mother charged £825 per week. The social worker said Betty would need to use up her pension and most of her savings and then sell her home to pay for the nursing home. Betty would need to pay £718.70 a week to the nursing home.
Rachel did not agree with the nurse assessor’s decision that her mother did not have a primary health need. She contacted Martin Searle Solicitors to ask for advice.
Cate advised Rachel to ask the PCT for a comprehensive health needs assessment of her mother’s eligibility. Cate told Rachel to insist on this even though the PCT had already decided on the basis of the simplified checklist that Betty could not qualify for fully funded care. The PCT agreed to undertake a full assessment.
Rachel asked Cate to advise what arguments she should put forward at the assessment meeting. Rachel lived 60 miles from our Brighton office. Due to her work and caring commitments, Rachel did not have time to come to the office. Cate explained she could advise Rachel by telephone and/or email if Rachel could send her all of the documents.
Using the information from the checklist and having taken examples and anecdotes from Rachel, Cate identified that the nurse assessor’s initial decision was flawed. Cate saw that Betty had a number of high level needs in relation to:
Cate provided Rachel with written advice about how to describe her mother’s needs to ensure the nurse assessor and other professionals understood that these needs, combined, were of a primary health nature.
Cate explained to Rachel how to argue Betty’s needs were neither stable nor predictable. She advised her to explain that there was a significant level of complexity in terms of staff being able to meet Betty’s physical, cognitive and mental health needs. Cate also explained how to ensure the nurse assessor did not ignore any well managed needs.
The nurse assessor agreed with Rachel’s arguments about the extent and nature of Betty’s needs. She made a recommendation to the Continuing Healthcare Panel that Betty should receive fully funded NHS care for an initial period of six months.
By taking advice for her mother, Rachel has saved her mother nearly £19,000 for the first six months she spends in the nursing home. If the fully funded care award is extended, Betty will save nearly £40,000 a year. Rachel does not have to rush in to any decisions about selling Betty’s home and the family can concentrate on settling Betty in to the nursing home.