How a Community Care caseworker in Brighton helped Mr and Mrs Carter – a couple whose adult son suffered brain injury due to a subarachnoid haemorrhage whilst working abroad – to keep their son’s specialist care home placement.
Mr and Mrs Carter got in touch with Clare English regarding their son, Matthew, aged 52.
Matthew had been working in Asia for several years when a subarachnoid haemorrhage left him severely brain damaged. Matthew was in a coma for four months in hospital in Asia. Mr and Mrs Carter were able to arrange for Matthew to be transferred back to the UK. They applied to the Court of Protection to be appointed as his Deputies for property and finance.
When Matthew was discharged from hospital to the specialist care placement, Mr & Mrs Carter believed funding for care would be “sorted out”. However, after Matthew moved, despite his severe and extensive health care needs, he was found ineligible for NHS Continuing Healthcare (CHC). This is funded by the Clinical Commissioning Group (CCG).
His fees at the specialist care home were “temporarily” funded by Social Services following a financial assessment. However, Social Services felt that the specialist care home was too expensive. Although Matthew’s suitable care placement was arranged by the NHS as part of his safe discharge from hospital, he was now faced with the threat of having to move from this placement, where he was very well cared for.
The parents felt their son was settled in his care placement but were concerned that Social Services funding would stop if they did not move him somewhere cheaper. They did not understand the complicated rules about paying for care and wondered if they needed fund their son’s care from their own savings and pension income. Matthew was due to receive a reasonably large work-related insurance policy pay out due to his brain injury “but it won’t last forever” Mr Carter told Clare.
As Mr and Mrs Carter thought that this insurance pay out would make Matthew a self-funder for care costs, they told Social Services about it. However, they thought that Matthew was still so unwell after such devastating health conditions, that the NHS should still fund his care.
By obtaining Social Services funding pending appeal against the NHS CHC decision, Clare helped to ensure Matthew could stay in his care home. She referred Matthew’s Social Worker to the well-being principles of the Care Act 2014, and argued that there were no alternative suitable placements available to meet Matthews’s needs. Social Services agreed to fund the care fees.
Clare assisted Mr and Mrs Carter to lodge an appeal against the CCG’s decision that Matthew was ineligible for NHS Continuing Healthcare funding. Clare reviewed the NHS Checklist and Decision Support Tool (DST) documents which had been completed for Matthew, and identified the inadequacies in the assessment process. Clare found that the care home had been told to complete the DST without any input from the CCG. She felt that the care home had over inaccurately scored Matthew’s needs in some domains, and failed to provide sufficient information for the CCG panel to make an accurate assessment.
Clare produced a ‘tips and tactics’ document which Mr and Mrs Carter could use to appeal the decision that Matthew was ineligible for NHS CHC funding. Clare helped Mr and Mrs Carter prepare for Matthew’s re-assessment meeting.
Clare also provided Mr and Mrs Carter with paying for care advice in case Matthew remained ineligible for NHS CHC funding. Clare explained the rules for Social Services financial assessments, and what effect Matthew’s insurance pay out would have on his eligibility for Social Services funding of his care.
Clare recommended that Mr and Mrs Carter also take advice from a personal injury trust specialist in case any of the element of insurance payout might be disregarded by being put on trust.
Mrs and Mrs Carter are awaiting the outcome from their NHS CHC appeal for Matthew. Clare’s advice on planning and paying for care has reassured Mr and Mrs Carter that, even if Matthew is not eligible for NHS CHC funding, he has a long term future at the care home where is content and well cared for.
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