Heartbroken that I'm being forced to sell mum's house, she worked hard for it and paid her national insurance

[Jkoakham]

And now her savings are running out I will need to sell her house to carry on funding it.

It all seems to very unfair, her house was supposed to be passed to me but instead it's affectively passed to government and private companies.

I thought the dimentia tax had been can cancelled?

Hatgirl - where DOES the line between medical care and social care lie? Is there a hard and fast definition?

Wiping bums and spoon feeding has never been paid for by the nhs though unless the patient is in hospital . Family members used to do this and in many countries family members are expected to do this in hospital too.if you want your parents assets you must do the bum wiping and spoon feeding if they need it. Why should a care assistant on minimum wage have to pay double the taxes so middle class people get an inheritance when they are doing the hard slog of caring.

On this - "Just for interest - for a child with social care needs, are there any differences in the way funding is arranged due to e.g. the crossover with education? Or is it just that they don't tend to have savings / assets?"

I suppose if it's education they need then that is need met for children in the UK. If their parents totally reject them and will not keep them at home then we do as a society pick that up and care for them - fostering etc. I suppose if a child had a £100m inheritance and its parents died the state would not fund its care but would provide state education - I guess?

Logically though the NHS deals with lots of stuff that's not an illness - IVF, contraception, gender reassignment. I suspect lots of things will stop being funded in time. But those people who can afford to pay for social care should definitely have to.

@cantkeepawayforever

The line is decided via a Decision Support Tool or DST.

For more information see the link

Enjoy -

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/690426/National_Framework_for_CHC_and_FNC_-_October_2018_Revised.pdf

Contraception, I suppose, could be regarded as 'prevention being better than cure' - hadn't considered contraception to be in the same bracket as my eczema emollients and soap alternatives, or my brown asthma inhaler, before, but iI would suspect it is cost-effective in terms of society as a whole....

Tesslike,

Ooh, that document is a JOY! I can read Education gobbledegook, but that document is clearly in NHSspeak and needs significant translation!

cantkeep I believe for children's services it's funded out of a bit of a joint pot between education, NHS etc but I'm not hugely up to speed wth exactly how it now works as I haven't worked in a service that has a crossover with under 18s for a few years.

What I do know is that that young people and their families often get a huge shock when they transition from children's services to adult services as suddenly their 'income' from things like DLA/PIP is taken into account to pay for their care when it hasn't been previously.

@cantkeepawayforever

I don't know what you mean! It's totally clear and objective and means decision making is always consistent.

....

....

/sarcasm

The real test is if the person has a a Primary Health Care Need .Here is a snippet that should clarify things-

Primary Health Need is a concept developed by the Secretary of State for Health to assist in deciding when an individual’s primary need is for healthcare (which it is appropriate for the NHS to provide under the 2006 Act) rather than social care (which the Local Authority may provide under the Care Act 2014). To determine whether an
individual has a primary health need, there is an assessment process, which is detailed in this National Framework. Where an individual has a primary health need and is therefore eligible for NHS Continuing Healthcare, the NHS is responsible for providing for all of that individual’s assessed health and associated social care
needs, including accommodation, if that is part of the overall need

Now I am sure everybody completely understands.

Thank you - and sorry for the derail!

So Tess, what that OUGHT to mean - to the layperson - is that someone with a very clear health condition - say MS - from Hatgirl's list, should have all their care and accommodation provided by the NHS, whereas someone with no specific health condition except general age-related decline should not.

However, I guess it's nowhere near that simple in reality....

@cantkeepawayforever

Nope because diagnosis and prognosis don't factor in (except for Fast Track) or if diagnosis some how fits into another category which have heard of but never witnessed.

The judgement whether someone has a primary health need must be based on what the evidence indicates about the nature and/or complexity and/or intensity and/or unpredictability of the individual’s needs

Recently the rule seems to be you need to score high in the first three domains to get the CCG to agree the funding (at least in my area but of course it varies stupidly from region to region).

If you Google DST CHC you can hit the top link and see the actual tool used at the MDT to determine this. I can't link because it starts an automatic download of a word document, it's NHS though so (probably) safe.

I knew it didn't mean what it looks to a layperson as if it means - as I say, it is clearly in NHSspeak, and like Education Gobbledegook, what it appears to say in 'normal English' and what it means in the relevant institutional jargon are often completely opposite!

A baby is needing care for a short time period and will eventually be able to look after themselves in the majority of cases. An elderly person who isn't able to look after themselves is normally looking at end of life as the next step. The prevention of disease is important for helping reduce medical costs, therefore I think it falls under medical care not housing. Then again I think care in the community should fall under the NHS too. Someone who needs care should have this help overseen by a medical team and not a council. Having seen how lacking the coordination is and how major things are missed because of this I think a joined up system would be much more efficient.

@cantkeepawayforever

It makes sense if you think about it (in the "logic" of the rules) because why would MS be treated any differently to arthritis?

Don't forget before funding is looked into the local authority has to assess if that persons needs are great enough to require residential care in the first place. The stipulation is that the needs must be a result of a physical or mental health condition, so being eligible for social care now necessarily means you have a health condition.

The prevention of disease is important for helping reduce medical costs

That would mean that the NHS should fund sewers (Bazalgette and cholera outbreaks come to mind)...

An elderly person who isn't able to look after themselves is normally looking at end of life as the next step

What about a 70 year old having a hip replacement?

What are we even defining as elderly?

FYI there is one diagnosis that means you never have to pay for care and that's CJD. I don't know why but if anybody here does I would love to hear the reason, Google turns up nothing for me.

Thanks Tess. Why is it that I have a picture of 2 boys, each pointing to the other and saying 'It was him! He should pay!' in my mind???

@cantkeepawayforever

Yup.

Change the boys to a social worker and a nurse and stick a bewildered family in the middle and you have a fair picture of a lot of DST's.

Cripes don't attempt to read the DST without a stiff drink and a donut!

The way I usually try and explain it is that medical is anything that requires carrying out/prescribing by a medical professional or regular oversight by a medical professional.

So for physical needs basically anything that district nurses would do rather than home carers in the community e.g dressing wounds, taking bloods, inserting catheters, complex PEG feeding, dealing with complex continence issues and administering certain medications would be medical.

Providing personal care (emptying catheters, changing pads, feeding and washing) would be social care.

It gets a bit trickier to define with mental health conditions e.g. dementia but again it basically boils down to does this person's needs require a registered mental health nurse overseeing their care on a day to day basis or can their needs generally be managed by a care assistant as part of the normal routines of the care home.

So someone violent, or extremely distressed, or someone requiring medication to be administered covertly because they refuse to take it would be seen to have medical needs.

The DST states that these medical needs must be considered in terms of their Nature, Complexity, Intensity and Unpredictability when deciding if the funding balance should be tipped into needing to be fully funded by the NHS.

What are we even defining as elderly?

That's a really good point. A colleague cares for a frail, very unwell mother who I assumed was of a similar age to my own (around 80). She is only just over 60, an age when my own mother seemed scarcely middle-aged.

@cantkeepawayforever

Indeed and I have know 90+ year olds (and, in fact one 100+) to have hip/knee replacements, rehab and return home with no formal support.

hatgirl, i can also see that very regular reviews might be needed in rapidly developing dementia, as a sufferer settled into a care home with mild dementia not funded by the NHS could deteriorate such that their condition could then meet the requirements of the DST - and then not just a new funding stream but potentially a change of institution comes into it.

Tess A 70 year old needing a hip replacement is most probably not going to be needing care beyond their hospital stay. They will be going home having gotten out of bed etc. while a 70 year old with dementia needs care every single day to stay healthy and can't look after themselves.

I wouldn't put the two cases in the same bucket. Both are elderly but one is in poor health the other isn't necessarily.