Advice wanted - Elderly Care after hospital discharge

[Neapolitanicecream]

My Dad has come home after serious illness he’s on his own and with palliative care, so hospital arranged 4 care visits for 6 weeks. Now social services say Dad has to pay and will backdate payments to the carers first visit. Is this correct he’s 91years and can just manage to the toilet with his walker was in hospital for 2 months. TIA

Yes if he can afford to pay for care, assets include the house and car as well as whatever's in the bank, he will pay. I think you only get it free if you have less than £20k ish in assets. Perhaps less now!

If district nurses are involved you can ask for a fast track CHC assessment. If not ask the GP or any other professional involved. If appropriate and approved all care will be funded. Without knowing the exact circumstances it’s hard to say if it will be the right thing for your father but it’s for palliative patients whose condition is worsening and they are approaching end of life.
I thought that after discharge a certain amount of care was funded but someone else will hopefully come along and give more info on that.

Does he claim attendance allowance? Also if care is palliative continuing healthcare costs may be paid by nhs? Contact age uk or Macmillan for advice.
In our area initial reenablement is free- 6 weeks.
Is he under a hospice?

Yes to paying and back paying. Has he been assessed for a claim for attendance allowance to help with this if eligible?

@hatgirl may be able to advise?

www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

I was under the impression you got 6 weeks free after a hospital stay. All of our residents have a free 6 weeks after a hospital stay. That being said, they never continue after the 6 weeks so perhaps they have to pay once the 6 weeks are up. I work in an independent living facility and the only people who ever take the 6 weeks are those who don't actually need care. The ones who are already receiving care just have their current care plan adjusted to suit thir new needs. I would think if you father is starting to struggle more an independent living facility would suit him. They're generally set out like flats with each resident having their own bedroom, bathroom, sitting room and kitchen/dinerjust like living at home but with the added security of having care staff on site if they fall or suddenly take ill and need extra assistance. You don't need to be recieving care to move into one. You can just rent it like a normal flat and take advantage of having the falls pendant. There is a fee for the falls pendant/emergency response but it's not per use and its quite reasonable.

Definitely apply for DLA. Apart from that, he will probably need to pay unless he has nursing needs, but that is a separate issue.

You can't get Dla at 91 he needs to apply for attendance allowance. You need to request a chc checklist to be completed via the gp or social services to see if he is eligible for funding. Details of the checklist are here

www.parkinsons.org.uk/sites/default/files/2018-10/NHS%20Continuing%20Healthcare%20Checklist.doc

My Dad has come home after serious illness he’s on his own and with palliative care

Who has determined he is in the palliative care stages? Does he have District nurses or e.g. cancer/ Parkinson's nurses visiting him at all?

hospital arranged 4 care visits for 6 weeks

This bit is really important. WHO at the hospital arranged his care? Was it the ward or was it the hospital discharge team (social services).

Did he receive any paperwork advising him that he may be financially charged for the care services. Was he told it would be free for 6 weeks or that it was a 6 week assessment period for rehab etc or anything?

Was he screened using a continuing healthcare (CHC) checklist before he was discharged?

Now social services say Dad has to pay and will backdate payments to the carers first visit. Is this correct

Depending on the answers to the questions above it quite possibly is correct. It shouldn't be coming as a surprise to him though if it is correct, if he genuinely wasn't informed and you challenge this then it may be that they will waive the charges up until the financial assessment date when he was informed.

he’s 91years and can just manage to the toilet with his walker was in hospital for 2 months

Age isn't a factor in whether someone has to pay for their care or not. If someone isn't eligible for CHC funding (fast track or normal) then they are financially assessed to contribute to their care whether they are 19 or 91.

It's highly unlikely based on what you have said so far that he would be eligible for normal CHC funding - but that depends on the nature, complexIty, intensity and unpredictability of his health needs.

Depending on what stage his palliative care needs are at there's a chance he might be eligible for Fast track CHC. This is usually awarded when there is a belief that someone's condition is deteriorating rapidly and they are nearing the end of their life. Anyone awarded Fast Track CHC will usually be reviewed under the full CHC process if they survive beyond 12 weeks after fast track CHC is awarded - the implication being that fast track may not be the appropriate funding stream if their life expectancy is expected to be significantly greater than 12 weeks.

If it is palliative care then it should be done through Continuing Health Care.

If care was not paid for on being discharged it sounds like he was fast-tracked through the CHC Framework.

You should have received a letter regarding this and whether they are going to continue to fund.

Who is part of his Palliative Care team for example if it was cancer he would maybe get support from Sue Ryder.

Speak to Beacon who are an organisation that helps with CHC funding. They will give free advice.

My biggest piece of advice from my experience is to fight and fight and fight for CHC to fund this care. They can be a nightmare but your father should not be made to pay for his palliative care. Is it should health care funded not social care funded.

If it is palliative care then it should be done through Continuing Health Care

Not necessarily. People can be cared for 'palliatively' for many many years. Prognosis isn't a factor in determining CHC eligibility it's entirely about the presenting healthcare needs and whether they constitute a primary health need, based on their complexity, intensity, nature and unpredictability.

For fast track CHC it has to be considered that the person's condition is rapidly deteriorating and/or entering the terminal phase.

The purpose of fast track funding is to speed up the process of getting care for people who are really unwell. As I said above though, if someone is in receipt of fast track funding if they are still receiving it after 12 weeks they will be reviewed under the normal CHC process and either continue to be funded that way or drop out of NHS funding and into social services funding again.

If care was not paid for on being discharged it sounds like he was fast-tracked through the CHC Framework

I don't think this is the case in this situation I'm afraid. Many local authorities know that they can't get out to people straightaway to financially assess so arrange to do the financial assessment after 6 weeks.

Most LAs offer 'free' reablement in this period, but if someone isn't felt to be suitable for reablement (I.e. they are as a good as it's going to get) they may just get sent straight home with a chargeable care package.

This can lead to confusion on wards with people being told by nursing staff that they will get 'six weeks free' when actually this isn't the case for everyone.

However, they have to be absolute explicit about what is going to happen. The person should be clearly informed that they may be charged and should be given information about the financial charging process in writing. If this hasn't happened then they can be challenged and the fees up until the financial assessment takes place will often be waived.

Most LAs offer 'free' reablement in this period, but if someone isn't felt to be suitable for reablement I though Reablement was NHS funded which is why you don't have to pay. You start paying as soon as it becomes evident you need long term care or after 6 weeks, whichever is the shorter.

Yes if he can afford to pay for care, assets include the house and car as well as whatever's in the bank, he will pay. If he's living in his home, it's not included in the assessment of income and wealth.

Most LAs offer 'free' reablement in this period, but if someone isn't felt to be suitable for reablement I though Reablement was NHS funded which is why you don't have to pay. You start paying as soon as it becomes evident you need long term care or after 6 weeks, whichever is the shorter

Funding arrangements differ depending on local LA/CCG agreements, and there is probably an element of joint funding, but I think most of the funding usually comes from the LA / Public Health (RIP) budgets rather than the NHS as reablement is available to anyone not just people being discharged from hospital.

It's usually provided as a free service because it's block paid for already anyway as part of commissioning / government funding arrangements so it costs the LA the same whether 1 person a week uses it or 10 and in theory a high uptake of it should reduce the long term care burden on the local authority and reduce residential care admissions.

The idea behind reablement is to rehab people back to their full potential with a view to reducing their long term care needs and costs, but due to chronic underfunding more often than not it's just a holding position until social services can get out to do a proper assessment.

Some CCGs/ Hospital trusts do operate their own separate scheme similar to reablement specifically to speed up the hospital discharge process but this isn't as widespread.