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Care fees, Hospitals, NHS Continuing Healthcare

Why are elderly people wrongly charged for care?

NHS Continuing Care – and the story of Peter and Arthur…

Every family is likely to be affected by long term care matters at some point, and it’s vital to be as informed as possible about what should (and shouldn’t) happen at the point where an elderly relative needs full time care – and what to do if things go wrong.

We’ve highlighted some of the issues using two fictional people as examples, and we’ve used a hospital setting as the context, because the same principles can be applied to someone still at home and needing full time care…

Peter, aged 52

…has just fallen off a ladder doing DIY at home, and he’s badly broken his leg. He’s taken to hospital where he’s admitted, and he undergoes surgery to pin his leg. He then remains in hospital until he is fit to leave. In the meantime he starts some rehab therapy and has ongoing treatment to heal the bones and the soft tissue damage.

Peter lives on his own, and it’s going to take some time for him to get mobile again and be safe at home. Once he’s out of hospital though, he can access the key healthcare services he needs such as his GP, a nurse at the surgery, a visiting district nurse and physiotherapy. Plus he can claim certain state benefits to help him through this time, as he cannot work.

Does he have to pay for any of this? Absolutely not. Healthcare and nursing care is free in the UK, and this is clearly set out in law.

Arthur, aged 79…

… is frail and has a bad fall at home and breaks his pelvis. He also has other chronic health problems that require access to medical/healthcare services. He’s taken to hospital where he’s admitted and he undergoes surgery, just like Peter. He then remains in hospital. His overall health needs are greater than Peter’s.

However, unlike Peter, Arthur quickly comes under considerable pressure to vacate the bed before he’s fit to leave, and in the meantime he is not offered any beneficial rehab therapy. Arthur lives on his own, and it’s going to take some time for him to get mobile again and be safe. The discharge team at the hospital continue their pressure to get him out, and they tell his daughter to find a care home for him. No one seems interested in the obvious signs that Arthur is deteriorating needlessly in hospital because of avoidable dehydration, malnutrition and lack of beneficial movement. Instead the hospital team ask how much money Arthur has, and whether he owns his own house. At no point was Peter asked these questions or put under such pressure to leave. The hospital does not seem interested in Arthur’s chronic disease.

Misinformation about paying for care

Arthur’s daughter (who is also his power of attorney) is understandably upset and stressed about what’s happening to her father. Her knowledge of the care system, based on what she hears on TV and in the press, and based on what other families say, is that when someone goes into a care home, they have to pay – and no one at the hospital has suggested anything to the contrary.

She knows her father can’t go home at this point and, because she wants him to be safe and can see he’s not being cared for appropriately in hospital, she agrees to find a care home. She succumbs to Social Service’s insistence on having evidence of Arthur’s financial situation, and she agrees to start paying for care in a care home.

Now that the hospital can effectively close their current files on Arthur, his daughter is even less likely to be given any accurate information about care fees and care funding. Arthur will simply continue to pay for what is, in his case, essentially healthcare and nursing care.

Access to NHS services in a care home

Once he’s in the care home, Arthur cannot easily access the key NHS healthcare services in the same way that Peter could – it’s harder to see a GP that actually knows him, he can no longer see a nurse at his local surgery and he will now also almost certainly be told to pay for physiotherapy. The care home will be in charge of this, deciding what he will have and when he might get to see a GP.

There may of course be nursing care provided in the care home. Is he charged for this? Yes.

For Arthur, healthcare and nursing care is no longer free (aside from a small weekly nursing benefit (Funded Nursing Care) that is paid directly to the care home, not to Arthur – but that doesn’t stretch nearly enough to cover the actual cost of his nursing care). Also, it seems increasingly likely that care home residents may have to pay to see a GP – and yet Peter doesn’t have to pay.

So what happened to the free healthcare that everyone else is entitled to?

Peter didn’t need full time care and yet Arthur does – so it perhaps it’s for this reason that Arthur’s finds himself in this situation. But Arthur has greater healthcare needs than Peter. And if care homes didn’t exist, Arthur would be in hospital receiving care provided free of charge by the NHS.

So what’s the difference between Peter and Arthur? One thing: their age.

When you get older and need care, one thing is absolutely guaranteed: You will be asked how much money you have before you’re asked anything else.

Arthur will now lose his savings, his home and everything he’s worked for to pay for care that should arguably be provided by the NHS. Indeed, in law, he should not be asked about his money before the NHS and local authority have looked properly at his care needs FIRST.

So on what basis should the NHS pay for care?

Let’s continue the story…

Arthur’s daughter continues to visit her father and manage the payments to the care home. She puts her father’s house up for sale, and gradually realises that very soon everything will be gone. She also knows that the proposed caps on care fees (due to come into effect in 2020) will actually make little difference to her father.

Then one day she happens to read something about NHS Continuing Healthcare funding for people in full time care – where those people have health needs. She looks into it and realises that, right at the outset, her father should have had an assessment for Continuing Healthcare in hospital before anyone did any kind of financial assessment for care.

And because Arthur is ‘self-funding’ (the ridiculous phrase used to describe someone forced to pay for care), no one in the local authority or the NHS is likely to be proactive in helping his daughter, because they have closed their files. She’s on her own trying to figure out what’s right and what’s not.

After doing some digging, she later finds out that an initial Checklist assessment for Continuing Care funding was in fact done at the hospital, but that she was kept out of the loop and the assessor simply rendered her father ‘ineligible’ for funding.

As her father’s power of attorney she should have been fully involved in the assessment and should have had the opportunity to give the assessor full information about her father’s health and care needs. In addition, the local authority’s (Social Services) primary focus should have been to assess care needs, not Arthur’s money. The local authority could now be in an illegal position.

Arthur’s daughter is now realising just how much incorrect information about care fees she’s been given by the various health and social care authorities, and that no one seems to be on her side.

Getting reassessed for NHS Continuing Healthcare

So now she also faces the battle of getting her father properly assessed for NHS Continuing Healthcare funding, making a retrospective claim to get back care fees he’s already paid and arguing at every turn with assessors – who are the same people who hold the purse strings.

This will be time-consuming, things will probably not be done correctly, the assessors may be unfamiliar with her father’s needs and with the legal framework in within which assessments must be carried out, and the care home may not be helpful as they will receive less money per week from the NHS should Arthur secure funding.

Plus, Arthur’s daughter will now incur her own significant time costs and expenses on her father’s behalf in a bid to get things done properly, and if she wants to get those costs back she will probably have to take legal action.

It’s an appalling situation.

And yet this is what happens every single day to families in the UK when an older relative needs full time care.

Social Services are usually the first point of contact that a family has with the health and care authorities. But Social Services are part of the local authority or local council… and local authority care is means tested. And so the problems start right at the outset.

And if the family asks about NHS funding, they will almost certainly be told they ‘won’t get it’ – and they’ll be given one of these 7 most outrageous reasons for not receiving a Continuing Care assessment.

So if you have an older relative needing full time care (or already in full time care and paying care fees), make sure they are properly (re)assessed for NHS Continuing Healthcare funding. This assessment should happen before they leave hospital, and it should happen before they start paying for care.

Case study: Getting assessed for NHS Continuing Healthcare before you leave hospital

Have you experienced the same situation?

February 24, 2013/25 Comments/by Care To Be Different

Hospitals

5 things to check before your relative is discharged from hospital

Many families report that their older relatives are often forced out of hospital and into long term care – or back home – before proper health needs and funding assessments have been carried out and before suitable care provision has been put in place.

If a hospital decides someone no longer has ‘acute’ health needs, it will want to hand the person over to the local authority as quickly as possible – and will often put pressure on the local authority (and on you as the next of kin) to get the person discharged.

If you have an elderly relative in hospital and you’re being pressured into finding a care home for them – or the discharge team are threatening to find one for you – follow these tips:

1. Your relative should be assessed for NHS Continuing Healthcare funding before they’re discharged. This is NHS funding and it covers 100% of the costs of ongoing full-time care if you need it primarily for health reasons, i.e. you have what’s called a Primary Health Need. Many people are discharged without this assessment having been done – effectively forcing them to pay for care before it has been properly established that they need to.

2. Make sure the hospital knows you want to attend all assessments. If you have power of attorney for your relative, this should be straightforward. If you don’t, but your relative still has mental capacity to give consent to you being their representative, this should also be reasonably straightforward. If you don’t have power of attorney or consent, it can be more difficult to get to see assessment notes – but always ask. You don’t have to tell the hospital that you don’t have power of attorney. It’s up to them to ask you.

3. Make the Discharge Team aware that you know about NHS Continuing Healthcare funding. Also, make sure you have been given the opportunity to attend these assessments and appeal any flaws in the process that has been used – before your relative is discharged. Once the Discharge Team is aware of your knowledge, they may stop pressurising you so much. Without this process being complete, no reliable decision can possibly be made about who is actually responsible for paying for care.

4. At the point where the hospital decides your relative is no longer their responsibility, the hospital will issue a ‘Section 2 notice’; this is effectively a notice to Social Services that the hospital is handing over responsibility for your relative’s care to the local authority. However, if your relative needs ongoing care for health reasons, this handover should only be done after a proper assessment for NHS Continuing Healthcare funding has been carried out.

5. Once your relative is ready to be discharged from hospital, make sure that on the day of discharge they are still properly cared for – and not left in a Discharge Lounge for hours. (We do hear of this happening.) Your relative should be properly dressed and fed, given enough drinks, and have any continence needs addressed throughout. Just because the hospital may want to free up their bed in the morning, doesn’t mean the NHS can wash its hands of responsibility for care while your relative is still on the premises.

May 10, 2012/97 Comments/by Care To Be Different

Hospitals

Malnutrition in hospitals: Elderly still denied care

Last week’s Channel 4 news report about Ken Rasheed, an 80-year-old man with Parkinson’s Disease, once again brings shame and disgrace on the way our hospitals and ‘health’care system treat elderly people.

It would seem that little has changed since the Health Service Ombudsman’s shocking report at the start of this year, which exposed many cases of elderly people dying of malnutrition and dehydration in UK hospitals.

The hospital in Ken Rasheed’s case states that “errors” were made and that treatment was “not in accordance with best practice”.

These words ring empty for anyone who has witnessed the demise of someone they love at the hands of a system that not only does not understand the importance of nutrition and hydration but creates such neglectful attitudes amongst staff. Shouting at a patient and not taking any account of a Parkinson’s patient’s difficulty swallowing is hardly an ‘error’.

Health care system is out of date

Aside from the less than ideal attitudes of some staff, reports like this also flag up some insane aspects of ‘health’care that are so engrained in our current system that they are rarely ever questioned:

If carers and nursing staff are not trained in understanding the key challenges people with Parkinson’s, stroke, multiple sclerosis and other neurological diseases have, then surely we are failing both staff and patients alike at a fundamental level
The malnutrition screening tools used in hospitals and care homes that measure nutritional risk primarily in terms of calories and weight are misguided. They ignore the need for specific vital nutrients and do nothing to improve health. The stubborn focus on the traditional ‘5 food groups’ is equally out of date.
The Care Quality Commission is reporting on “whether older people are treated with respect and whether they get food and drink that meets their needs”. However, the physical act of feeding a patient is largely irrelevant if they’re not being fed the nutrients they need to sustain life.

If I had kept my own father at home without proper nourishment until he died of starvation and dehydration, I would almost certainly have been charged with neglect or manslaughter at the very least, and I would no doubt end up in prison. And yet if this happens in a hospital of all places, it’s allowed to continue as part of the system – and nobody is held to account in the same way. The care system and the people working in it, whose actions are those of neglect, seem to be above the law.

Until we put nutritional and physical therapists in charge of care – ones who have been trained outside the closed-minded drugs-for-every-symptom approach, it’s hard to see how care for our elderly people will ever really improve.

September 11, 2011/2 Comments/by Care To Be Different

Hospitals

Dehydration: Why are elderly people still dying of thirst?

The journal, Nursing Times, has recently reported on the dangers to patients of dehydration and the subsequent cost to the NHS…

It quotes some shameful statistics in terms of cost – not least, the needless suffering of patients denied vital water for life.

According to the magazine:

Proper hydration alone could lead to savings of £0.95 billion.
Pressure ulcers (made far worse by dehydration) costs £1.4-2.1bn
Falls cost £15m – and falls are a well-known symptom of dehydration
Malnutrition costs £7.3bn
Urinary tract infections (very common amongst older people in hospital and in care homes) account for 798,000 bed days – and even back in the 1990s were thought to cost £124m
Constipation accounts for 135,273 bed days

It’s staggering that, in 2011, a mainstream journal still has to put out such an obvious message: that water is essential for life and health. And yet it’s a message that clearly needs to be heard, so full credit to Nursing Times for addressing it.

Many people in hospital, particularly elderly people, would become well – or at least a whole lot better – with two blindingly obvious things: water and nutrients.

Dehydration is never going to be ‘cured by drugs. It’s cured by water. And malnutrition is only ever reversed by nutrients. How long will it take for mainstream medical training to detach itself from its outdated drugs-based, side-effect-laden thinking and teach people the basics of health? Whatever happened to the Hippocratic Oath?

As well as the above costs, deydration also leads to mental confusion, weakness and frailty, poor mobility, infections, broken bones, a greater need for full-time care. And, of course, dehydration ultimately leads to death.

If the ‘health’ service needs to save money, then providing something as basic as water – and nourishing people back to health – is surely one of the easiest things to do.

June 20, 2011/0 Comments/by Care To Be Different

Hospitals

UK hospitals – neglect in elderly care

A recent report by the Health Service Ombudsman, Ann Abraham, details the appalling and shameful neglect of elderly patients in UK hospitals.

Although the report is new, the scandalous lack of care is not. It has been going on for years.

The Ombudsman’s report details the specific cases of 10 elderly patients who died after being admitted to NHS hospitals. The report confirms that the NHS did not even meet the most basic standards of care.

Callous neglect

Elderly patients are left without food or water, wounds left open and dressings unchanged, patients are unwashed, there is woefully inadequate toileting leaving people soaked in urine or lying in faeces, lack of pain relief, incorrect medication, people left on the floor after falling, and so on.

This article in the Daily Telegraph outlines this “callous treatment of the elderly” and shows what many families have known and complained about for years.

Established hospital discharge procedures are also regularly flouted, leaving elderly patients trapped in the blame game between the NHS and Social Services, left for hours without attention and sent home in an appalling state. One NHS Trust in Merseyside is now also threatening to use anti-trespass laws and court orders to force patients out – to free up beds.

Indifference such as this in the NHS is tantamount to euthanasia – and yet not one single member of staff in any of the hospitals concerned has been sacked or even disciplined. These are surely cases of manslaughter at the very least.

Skewed priorities and lack of accountability

When my mother had a stroke several years ago, she was taken to an ‘Observation’ ward in hospital. Her food was left at the bottom of her bed and she had no access to water. Perhaps staff were planning to simply ‘observe’ her death. I asked a doctor where I could get water for her. He replied that he didn’t know “because he was a doctor”.

It doesn’t take any nursing or medical training to know that food and water are the most vital elements of life. It would seem from his response that common sense is ‘trained out’ of our medical and nursing students.

Whatever happened to the Hippocratic Oath? And why are we paying high salaries to doctors when the training we give them teaches them nothing about sustainable health and people are worse off in their ‘care’?

Where is the Health & Safety Executive when it comes to the safety of patients?

And where is the Human Rights Act in action?

The NHS’s stated principles about human rights, quality of care and respect for patients are empty words.

Soft target

We treat and fund our criminals better than we do our elderly people. It’s not always easy for elderly patients to stand up for themselves and fight back. They are an easy target for sloppy treatment and complacency.

In 2010 alone the Ombudsman received 9,000 complaints about NHS care, with nearly 20% about elderly patients.

If doctors and nurses don’t regard water and food and keeping patients free of bedsores part of their jobs, it fuels the ridiculous notion that health care and social care are two separate things. All the high-tech medical ‘intervention’ in the world will not keep someone alive if they’re dying of thirst or starvation.

Excuses

As this BBC report shows, Nigel Edwards, chief executive of the NHS Confederation, added insult to injury when he confirmed that the lack of care outlined in the Ombudsman’s report was “completely unacceptable”, but then implied that the 10 cases it highlighted must be seen in perspective, given the number of patients the NHS sees every day.

What he chooses to ignore here is that, although the Ombudsman’s report highlights just 10 cases, the Ombudsman has looked at 228 cases in this instance – and this is out of the thousands of complaints submitted over the past few years.

New hospital inspections

In response to the Ombudsman’s report, the Care Quality Commission’s (CQC) plans to carry out unannounced inspections at 100 hospitals from the beginning of March. Anaesthesia UK reports the move here.

It remains to be seen what impact, if any, the inspections will have. If they’re anything like the routine inspections of care homes, they may simply be box-ticking exercises and have no relevance to the real welfare and hour-by-hour treatment (or lack of) experienced by an elderly patient.

February 22, 2011/3 Comments/by Care To Be Different

Hospitals

Hospitals and elderly people

Going into hospital can be daunting for elderly people – and it’s vital to be aware of the risks

When an elderly person goes into hospital it’s often at a crisis point – perhaps after a bad fall or during an acute decline in health. The care that older people receive is, sadly, not always as good as it should be.

If your relative is currently in hospital, you may be coming under increasing pressure to get them out and into a care home. However, the correct NHS Continuing Care assessments may not have been done. Make sure the assessment process is complete before being discharged from NHS care.

Holistic care?

A holistic approach to elderly care is vital, and yet many families report that there seems to be little joined-up thinking in the care system, particularly in hospitals.

Elderly people usually have several overlapping health needs, and treating one problem in isolation simply causes other aspects of health to deteriorate.

Elderly people are vulnerable and can quickly become dehydrated and malnourished. It’s also not uncommon to hear about people sustaining broken bones falling out of bed in hospital.

Such a disjointed approach not only causes untold distress to the patient and their family, but also wastes millions of pounds of tax-payers’ money – every day – in preventable re-admissions and ongoing problems.

Hospital discharge process

If you’re under pressure to get your relative out of hospital and into full time care, make sure the proper health needs and funding assessments have been done first. If your relative needs ongoing full time care you will almost certainly be told they have to pay for it. This may not be true. Read the articles on our blog about the hospital discharge process and Continuing Care assessments.

Many elderly people go from hospital straight into a care home, and yet families often receive very little information or guidance about how to choose the right care home for their relative.

That’s why we’ve put together this practial guides to help you:

How To Choose A Care Home

This 39-page practical guide helps you ask the right questios when you’re looking for a care home. It means you make a better decision, you save a lot of time – and you avoid unnecessary care costs later on. Read more..

July 18, 2010/19 Comments/by Care To Be Different