Discharged from hospital?
To incentivise quicker hospital discharge, the Government has put in place a COVID discharge funding scheme to help patients going into care.
Did you know that, from 1st September 2020, if you (or your relative) are discharged from hospital into a care or nursing home, and require a new or additional package of care, you are entitled to receive free NHS funding for the first 6 weeks of your care, or until such later date as your long-term care needs have been assessed and the outcome is notified to you?
In the meantime, until the assessment has taken place and you have been informed of the outcome decision, your local Clinical Commissioning Group (or Local Authority) are obliged to continue paying for your care from their own resources and you should not be asked to pay a penny.
For more information, read our blogs:
Are you ready for 1st September 2020? CHC Funding Gets Back to Business
Read this if your relative is about to be discharged into a care or nursing home
Part 1. Explaining The Vital Difference Between Social Needs vs Healthcare Needs
This pot of available funding is not widely known nor volunteered, and unless you happen to chance upon it, there’s a real likelihood that you could be paying for your first 6 weeks in a care home, quite unnecessarily.
We applaud the BBC Radio 4 programme, ‘You and Yours’ dated 4th November 2020 for highlighting this specific issue on their excellent radio programme.
We also wanted to make special mention and thank ‘Caroline’ who called into the programme to share her story and for specifically mentioning Care To Be Different. She had no idea about the Government’s COVID discharge fund until she got in touch with us. We are pleased to hear that she found our services and information helpful.
Here’s our transcript of the interview slot in case you missed it. You can read about Caroline’s issue and the lack of transparency and public awareness of the COVID discharge fund. We have tried our best to portray the interview verbatim. You also can listen to it via this link (for as long as it is available): https://www.bbc.co.uk/sounds/play/m000p1gl
Presenter (Winifred Robinson): “The NHS is needlessly adding to families’ emotional and financial burden by refusing to fully fund the care of people who qualify for that funding. That is the key finding of a report published today by the official body that investigates complaints. If this story sounds familiar to you, it’s because it is. Wrongly denying very sick people discharged from hospital free, NHS Continuing Care has been going on now for years and years. Here at ‘You and Yours, listeners email us about it regularly. Caroline got in touch with us only last Thursday from Sussex, to tell us about her mum.
Caroline: “Well she’s got Dementia. She’s been in a residential home and she had a fall broke her leg and elbow and was taken to hospital. At the hospital, they said that she couldn’t go back to her residential home because she would need the care of two, and so we would have to be looking for a Dementia nursing home, and of course, the nursing care is almost double what a residential home is. To be honest, we’re right at the end of funding. Mum’s house has gone, the savings have gone, and I was panicking a lot to be honest. We found the home, paid them four weeks of respite which is £5,500, and then I thought I’m going to get in touch with Dementia UK and find out about continuing health care and whether she would, you know, qualify for it now. And they put me in contact with a company called Care To Be Different. They said, she’s entitled to what’s something called Covid discharge arrangement, and I said, sorry I don’t know what you’re talking about, and they said, basically it’s a national government directive and whereby, an elderly person, if they are discharged from hospital to a nursing home, they are entitled to up to the first six weeks of fees, and you know the CCG will pay them. And I haven’t been told this at all. None of the Department bodies that I dealt with at the hospital, you know the social services, the hospital discharge or any of them, had said anything about this.”
Presenter: “Rob Behrens is the Parliamentary and Health Service Ombudsman*, an independent arbitrator, he is the author of today’s report. Rob Behrens, our listener, Caroline, has been told by a care company [sic Care To Be Different] that her mum and anyone else discharged from hospital to a nursing home in England in the pandemic, is entitled to six weeks of NHS Continuing Care. Is that your understanding?”
RB: “Well, first of all I want to say how sorry I am to hear about the distress Caroline and her mother have been through – that’s not untypical. We’re talking about fundamental rights here, and the absence of them in this case. Yes, the government has put in place special arrangements during the pandemic, which at the moment means that, anyone discharged from hospital into a nursing home will have the first six weeks of their care paid for – to allow ongoing care arrangements and a full continuing health care assessment to take place. Now, one of the issues here is finding out what you can have access to, and I suggest that anyone listening goes onto a number of websites which spell it out very clearly… Beacon is one, Voiceability, Age UK, Parkinson’s UK – spell it out. Now, I’m not defending the absence of Caroline being told this by the authorities, but you know, you have to do what you can in a crisis situation.”
Presenter: “Rob, well we spent ages this morning, our team, looking at government guidelines, pages and pages and pages of them, and I couldn’t find it clearly spelt out in any of those guidelines. I mean these rules are complex, and it feels as if officialdom, from top to toe, make them as a opaque as they can.”
RB: “Well, there is a big issue here. I mean continuing healthcare has been a challenge for a long time, as I think you know, and it is very complicated in order to meet needs, and it’s a complicated process. It involves a number of agencies, supposedly working together; it requires professionalism on the frontline, and if people are not communicated to during a time of personal crisis and told what their rights are, they’re not going to easily find out. So, I think you’re absolutely right, and the NHS needs to sit up and take notice of what you’ve just said and what is clear in in my full report.”
Presenter: “I can remember this story on ‘You and Yours’ when I first joined the team, and that was 20 years ago, and I can remember MPs calling NHS Continuing Care, and I’m quoting now, “The best kept secret in the NHS.” What do you recommend should happen now?”
RB: “Well, I think first of all, I should pay tribute to what You and Yours have done to run with this issue and that’s unusual and very important. Secondly, we have laid this report, which I commend to your listeners to read, before Parliament and its Select Committees, to make sure that the NHS gives an account of what it’s doing and what changes it’s going to make as far as the recommendations, and the failures that that we’ve talked about. But, remember that the Ombudsman has no binding power to force a change under our current law, so we are dependent upon Parliament raising the issue in a way that forces the NHS to act.”
Presenter: “Do you think it’s really just a case of the NHS and the government rationing what funds there are?”
RB: “I think there are a lot of problems. On the basis of a very comprehensive study that we’ve done – we looked at over 300 decisions which we’ve made in the last two years – that’s a lot of cases – where we did 150 full investigations. I’m not able to say… I say a lot of things about failures, but I’m not able to say that it’s a result of financial rationing which has led to these issues. There are many other issues as well. Though, I accept, as I’m sure you’re aware, that the health service is going through unprecedented challenges at the moment and that doesn’t make it any easier.”
Presenter: “We asked NHS England if they’d like to come on the program but they said they couldn’t do that today, but they did say they look at the recommendations that you have set out, together with local health groups and the government who currently set the guidance on eligibility, and they also say, those who are concerned, can request an independent appeal review. How easy is that?”
RB: “Well, I mean it goes back to your point that these issues are not easily articulated. It’s difficult to find out about them. It’s quite hard to get from where the assessment is made to the Ombudsman’s office and increasingly smaller numbers of people go through the process. So, one of the key things, and I think there are two issues here – one of the key things is that the NHS needs to do a lot more to make this system understandable to users and to advocates who help the users. And secondly, Parliament has to call to account those who have responsibility for this through the Select Committee system to ensure that they give an account for what they’re doing. We have asked for the government to give a response within six months of what it’s doing in response to my report, and that is sensitively taking account of the current crisis. So, you know, there’s plenty of time for them to act on this and it’s up to Parliament to make sure that they do.”
Presenter: “I’m sure we will have you back, but people can complain to you, can’t they, when they feel they have been wrongly denied NHS Continuing Care? What proportion of cases do you uphold?”
RB: “Well, we get around between 500 and 800 complaints about this issue every year. We have a special team dealing with continuing healthcare because it’s complicated and it needs expert advice. Not everything that we receive is eligible, because you have to go through the frontline body first before you can make a complaint to us. But, we’re upholding around a third of the full investigations that we hold and there are significant failures which we’ve discovered, including two people losing £250,000 each as a result of the failures of the system.”
*Parliamentary and Health Service Ombudsman – “The Ombudsman’s role is to investigate complaints that individuals have been treated unfairly or have received poor service from government departments and other public organisations and the NHS in England.” Visit: https://www.ombudsman.org.uk/making-complaint
Summary:
Thanks to the BBC ‘You and Yours’ and to Caroline for featuring this issue and bringing it to the public’s attention.
If you want to make a complaint, you must first exhaust the CCG’s own complaint procedure. For more information, see: https://www.ombudsman.org.uk/about-us/who-we-are/the-ombudsman.
For more information, take a look at these blogs:
Rationing NHS Continuing Healthcare Funding – The ‘NHS’s Best Kept Secret’
Essential Preparation and Planning As CCGs Restart Assessments and Appeals From 01/09/2020
You, too, can spread the word and tell others about their entitlement to first 6 weeks’ free care upon discharge from hospital to a care facility. Let us know if, like Caroline, you were unaware of this available funding, and what you did about it when you did find out. Did you get reimbursed, and how long did it take?
Leave a comment below if you want to contribute to the debate…
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My mum is waiting to be discharged but all the half decent homes are insisting the family pay a top up of £200 per week? Is this right do we have to pay?
Thought I’d add some good news, in that my mother is about to be discharged to a care home after a specialist unit stay here in Lincolnshire and they have mentioned the 6 week payment on a number of occasions, without any prompting, so the NHS has either got the message or this particular NHS facility is very good at their job.
My husband has just been awarded chc this was done with records video calls and phone because of covid 19
I first asked about chc in March this year when he came out of a rehab hospital after suffering a stroke and his vascular dementia escalating and UTIs with catheter problems was then back in hospital where after an operation I mentioned it again as he had to be hoisted as his core had gone ( through lack of physio) so could not stand even with a mechanical device still nothing he desperately wanted to come home but needed a large package of care but a week before lockdown I got him home as this care package was means tested I only had to pay 53 pounds a week. My hubby is 76 and I am 70 I had cared for him for 13 years with no help as we managed between us and are very proud but his diagnosis of vascular dementia in August 2019 knocked us for six.with the care package in place it was not really working properly as his dementia got worse not helped by numerous visits to hospital with catheter problems antibiotics and anesthetics so in October this year eluctantly I realised we both needed some respite I was not handling his dementia very well and did not recognise this person I was caring for as my lovely husband he looked like him but the vile and hurtful things coming out of his mouth were so hurtful.
It was all done in a big of a rush as he had got frustrated and scratched all my face and drawn blood.
I took him to the home myself as I could walk there when visiting how nieve was I. I had to leave him in a small reception was told he would be isolated for two weeks which had I known before hand I would have kept him home, within just over a week he was taken to hospital in the early hours no one from the home went with him he has non capacity no one called me I have power of attorney so he went in to have his superpubic catheter put back in and came out with a urethral why he was able to do that I do not know as he had 24/7 care for the first five days in his nursing room no p e could tell me at the time why this had been done.
He then had a very nasty infection and was admitted again very poorly came out after 5 days isolated again then a staff member took in covid so another period of isolation then in hospital again for 5 days infection again isolation again this time I asked the hospital to let him come home to me as I had POA and was trying to get private care but they sent him back to the home without my permission I was devastated as he had deteriorated so badly from when he went in weight loss couldn’t feed himself or hold his drinking cup it was his birthday on the 27th November I asked them to video call me so I could wish him happy birthday but I waited all day and they never called I have had two proper video calls yesterday and Saturday but he does not say anything he is a shadow of himself i hope it isn’t too late to try and get a little something of him back as i have got him home tomorrow and I had confirmation Saturday he had chc which was a big surprise as they only did the decision tool last week so it has been a long journey but the stress it has caused to get to this point has been unbelievable I feel I have been fighting the system to get the care my husband deserves as there have been many mistakes made which my husband did not deserve and which deprived us of our retirement after working all our lives.
So anyone out there don’t despair its sites like this one who get you there in the end and unless these politicians have gone through these traumas with family,y and friends they haven’t got clue
My mother-in-law moved to an assisted living facility in February 2020. She is 94 and made the move as she had first signs of dementia and could no longer manage her own house. She wanted to be closer to us, her only family, in London. She owns 25% of her 1 bedroom apartment and pays supplementary rent . When she first moved, she paid for a basic care package involving two or three carer checks a day. When Covid struck and we were not allowed to visit her, her dementia increased considerably. On September 11th she fell and broke her hip. She was discharged from hospital on 30th September, but then required a much larger care package, involving night time visits. This care is available in her building but is charged at an hourly rate. We cannot contribute to her care or well-being as we aren’t allowed in the building. Does her post-hospital care qualify for Covid Discharge Arrangements? If so, to whom should we apply? (We have power of attorney).
Hi Lyn – Many thanks for sharing this. The hospital should have discussed all of this with you when your Mum was discharged. I would suggest you make contact with the discharge team and ask why it was not put in place. Kind regards
My Mother in Law who is 91 went into hospital nearly 3 weeks ago and was tested positive for COVID. She has undiagnosed dementia ( the mental capacity assessment was due to take place but then she became unwell), severe arthritis in her hands and her mobility was dependant on a Zimmer frame, she was transferred from hospital ( the COVID didn’t present any symptoms) to a care home rehabilitation centre after approx 9 days in hospital for her mobility as it had worsened. She is being discharged from the rehabilitation today so we have been frantically searching around for a care home that deals with Dementia. My husband, her son, has mentioned the chc process to doctors, nurses, occupational therapists etc from the very beginning but kept being passed from pillar to post. Persisting he eventually spoke with a lady from the CHG, who from the off said, although she hasn’t met his mom, she has seen the reports about her and said she wouldn’t qualify, plus the matter is so time consuming and a waste of resources if they are not going to qualify! My husband basically said we still have the right for a referral and want to proceed with the matter. It was by chance that I came across this 6 weeks free care yesterday and she is being discharged today, ( the decision has been made by her family she is not able to live in her own home anymore so only having been told about her discharge this Monday, I think, we have been frantically trying to think of ways to deal with this situation with no guidance from the NHS as such, the home visit was cancelled, so it has been decided to have her transferred with the existing care home on a temporary basis until something permanent can be arranged. They said this is going to cost £950 per week and they want the full month paid up front. My Sister in law, Sarah, spoke with her moms social worker yesterday and was told she is not entitled to it! Sarah has asked him to refer to his manager and she is insisting insisting that she her mom is
….watch this space! This has been a minefield so far and it’s only been 3 weeks!!!
Hi Maxine – many thanks for sharing this. We do offer 1:1 support if required. Please feel free to call us on 0161 979 0430 Kind regards
Thank you so much for your reply. Sarah persisted after being told mom was not entitled to this, or indeed they weren’t aware of it! eventually late Friday afternoon she obtained a letter from Adult Care and Support Directorate – headed ‘ Charging for social care services’ stating – social care services are chargeable services but during the response period to COVID – 19 from 1/9 to 31st March the government has agreed to fully fund the cost of new or increased out of hospital health and social care support services for a period of up to 6 weeks. This is to enable long term plans to be put in place. Then the letter goes on about assessments and capital savings over £23,250 etc. It was a battle to get this letter but now Sarah has to speak with them on Monday for more details on how this operates. Meanwhile we were told mom was going to be transferred to the care home yesterday, but she is still in the rehabilitation bed! We presume it’s because the care home weren’t paid the £4600 they requested upfront for the temporary month, while care was sourced! I have ordered your book re the care homes and we will be looking into that as soon as. We do envisage many obstacles re the CHC and Simon has left a message with Beacon so that he can ask for their advice and potentially instruct if need be. This is a minefield, not one of these professionals have provided any advice pertaining to the CHC or free hospital provisions for six weeks. It’s only due to trawling the internet and finding fabulous sites like yours that we are aware. You have been a god send and like I said we are just about to go into week 3 and have hit many obstacles already. Let battle commence!
Hi Maxine. Thanks for sharing this. Don’t forget we can offer some 1:1 support if required. Don’t hesitate to contact us. Kind regards
Hi Maxine. Thank you for sharing this. We are able to offer you 1:1 support if required. Please feel free to call us on 0161 979 0430. Kind regards
Hello Maxine,
It is a minefield!, but you have the tenacity and determination to get a CHC checklist done for your MIL. I urge you to download the National Framework for CHC and read it thoroughly. How on earth can you challenge this process if your CCG refuse to do the initial screening? The people you have spoken to from either CCG or Social Services are fobbing you off, in the hope that you’ll give up and accept that your MIL isn’t eligible. No one can know if your MIL is eligible unless the checklist has been completed and you have seen it! I had exactly the same thing happen to me and my late father, when he was in hospital. I repeatedly asked for the checklist and was repeatedly ignored. The checklist was eventually completed months later by a “bank nurse” who had little knowledge of my father’s condition/deterioration. Once I received notification from my CCG, that my father had not passed the screening, I was able to then initiate the challenge/Appeal. A further checklist was completed within days by a registered nurse treating my father and you’ve guessed it, he was eligible! But this is only the beginning of a very long winded process.
After an eligible checklist, comes the full assessment using the Decision Support Tool.
The process is overwhelming to start with, but trust me, if you have the time and you are used to dealing with paperwork, it is possible to deal with it yourselves.
After all, you and your husband know everything about your MIL’s health and care needs.
Make sure as your MIL’s attorney that you are fully informed of the process. Don’t let them organize assessments/meeting without being present…..there’s no excusing because of the pandemic……they should make it possible through digital means.
Keep the pressure on them and inform them they are denying your MIL the right to a CHC checklist. They have a duty to do this, it’s not their decision to make!
Good Luck!
Hello Michelle,
Well Sarah and Simon had the 6 week discharge call with the social worker and Occ. Therapist and MIL is going to be funded for up to 6 weeks of free care. Sarah is looking at sourcing care homes sharpish and the social worker will be checking in every 2 days for updates as they got to be seen to be actively seeking a home. Simon mentioned the chc process and the social worker said straight off mil isn’t eligible as there are 3 stages ( according to him) Red, Amber and Green and apparently she falls in the green category so doesn’t qualify and the nursing staff should have rung and told him by now. We haven’t heard anything from anybody. Obviously Simon said she is entitled to a proper assessment and nobody has done this yet and he wants it done properly! So Simon has chased the lady at the chc but she is now on leave until mid December so he has asked for someone e,set to call him back ( they probably won’t so more chasing will be done ). Simon has still not received a call back from Beacon so will be chasing them also…..oh the joys!
I will look to getting the national framework printed off and go through it..thank you.
Maxine
Hi Maxine – you can always contact us for help. Please email enquiries@caretobedifferent.co.uk Kind regards
Hello Maxine,
I read your 2nd post and was compelled to reply back. Well done for standing your ground so far! It’s good that you have the help of your brother and sister in law as this process can take its toll on your mental health.
In terms of what the Social Worker is telling you about your MIL not beIng eligible….you need to ask for a copy of the checklist that has been completed that has screened her out of CHC.
I have heard of the traffic light system but I have not encountered it anywhere in the National Framework for CHC……so my initial reaction was the Social Worker IS NOT applying the process transparently and is fobbing you off! Without the Checklist being completed by someone who knows and is qualified to assess your MIL’s healthcare needs, then no one can know if your loved one is eligible or not at this early stage. Even with the pandemic the process has not changed and don’t let anyone tell you otherwise! Yes there are going to be delays in the administration but your MIL is entitled to have this process started. It’s such a simple screening tool, but if it’s not completed then it’s stalemate. You can’t move forward! You can’t enter into the process unless you can force them to do a checklist. Keep at them and keep asking to see the CHC paperwork.
I urge to read as much as you can on CTBD.
This is by far the best website for information and support and if you are considering asking for legal help, then I would only recommend Andrew and his team at FarleyDwek. Care to be Different is FarleyDwek! I have spoken to them once or twice and would have no hesitation in using them should I have to in the future.
However! If you do choose to get representation then if your case is successful you will NOT be able to claim any legal fees back. This could amount to thousands and thousands.
I was able to successfully recover my late fathers fees, but at a cost to my own health.
If I were you, at this early point in the process I would push on and Demand that your MIL has a checklist completed. You will then know what you are up against and whether you consider fighting on. You will need to get to grips with what a Primary Healthcare need is! In other words if your mums daily needs are overwhelming for health reasons then she will qualify.
God Luck!
A friend was discharged from hospital in August, was Fast Tracked and granted Continuing Healthcare and transferred to a care home. The discharge indicated a terminal condition and stated life expectancy was 3 months. A re assessment took place in September (6 weeks after discharge), the result of which is he is now deemed stable and is not entitled to Continuing HC. Are they using the Covid legislation to assess after 6 weeks just because his discharge fell during Covid?
. The Framework seems to indicate an assessment should only take place after 3 months.
Hi Daniel, I’m sorry about your friends deteriorating health and diagnosis.
You are right to question the removal of CHC funding following the Fast Track having been granted. I found myself in exactly the same circumstances with my late father.
I would urge you to read the national framework and familiarise yourself with with the rules! Your particular CCG should have robust reasons for withdrawing this element of funding especially as the discharge from hospital gives a terminal diagnosis. There should have been a review with family and professionals involved in the process before the funding was withdrawn! More importantly your friends representatives should have been informed of the process of appeal! The issues of Covid, have impacted on the administration of CHC but as far as I know the NHS CHC regulations regarding eligibility remain the same. I would urge your friends representatives to challenge what has happened! Just because your friend didn’t die within 6 weeks does not mean that eligibility is immediately withdrawn without evidencing that person does or doesn’t have a primary healthcare need! Good Luck.
A couple of years ago my Mum was discharged from hospital to a care home. At no time did anybody mention the 6 weeks free care. Is it too late to claim it back now? Thanks.
Hi Pat – this has only been introduced this year by the Covid Legislation as a result of the pandemic. Kind regards