Third Party Top Up

[JPG1]

I'm not sure if there's a smiley for "sticking neck out" but no doubt someone will tell me if there is.

My guess, Elaine, is that the PCTs are under the SHAs who are under the DoH which is under the .... PM! Along the lines of the hip bone's connected to the ... and so on.

But as there is no declared 'external supervision' of PM and Government, then I guess there may well be no similar reviewing system for PCTs.

I have been told that PCTs are now all going to change their names, because nobody (meaning general public) understands what a Primary Care Trust means or does. So they are now going to become NHS Trusts.

But that doesn't answer your question, does it.

Answer is : no idea!!

But I wish that an external supervision system existed for assessment wards. I really do, but only based on my own experience, and I realise that those of us who have experience of them may have both good and bad experiences, depending on where those assessment wards may be.

Interesting question there.

.

 

[ella24]

another idea - would it be escalated to PALs? Patient Advice and Liason Services

http://www.dh.gov.uk/en/Managingyou...nt/Patientadviceandliaisonservices/DH_4081305

 

[jenniferpa]

I do think PALS can be very variable - I had a great deal of success using them but I know other people have described them as a waste of space (or worse). It all seems to come down to the specific hospital. I don't think they could be described as independent though.

 

[Brucie]

I do think PALS can be very variable

As I said in the masons thread - often it comes down to individuals.

Good, capable people can make a service work well, even under difficult circumstances.

Bad, incompetent people can make a service rubbish, even under the best of circumstances.

Communication skills, attitude, ability, wish to help, likeability..... all are critical. I think they are either there from birth, or can be learned through experience. I'm not sure they can be taught, necessarily.

....just my thoughts

 

[connie]

My twopennyworth here.

I placed Lionel into care when he could no longer be managed by one person at home 24/7. As he had some monies he had to be self funding. At that stage he would not have met the strict criteria for Continuing Care.

However dementia, of any sort, is a deteriorating condition. When I deemed that he had gone down markedly I asked for an assessment through his CPN.

The assessment was done at the care home, the records of the home playing a great part, and of course, my input. Never an easy time, but not being in either an assessment unit, or nursing home, should not be a barrier.

We were successful, despite warnings from all and sundry that we did not stand a chance.

Facts, reasonably presented, do sometimes work.

 

[JPG1]

I have a question which someone may be able to answer for me:

If there is something called a 12 week disregard, then what does disregard mean?

I ask because Gemini says that she understands that “Social Services pay the care home fees outright during this period, after which Mum's 'Estate' is expected to re-imburse them”.

So does that mean that the disregard is disregarded?

Doesn’t a disregard mean that it is disregarded forever, not that you have to pay it back/re-imburse them after the disregarded period has elapsed? If it does, then it was never disregarded, merely postponed.

Connie, you say that you were successful. Do you mean that you were successful in achieving Continuing Health Care, or that you were successful with whatever assessment was being carried out for Lionel at that time in the care home? Sorry, but I may have misunderstood your post.

Again, I ask because our mental health care ward ‘assessment unit assessment’ was nothing to do with Continuing Health Care, but merely described to us as a way of determining :

(a)) whether the extra-care sheltered housing could no longer be required to accept responsibility and be required to provide suitably extra-care sheltered housing facilities for a person with Vascular Dementia who had wanted to wander and to walk and to talk and to be stimulated and to be cared for with medication prompting which the sheltered housing could not manage;
and
(b) whether residence in a care home was deemed to be required/essential;
and
(c) which particular problems were deemed to be present so as to warrant placement in a care home (long before financing was ever discussed).

I’m just wondering whether we are talking about different kinds of assessments at different times and, obviously, in different places, and for different reasons.

We never had a CPN attached, nor even a fully functioning SW, if there is such thing these days. All we had was a locum SW who had never before worked within the geographical locality, nor with “older people”, let alone with people with dementia.

But beginners, as we were then,we thought [perhaps naively] that assessment meant a means of assessing all needs, not just CHC eligibility. We had then never heard of Continuing Healthcare funding. Dementia raced ahead so quickly, and within two years had moved things on from diagnosis to the very care home requirement that we had hardly even started to think about then.

We had no chance to even discover which facts might be required for anything.

With apologies to Gemini who started this thread about Third Party Top Up payments – we seem to have diverted you! Sorry.

.

 

[ella24]

Jpg

The 12 week disregard paymen tby the LA is disregarded, then if the house is sold before 12 weeks the service user becomes self funded, or if the house is sold after the 12 weeks you repay from the 13th week

this explains it quite well

http://www.direct.gov.uk/en/HealthAndWellBeing/HealthServices/CareHomes/DG_10031411

 

[jenniferpa]

To ellaborate further. Mum is currently in the 12 week disregard period. As we understand it, Social Services pay the care home fees outright during this period, afterwhich Mum's 'Estate' is expected to re-emburse them. If her house is sold then we use the cash in the bank (so to speak) other wise the fees are acruing until such time when her house does sell and we then 'Settle up'.

I must confess I read that twice myself. With the word "outright" in there I assumed that when Gemini was talking about settling up and reimbursing them she was talking about what happens after that 12 week period (when they will be in a deferred payment scheme). It is absolutely true that that 12 weeks does NOT have to be repaid.

I hope they haven't implied to Gemini that that is not the case 'cause I can definitely give her chapter and verse about that.

 

[JPG1]

That was precisely my concern, namely that Gemini may have been told that they will have to repay the lot.

You do not need to do that, Gemini.

A disregard is a disregard.

.

 

[gemini]

Hi again

Sorry I didn't explain that very well at all!

SS pay for mil's care home (except £10) for 12 weeks. (So called the disregard period as I understand it because they 'Disregard her assets') After that they continue to pay (except £10), but expect to be re-imbursed from mil's 'estate' from then on!

I hope thats a better explanation! Although to be honest yet again it has not been explained thoroughly to us at all!

Mark; we haven't signed anything with the Care home! The only documents that we've signed were from the finance dept, who called to gather info about mil's finances and assets in order to determin how much she will have to pay towards her care fees. The forms we signed were to verify that all the info we gave was accurate!

Regards Gemini

 

[ella24]

we haven't signed anything with the Care home! The only documents that we've signed were from the finance dept, who called to gather info about mil's finances and assets in order to determin how much she will have to pay towards her care fees. The forms we signed were to verify that all the info we gave was accurate!

Just as a flag-up - we didn't have to sign anything (finance wise) with gran's CH - the contract etc is between us and the LA finance dept, but it came as a legal agreement and is labelled as such with a part that you sign to agree the top-ups

 

[JPG1]

A very nice description of the process that should be undertaken when deciding on financing of care home placement. Can we all move to Cornwall now?

http://www.cornwall.gov.uk/index.cfm?articleid=2288

This is the first one I've come across which makes it quite clear that it is not the Social Worker who should be carrying out any financial assessment. It should be carried out by the Finance Officer either in person, or in our case by post, because the Finance Officer didn't then often move a mile from the office!!

But it is not the place of any Social Worker to carry out a financial assessment. But I do accept that many Social Workers may themselves not even know that.

It's just not fair either on the SW or on the person needing residential care, for someone dealing with the care needs to be influenced in any way by what they know about the available finances of a person in need of care.

The care needs must be the main point of focus for the Social Worker.

Otherwise the Finance Officer should be out of a job.

.

 

[burfordthecat]

A very nice description of the process that should be undertaken when deciding on financing of care home placement. Can we all move to Cornwall now?

http://www.cornwall.gov.uk/index.cfm?articleid=2288

This is the first one I've come across which makes it quite clear that it is not the Social Worker who should be carrying out any financial assessment. It should be carried out by the Finance Officer either in person, or in our case by post, because the Finance Officer didn't then often move a mile from the office!!

But it is not the place of any Social Worker to carry out a financial assessment. But I do accept that many Social Workers may themselves not even know that.

It's just not fair either on the SW or on the person needing residential care, for someone dealing with the care needs to be influenced in any way by what they know about the available finances of a person in need of care.

The care needs must be the main point of focus for the Social Worker.

Otherwise the Finance Officer should be out of a job.

.

Hi JPG1

Your post is just so relevant to me. I have just completed dad's financial assessment this morning for his CH placement. Yes, it was my SW who did the assessment. She basically filled out the form and saw "original documents". She then faxed it all to the "financial dept" who would number crunch and let me know how much "poorer" my lovely dad would be.

My situation was slightly different, because dad had already been placed in a CH and I had negotiated "no top up fees.....fingers crossed on this one!" before the financial assessment was completed.

Love Burfordthecat x x

 

[JPG1]

Fingers crossed for you, Burf!

i think Social Workers often carry out these financial assessments when they really should not be doing them.

It is s.d all to do with SWs. They are there to do the social worker bit, but not the financial assessment part. So methinks they are often used as a 'go-between' when they should not be.

But as you say, your circumstances may be ... hopefully different.

Having said that, I don't think it matters whether the CH placement has already happened or not. It should not be carried out by a social worker. But by the Finance Officer.

Did your SW give you a copy of whatever form was filled in, because otherwise .... I would ask for it tomorrow. Otherwise you may not be able to query it in the future, if the need arises, which it may well not.

Fingers Xed.

.

 

[burfordthecat]

Did your SW give you a copy of whatever form was filled in, because otherwise .... I would ask for it tomorrow. Otherwise you may not be able to query it in the future, if the need arises, which it may well not.

Fingers Xed.

.

Good point JPG1!

The form which my SW filled out was a "hand written booklet" a little like "multi-guess when at school". She was not able to give me a copy. Believe me, when I get the "bill" for dad's care, I will be over it with a fine tooth comb. (Having been an auditor - amongst other things - before becoming a full time mum, I will not just accept, I will question and continue to question until I get an appropriate answer). Dog with a bone, springs to mind

Thanks for your reminder.

Love Burfordthecat x x

 

[JPG1]

Bones are very close to my heart!! For undisclosed reasons.

Shall worry no further then - you're on the case!!

.

 

[MarkEdge]

Mark; we haven't signed anything with the Care home! The only documents that we've signed were from the finance dept, who called to gather info about mil's finances and assets in order to determin how much she will have to pay towards her care fees.

Hi Gemini

That's very good news for you! Just refuse to sign anything, ask the NHS to do a full CHC assessment and tell the care home what you are doing and that SS or NHS may have to pay for the time being at least. As the NHS appear to have been totally delinquent in not following the process, you have the upper hand.

Just a couple of questions, however, if you don't mind:
1 Did your MIL go into a care home straight from hospital or from home?
2 Is she in a residential care home or a nursing home?

Have a good weekend!

Mark

 

[Sandy]

Hi Elaine,

Hi,
In a round about way, this sort of comes back to a question I asked a long time ago about assessment wards and their accountability .....

My Mum and I had been visiting various care homes ...... asking lots of questions ....... reading all the care home reports ..... and it occurred to me that if I applied the criteria in the reports to the assessment ward, they would be found severely lacking! I wondered why assessment wards weren't reviewed by an independent body??

Similarly, why aren't PCTs reviewed by some external body to see how well they comply with procedures?

Or are they??

Elaine

I think that I did reply to this question at the time, but it's at the end of the thread, so perhaps you missed it:

http://www.alzheimers.org.uk/talkingpoint/discuss/showthread.php?p=183325&highlight=healthcare+commission#post183325

The short answer is: yes, it is the job of the Healthcare Commission (HCA) - http://www.healthcarecommission.org.uk/homepage.cfm

It's not the most high-profile of oganisations (only established in 2004). It hits the news when it releases its league tables:

http://news.bbc.co.uk/1/hi/health/7672260.stm

Also, it has been in the news lately in relation to the failings of that hospital in mid-staffs, where their 'light-touch' approach to inspection is now being questioned:

http://news.bbc.co.uk/1/hi/health/7948162.stm

Take care,

Sandy

 

[gemini]

Hi Mark

MIL was admitted to Hospital just b4 Xmas as she became incredibly violent. Prior to this she was living at home. With the help of crossroads and other homecare specialists a comprehensive care package had been in place. My husband was desperate to keep her at home for as long as possible as years ago she had made him promise that he wouldnt put her in a home. This plea had always plagued him and so he was very reluctant to consider this option until the last possible moment.

The Occupational theripist that was on her case via the dementia clinic she attended, had assured us they would do everything they could to keep mum at home for as long as possible! but we knew they were dying to get her in a home to get her 'off their books' so to speak. We knew when she was admitted to hospital that they would do everything they could to insist she went into a home and we were right. 6 weeks later he was told emphatically that she had deteriorated since her hospital admission and could not realistically come home. She never showed any aggresion whatsoever while in hospital. She has no mobility issues. Apart from her mental confusion and slight incontinence phisically she's in perfect health! She can't look after herself that's clear, she can't perpare a drink or meal etc, but that was why she had all the homecare!

My husband reluctantly agreed to place her in a residential care home. In a way it was probably for the best as he feels that THEY put her in a home not him, and so in that respect he didn't break his promise to her!

Regards
Gemini