1. Our next Q&A session is on the topic of Christmas and dementia.This time we want our Q&A to involve our resident experts, you! Share tips and advice on navigating Christmas here in this thread.

    Pop by and post your questions or if you prefer you can email your question to us at talkingpoint@alzheimers.org.uk and we'll be happy to ask them on your behalf.
  1. Doreen

    Doreen Registered User

    Dec 3, 2004
    50
    Oldham
    Hi All,

    My husband Jim has been in an Assessment Ward now for 8 weeks, he was taken in with violent aggression, in the time he has been there he has had his Aricept stopped, had an infection, is now doubley incontinent, unable to feed himself, cannot stand or walk, he is put in and out of bed with a hoist etc. When I saw his Consultant 3 weeks ago he said that he would need and EMI Unit when he left the ward. He is now in a more stable condition and I have a feeling that it will now not be long before he gets his discharge, I have looked around the Units and found I hope a suitable one, not my first choice, but there was a long waiting list for my first choice.

    The wheels were set in motion and last week I had a meeting with a Finance Officer from the Council, she explained the low, middle and high payments to cover his nursing care, then she added that I should ask for a continuous NHS care assessment. Has anyone any knowledge of this, or has anyone been given full payment of a Care Home after this Assessment.also as Jim will start as self funding has anyone come across the procedure of charging more for self funding patients, I spoke to one home last week which was £100 per week more for self funding they can't do that can they???

    Your comments would be appreciated.

    Doreen
     
  2. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Doreen,

    When Jan was about to be discharged from her assessment ward to her care home nearly four years ago, Ronnie Callanan, an angel then working at the local Alzheimer's Society branch in Haslemere, Surrey first brought up the possibility of Continuing Care. Jan's consultant and the local health authority seemed to know nothing about it, and Ronnie had to produce the relevant paperwork and run them through it.

    Following this - and since then - Jan has had Continuing Care funding, plus other special 1-to-1 funding, all paid for.

    It is a lifesaver, so do go the route of trying to get it.

    There are periodic reassessments to go through once you have it.
     
  3. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    NHS Continuing Care

    Hi Doreen,

    I have been looking into the different aspects of funding my father-in-law's possible future care needs and have done some "homework" on NHS Continuing Care.

    The main purpose of defining who qualifies for NHS Continuing Care is to distinguish between what Social Services pays for ("social care") and what the NHS pays for ("medical care"). The fact that dementia blurs many of these distinctions makes it a bit of an "Alice in Wonderland" exercise.

    At the moment, each Primary Care Trust (PCT) within a given Strategic Health Authority(SHA) has it's own set of guidelines for deciding whether or not a person's needs fall within the responsibility of Health or Social. I wrote to the my father-in-law's PCT (Colchester in his case) asking for their guidelines (as they weren't on their web site). If you could get a copy of these guidelines for your PCT it might help you understand exactly what they will be assessing.

    Looking over the Colchester document, and other bits of information of the web, NHS Continuous Care funding is linked to statements like the need for "continuous access to a qualified nurse". There has been an emphasis on medical procedures like changing dressings and the care of broken skin. However, recent challenges, by people like Barbara Pointon, have drawn attention to the need to consider the psychological needs of the patient (funny how certain government agencies can forget that mental health is also part of the NHS remit) aswell as the purely physical.

    There are some good fact sheets on the Alzheimer's Soc. web site:

    Fact Sheet 1


    Fact Sheet 2

    Forgive me for mentioning the next bit, but it could be important in getting NHS Continuing Care. If your husband's admission to hospital was under the Mental Health Act, the NHS has specific aftercare resposibililties under section 117 of that Act. The Alzheimer's Soc. web site also has a fact sheet on that:

    Fact Sheet 3

    There is also some good information on Scetion 117 on the Public Guardianship web site:

    Public Guardianship Office article

    Finally, the Department for Health has a section on Continuing Care which is here:

    Department for Health - Continuing Care

    As for the different rates charged to self-funders vs. Social Services, it may seem unethical, but it isn't illegal. I think that local Social Services negotiates a local fee structure with the independent care homes in its area.

    I think that the tricky thing in the past has been when people enter a home as self-funders and then eventually qualify for Social Services(SS) funding. There used to be a system of top-ups if the home charged more than the SS rate. One care home director told me that this situation was now different with government directions stating that SS have to pay the full rate in cases where someone was already settled in a home and moving them would damage their helath. I think that I would get more information on that before contracting with any home that charged more than the local SS rate.

    Take care,

    Sandy
     
  4. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Hospital Discharge and Continuing Care

    Hi Doreen,

    I forgot to mention that the Department of Health has issued directions to hospitals requiring them to assess patients for eligibility for NHS continuing care before release. This applies to all cases where "where the NHS considers that it would be unlikely to be safe to discharge the patient unless community care social services are made available when the patient leaves hospital".

    In other words, before notifying social services that a patient will needing some package of social services care is due to be discharged, the hospitial should automatically assess that patient for NHS-funded continuing care.

    The actual directive is here:

    Department of Health article on discharge and continuing care assessment

    It's interesting that your council's Finance Officer was the person who brought this up first as it should be standard practice. However, even if the hospital was planning to do this at some time, if you had a copy of their guidelines and could have some input to the assessment, you would be more likely to get a "fairer" hearing.

    Take care,

    Sandy
     
  5. Doreen

    Doreen Registered User

    Dec 3, 2004
    50
    Oldham
    Thank you

    Hi Bruce & Sandy,

    Thank you for all the information, I have spoken to the Social Worker and it is now in her hands to see the Consultant. I also mentioned it to the Ward Manager today, she was non-commital, so whether it is their practice to assess all patients for continuous NHS care, I could not say.

    I have been on the internet looking round, so thank you for the web sites.

    Now I will have to wait and see when they want to discharge him, he was not well today, I mentioned this to the Ward Manager as well, the answer was good days and bad days, to me that means unstable - just one of the criteria for continous NHS care.

    Doreen
     
  6. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Doreen

    well done, and good luck.

    Wouldn't you kind of think that the NHS people looking after him would KNOW instinctively that a person needs the sort of care that is defined as Continuing Care? And if not, WHY NOT???
     
  7. Doreen

    Doreen Registered User

    Dec 3, 2004
    50
    Oldham
    Hi Bruce,

    With regards to your question, as I said the Ward Manager was non commital, but she said they did not have anything to do with the assessment, seemingly someone comes along to do it, as yet do not know where from,. perhaps she knows the answer but is not in a position to say. Tomorrow the consultant does his ward round and I am hoping our SW will be there, but then again Jim was not well at all today, so I don't know what the discharge position will be. I will expect some answers one way or another tomorrow.

    Doreen
     

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