Sophie was approached by the daughters and attorneys of Mrs T, who had recently gone into to a care home for a period of respite care following a deterioration of her dementia. Once in the care home, Mrs T’s behaviour began to deteriorate even further. She became more agitated and was talking about suicide. The care home couldn’t cope and Mrs T was admitted to a local hospital who confirmed that her behaviour was the result of her dementia.
When she came to be discharged from hospital and back into a care home, one care home refused to accept her due to her behaviour. Another care home did agree to accept her, but only with 1:1 care in place. It was originally planned that this 1:1 care would be withdrawn at a later date. However, the withdrawal could not be implemented as Mrs T’s behaviour continuing to be challenging.
Under the funding rules the whole of Mrs T’s capital was taken into account when assessing eligibility for care home fees funding. Mrs T’s family asked for a ‘Decision Support Tool’ to be undertaken to see whether her care home fees should be paid by the NHS. While this resulted in her being awarded some financial assistance, full NHS Continuing Healthcare funding was refused.
Sophie therefore agreed to take up the matter, working on a no win, no fee basis. She carried out a thorough review of Mrs T’s care home, GP and recent hospital records in order to provide evidence to the appeal panel of the factors that had been ignored by the ‘Decision Support Tool’. Her medical records made it clear that Mrs T had a number of significant care needs that needed to be met. In particular, she was underweight and unable to understand that she was making herself weaker by not eating. She also suffered a number of falls in the care home when having altercations with other residents, which involved incidents of both physical and verbal aggression. This caused harm to herself, care home residents and members of staff.
Sophie argued that Mrs T’s cognitive impairment was affecting her both physically and psychologically, which made her behaviour difficult to control, as an outburst of her behaviour could not be defused easily without injury being caused to either herself or others.
After considering the case papers prepared by Sophie, the appeal panel overturned the ‘Decision Support Tool’ and Mrs T was awarded backdated NHS Continuing Healthcare funding. As a result of Sophie’s submissions we obtained a care home fee refund of £60,639.21. In addition to this Mrs T’s care home fees going forward are now paid by NHS England.
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