Case studies
Please read through some of our
case studies:
Mr Leslie Terry
Hugh James’ successfully obtained
reimbursement of over £250,000 for Mr Leslie Terry in wrongly paid
care home fees from the NHS through the scheme. Mr Terry suffered
with Alzheimer’s disease, was admitted to hospital in October 2002
after being found collapsed at his home suffering with severe
pemphigoid. The family were informed that he could not return home.
Mr Terry was then admitted to a nursing home in December
2002.
Mr Terry suffered with Alzheimer’s
disease and dementia and as a result of his illness, he is
agitated, totally confused and disorientated in time and place. He
is totally immobile and not been out of bed for over four years,
also at risk of choking and unable to verbally communicate. On
admission, he suffered with multiple skin lesions which required
daily dressing and cleaning. His family, helped by Hugh James, had
to prove that he had ‘health needs’ which meant he was entitled to
NHS Continuing Healthcare and did not have to pay an average of
£3,500 per month for his long-term nursing care.
The family had been told that due
to Mr Terry’s capital and income, he would have to pay for his own
nursing care costs. However, the Primary Care Trust admitted that
Mr Terry should have had his care home fees paid by the NHS and he
was reimbursed all the money he had paid in care home fees.
Families have been given a last
chance to claim after the Department of Health announced a
close down of claims for wrongly paid care home
fees for the period 1 April 2004 to 31 March 2011 in
England. Any new claim needs to be registered before the 30
September 2012.
Lisa Morgan, who acted for Mr Terry
goes on to say ‘Families like Mr Terry’s need to be aware of this
deadline. It is important that they take steps now so that they do
not miss out”
Mr Robert Beaman
Mr Robert
Beaman was admitted to a nursing home in 2009. Due to his capital
and income, the family were told that he had to pay for his own
nursing care. With the help of Hugh James solicitors and after a
four year fight, the family have now recovered the nursing home
fees wrongly paid.
Mr Beaman, a retired postman,
suffered with Parkinson's disease and Lieu Body dementia. Following
a fall which resulted in a broken hip requiring surgery, Mr Beaman
was admitted to St Peter's Hospital in Surrey. The family were
informed that he could not return home as he required 24 hour
nursing care as his dementia had worsened and he was now in a
wheelchair unable to weight bear. Mr Beaman was then admitted
to Sunrise Senior Living Care Home in Bagshot, Surrey where he
remained until he died in December 2010.
As a result of his illnesses, Mr
Beaman was agitated, totally confused and disorientated in time and
place, he was unable to feed or wash himself and was doubly
incontinent, he had to be moved by hoist from bed to chair which
caused him enormous pain and upset, and, due to his type of
illness he also suffered a series of mini strokes which, when these
occurred caused the dementia to worsen. His family, helped by Hugh
James, had to prove that he had 'health needs' which meant he was
entitled to NHS Continuing Healthcare and did not have to pay £6000
per month needed for his long term nursing
care.
Continuing healthcare is where the
NHS is responsible for, and fully funds care. It mainly affects
very ill patients, often elderly, in nursing homes. It can also
apply if a person is in hospital long term or needs nursing care at
home.
Mrs Daughne Taylor, Mr Beaman's
daughter said: "The only reason my father was in a nursing home was
because he was very ill and required 24 hour nursing care. I was
simply told that as he had savings and a house, he had to pay for
his nursing home fees. No other option was given. If we hadn't seen
an article about a person who managed to claim back her mother's
care fees we wouldn't have known about NHS continuing care."
She went on to say "I've battled
the system for over four years until we finally won the claim
for my dear father who was suffering with Dementia. I was
determined he was eligible for funding even to the point where I
was told by one social services person that to qualify you almost
have to be dead. We weren't asking for anything that my father
wasn't entitled to but we were made to feel like a charity
case, how is this upholding elderly peoples dignity, many, many
people in the same situation as we found ourselves don't know that
they can claim back money they are entitled to as it is rarely
publicised or even discussed by care homes themselves as they also
know how difficult it can be to get it. It is criminal that our
elderly are treated so badly they don't ask for much and in some
cases don't ask at all and this is what the 'system' plays on, I am
just grateful for the help we received from Hugh James without them
fighting for us in our corner we may well have given up, but we
shouldn't have had to fight in the first place.”
Related
articles:
Mrs Phyllis Blatchford
Mrs Phyllis Blatchford was admitted to a nursing home in
June 2006. Due to her capital and income, the family were told that
she had to pay for her own nursing care. With the help of Hugh
James solicitors, the family have now recovered all the nursing
home fees wrongly paid, amounting to almost £70,000 in total.
Mrs Blatchford suffered with
dementia and was admitted to Derriford Hospital in Plymouth in 2006
as she suffered a stroke. The family were informed that she could
not return home as she required 24 hour nursing care and she was
then admitted to the Tamar Nursing Home in Saltash, Cornwall. She
remained here until she sadly died in February 2010 aged eighty
eight.
Mrs Blatchford, from Saltash in
Cornwall, suffered with Alzheimer’s disease. As a result of her
illness she was agitated, totally confused and disorientated in
time and place and was aggressive. She was doubly incontinent,
frequently fell and could not communicate her needs. As her health
deteriorated, she became immobile, and ultimately lost her ability
to swallow. Her family, helped by Hugh James, had to prove that she
had ‘health needs’ which meant she was entitled to NHS Continuing
Healthcare and did not have to pay her care home fees of £1600 per
month.
Cornwall and the Isles of Scilly
Primary Care Trust found her eligible for NHS Continuing Healthcare
in May 2009 and met Mrs Blatchford’s ongoing care costs. However,
sadly Mrs Blatchford passed away before the PCT completed the
retrospective review.
Following this initial review, the
Cornwall and the Isles of Scilly Primary Care Trust then agreed
that Mrs Blatchford was eligible for NHS Continuing Healthcare from
February 2008. This decision was appealed by the family with the
assistance of Hugh James to the South West Strategic Health
Authority. Following an Independent Review Panel, it was concluded
that the late Mrs Blatchford’s estate should be reimbursed all the
care fees paid, in the sum of over £67,000, as the NHS should have
paid for her entire period of care.
Mrs Cynthia Bunt, daughter of the
late Mrs Blatchford said “This has been a long and very complicated
journey – we’re grateful for the help and support from the team at
Hugh James and obviously very pleased to finally have confirmation
that the NHS should have been paying these care home fees and not
the family. Unfortunately for us it’s come too late for mum who is
sadly no longer with us, we can only hope that our story will help
other families to realise that they may also be wrongly paying for
nursing care and that it is possible to get that money back.”
Related
articles:
Mrs Ada Whittaker
Hugh James solicitors have
successfully helped the family of the late Mrs Ada Whittaker to
recover over £90,000 in wrongly paid care home fees from the NHS.
Mrs Whittaker from Rossendale, suffered with dementia and was
unable to care for herself. As a result she was admitted to
Turfcote Nursing Home in Rossendale in December 2001 where she
remained until she died on 1 March 2009.
Mrs Whittaker suffered with
dementia and as a result of her illness she was agitated, totally
confused and disorientated in time and place. She could also be
aggressive. She was at high risk of falling and experienced a
number of falls during her time in care, due to her tendency to
aimlessly wander. Cognitive impairment meant that Mrs Whittaker was
unable to reliably communicate her needs and was also an insulin
dependent diabetic. She required constant supervision to ensure
that she did not take food that she should not eat and monitoring
of her blood sugar levels. Her family, helped by Hugh James, had to
prove that she had 'health needs' which meant she was entitled to
NHS Continuing Healthcare and did not have to pay an average of
£1,900 per month for her long-term nursing care.
The family had been told that due
to Mrs Whittaker's capital and income, she would have to pay for
her own nursing care costs. However, East Lancashire Primary Care
Trust has now admitted that Mrs Whittaker should have had her care
home fees paid by the NHS and her estate was reimbursed the money
she had paid in care home fees from 1 April 2004 until her death.
Mrs Whittaker's family missed out on claiming the care home fees
paid from December 2001 to 30 March 2004 due to an earlier deadline
imposed by the Department of Health.
Mr Morgan, Mrs Whittaker's
son-in-law said: "The only reason my mother-in-law was in a nursing
home was because she was very ill and required 24 hour nursing
care. I am pleased that the Primary Care Trust have finally agreed
that they should have met the care fees as she was so ill. I would
urge families to act if their loved has also paid for care, as they
may also recover the wrongly paid care fees"
Hugh James Solicitors, who acted
for Mrs Whittaker's family, commented that “Families like Mrs
Whittaker's need to be aware of the deadline for NHS
Continuing Healthcare claims. It is important that they take
steps now so that they don't miss out."
Related
articles:
Mrs Betty Wadham
Seventy nine year old Betty Wadham
suffered a major stroke in August 2003 and was admitted to Harlow
General Hospital. She received
care from Bishops Storford Hospital Stroke Unit before being
admitted to various nursing homes until she was moved to
Elizabeth Lodge Nursing Home in May 2006, where she currently
resides.
Mr Mark Wadham, Betty's son, came
to Hugh James in August 2009 having read a piece in the Mail on
Sunday. At this time Mrs Wadham's house had already been sold to
fund the care home fees of approximately £3,500 a month.
Betty has dementia. She is
confused and unaware of her surroundings, disorientated in respect
of time and place, and unable to recall friends, relatives, or
everyday activities. She is likely to repeat herself, lose her
train of thought, and forgets recent events.
Mrs Wadham is immobile and
wheelchair bound, she is fully dependent on staff for any form of
mobility. A hoist is required to move her in and out of bed and
into her wheelchair and she requires full assistance with all
personal hygiene needs, such as washing, bathing and dressing.
She is unable to do even minimal things for herself, such as
washing her face. She is totally dependent upon the staff. She
needs someone to feed her, enable her to drink, and to encourage
her to eat.
Hugh James first contacted Enfield
Primary Care Trust (PCT) in September 2010 to request a
current assessment of Mrs Wadham against the eligibility criteria
for NHS Funded Continuing Health Care. NHS Barnet and NHS
Hertfordshire (PCT’s that were responsible for Mrs Wadham
previously) have stated that they would not undertake a
retrospective review of Mrs Wadham’s needs until the outcome of the
current assessment was established. Almost three years later the
family is still waiting for a current assessment to be done.
Mark Wadham (Betty's son) has
spoken out about the family's struggle to obtain continuing care
funding calling it a 'nightmare' process.
Related articles
Mrs Evangeline McConnell (deceased)
Eighty eight year old Evangeline McConnell suffered a
severe stroke in October 2002 and was admitted to the Royal Albert
Edward Hospital in Wigan. She was then transferred to Leigh
Infirmary in Lancashire for six months for rehabilitation.
However, the family were informed that she could not return home as
she required 24 hour nursing care. Mrs McConnell was then admitted
to the Arncliffe Court Nursing Home in Halewood, Liverpool in April
2003 and later to St Bartholomews Court Nursing Home in Huyton,
Merseyside where she sadly died on the 3 November 2011.
The family were told that due to
Mrs McConnell’s capital and income, she would have to pay for her
own nursing care costs. Mr Phil McConnell, Evangeline’s son, asked
the NHS for an assessment before she was discharged from hospital
in 2003. However, the NHS said that she was stable and not complex
and therefore not eligible. This meant that she became the
responsibility of the social services and due to her capital and
income, had to sell her home to pay for her nursing care fees of
£2,000 per month.
Mrs McConnell had suffered a
catastrophic stroke which resulted in her being immobile,
incontinent, unable to communicate and swallow. She was
totally reliant on two to three carers to attend to all
her needs and a tube was placed in her stomach to provide her with
nutrition and medication. Yet, the NHS maintained that she did not
have ‘health needs’ which meant she was entitled to NHS Continuing
Healthcare. The family, helped by Hugh James, had to prove that she
her health and living needs meant she should never have had to pay
her own care home fees.
Despite regular assessments, it was
not until January 2008 that Mrs McConnell was assessed as meeting
the criteria and all her future fees were to be paid by the
NHS.
Following a seven year fight
with the help of the Hugh James Nursing Care Team, the NHS have
admitted that their decision on care fees was wrong and the family
of Mrs Evangeline McConnell have finally been reimbursed with
£117,000 in wrongly paid care home fees.
Read more about Mrs Evangeline McConnell's
case
Related press
articles
Mrs Beryl Waite (deceased)
Mrs Waite was admitted to a nursing
home from November 2004 until she passed away in January 2007. She
suffered with Chronic Obstructive Airways Disease, was confused and
unaware of her surroundings, immobile and had suffered a number of
falls. As well as this she also had difficulties with her eating as
she was at risk of asphyxiation due to her breathing
problems.
The Local Health Board were asked
to undertake a retrospective assessment together with a current
assessment whilst Mrs Waite was still alive in October 2006.
A current assessment was undertaken
just before she died in January 2007, but the decision was not
finalised. Since then a number of complaints have been made to the
both the Ombudsman and the Health Board about the delay and we are
still waiting for the Health Board to consider it.
Mr Kenneth Waite, Beryl’s son, has
instructed Hugh James to help him recover fees that he believes
have been wrongly paid. He has contacted his local AM to complain
and also appeared in both press and television programs.
Related press
articles
Massive delay for claims to reimburse cash for nurse
care
Western Mail
06 | 01 | 10
Wait for care home
fees refunds ‘could be three years’
BBC Wales
16 | 10 | 11
BBC Politics Show
16 | 10 | 11
Mr Harry Denham (deceased)
Mr Denham was admitted to Beechwood
Park Nursing Home in July 2002. He was suffering with Alzheimer’s
disease and as a result was severely confused and disorientated
regarding time, place and person. He also displayed difficult
behaviour associated with the illness, including anxiety, agitation
and aggression. He was initially mobile, but walked with an
unsteady gait which meant that he was at a high risk of
falls.
However, as his condition
deteriorated he required two members of staff to assist him to
mobilise and a wheelchair was required for long distances. By July
2006 he was no longer mobile and mainly bed and chairbound. He was
totally reliant on nursing home staff for all his activities of
daily living. Due to the closure of the Beechwood Park Nursing
Home, Mr Denham was transferred to St Annes Nursing Home on the 13
July 2006 and was a resident there until his death on the 5
February 2007.
Mr Denham paid a contribution of
£85 per week until his wife’s death in April 2003 and thereafter
had to pay approx £750 per week until his death. Hugh James
successfully challenged the Local Health Board’s decision to
refused continuing health care funding and Mr Denham’s estate was
awarded retrospective continuing health care from the date of
admission to Beechwood Park House and was reimbursed over £100,000
in nursing home fees.
Related press articles
Mrs H
We were successful in
challenging the refusal of continuing health care by the Primary
Care Trust for the above lady. Mrs H was a resident of a
residential home from 2001 to 2005, when she was moved to a nursing
home, where she currently resides.
Mrs H suffers from
arthritis, gout, strokes, which left her with paralysis of the left
arm and problems. She also suffers with advanced dementia, which
resulted in her being unable to communicate in any form, including
letting carers know when she is in pain. She is immobile and as
therefore at high risk of pressure damage. She is fed a pureed
diet due to her swallowing problems. Mrs H was totally reliant on
nursing home staff to attend to all her needs.
The Primary Care Trust
initially assessed the case and concluded that Mrs H was not
eligible for NHS Continuing Healthcare. Hugh James challenged this
decision and the Primary Care Trust concluded that Mrs H was
eligible for continuing healthcare and had been eligible since her
admission to the care home in 2001. Mrs H was then reimbursed a
total of £105,194.57 in past nursing home fees and was awarded
continuing health care status for the future, resulting in future
savings of £2,100 per month.
Mrs N
Mrs N has been a nursing
home resident since 2002. Mrs N suffers from Osteoarthritis,
Parkinson’s disease, Cervical Sponylosis, Sciatica, Upper Thoratic
Scoliosis, Hypertension and Angina. She is unsteady on her feet and
at high risk of falls and has fallen on occasions. She suffers from
confusion and can be restless, disorientated and prone to
wandering. Mrs N is occasionally incontinent and requires toileting
every two hours. Mrs N suffers with severe Parkinson’s disease
which is variable from day to day. She also suffers from
Osteoporosis and was on a atromorphine pump daily, Fentenyl patches
changed every three days and additional pain relief when
requested.
Hugh James successfully
challenged the Primary Care Trust’s decision to refused Continuing
Health Care Funding and Mrs N was awarded retrospective continuing
health care from date of admission. She was reimbursed over
£120,000 in past nursing home fees and was awarded continuing
health care status from then on, resulting in future savings of
over £800 per month.
Mr Youell (deceased)
Mr Youell was a resident
in a nursing home in South Gloucestershire from May 2006 to his
death in October 2007. He suffers with rheumatoid arthritis and
frontal lobe dementia. He was unable to communicate verbally due to
confusion and memory loss. He had a history of depression and
anxiety. He was totally disorientated and confused. He was unaware
of his surroundings and disorientated in time, place and person. He
was also noisy and restless. He required full assistance with all
aspects of personal hygiene needs. He was unable to feed himself
and was at risk of chocking and therefore needs to be monitored
closely when eating. He was chair/wheelchair bound and required the
assistance of two carers and a hoist for transfers. He had a
history of falls and has been hospitalised as a result, he has
fractured his hip and sustained several head injuries as a
result.
Hugh James successfully
challenged the Primary Care Trust’s decision to refused Continuing
Health Care Funding and Mr Youell’s estate was awarded
retrospective continuing health care from September 2006 and was
reimbursed over £22,000 in nursing home fees.
Mrs Irene Bury (deceased)
Mrs Irene Bury was admitted to a
care home in April 2003 and remained there until she died in August
2006. The family were told by the NHS that she was not their
responsibility and not eligible for NHS continuing care to cover
the cost of her nursing care fees. After a five year fight
with the help of Hugh James Nursing Care Team, the NHS have
admitted that their decision on care fees was wrong and have now
reimbursed her estate over £100,000 in wrongly paid fees.
Mrs Bury was admitted from her home
in Warminster in Wiltshire to Bath Royal Hospital in July 2002
following a fall. After a period in hospital, the family were told
that she could not return home and she was discharged to Broadway
Lodge Care Home in Surrey on the 11th April 2003. Due to Mrs Bury’s
capital, the family were told that she would need to meet the full
cost of her care fees.
Mrs Bury suffered with Alzheimer’s
disease, as a result of her illness, she was agitated, totally
confused and disorientated in time and place, she was aggressive
and was resistive to care. She was unsteady on her feet and
suffered falls which resulted in her fracturing her right femur in
May 2004 and left femur in November 2005. She was doubly
incontinent, blind, deaf and unable to communicate. In August 2005,
Broadway Lodge Care Home could no longer cope with Mrs Bury’s needs
so she was transferred to Jubilee House Care Home in Godalming in
Surrey where she remained until she died in August 2006.
Read case
history
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