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14 July 2022 | Case Study | Article by Nicola Sidoli

Case study: CCG reimburses Mrs J's care fees after failing to complete assessment before her death

Mrs J was diagnosed with dementia and due to her associated nursing care needs required a placement in a residential care home from February 2006. She was admitted to hospital following a fall in August 2010 and subsequently transferred to a nursing home due to her increased needs. By 2012, Mrs J had significant cognitive impairment and was unable to communicate her needs, becoming totally reliant on staff to anticipate and meet all needs.

Mrs J had severe arthritis. Her mobility decreased and she developed contractures to her legs by 2012, which required increasing amounts of analgesia due to experiencing pain on movement. From 2012, Mrs J’s skin integrity also began to break down and she required regular dressings of her legs. She was also prone to chest infections and developed a chronic cough by 2012.

Mrs J’s son approached Hugh James in 2012 and we requested an assessment of Mrs J’s current needs, as well as retrospective review of her needs from her entry into the residential care home in 2006.

The local clinical commissioning group (“CCG”) failed to complete the current assessment before Mrs J died in 2013.

A retrospective review was subsequently completed, and the CCG originally agreed to reimburse the fees paid by Mrs J from 1 January 2013 to the date of her death. Hugh James appealed the decision further and following two Independent Review Panels held by NHS England, the CCG agreed to reimburse a further period of care from 9 January 2012 to 31 December 2012.

Mr J’s estate was reimbursed over £45,000.00 which included all care home fees paid from 2012 together with interest.

 

Mr GJ, said:

"I would recommend Hugh James to anyone wishing to recover care home fees from the NHS. They were able to recover substantial amount of my mother's care home fees. I was very pleased with the professionalism they showed, and the support given to me"

 


Author bio

Nicola is a Consultant in the Nursing Care Department and is an experienced specialist in health care work, particularly current and retrospective challenges to decisions to refuse NHS funded continuing healthcare to long-term nursing home residents.

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Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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