Please read through some of our case studies:
In July 2008, Mr Wilfred Gibson suffered a stroke which resulted in him moving into care. He resided in care until February 2013, when he passed away aged 92.
When Mr Gibson first entered care, his family were told that they would be responsible for the fees, and that no financial help was available. This included being explicitly told that Mr Gibson would not be eligible for NHS Continuing Healthcare. Feeling let down by the system and unsure of where to turn, Mr Gibson’s son, Stan, contacted his local MP. Unfortunately, he was told that there simply wasn’t any money for his father’s care home fees.
However, after hearing a radio talk show about NHS Continuing Healthcare, Stan Gibson contacted Hugh James Nursing Care in September 2012. His case manager contacted the relevant Clinical Commissioning Group to request that an assessment be undertaken for NHS Continuing Healthcare. Eventually, after much deliberation, in December 2015 a decision was received that Mr Gibson was eligible for funding for the entire period of his care.
Mr Gibson’s family were reimbursed a six figure sum, which included wrongly paid care fees and interest.
Stan Gibson said: “All in all, we wouldn’t have got what we did without Hugh James. If we hadn’t been successful, it wouldn’t have been for lack of trying.
“As with so many families caring for loved ones in a similar situation, we only had so much money to fund my father’s care. This became a major concern for us and not long before he passed away, we had started to consider the very real prospect of needing to sell my father’s business to release equity if we needed it. As a family, we are delighted that we have been able to reclaim this wrongly paid money.”
Mrs Flint was admitted to a Hertfordshire care home in 2007. At the time, her family were told that due to the level of savings and income that she had, she would need to pay for her own care home fees – despite suffering from the early stages of dementia and having general ill health.
Forced to sell her flat to pay for her care, Mrs Flint not only suffered from dementia, which left her leaving very confused and severely depressed, but she was also doubly incontinent and got agitated easily and experienced hallucinations. Mrs Flint also suffered from oesophagitis that caused her swallowing problems, as a result, she regularly refused food and fluids.
As Mrs Flint’s health deteriorated, her ability to move varied from day to day and she would try to walk without assistance – putting her at risk of falls. She eventually became immobile and unable to support her own weight. She also struggled to communicate her needs with carers, which meant that over time she started to have more frequent episodes of challenging and physical behaviour.
Mrs Flint’s family worked closely with the Nursing Care team, who believed that Mrs Flint should have been eligible for NHS Continuing Healthcare due to her complex care needs.
Following the local Clinical Commissioning Group’s initial review, the Nursing Care team provided them with entries from Mrs Flint’s healthcare records which were missed off their original review. After the Clinical Commissioning Group received the comments on Mrs Flint’s healthcare needs, a panel meeting was held with health professionals and it was found that Mrs Flint should be reimbursed for the care home fees paid from July 2009, which amounted to a six-figure sum.
In eventually being able to prove that Mrs Flint had ‘health needs’, Hugh James Nursing Care were able to ensure that she was entitled to NHS Continuing Healthcare funding and did not have to pay her home care fees of £2,824 per month.
One of Mrs Flint’s three daughters explained: “We only found out by chance that our mother had been wrongly paying for her care home fees for several years. We simply assumed that she had to sell her flat to release funds as she had a certain level of capital and income. However, we didn’t know about the NHS Continuing Healthcare funding, and it transpires that the Clinical Commissioning Group hadn’t assessed her ailing health properly. The picture could have been very different had we only been aware.
“Understandably, we always worried about what would happen when the money ran out and how we would be able to pay for our mother’s ongoing support. I only discovered that our mother could be entitled to free care when I read about someone in a similar situation to me in a newspaper, and a relative mentioned that it may be sensible to explore our options further to double check if there was anything we could do.
“At what was a terribly distressing time anyway, we found it shocking that nobody proactively came forward from the authorities and told us that we were actually entitled to having the fees paid, there must be many others like us in similar positions. It may have taken four years to reclaim the nursing fees, but the team at Hugh James managed to get all of the money back on behalf of our mother and we now can ensure that she is comfortable and getting the best possible care that she is entitled to.”
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 Nursing Care 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 £6,000 per month needed for his long-term nursing care.
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 Healthcare.”
She went on to say “I 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 people’s dignity?
“There are many people in this situation who 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.”
Hugh James 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 for four years, 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 other health 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 is 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 healthcare status for the future, resulting in future savings of £2,100 per month.
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 refuse 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.