Advice please, re-Social Services claiming back-dated contributions for care home fees.

[cupid_stunt]

Long story short, a couple I know has asked me for advice re-social services back-dating a larger claim for contributions to her father's care home fees, let's call him Fred.

Fred went into a care home in Nov. 22, in Feb. 23 they received a letter that his contributions would be 'X' amount per week, then in June 23 they received a form for doing a financial assessment, which was completed and returned.

In Feb 24 they received letters dated Aug 23 increasing the amount payable, and social services adjusted the amount paid to the care home, resulting in the care home invoicing them for almost £2000, they have emptied Fred's bank account, and paid £750, leaving £1250 outstanding.

There is money missing from the account, because when this first started, Fred had, given his cashpoint card to his son and told him to help himself to cash when he needed it, which he did for various fairly small amounts, every few days, over a period of several weeks, otherwise the money would be there to pay the outstanding £1250.

However, to me, this was basically Fred giving cash to his son, when he didn't know that it would be needed to cover care homes fees, it could be said that the son somewhat took the piss TBH, but there's certainly no suggestion of fraud.

They are worried about being chased for this money, as they simply don't have it, I've told them not to worry as it's not their debt, and they can't be held responsible for Fred's debt.

I am assuming a simple letter to social services, copied to the home, basically setting out the above, should resolve it, and social services will just have to swallow it, in view of their delays in issuing a correct demand for contributions, which was well after the money had been spent by Fred's son, who also has no way to re-pay the money back.

Just wondering if anyone has experience of this sort of thing, and can offer any advice, before I write a 'YP' letter to social services.

*YP= Your Problem.

 

[MickiQ]

I hate to be the bearer of bad news but I think social services can chase them for the money because they and not Fred's kids have prior claim on it. When Mum Q went into care, the solicitor stressed strongly don't do things like that because it's evasion.
However this still seems a bit odd since once savings get down to £14k then the council takes over funding in full. If there was only around £2k left then they shouldn't have been trying to take anything. You sure you've got the full story here?

 

[Spandex]

However this still seems a bit odd since once savings get down to £14k then the council takes over funding in full. If there was only around £2k left then they shouldn't have been trying to take anything. You sure you've got the full story here?

When Social Services calculate savings for people who've gone into a care home, they can include the value of their home if they own one (as in Social Service think, they no longer live there so it's an 'asset'). This isn't counted for the first 12 weeks, which would explain why a new financial assessment form came just over 3 months after the initial letter about 'contributions'.

If this is the case for Fred and he still owns his home he, or his relatives if they have Power of Attorney, can make a deferred payment agreement (DPA) with Social Services to repay the care home costs once the house is sold.

If Fred doesn't own a home, then you're right something has gone wrong with the assessment as you don't have to pay for care if your savings and assets are below £14,250 (and the 'contribution' reduces between (£14,250 and £23,250).

If Fred does own a home, then its Social Services' failure to notify Fred and his family of the increase in 'contributions' that needs challenging. If the letter was dated Aug 23 and didn't arrive until Feb 24 why is that? It wouldn't surprise me that a Social Service department have fucked something up. It also wouldn't surprise me if they took a hard line over when the increase in care costs happened - when they say it was or when Fred and his family were finally told about it. Worth challenging them on it though - how can you budget for an increase in care costs if you're not told about them?

 

[LakieLady]

I think this looks like a fuck up too. I'd submit a complaint to social services regarding their utter tardiness in not telling Fred that he'd have to stump up some money for fees, and explain that it's because of their failure to let him know how much he would be liable for in a timely manner that he has since spent all but £750 of the money.

I'd also add that if he doesn't get a satisfactory response to his complaint, he will be referring the matter to the Ombudsman for Local Govt and Social Care.

Councils hate ombudsman investigations, they take up a massive amount of staff time even when the council has done nothing wrong. It would cost them more to fight it than to pay up, and even if the council is only slightly in the wrong and the Ombudsman's finding is minor maladministration, they often award the complainant a couple of grand for their trouble.

The complaint will have to come from Fred "officially", but the family can draft it for him, or he can give full consent under GDPR for someone else to write on his behalf.

 

[cupid_stunt]

Sorry for not replying earlier, it has taken time to get all the info together -

1 - The money Fred's son took from his account is not actually a concern, he had stopped taking it before Fred went into the care home.

2 - It turns out Fred's daughter took the cashcard at this point, as this was the only way she could get cash out to pay the care home, she was under the impression that what was left after paying the home was Fred's money to do as he pleased with.

3 - Fred asked for various 'treats' to be brought in on visits, and so money was spent on these, not knowing at some point they would get a massive backed dated bill from the care home in May '24.

4 - I've just today sent an e-mail to the home's account manager asking why it took from Feb. '23 to May '24 to issue this bill, and that I suspect this was down to SS, and if so, can he confirm when SS first advised them of this shortfall.

5 - Once I get that confirmation, I'll make a complaint to SS over maladministration, asking them to meet the shortfall, and if they don't, it will be taken up with our new local MP, the local newspaper, and the Ombudsman.

The complaint will have to come from Fred "officially", but the family can draft it for him, or he can give full consent under GDPR for someone else to write on his behalf.

That sadly can't happen, he's very near end of life, and beyond understanding what is going on, and just about blind too. The bill is addressed to his daughter, who both SS and the home have been dealing with all the way along, she'll be telling them that I'll be dealing with it on her behalf.

...

There's another matter that I'll take up with the home, once I get confirmation of the date SS advised them of the shortfall, and that's the extra £200 per three months they have been taking to cover 'other expenses', I want them to explain exactly what this covers, and supply a detailed break-down on what it has been spent on.

When my mother was in a home, they asked for £50 every 2-3 months to cover having her hair and nails cut, £200 every three months does not sound right to me.

 

[pinkmonkey]

I was chased for care home fees via the local authority before dad died, but we needed the money in his account to pay other bills and I'd no idea what would be left. once I'd called in debts etc. So I said to them, no, not yet.
I told them that I was executor and that I'd settle it out of his estate, when I was able to. I paid it last month. He died last October.
In this case I suppose you could be frank with the care home, say this is an unexpected bill and that you'll be following up with the local authority to try to find out what has gone wrong.

We had the opposite issue, they'd mis calculated and we owed the council about £1500 less than what they'd originally billed us for. I'd done the financial assesement forms, but at the time they told me we wouldn't get any discount then we did.

You're a star for helping them, you and I know how it is, the last thing you want when a parent is dying is to deal with bureaucracy.

 

[cupid_stunt]

There's no estate in this case, he was a council tenant, the only money is what goes into & out of his current account.

 

[cupid_stunt]

In this case I suppose you could be frank with the care home, say this is an unexpected bill and that you'll be following up with the local authority to try to find out what has gone wrong.

That's what I will do, once I have confirmation of the date they were made aware of the shortfall by SS.

 

[Thora]

There's no estate in this case, he was a council tenant, the only money is what goes into & out of his current account.

If he's a council tenant with no money then it sounds like the financial assessment was incorrect. Of course he should be able to spend the small amount of money he had in his current account to buy himself treats.

 

[cupid_stunt]

If he's a council tenant with no money then it sounds like the financial assessment was incorrect. Of course he should be able to spend the small amount of money he had in his current account to buy himself treats.

Sadly the financial assessment is correct, the only basis for a complaint is that it took well over a year for this bill to be issued.

They basically take all income from pensions & benefits, minus around £25pw as 'pocket money', about £325 per 3 months, but then the care home is taking £200 of that for 'other expenses', leaving him with just £10pw.

 

[AnnO'Neemus]

There's a problem many families face whereby the elderly family member has to pay care home fees, because they're assessed as having social care needs, which the individual funds, rather than nursing care, which the state funds.

Depending on how long the person has been living in a care home and what their level of needs was when they moved in, it might be possible to get the whole period of their stay reassessed.

Alternatively, if their health has declined and maybe they didn't originally need nursing care, but they do now, then if it's assessed that they're in need of/receipt of nursing care, then the costs should be covered... Not sure who by, sorry, whether it's the NHS or council or some other organisation that they need to apply to, but many families have successfully appealed and had monies refunded.

Also suggest that they check whether it's just a care home or whether it's a care home and nursing home, as that might give them a clue as to whether the level of care might've been 'upgraded' at some point from social care to nursing care.

I wouldn't want to get their hopes up too much, in terms of potential refunds, but overcharging is definitely a thing.

I just Googled to try to find an article that I'd read a while back about it, but loads of law firm websites came up in the results offering help reclaiming fees - but bear in mind they will charge for their services and take a chunk out of the fees being refunded.

'We got £90,000 back in care home fees using little known NHS scheme'

NHS continuing healthcare is a little-known scheme that covers care home fees for the most vulnerable people and it could save families thousands of pounds

www.thetimes.com

The family could try contacting someone else first, maybe Age UK? Or a law centre that's part of the law centres network? Or if the person had/has house insurance, it might include legal cover.

 

[pinkmonkey]

NHS Continuing healthcare is something that we were automatically offered by the care home manager. Dad was declining and his gp told him he could go back to hospital or stay at the home and he chose the home.
I told the manager I thought dad was, ‘on his way out’ and that I thought he needed a higher level of care. Soon as I said that the manager said, ok we will get him assessed for NHS CHC funding and move him to the nursing floor immediately and that there’d be nothing more to pay.
Age UK is a good call! Money saving expert forums and Alzheimer's UK forums are great places to ask for advice.
When dad was in the nursing home he’d say, ‘take some money out! Theres’s plenty there!’ There wasn’t and I daren’t touch it anyway because I knew we had to pay the care home bill.

 

[InArduisFouette]

There's a problem many families face whereby the elderly family member has to pay care home fees, because they're assessed as having social care needs, which the individual funds, rather than nursing care, which the state funds.

Depending on how long the person has been living in a care home and what their level of needs was when they moved in, it might be possible to get the whole period of their stay reassessed.

Alternatively, if their health has declined and maybe they didn't originally need nursing care, but they do now, then if it's assessed that they're in need of/receipt of nursing care, then the costs should be covered... Not sure who by, sorry, whether it's the NHS or council or some other organisation that they need to apply to, but many families have successfully appealed and had monies refunded.

Also suggest that they check whether it's just a care home or whether it's a care home and nursing home, as that might give them a clue as to whether the level of care might've been 'upgraded' at some point from social care to nursing care.

I wouldn't want to get their hopes up too much, in terms of potential refunds, but overcharging is definitely a thing.

I just Googled to try to find an article that I'd read a while back about it, but loads of law firm websites came up in the results offering help reclaiming fees - but bear in mind they will charge for their services and take a chunk out of the fees being refunded.

'We got £90,000 back in care home fees using little known NHS scheme'

NHS continuing healthcare is a little-known scheme that covers care home fees for the most vulnerable people and it could save families thousands of pounds

www.thetimes.com

The family could try contacting someone else first, maybe Age UK? Or a law centre that's part of the law centres network? Or if the person had/has house insurance, it might include legal cover.

it's a long while since i worked in the interface between between Care homes / NHS Funding and Local authority funding, but CHC was well established at that time as it's not a new system or process

people often throw up CHC funding as a something which is likely to happen , the reality is that for many elderly people they are not going to get CHC funding, but if they are assessed as needing a care home with Nursing place they will get the NHS contribution towards Nursing care

the CHC funded Nursing Home residents i have met fall into 2 major groups

1. people with Dementia or Learning disabilities who display a level of challenging behaviour such that if they were working age they would likely be in a secure unit, there is also a a resistance ( which will be mandated into law with the New MHA the current Government is proposing ) to sectioning people solely on the basis of challenging behaviour ( as in some circumstances these individuals might get a contribution to their ongoing care after coming off a an S3 under S117 provisions)

2. people with a known severe physical health problem who without the extra support and services CHC funding brings into their care setting would be 'blocking' an acute hospital bed

https://assets.publishing.service.gov.uk/media/63074037d3bf7f366522beec/Public-Information-Leaflet0NHS-Continuing-Healthcare-and-NHS-funded-Nursing-Care-2022.pdf

there is also the aspect of the 'checklist' having a simplified scoring regime to triage out people who clearly aren't going to be eligible for CHC, getting a checklist score which means a full Decision Support tool (DST) assessment has to be applied doesn;t mean that someone will automatically get CHC - there are some domains - the 'Starred' ones in the checklist where getting higher needs scoring on the checklist means that there is an increased likelihood of getting CHC - while the DST is designed for completion by Healthcare Professionals - looking at it might help some people understand exactly what is needed to get CHC ( and the level of care input required to get get 'high', 'severe' or ' priority' needs in a care domain)

https://assets.publishing.service.gov.uk/media/635171fee90e07768d7f926c/NHS-continuing-healthcare-decision-support-tool-referral-form.pdf

 

[InArduisFouette]

NHS Continuing healthcare is something that we were automatically offered by the care home manager. Dad was declining and his gp told him he could go back to hospital or stay at the home and he chose the home.
I told the manager I thought dad was, ‘on his way out’ and that I thought he needed a higher level of care. Soon as I said that the manager said, ok we will get him assessed for NHS CHC funding and move him to the nursing floor immediately and that there’d be nothing more to pay.
Age UK is a good call! Money saving expert forums and Alzheimer's UK forums are great places to ask for advice.
When dad was in the nursing home he’d say, ‘take some money out! Theres’s plenty there!’ There wasn’t and I daren’t touch it anyway because I knew we had to pay the care home bill.

Yhe care home manager was, in my opinion. brave ( even if they are an RN professional background) to be so certain of getting CHC - but equally i don't know what state your Dad was in when it come to the point of moving him from a 'Residential' bed to a 'Nursing' bed ( and whether he should have bene moved / re classified as Nursing sooner)

 

[pinkmonkey]

He was obviously dying, all the signs were there, he was aged 92, not eating much anymore and losing weight rapidly. Unable to do anything for himself, couldn't even hold a cup of water on his own. The manager was a RN professional, many in the home were, the paperwork was done and signed off in less than 48 hours. She told me that day when I asked the prognosis, 'I'll be surprised if he's still with us in a month.' He managed nearly 6 weeks, hanging on to see old friends on their final visits. Yes, in hindsight, I think he should've been moved to nursing care sooner. He seemed to think he could still walk and we needed to move him to a place of safety with high sides on the bed so he wouldn't fall out. I'm eternally grateful, because the alternative/choice dad was offered was to go back to hospital to a ward, which he'd already spent about 10 weeks in, during that time, several other old men had died in that ward. Such a public place for grief isn't it? We had some privacy in his final moments at least.

 

[InArduisFouette]

He was obviously dying, all the signs were there, he was aged 92, not eating much anymore and losing weight rapidly. The manager was a RN professional, many in the home were, the paperwork was done and signed off in less than 48 hours. She told me that day when I asked the prognosis, 'I'll be surprised if he's still with us in a month.' He managed nearly 6 weeks, hanging on to see old friends on their final visits. Yes, in hindsight, I think he should've been moved to nursing care sooner.

That absolutely explains it and also likely it went through on the End of Life Fast track. I think you'd have to be the worst kind of git to dispute that this scenario absolutely was appropriate , it;s the kind of scenario where if someone is in their own home the Hospices and Community Nursing teams pull out all the stops as well .

This is also likely significant merit in your view that he might well have benefitted from an early move to a Nursing bed vs residential

 

[cupid_stunt]

Yes, in hindsight, I think he should've been moved to nursing care sooner. He seemed to think he could still walk and we needed to move him to a place of safety with high sides on the bed so he wouldn't fall out.

How odd, my mum was only in a care home, and they had hospital style beds, I am surprised that some don't.

 

[pinkmonkey]

That absolutely explains it and also likely it went through on the End of Life Fast track. I think you'd have to be the worst kind of git to dispute that this scenario absolutely was appropriate , it;s the kind of scenario where if someone is in their own home the Hospices and Community Nursing teams pull out all the stops as well .

This is also likely significant merit in your view that he might well have benefitted from an early move to a Nursing bed vs residential

Yes it was CHC fast track funding for end of life. The hospital that geriatrics are put in, in our region is a 90 minute round trip drive from my mums house, the care home a 10 minute walk. He didn't do well in hospital, having terrible bouts of delirium caused by low sodium levels. He had not one episode when we moved him to the care home all thanks to them and their amazing chef who would make him food to order to try to get him to eat. We couldn't care for him at home, we tried but it was a disaster, I'm self employed but I couldn't do any work because he needed help literally every half hour. I had to live in because my mum was really unwell at that time. I'm convinced that the situation was the trigger for her blood cancer. Fortunately social services and my dad agreed it wasn't working at home. We'd gone for the deferred payment scheme but in the end I think we paid about £2000, after further financial assessments and getting the CHC funding. It was still such a fight though, I spent hours poring over the alzheimers forums (even though dad didn't have it and was compos mentis to the end), because the advice for dealing with hospitals/care homes/ social services was gold.

 

[pinkmonkey]

How odd, my mum was only in a care home, and they had hospital style beds, I am surprised that some don't.

He had a hospital type bed and we could've had one with sides on in the care home side but he needed nursing care and it made more sense to move him to a new room and bed in one day, less disruption. If someone is dying then they go in a room opposite the nursing station and that's where he was moved to.

 

[InArduisFouette]

How odd, my mum was only in a care home, and they had hospital style beds, I am surprised that some don't.

it;s related to having suitable policies and procedures in place around Restraint asa bed sides are restraint if there are questions over someone's Mental Capacity ...

if someone is going to climb over a bed rail it;s long way down even with a bed that can go down to the floor

 

[InArduisFouette]

Yes it was CHC fast track funding for end of life. The hospital that geriatrics are put in, in our region is a 90 minute round trip drive from my mums house, the care home a 10 minute walk. He didn't do well in hospital, having terrible bouts of delirium caused by low sodium levels. He had not one episode when we moved him to the care home all thanks to them and their amazing chef who would make him food to order to try to get him to eat. We couldn't care for him at home, we tried but it was a disaster, I'm self employed but I couldn't do any work because he needed help literally every half hour. I had to live in because my mum was really unwell at that time. I'm convinced that the situation was the trigger for her blood cancer. Fortunately social services and my dad agreed it wasn't working at home. We'd gone for the deferred payment scheme but in the end I think we paid about £2000, after further financial assessments and getting the CHC funding. It was still such a fight though, I spent hours poring over the alzheimers forums (even though dad didn't have it and was compos mentis to the end), because the advice for dealing with hospitals/care homes/ social services was gold.

unfortunately a lot of people who do end up 'forced' into care homes it;s becasue of Dementia hence all the support you found on the dementia forums etc. Residential care seems to be an elective decision for a lot more of the people who go there , often those who have good DB pensions and other assets without selling their home , where other peopel struggle on in their own homes with 4 * daily carer visits and whatever family input ...

 

[Sasaferrato]

He had a hospital type bed and we could've had one with sides on in the care home side but he needed nursing care and it made more sense to move him to a new room and bed in one day, less disruption. If someone is dying then they go in a room opposite the nursing station and that's where he was moved to.

In my first ward as a student nurse I sat several times with the dying. The wards sister's very robust views were a. No on on her ward died alone. b. The death watch sitters were the most junior students, on the basis that the sooner we saw and dealt with death the better it would serve us in our careers. I had laid someone out out before I was taught how to give an injection.

 

[pinkmonkey]

In my first ward as a student nurse I sat several times with the dying. The wards sister's very robust views were a. No on on her ward died alone. b. The death watch sitters were the most junior students, on the basis that the sooner we saw and dealt with death the better it would serve us in our careers. I had laid someone out out before I was taught how to give an injection.

You were taught well! It's so important isn't it? I had a long chat with the nurse before he died, she told me she would know and ring me so I could dash over there and she did. She said she always knew. I see is as a great privilege to be with someone in their last moments on earth, I assured dad I'd be with him until the end and I was. My partners mother died at home, she had cancer. We knew the end was near when her breathing changed and we stayed up with her into the early hours when she died.