Case Studies

Mrs. H

Mrs H was in care for 3 years until she sadly passed away in 2007. We issued a retrospective review in September 2012 for the period she was in care.

Mrs H had a variety of health conditions including arthritis, B12 deficiency, partially blind, IBS, depression and Alzheimer’s Disease. Her Alzheimer’s was fairly advanced which had a huge impact on her psychological and emotional needs.

The unpredictable behaviour of Mrs H was an issue. She had a tendency to wander and abscond putting herself at risk. She had to be closely monitored to keep her safe. Her care needs were intense especially relating to her psychological needs.

We worked closely with Mrs H’s daughter throughout the claim and disputed with the NHS (Buckinghamshire in this case) for 18 months and after intense investigations of the medical and care home records, the NHS agreed that Mrs H should have received NHS Continuing Healthcare funding for the year prior to her passing.

Mr. M

Mr M is an ongoing case but we started the retrospective review in September 2012 as he entered the care home in 2008 and the family believed that he should have been entitled to NHS Continuing Healthcare from the date he entered care. Mr M sadly passed away in 2014.

Mr M suffered a stroke prior to entering care, had diabetes and psoriasis. He did have cognitive impairment especially with orientation to time and place. Mr M was bedridden from 2009 and required constant assistance with his mobility. Due to this, he was unable to feed himself and suffered from weight loss.

Mr M’s care needs was intense and complex. As he was bedridden, this led to a number of other care needs such as pressure sores.

The NHS completed a Checklist in June 2013 and Mr M went through for full referral. He was later found eligible for NHS Continuing Healthcare which we successfully argued should have been paid from at least the date of the Checklist in 2013. We further argued for interest on the amount which had accrued to a substantial amount.

We are now disputing the period prior to June 2013 and will do our best to ensure we do Mr M justice when he shouldn’t have been paying for his care fees.

Mr M is an ongoing case but we started the retrospective review in September 2012 as he entered the care home in 2008 and the family believed that he should have been entitled to NHS Continuing Healthcare from the date he entered care. Mr M sadly passed away in 2014.

Mr M suffered a stroke prior to entering care, had diabetes and psoriasis. He did have cognitive impairment especially with orientation to time and place. Mr M was bedridden from 2009 and required constant assistance with his mobility. Due to this, he was unable to feed himself and suffered from weight loss.

Mr M’s care needs was intense and complex. As he was bedridden, this led to a number of other care needs such as pressure sores.

The NHS completed a Checklist in June 2013 and Mr M went through for full referral. He was later found eligible for NHS Continuing Healthcare which we successfully argued should have been paid from at least the date of the Checklist in 2013. We further argued for interest on the amount which had accrued to a substantial amount.

We are now disputing the period prior to June 2013 and will do our best to ensure we do Mr M justice when he shouldn’t have been paying for his care fees.

Mrs. B

Mrs B passed away a few years ago and we are still completing a retrospective review. Once the application had been submitted, the NHS returned stating that a previous assessment had been undertaken and therefore we could not take our case further.

We requested this documentation and completed a detailed analyse . The assessment was completely flawed. Various care needs had been omitted and other people had been referred to in the document.

We raised our concerns with the NHS and after much debate, requested that we receive a reimbursement from at least the date Mrs B left the Hospital (she passed away shortly afterwards). We further requested that that a retrospective review be commenced on the period prior to Mrs B entering the Hospital which the NHS reluctantly agreed to.

The family received a reimbursement of over £4,000 and we are continuing to complete the retrospective review.

Mrs. L

Mrs L was in care for just over a year. We commenced a retrospective review to decide potential eligibility for NHS care fees. As soon as we applied, the NHS responded stating that relevant assessments had already taken place, therefore we could not apply.

Upon inspection of the assessments, it was clear that maladministration had occurred including sending the outcome and apparent appeal letter (there was no mention of appeal in the letter) to Mrs L even though the assessments had clearly recorded that she suffered with severe cognitive impairment. Upon raising this, the NHS continued to refuse the application claiming they had provided a ‘fair and robust’ assessment.

We exhausted the internal complaints procedure and the NHS refused to budge. We therefore took the case to the Health Ombudsmen. The NHS then decided that the assessments were not completed fairly and have now agreed to complete a retrospective review which is still ongoing.

Mr. S

We are currently completing a retrospective review for Mr S. The NHS returned to us stating that previous assessments had been undertaken therefore they would not complete the retrospective review.

Upon receipt of the assessments, it was clear that the NHS had not fully completed their duties namely not obtaining all evidence, sending the outcome to the patient diagnosed with dementia and not informing the patient (or representative) of their right to appeal.

We highlighted all of these issues to the NHS who have now agreed to commence the retrospective review in full.

Micaila Williams - Seatons Solicitors

Residential Care Fee Help

My name is Micaila Williams and I am a lawyer who specialises in Residential Care Fees. We aim to provide our clients with an outstanding legal service.

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