Month: August 2017
Mr and Mrs J. have lived in their family home in a rural area of West Sussex for over 40 years. They have two adult children, a son living overseas and a daughter who lives approximately ½ hour’s drive away but who has two young children and works part time.
Mr J. is 76 and is in good physical and mental health for his years.
Mrs J. is 74 and was in good physical and mental health until two years ago when it was necessary for her to have major surgery. Her recovery from the operation was prolonged by post-operative complications and she was in hospital for several weeks. Mr J. had observed that since his wife’s operation her short term memory has deteriorated.
She had also developed back pain associated with worsening scoliosis of the spine. This pain was exacerbated following a fall approximately 3 months ago and at the time Mr J. got in touch with me she was struggling to look after herself. The only support in place was a housekeeper who visits one morning per week for the purpose of housework and laundry.
Their property is jointly owned and Mr J. has assets significantly in excess of the Local Authority upper capital limit and income from state and occupational pensions.
His wife has savings in the region of £20,000 and income from state pension alone.
Mr J. was struggling to combine daily household tasks with providing personal care for his wife and he needed advice on how he and his wife could be supported at home. He told me he did not know who he should be speaking to or the questions he should ask.
We agreed that I should conduct a Consultation with them both in their home and I was able to listen to their respective view points and observe Mrs J. as she moved around her home.
Based on the information shared with me at the time of our Consultation I was able to advise the following:
- The range of care options available to them now and in the future.
- The importance of appointing a Power of Attorney, the different types and how to create these.
- The different levels of support available to Mrs J. in her own home and how these could be accessed.
- The importance of Mr J. looking after himself, the support available to him as his wife’s main carer and how to access this.
- Suggested referrals to other healthcare professionals and how to make these, with particular reference to Mrs J’s memory, risk of falls and pain management.
- The role of Social Services and the NHS in relation to assessment and financial support.
- Other benefits that Mrs J. would be entitled to via the Department of Work and Pensions.
- That whilst Mrs J’s eligibility for financial support from the public purse would be based on her means alone it would be advisable for Mr J. to seek the advice of a financial adviser in relation to his own financial affairs moving forward.
Before I left, Mr and Mrs J. requested that I research and report on good local care agencies able to provide personal care each morning for Mrs J. and an afternoon sitting service for Mr J. once per week in order that he could enjoy his hobby of walking and bird watching.
Consequently suitable care agencies were identified to support them both at home and appropriate referrals to other healthcare professionals were made which improved Mrs J’s independence and safety in her own home.
In addition, Mrs J’s eligibility for funding via the Local Authority and the Department of Work and Pensions was confirmed and Mr J. sought the advice of a financial adviser with regard to his own funds and likely requirements moving forward. Power of Attorney arrangements were also put in place before Mrs J’s memory deteriorated further.
We have agreed that I should conduct a six monthly monitoring visit with Mr and Mrs J. in order to confirm that her health and care needs continue to be met and to advise on further support which may be beneficial to both of them in the future.
Mrs R. is living with dementia and moved to a care home approximately one year ago when it became clear that her health and care needs could no longer be effectively and safely managed in her own home.
During her time at the care home she had become more physically and mentally frail and the care home staff had requested the support of the Community Mental Health Team in managing the more challenging aspects of her behaviour.
Her daughter, Mrs M, had recently read about funding from the NHS in a newspaper article about care fees funding and she contacted me to enquire whether this may be applicable to her mother.
I was able to explain NHS Continuing Healthcare Funding to her and on further discussion it transpired that the first of the two stage assessment process for this level of funding had already taken place several weeks before and that that the second was due to follow at a meeting at the care home the next month. However this process and the purpose of the meeting had not been made very clear to her despite the fact that she was her mother’s closest representative.
I explained the different services that I provide and we agreed that an Independent Health and Care Needs Assessment would be the best way for her to fully understand Mrs R’s care needs, in the context of NHS Continuing Healthcare funding, in readiness for the meeting at the care home.
Having first considered the steps I needed to take to comply with the Mental Capacity Act, I conducted my Independent Health and Care Needs Assessment at the home. My assessment took into account the views of the manager and three members of staff who were responsible for the day to day delivery of Mrs R’s care, the content of her care plan and risk assessments and of course the views of Mrs M. who was a regular visitor to the home.
My assessment scrutinised social, personal care and nursing needs in order to identify well met need, unmet need, suggested additional support and likely eligibility for financial support with direct reference to the Local Authority and NHS eligibility criteria and tools. I was able to make recommendations based on an evaluation of all information gathered and I concluded that there was a case to answer for NHS Continuing Healthcare Funding.
I was also able to make suggestions to the care home staff about how the documentary evidence of the care needs they had described to me could be improved in time for the meeting with the health and social care professionals the following month.
Mrs M. received a copy of my assessment and we made time to discuss my findings in advance of the meeting. At her request I attended on the day and in addition to my own input I observed first-hand how she was able to contribute effectively to the discussions about her mother’s health and care needs with the health and social care professionals involved in her care, from an informed perspective.
My Independent Health and Care Needs Assessment provided an opportunity for an independent review of Mrs R’s health and care needs, gave Mrs M. the confidence she needed at the NHS Continuing Healthcare meeting but also Mrs R. the best possible chance of being awarded NHS Continuing Healthcare funding.