Care Review Bureau - News

Justice over care home costs: NHS forced to refund £350,000 fees to grieving families

August 19th, 2009 | Mail Online

Three grieving families have won back almost £350,000 they were wrongly charged by the NHS for their relatives’ care.

In two cases, the family home had to be sold to meet the huge costs for long-term Alzheimer’s and Parkinson’s care that should have been funded by the NHS.

The families, who managed to secure backdating of their claims for the entire period of care, are urging others battling for NHS funding to appeal to the Health Service Ombudsman and take legal action.

They say their cases prove that victory is possible, even though obstacles were put in their way at every turn.

So far, about £8million has been recovered by solicitors representing a further 750 families who claim they have been wrongly charged nursing home fees.

Tragically, in the latest cases all three patients died before their protracted and expensive cases were concluded.

Under English law, elderly people must pay for their own residential care unless their needs are health-related, though it is provided free in Scotland.

The Daily Mail’s Dignity for the Elderly campaign has repeatedly highlighted the unfairness of the means test system which penalises families who need nursing care for conditions such as Alzheimer’s.

Many are denied funding by primary care trusts – which foot the bill – because the disease itself does not automatically make the patient eligible for free NHS ‘continuing care’.

Despite national guidelines, campaigners say local trusts have discretion over who qualifies for free ‘continuing care’, which results in many requests being unlawfully rejected. The family of Judith Roe, who died of Alzheimer’s aged 74 last October, won back more than £130,000 in care home fees which her local NHS trust had refused to pay, saying her condition was not health-related.

She was forced to sell her home of 30 years for £200,000 to pay the £600-a-week nursing home fees.

After a five-year battle, the Health Service Ombudsman ordered NHS Worcestershire to reimburse the fees.

Mrs Roe’s son Richard, 40, wrote dozens of letters to the NHS Worcestershire Primary Care Trust begging them to reassess his mother.

He said: ‘She was extremely ill. She couldn’t make a cup of tea and forgot she had put food on the stove. It was clear she needed full-time care.

‘I wanted to know just how ill my mother had to be before her condition was deemed a health issue. The way the health trust behaved was scandalous.

‘I want anyone else going through a similar experience to know they may be entitled to care. Even if they’re being told they’re not entitled, they should fight for it.’

Paul Bates, chief executive of NHS Worcestershire – which has replaced NHS Worcestershire PCT – said: ‘Decisions around eligibility for continuing NHS care are extremely difficult. There are clearly lessons for us to learn.’

Last month the family of 88-year-old Alzheimer’s patient Marjorie Eyton- Jones won back the £165,000 they had paid in nursing home fees.

Mrs Eyton-Jones went into a Wirral nursing home in 1998 and the family was forced to sell her home after the local trust decided she did not need 24-hour nursing care and refused to foot the bill.

It was not until last month – two years after Mrs Eyton-Jones died – that the North West Strategic Health Authority decided the fees should have been paid from the start of her care.

Her son Gordon Line, who has a large legal bill to pay, said: ‘It has been a long and emotional fight with obstacles put in our way at every step. It’s upsetting it wasn’t resolved before Mum died.’

The family of 54-year-old Rod Johnson fought a four-year battle with the Central and Eastern Cheshire PCT to get back the £51,500 they had to pay for his care after he suffered a brain haemorrhage which left him partly paralysed. He died last year.

His brother Stephen, of Acton Bridge in Cheshire, who has a £14,000 legal bill, said: ‘The whole process is so frustrating. It destroyed my health.’

Andrew Harrop, head of policy for Age Concern and Help the Aged, said: ‘The system for deciding where the line is drawn between free NHS continuing care and paid-for social care has been a mess for years.

‘We strongly encourage anyone who believes they are unfairly missing out on NHS support to fight for their rights.’

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