Case studies
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Mrs H
We 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 from 2001 to 2005, 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
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 as 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 health care. 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 health care status for the future, resulting in future
savings of £2100 per month.
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Mrs N
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 refused 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.
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Mr Youell (deceased)
Mr Youell was a resident
in a Nursing Home in South Gloucestershire from May 2006 to his
death in October 2007. He suffers with rheumatoid arthritis and
frontal lobe dementia. He was unable to communicate verbally due to
confusion and memory loss. He had a history of depression and
anxiety. He was totally disorientated and confused. He was unaware
of his surroundings and disorientated in time, place and person. He
was also noisy and restless. He required full assistance with all
aspects of personal hygiene needs. He was unable to feed himself
and was at risk of chocking and therefore needs to be monitored
closely when eating. He was chair/wheelchair bound and required the
assistance of two carers and a hoist for transfers. He had a
history of falls and has been hospitalised as a result, he has
fractured his hip and sustained several head injuries as a result.
Hugh James successfully challenged the Primary Care Trust’s
decision to refused Continuing Health Care Funding and Mr Youell’s
estate was awarded retrospective continuing health care from
September 2006 and was reimbursed over £22,000 in nursing home
fees.
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Mr Harry Denham
(deceased)
Mr Denham was admitted to
Beechwood Park Nursing Home in July 2002. He was suffering
with Alzheimer’s disease and as a result was severely confused and
disorientated regarding time, place and person. He also
displayed difficult behaviour associated with the illness,
including anxiety, agitation and aggression. He was initially
mobile, but walked with an unsteady gait which meant that he was at
a high risk of falls. However as his condition deteriorated
he required two members of staff to assist him to mobilise and a
wheelchair was required for long distances. By July 2006 he
was no longer mobile and mainly bed and chairbound. He was totally
reliant on nursing home staff for all his activities of daily
living. Due to the closure of the Beechwood Park Nursing
Home, Mr Denham was transferred to St Annes Nursing Home on the 13
July 2006 and was a resident there until his death on the 5
February 2007. Mr Denham paid a contribution of £85 per week
until his wife’s death in April 2003 and thereafter had to pay
approx £750 per week until his death. . Hugh James successfully
challenged the Local Health Board’s decision to refused Continuing
Health Care Funding and Mr Denham’s estate was awarded
retrospective continuing health care from the date of admission to
Beechwood Park House and was reimbursed over £100,000 in nursing
home fees.
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