Maria’s story

Key points

• Care funding wrongly denied three times

• Maria’s son James and his family incurred costs of almost £85,000 – which should have been covered

• Compensation of more than £90,000 has now been awarded

Background

Spanish born Maria, who met James’ father while he was serving in the army in Gibraltar before marrying in 1956, fell ill with Alzheimer’s and was living in a residential home when her condition deteriorated.

Her condition became unmanageable for the staff at Freestones residential home in Irthlingborough, and she was moved to psychiatric hospital.

Maria moved from the hospital to Brockfield House Nursing Home in Stanwyck. She stayed there for three months and accrued costs of almost £20,000 (£19,861.65).

Maria was then moved to Cottage Nursery Home in Irchester in April 2015.

Battle for funding

An CHC assessment was conducted by Arden and Greater East Midlands Commissioning Support Unit (commissioned by Nene Clinical Commissioning Group) on 10 April 2015 – but funding was not granted. This was despite Maria’s needs being assessed as ‘severe’ in two of the assessment criteria.

Now working with Farley Dwek to support his battle for funding, James appealed the decision. The appeal hearing took place on 23 November 2015. Again, despite the fact Maria had been adjudged to have severe needs two categories, the appeal panel still refused to provide full funding.

Instead, they found Maria was eligible for funded nursing care – a small fixed contribution which should reduce what the patient pays.

On 14 October 2016 a specialist nurse appointed by Farley Dwek assessed Maria and believed she should be eligible for full funding. A further MDT assessment was then completed on this date.

Again, Maria was found ineligible for funding. This is despite the fact that during the assessment Maria became exceptionally distressed, screaming and beating the walls and doors of the room she was in.

James and Farley Dwek then appealed to an independent review panel. The hearing took place on 04 April 2017, with a Farley Dwek appointed specialist nurse in attendance as an advocate to support family.

James and his family were pulled aside at the review and told that funding should have been granted from the first assessment.

The family have finally secured compensation

Following the findings of the hearing, Farley Dwek received a letter dated 12 June 2017 advising on the successful outcome of the appeal and confirming Maria was eligible for 100 per cent funded NHS Continuing Healthcare from 10 April 2015 to 01 August 2017 – the date of the first assessment – and that full CHC funding would be provided from there on.

During the period the ruling applies to, James’ family spent £84,895.30 in care costs. James’ family has now received £93,359.20 in compensation, including interest accrued.

James believes that the MDT’s job is to ‘fob you off’ and said that his experience chimed with the experience of others highlighted in the Dispatches documentary on the issue.

Maria, now 83, is currently still living at Cottage Nursery Home, where James says she is happy.