Family told by NHS: Alzheimer's is not a 'health condition'

This is from The Telegraph in the UK. It is precisely why I am so adamant against a government run health care in the US.

By Nick Britten
Published: 4:28PM BST 18 Aug 2009

NHS Worcestershire ruled that Judith Roe, 74, did not qualify for NHS funding because her condition was a "social" rather than "health" problem, even though she was so ill she could not make a cup of tea and regularly left the stove on.

She was forced to sell her £200,000 home to pay her £600-a-week nursing home fees, which would have been funded if she had been categorised correctly.

Mrs Roe's family appealed to the Health Service Ombudsman, which ruled that Mrs Roe's assessment had been incorrect and her treatment should have been funded by the NHS. NHS Worcestershire has now reimbursed them for six years of care.

Her son, Richard, 40, urged other families in a similar situation to fight for the care they are entitled to.

He said: "The way the health trust behaved was scandalous. It has been very stressful.

"All the time we were told we were wrong while believing we were right.

"They told me I should count myself lucky because there are people that are more ill than my mother, which was an outrageous thing to say.

"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.

"With us, they made a mistake. They did not carry out their duties properly."

Mrs Roe, a retired church warden and school teacher, was diagnosed in 2002 with severe Alzheimer's and Parkinsons.

Under English law, elderly people must pay for their own residential care unless their needs are deemed health-related.

She was assessed but her needs were regarded to be social rather than health, meaning she did not qualify for funding.

In August 2003 her family paid for a social worker to visit her twice a day and in 2004 she moved into a nursing home because she was too ill to stay at home.

In 2007 she was moved into another home because her condition had deteriorated.

Despite being bedridden and requiring round-the-clock care, NHS Worcestershire PCT refused to pay a penny towards her fees.

Throughout this time Mr Roe wrote dozens of letters to the PCT asking them to re-assess his mother.

He said: "I wanted to know just how ill my mother had to be before her condition was deemed a health issue.

"The NHS doesn't want to admit elderly people have health issues because then it falls to them to pay for their care."

He added: "We made the difficult decision to sell her home because we were under the assumption that older people sell their houses to pay for care.

"It was only when we started to look at funding and ask the PCT what funding was available that we realised that she shouldn't have had to self-fund."

Finally, in May 2008, on the recommendation of the Ombudsman, two social workers from the PCT assessed Judith and agreed she qualified for continuing care and paid for her fees at the home until she died in October.

However, the Health Services Ombudsman said she should have had continuing care from 2002 and NHS Worcestershire agreed to pay.

He said: "It should never have got to the point where I had to write to the Ombudsman.

"The PCT did not follow the correct procedures and as a result we had to sell the family home and use her savings for care which should have been funded by the NHS.

"We became very angry because the primary care trust was very arrogant and unhelpful."

Paul Bates, chief executive of NHS Worcestershire, said: "Decisions around eligibility for continuing NHS care are extremely complex and difficult even though we have national guidance to assist us.

"The line between the need for healthcare and social care is a very thin one indeed, but the impact for the individual is the difference between free care and care which is means tested.

"We would not wish to see Mr Roe's experience repeated and there are clearly lessons for us to learn."

Each NHS trust has its own criteria for interpreting the Government's guidelines on who qualifies for free nursing care.

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 are still very concerned that older people may wrongly be forced to pay for their care when it should be free.

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

The Health Service Ombudsman concluded 53 cases of continuing care last year having investigated them. 75 per cent of cases were either fully upheld or partly upheld.

A spokesman refused to comment on the case, other than to say its role is to assess whether the strategic health authority's decision was based on following correct procedure, rather than the need of the patient.

In 2006, a government review revealed that one in five elderly people were being wrongfully denied free care.

http://www.telegraph.co.uk/health/healthnews/6049942/Family-told-by-NHS-Alzheimers-is-not-a-health-condition.html