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Dorothy: Hospital to Nursing Home

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Before hospitalisation

Dorothy is 90 years old. She lives with her husband, Edward, in sheltered housing. She has moderate dementia and needs to have someone with her 24 hours per day. This is usually Edward, but she attends a Day Centre twice a week and a sitter comes from the local authority every Wednesday afternoon for 4 hours when Edward can have a break.

Dorothy has help with washing and dressing every morning provided by the care team at the sheltered housing. She is incontinent and takes 4 medications every day, including one to treat depression. She has meals on wheels every day and a home help once a week, which she pays for. She also pays for podiatry, and had two treatments in the 6 months prior to going into hospital. During this 6 months, Dorothy’s GP saw her once at her home.

Cost of care (over 6 months):

Continence pads, 21 @ 30p/pad for 26 weeks £163.80
Continence protection sheet x 1/week @ 12p £0.72
Medications @ £20.75/month for 6 months £124.50
1 x GP visit @ £120/visit £120.00
Day care @ £156/day £8,112.00
Sitter, 4 hours/week @ £21.50 per hour £2,236.00
Meals on Wheels, paid for by Dorothy £520.20
Home help, paid by Dorothy £390.00
Total: £11,667.22

Hospital admission

Dorothy was admitted to hospital in January, with a perforated hernia.

The rates charged to the NHS for a hospital stay is agreed with the Department of Health (DoH) in national tariffs. The tariff is the rate payable and the number of days required for treatment of every condition. If a patient stays longer in hospital than allowed within the tariff, the reimbursement from the DoH to the hospital per day is reduced. In this case, Dorothy should have needed 7 days in hospital, but actually stayed for 49. 42 days were charged as NHS excess bed days - i.e. excess to the number of days required by her medical condition, see National Tariff.

Cost of Care:

7 days @ £346 £2,422.00
42 days @ £255 £10,710.00
Total: £13,132.00

After leaving hospital (first six months)

Dorothy was discharged to a Care Home specialising in care of people with dementia with nursing. The fees were £600 per week. Dorothy received NHS contribution for nursing care of £108.70 per week, and paid the rest herself @ £491.30/week.

Cost of Care:

Continence pads, 28 @ 30p/pad for 26 weeks £218.40
Medications@ £20.75/month for 6 months £124.50
GP visits x 7 @ £120.00 £840.00
District Nurse vists x 2 @ £27.00 £54.00
A & E admission x 2 @ £97.00 £194.00
Care home fee (funded), 26 weeks @ £108.70 £2,826.20
Care Home fee, self funded, 26 weeks @ £491.30 £12,793.80
Podiatry x 4 @ £28/treatment £140.00
Total: £17,189.50

After leaving hospital (six-twelve months)

Twelve months after leaving hospital, Dorothy lived in the same Care Home. One of her medications had been stopped.

She had 3 visits from the District Nurse, 7 from the GP and 1 from the Social Worker to review her care. She was seen by an NHS dentist.

She had 4 podiatry treatments, that she paid for herself.

Cost of Care:

Continence pads, 35 @ 30p/pad for 26 weeks £273.00
Medications @ £56/month £339.00
GP visits x 7 @ £120/visit £840.00
Social worker visit x 1 @ £213 £213.00
District Nurse visit x 8 @ £27.00 £216.00
Care Home fee (funded), 26 weeks @ £108.70 £2,826.20
Care Home fee, self funded @ £491.30/week £12,793.80
NHS Dentist @ £17 £17.00
Podiatry x 4 @ £28.00 £112.00
Total: £17,630.00