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More about Dorothy's care

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 mostly 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 rest or go out to visit their daughter.

Assessments of Dorothy’s health, activity and dementia score were done at the beginning of the study.

She is incontinent and takes 4 medications every day, including one to treat depression.

Dorothy has help with washing and dressing every morning provided by the care team at the sheltered housing. 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.

Dorothy has an income of less than £15,000 pa.

Costs of care for 6 months before hospitalisation:

Continence pads, 21@ 30p/pad for 26 weeks £163.80
Continence protection sheet x 1/week@ 12p sheet £0.72
Medications @ £20.75 per month £124.50
1 GP visit @ £120 visit £120.00
Day care @ £156 per day £8,112.00
Meals on wheels, paid for by Dorothy @ £3.40 per day £520.20
Home help paid for by Dorothy @ £15 per session £390.00
Total: £9,431.22
NHS
Social care
Self-funded

Dorothy was admitted to hospital with a perforated hernia. She stayed in hospital for 49 days. 7 days were needed for treatment of the hernia, but discharge was delayed because of concerns about how Dorothy and Edward would cope when she went home.

Cost of hospital admission:

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

It was decided that Dorothy needed more care than Edward could manage and she was discharged to a Specialist Care Home with Nursing, with registration for care of people with dementia, close enough to the sheltered housing so that Edward could visit every day.

Dorothy was eligible for NHS Nursing contribution of £108.70 per week, and Edward and Dorothy paid the remaining to pay £491.30 every week of the £600 per week fee.

On arrival, her health and level of independent activity were worse than they had been before she went into hospital.

In the next 6 months Dorothy stayed on the same medications. She saw the GP in the Care Home, 7 times and the District Nurse twice. She had 4 podiatry treatments, which she paid for.

Costs of Care 0 - 6 months after leaving hospital:

Continence pads, 28 @ 30p/pad for 26 weeks £218.40
Medications@ £20.75 for 6 months £124.50
GP visit x 7 @ £120 £840.00
District Nurse visit x 2 @ £27 £54.00
Hospital A & E admissions X 2 @ £97 £194.00
Care Home fee part funded, 26 weeks @ £108.70/week £2,826.00
Care Home fee, own contribution, 26 weeks @ £491.30 £12,793.80
Podiatry x 4 @ £25 £100.00
Total: £17,150.70  
NHS
Social care
Self-funded

Dorothy was still living in the EMI Care home 12 months after leaving hospital. During the second half of the year after her hospital stay she had no further hospital visits. She had reduced to three medications.

She had 7 visits from the GP, and was reduced to 3 medications. She had 8 visits from the District Nurse and 1 from the Social worker. She was seen once by a dentist. She paid for a further 3 podiatry treatments.

12 months after starting the study her health, activity and dementia scores were assessed again.

Costs Care 6 - 12 months after leaving hospital:

Continence pads, 35 @ 30p/pad for 26 weeks £273.00
Medications@ £56.50 per month £339.00
GP visit x 7 @ £120 £840.00
District Nurse visit x 8 @ £27 £216.00
Care Home fee part funded, 26 weeks @ £108.70/week £2,826.00
Social worker x 1 visit £213.00
Care Home fee, own contribution, 26 weeks @ £491.30 £12,793.80
Podiatry x 4 @ £35 £140.00
Dentist, routine check up £17.00
Total: £17,657.80
NHS
Social care
Self-funded

Costs of care are taken from the Personal Social Services Research Unit Report, 2011, written by the University of Manchester, The University of Kent and the London School of Economics.