Lily is a lady of 95, who lived alone. Her son lived nearby and visited regularly to make sure that she was coping.
Lily had no recorded diagnosis of dementia, but assessment showed her to have moderate dementia. She was mobile and independent, but had been depressed in the past and took medication for depression. The Mental Health Nurse visited regularly.
The GP had visited twice in the past 6 months because Lily complained of pain in her hip and was feeling unsteady on her feet. He arranged a visit from an Occupational Therapist to consider modifications to Lily’s house. The OT recommended that a key safe be put on Lily's door, and rails be put up to make access to the front door easier. This would be paid for by the NHS.
Lily paid for a home help to come in once a week and she bought meals on wheels every day. She has help to get washed and dressed 5 days a week, managing on her own at weekends.
One frosty day Lily slipped on her doorstep, fell and was admitted to hospital. She was cold and distressed by the time her neighbour came to her assistance.
Costs of care for 6 months before hospitalisation:
|Medications @ £ 16 per month||£96.00|
|1 visit from Mental Health Nurse||£56.00|
|2 visits from GP||£240.00|
|1 contact with occupational therapy||£46.00|
|Personal care; 5 contacts per week for 26 weeks @ £25/ visit||£3,250.00|
|Home help, x 1 per week||£325.00|
|Meals on wheels x 7 days per week for 26 weeks @ £3.30||£600.60|
Lily was admitted to hospital after the fall, and stayed in bed, too anxious and sore to get up. She was treated for 7 days for her fall, but remained in hospital for a further 34 days until she was strong enough to manage alone. She started treatment for osteoporosis while in hospital.
Cost of hospital admission:
|7 days @ £346||£2,422.00|
|34 days @ £255||£8,670.00|
While in hospital, Lily became incontinent and her mobility reduced.
Costs of Care 0 - 6 months after leaving hospital:
On returning home from hospital she needed more help at home, and carer visits increased to 18 per week. She still had her home help weekly, and regular help from her son. Her son started providing her meals in place of meals on wheels, which he thought she was wasting.
In the 6 months after leaving hospital, Lily was visited by a psychiatrist, her GP, a social worker, a specialist incontinence nurse, a falls nurse and a chiropodist. She paid for the chiropodist herself.
Twice during this 6 months, Lily was taken to A & E after another fall.
|Continence pads x 21/ week @ 30p/pad for 26 weeks||£163.80|
|Medications@ £ for 6 months @ £25.05/month||£651.30|
|GP visit x 4 @ £120||£480.00|
|Psychiatrist visit x 2 @ £117||£234.00|
|A & E admissions, x 2 @ £97||£194.00|
|45Visit from Incontinence Nurse||£45.00|
|Visit from Falls Nurse||£45.00|
|Social worker x 1 visits @ £213||£213.00|
|Personal care, 18 contacts/ week @ £25||£11,700.00|
|Protection sheet x 7/ week @12p||£21.84|
|Chiropody x 6 @ £30||£180.00|
|Home help x1 / week @ £12.50||£325.00|
Costs of Care 6 - 12 months after leaving hospital:
(Costed at 10 weeks at home, 4 weeks in hospital, 12 weeks in EMI Care Home)
It was apparent that Lily was becoming less able to cope on her own. She was losing weight and the family was concerned about her. She was seen by a psychiatrist and by her GP and District Nurse. Personal care visits were increased to 4 per day. 9 months (week 36) after returning home from hospital, Lily fell again and broke her wrist. She was in hospital this time for 31 nights. After this, her son decided that Lily could not continue to live alone, and 10 months (Week 40) after the end of her first hospital stay she was discharged after her subsequent hospital admission to a Residential Care Home, paid for by the local authority. She was seen once for follow up in Out Patient department.
|Continence pads, 14/ week @ 30p/pad for 6 months||£109.20|
|Medications@ £25.05 per month for 6 months||£651.30|
|GP visit x 1 @ £120||£720.00|
|District Nurse visit x 2 @ £27||£27.00|
|Psychiatrist @ £117||£117.00|
|Hospital inpatient stay, 31 days @ £346||£10,726.00|
|Personal care, 28 contacts/ week @£25 per visit for 10 weeks||£7,000.00|
|Care Home fees @ £456 for 12 weeks||£5,472.00|
|Chiropody x 1 @ £30||£30.00|
|Home help @ £12.50 for 10 weeks||£125.00|
|Incontinence sheet @ 12p x 1/ week for 10 weeks||£1.68|
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.