Before hospitalisation

Mary is 86 years old and lives in a large detached house where she had brought up her 3 children. Mary was diagnosed with dementia 5 years ago, and her family has become increasingly concerned about her.

Mary was recently found near to her house, in the rain without a coat, having fallen and not knowing where she was.

Mary was taken to A&E and spent 2 nights in hospital. After this, a place was found for her at a Residential Care Home, to be paid for by the family, funded by the sale of the family house.

Cost of care for 6 months; 21 weeks in her own home 5 weeks in a Residential Care Home:

Mary seemed content in the Care Home, but after a few weeks she became unwell and was admitted to hospital. She was in hospital for 37 days during which time she became increasingly withdrawn and uncooperative.

After an assessment in hospital, the Residental Care Home decided that they were unable to take Mary back and she was discharged to a Specialist Care Home, again self funded.

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 by the DoH to the hospital per day is reduced. In this case, Mary should have needed 7 days in hospital, but actually stayed for 37. 30 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:

Mary was discharged to a Specialist Care Home with registration for dementia care. She was seen by her GP once and by a Psychiatrist twice. She was visited regularly in the Home by a Mental Health Nurse. She was prescribed memantine, but her condition continued to deteriorate.

Her mobility reduced. It became very hard to give her an adequate diet because she had difficulty swallowing, and she became completely uncommunicative. It was a distressing time for the whole family.

After 3 months, Mary became severely dehydrated, she was admitted to hospital and after 14 days there, she died.

Cost of Care:14 weeks after hospital discharge. 12 weeks in Specialist Care Home, then 2 weeks in hospital.