Before hospitalisation

Lily is a lady of 95, who lives alone. Her son lives nearby and visits regularly to make sure that she is coping.

Lily has no recorded diagnosis of dementia, but assessment shows her to have moderate dementia.

She is mobile and independent, but has been depressed in the past and takes medication for depression.

The Mental Health Nurse visits regularly. The GP has visited twice in the past 6 months. He arranged a visit from an Occupational Therapist to consider modifications to Lily’s house. The OT recommended some modifications to Lily's home, to be paid for by the NHS.

Lily pays for a home help to come in once a week and she buys meals on wheels every day.

Lily needs help to get washed and dressed 5 days a week, managing on her own at weekends.

Cost of care (over 6 months):

Lily was admitted to hospital after a 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.

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, Lily should have needed 7 days in hospital, but actually stayed for 41. 34 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:

While in hospital, Lily became incontinent and her mobility reduced.

When she got home, she needed more help at home, and carer visits increased to 18 per week.

The home modifications recommended by the Occupational Therapist had not yet been implemented.

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 falling again.

Cost of Care:

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. 6 months after coming home, 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 Specialist Care Home with Nursing, self funded.

She was seen once for follow up in Out Patient Department.

Cost of Care for 12 weeks at home, 31 days in hospital then 12 weeks in EMI Home