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Vera: Hospital to Nursing Home


Before hospitalisation

Vera is 86. She lives in her own flat, with her son who spends long periods away from home.


Vera has moderate dementia and is also being treated for breast cancer. She was taken to A&E three months ago and admitted to hospital where she stayed for 3 months.

She returned home, and had regular visits from her GP, the Social Worker, a Mental Health Nurse and a Breast Care Nurse. Vera has help with washing and dressing from 2 carers twice a day.

Cost of care (over 6 months):

Personal care x 28/ week for 15 weeks @ £25 £10,500
Medications @ £89.00/ month for 6 months £534.00
Continence pads 20/ week for 15 weeks @ 30p £90.00
Protections sheet x 1/ week @ 12p £7.44
1 x Mental Health Nurse visits @ £56/visit £56.00
Breast care Nurse x 1 visit @ £45 £45.00
GP visits x 3 @ £120.00 £360.00
Social work visit @ £213.00 £213.00
Practice nurse visit @ £12 £12.00
Podiatry x 2 @ £28 £56.00
Respite, 4 days @ £78 £312.00
A & E visit x 1 @ £97 £97.00
Hospital admission 75 nights @ 346/ night £25,950.00
Total: £38,232.44

Hospital admission

Vera was admitted to hospital after a fall. She had been alone in the house and was unable to get up when she fell, so had become cold and dehydrated.

She became increasingly frail while in hospital, and was there for 67 days. It was agreed that she would not manage at home, and she was discharged into a Care Home with Nursing. The Care Home fees will be part paid by the local authority, part by NHS Nursing Contribution and part by Vera and her family.

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, Vera should have needed 7 days in hospital, but actually stayed for 67. 60 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
60 days @ £255 £15,300.00
Total: £17,722.00

After leaving hospital (first six months)

6 months after discharge from hospital, Vera’s physical health was better, but her dementia was worse and she needed more help with activities of living.

2 of her medications were discontinued, and she had started taking iron tablets.

She saw her GP once during the 6 months after discharge from hospital, but had no other contact with health or social services from outside her Care Home.


Cost of Care:

Continence pads, 21 @ 30p/pad for 26 weeks £163.80
Medications@ £82/ month 6 months £492.00
GP visit x 1 @ £120 £120.00
Care Home fees, LA & NHS funded, 26 weeks @ £390 £10,140.00
Care Home, self funded top up 26 weeks @ £113 per week £2,938.00
Total: £13,853.80

After leaving hospital (six-twelve months)

12 months after leaving hospital, Vera lived in the same Care Home with nursing. The financial arrangement remained unchanged, with Vera and her family paying a top up of £113 per week.

In the second half of the year following admission to the Home, she saw her GP 6 times but had no more hospital visits.

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

Continence pads, 28 @ 30p/pad for 26 weeks £218.40
Medications @ £82.00/ month for 6 months £492.00
GP visit x 6 @ £120 £720.00
Care Home Home fees LA & NHS funded @ £390 for 26 weeks £10,140.00
Care Home fees, self funded top up 26 weeks @ £113 £2,938.00
Podiatry x 3 @ £25.00 £75.00
Total: £14,583.00