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Harold: Home again after Hospital


Before hospitalisation

Harold is 91 years old, he has dementia which was diagnosed 3-5 years ago. He lives with his wife, Kathy, who is frail and cannot take care of Harold. Their main carer is Kathy’s sister, Maureen, aged 72.

Harold has an income below £15,000pa.

He takes 4 medications daily.

During the 6 months before going into hospital, Harold went to one Out Patient appointment to see an eye specialist.

Harold and Kathy have regular respite placements at a local care home, for 6 weeks per year. They have spent 28 days in respite during the past 6 months.

Harold and Kathy have a care package to enable them to stay at home; carers come in 24 times per week and Maureen spends on average 5 hours a week with them.

Cost of care (over 6 months):

Medications @ £13/month for 6 months £78.00
1 x OPD appointment @£100 £100.00
Personal care, 24 visits/week for 7 weeks and 2 days @ £25/visit £4,327.00
Respite care, 28 days @ £546/week £2,184.00
Total: £6,689.00

Hospital admission

Harold was admitted to hospital with a chest infection. While he was away, his wife went into a care home.

He was treated for 7 days for a chest infection, but was not able to return home for a further 35 days because his mobility got worse and it was not clear if he would manage at home after discharge.

The rates charged to the NHS for a hospital stay is agreed with the Department of Health (D0H) 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, Harold should have needed 7 days in hospital, but actually stayed for 42. 35 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
35 days @ £255 £8,925.00
Total: £11,347.00

After leaving hospital (first six months)

As Harold got better, his mobility improved and he was discharged home. Kathy also came home again.

Harold had become incontinent while in hospital. Personal and social care increased, as shown in the table.

He saw his GP once, a mental health nurse once and an ophthalmologist once to check on his glaucoma. A social worker visited 3 times to make sure that Harold and Kathy were coping at home.

He was seen in Out Patient clinic and admitted to hospital again for one night because of suspected dehydration.

Harold and Kathy were both treated at home by their podiatrist once, which they paid for.

Cost of Care:

Continence pads, 14 @ 30p/pad for 26 weeks £109.00
Medications@ £111.00/month for 6 months £666.00
GP visits x 1 @ £120.00 £120.00
Mental Health Nurse vists x 1 @ £56.00 £56.00
Hospital admission x 1 night @ £346.00 £346.00
Out patient appointment x 1 @ £100 £100.00
Social worker visit x 1 @ £213.00 £213.00
Personal care 30/week @ £25 £19,500.00
Podiatry x 4 @ £28/treatment £140.00
Total: £21,250.00

After leaving hospital (six-twelve months)

From 6 to 12 months after leaving hospital, Harold remained well.

Assessments of his health, activity and dementia showed no change.

He had no further contact with hospital and no periods of respite care.

His GP visited him once and the District Nurse twice.

Cost of Care:

Continence pads, 7 per week @ 30p/pad for 26 weeks £46.20
Medications @ £111/month £666.00
1 x GP visits @ £120/visit £120.00
District Nurse visit x 2 @ £27.00 £54.00
Personal care, 30/week @ £25 each £19,500.00
Podiatry x 2 @ £35.00 £70.00
Total: £20,456.00