residential accommodation 13 wk v 52 wk

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  • #38749
    mthorne
    Participant

    This is probably obvious, but has anyone got any opinions on the difference between 13 week temp abs for someone in a care home on a trial basis, and 52 week temp abs being in a care home othere than on a trial basis?

    I have a claimant who was on hospital a few days and was sent to a care home as she could not look after herself. Social Services (for whatever reason) did not assess her until 5 months later and deemed that she was unable to care for herself at her own address and would be unable to return to it.

    Am I right in reading the 2 regs as the 13 week one is voluntarily going into a carehome to see what its like, and the 52 week one is placed in a care home as unable to cope on their own rather than occupy a hospital bed?

    I tried looking but the search is just giving me a pretty pink error message at the moment 🙁

    #109486
    Anonymous
    Guest

    Unfortunately I think you need more information before you can make a decision and it is not as simple as whether it is 13 or 53 weeks temporary absence.

    At the moment you do not say whether there was an intention to return. The intention must be a realistic one.

    There are times when it is more appropriate for a patient to receive care elsewhere than in hospital and the intention would be that once they are able they can return home.
    In the case of your customer there may never have been an intention to return – but it required Social Services to dot the I’s and cross the t’s – or they may have intended to return and then their condition worsened making that an unrealistic proposal.
    The thirteen week temporary absence is not relevant I do not think – I think the 52 week rule is more appropriate particularly if the medical care was approved by a docter.

    You need more information before you revise the claim. If there ends up being an overpayment then you may want to consider not recovering it depending on the circumstances surrounding how it came about and the health of your customer

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