Continuing care is defined as, professional care given to meet the physical or mental health needs of adults with a disability, injury or illness over an extended period of time.
NHS continuing healthcare means a package of care that is arranged and funded by the NHS and is free of charge to the person receiving the care, be it in a care home or in their own home and is usually referred to as “fully funded NHS care”.
As one in three women in Britain, and one in five men, will eventually need long term care, the funding of such care is an issue that is likely to touch most people’s lives in one way or another. So over the last few years, the Government has attempted to make clear in law the type of healthcare needs that qualify for NHS continuing healthcare.
A national framework has been developed to provide guidance to the NHS about this and to try to ensure that consistent decisions are made across the country.
NHS continuing healthcare assessments
Primary care trusts (who manage local health services) are required to carry out an assessment for NHS continuing healthcare where health services might be needed for elderly home care.
The assessment should be carried out for Continuing Care when a patient is discharged from hospital before referring the person to social services for help with social care needs. Also, an assessment should be requested if the physical or mental health of the person you are looking after deteriorates significantly. Some people who need an urgent decision, such as those who are terminally ill, should be fast-tracked to receive NHS continuing healthcare immediately.
Where is NHS continuing healthcare offered?
NHS continuing healthcare can be provided by the NHS in any setting, which includes a care home, hospice, hospital or the home of the person being looked after. Where NHS continuing care is provided in the home of the person being looked after, it will cover personal care and healthcare costs.
Responsibilities of social services
If NHS continuing healthcare is provided for care in the home, then the local social services may still have responsibilities to provide some services in addition to the home care. It is possible to receive ‘mixed’ packages of care, where some services come from the NHS and some from social services. Where local social services provides the care services, it will usually do a financial assessment to decide whether the person you look after must make any financial contribution.
The NHS team will consider each of the healthcare needs of the person looking for continuing care funding, which are:
- behaviour,
- cognition (understanding),
- communication,
- psychological/emotional needs,
- mobility,
- nutrition (food and drink),
- continence,
- skin (including wounds and ulcers),
- breathing,
- symptom control through drug therapies and medication, and
- altered states of consciousness.
An example of the type of care that might warrant continuing care funding is “Fred has been diagnosed with Alzheimer’s disease. His Alzheimer’s has reached an advanced stage and because he lives at home he needs assistance with all of his personal care tasks. In particular Fred needs help with his washing and eating and he also has both bowel and urinary incontinence, and needs constant supervision to ensure his safety.”
The value of Continuing Care may exceed £1,000 per week, but You do not receive the cash directly yourself, but instead the NHS spends it on your behalf in accordance with the needs and aims stated within a Care Needs Assessment. The health authority (Primary Care Trusts in England, Health Boards in Scotland and Wales) are obliged to take the wishes of the client into account though. So if you want, for example, to have a live-in carer provide you with the care you need at home you should make this clear to the NHS, as early as possible during the care needs review.
If you want to continue this discussion you will find the sam esubjuect on our forum here – NHS Continuing care funding for the elderly.
44 responses so far ↓
1 george // Jun 30, 2009 at 7:48 am
Hello there, what if a disabled person lived at the same house (i`ve lived there for 6 months now) with elderly parents needing to go into a care home or a nursing home – would the disabled person have to sell the house to pay for his/her parents care/care home fees and move out and find somewhere else to live ? thankyou.
2 admin // Jul 7, 2009 at 11:33 am
I suppose the obvious question is – in whose name is the house in that you live – is it in your name or your parents name?
3 stan ramsay // Aug 11, 2009 at 12:54 pm
my mother is blind, has had a stroke and is catheterised , could she qualify for continuing care
4 admin // Sep 9, 2009 at 1:06 pm
It is possible and I suggest you contact you local social services and ask for a visit by your local Social Worker to assess you Mum for this situation – I hope this helps
5 angela // Sep 30, 2009 at 2:24 pm
my mother has dementia and is currently in a residential home and is self funding,they are now saying that they can not meet her needs as she is unable wash,dress, eat without prompting, is double incontinent and can not understand anything that is said to her. She has been assesed as needing nursing care she has approx £35k left from sale of house 4 1/2 yrs ago. What help can she get and what is continuing care.
Thank you
6 admin // Oct 9, 2009 at 2:31 pm
Thank you for you question about your mother Angela – You ideally want to have your mother placed into a nursing home so that she receives the care she needs. Secondly, your local social services should fund the care for your mother once her funds are no more than £23,000. However, the funds available to your mother will be subject to them carrying out an assessment of her beforehand, so I suggest you contact your local social services as soon as possible to arrange this assessment before the funds dip below this £23,000 threshold. I hope that this answers your question and if you have any further questions please do not hesitate to ask.
7 admin // Oct 9, 2009 at 2:35 pm
Having answered Angela – I would like to add that if there was the possibility of caring for her Mother in her own home then I would have recommended this in preference to a nursing home. However, as the house has already been sold this option is not open to her at this stage. I wanted to make people totally aware of the fact that you can be cared for in your own home – no matter what the level of care is required – except of course where people have to admitted to hospital for hospital type care.
8 cellie // Oct 14, 2009 at 12:27 pm
my mum has just been discharged from hospital, and had a continuous care assessment before she was discharged. She is now in a nursing home but I am unclear what happens next. All I have heard is that she has been granted the continuous care. She has been in the home just over a week now and I have’nt received the first months invoice yet. How will this work? will the home get the funding direct and mum will have to pay the remainder? I have found social services totally unhelpful. My mum is self funding.
9 Sarah // Oct 14, 2009 at 7:28 pm
Hello,
further to Angela’s question can I ask why her mother would not be assessed as needing NHS continuing care? How can this not be a medical need? My mother is in a similar situation but not to such an advanced stage (we’re self-funded too). I’m confused about the difference between a social need and a health one.
10 linda // Oct 19, 2009 at 7:00 pm
my elderly father has dementia;he understands very little, speaks ‘gobbledygook;’ and no longer recognises anyone, even my mother. But he is physically still quite healthy, able to feed himself, shuffle about up corridors, etc. He is currently in a self-funded dementia unit. What will be the position for funding as his physical condition deteriorates? At the moment, my mother still lives in their home, and can just about afford to pay the care home fees from pensions and savings. Will the 23,000 rule still apply if he goes either temporarily or permanently into a nursing home for instance? Or as he deteriorates, and his needs start to meet the ‘checklist’ criteria, can he then be nHS funded without my mother having to use up her savings and then sell their home?
How do we start the process of assessment once this happens?
thankyou.
11 Margaret O'Brien // Oct 21, 2009 at 10:44 am
All that is needed to qualify for NHS continuing care is that the patient has a health need. The authorities deliberatetly mislead and withhold information regarding patients lawful rights in order to avoid funding. If you wish to know more google ‘Coughlan’ and ‘free nursing care’ and ‘Lovelock’. There are internet forums available run by people who have fought for their rights in this respect. You can fight for your rights but be warned it can be hard to access them.
12 admin // Oct 22, 2009 at 2:47 pm
Angela –
Your mother needs to be assessed for nursing care and if it is agreed
by the NHS that she is in need of this level of care, she will receive a
contribution towards the nursing care costs of £106.30 per week
(actually assistance with washing, eating, dressing etc may only be seen
as a social need, and may not qualify for nursing care contribution, but
it is certainly worth asking the question, especially as I assume it is
the residential care home saying that she now needs nursing care). Any
additional cost of care would be funded by herself whilst her own assets
are in excess of £23,000, and during this time she would continue to
receive the non-means tested benefit Attendance Allowance higher rate of
£70.35 per week – I would expect her to receive this at the higher rate
(ie needs some level of care day and night)
When her assets reach the £23,000 level she should have assistance with
payment from the local authority – get them involved before her assets
run down to this level. At this point all her income (pension, state
pension, Attendance Allowance etc will be used to pay for her care) –
less a weekly personal expenditure amount, which she is able to retain
of £21.90 – will be used to cover her costs. The local authority will
also make a contribution towards the care costs. However, if the care
home fees are still higher than this total sum and the care home is not
prepared to accept the lower funding level, the family could be asked
for a third party top-up to cover the full care costs – or your mother
could be asked to leave that particular home and go into one that is
less expensive.
As your mother has relatively low assets, which would run down to the
Local Authority funding level quite quickly, I would ascertain with any
nursing care homes you are considering, how they would look at your
mother’s situation ie would they accept Local Authority funding in the
future and if not, what the third party costs would be, so that as a
family, you can decide whether this is affordable in the long term. This
may make this one of the paramount criteria for selection of the nursing
care home.
13 admin // Oct 22, 2009 at 2:48 pm
Cellie –
If your mother has been granted continuing care, this means that all of
her care is paid for by the NHS, whilst she is considered eligible
(Attendance Allowance and other State benefits may be affected). If your
mother’s situation stabilises she may be re-assessed and may then only
qualify for nursing care contribution (£106.30 per week) for example,
payable towards her nursing care costs, any additional costs would be
payable by herself as she is self-funding ie has assets in excess of
£23,000 – she should still get attendance allowance in this event.
The NHS pay the care home direct for continuing care and so you should
not need to get involved as this point.
14 admin // Oct 22, 2009 at 2:48 pm
Sarah –
There are criteria established for assessment of care requirements.
Social care is basic help with activities of daily living, ie dressing,
washing, feeding, mobility and toileting. Nursing care involves a higher
level of care that requires a registered nurse on site. Continuing care
is a higher level of care still – often hospitalisation or thereafter;
or should someone be in a very unstable condition – once stabilised the
level of care required may be re-assessed and could then be reduced to
nursing care and the individual would then receive only the nursing care
contribution of £106.30 per week (plus attendance allowance) if self
funding.
15 admin // Oct 22, 2009 at 2:49 pm
Linda –
Should your father become in need of nursing care, he should be assessed
by the NHS to ensure he is in receipt of all benefits due to him.
I assume he has assets in his own right in excess of £23,000, as the
house should be excluded from any financial assessment whilst your
mother lives in it and your mother can have other assets in her own
right too, she does not have to use her own savings to pay for his care,
but he must use his own savings up to the £23,000 level – I would
recommend splitting their savings so that it is obvious what belongs to
your father and what belongs to your mother. If your father cannot
afford to pay for care from half pension (ie half of their total income)
and attendance allowance and he has assets below £23,000, then he should
have assisted funding from the local authority and needs to have a
financial assessment urgently. Your mother’s assets (including the
house) should not be taken into account in this assessment
The £23,000 applies to permanent care (whether residential or nursing),
but it sounds as if this is the case, as you have implied that your
father is unlikely to be able to go home.
If he meets the nursing care criteria in the future, he will receive the
nursing care contribution towards nursing care of £106.30 per week,
which may or maynot fully cover the cost of the nursing care, depending
on the care home fees. Family may be asked to make a third party top up
towards additional costs, but your mother should not be forced to sell
the property to pay for your father’s care. Your local social services
representative should be able to help with arranging an assessment – the
care home may also help as well, as they would be dealing with him on a
day to day basis and would be in a better position to know his medical
needs. To be fully NHS funded (Continuing care) your father would need
to be in very poor health or to be in a very unstable condition.
16 sharon // Oct 22, 2009 at 9:36 pm
Hi my mother in law has been in hospital for 6 months now after having a severe stroke. She has since been diagnosed with a brain tumor which is untreatable and is now terminally ill. The hospital has advised that she will need continuous care and that she would be elligiable for this. Will we, the family, have to pay?
17 Lorna // Oct 23, 2009 at 10:55 am
Hi
my brother has Downs and Alzheimers (late stage) – he lives (and has lived for over 20 years) in a residential home with 7 other residents who have all been there for the same period. The home are saying that he now is costing too much (£2,000 a week) to look after and so should be moved to another residentail home which is cheaper !!! Can they do this? We have offered to pay for the shortfall. Would NHS funded continuing care funding apply to him? who do we go to to get it? Would that pay for the difference in costs? Brother is in wheelchair, incontinent but otherwise well (doesn’t recognise us etc). Please HELP
18 admin // Nov 10, 2009 at 7:59 pm
Sharon
Continuous care means the NHS will fully fund the necessary care due to your mother in law’s poor health. There is no need for any payments by the family, no matter what your mother in law’s financial circumstances.
19 admin // Nov 10, 2009 at 8:01 pm
Lorna
It really depends on the level of care that your brother needs. Incontinency generally only requires residential care; nursing care is when a registered nurse is required to perform medical tasks other than those such as washing, dressing, bathing etc.
It would be worthwhile asking for an assessment to ascertain his needs and to ensure that your brother is receiving the level of care required. At late stages of Alzheimers it is possible that your brother could receive full NHS funding (continuing care), if he is unstable or very poorly (from what you have said, it does not sound as if he is at this point), which would cover all costs.
I assume your brother has no funds of his own and therefore the local authority do have the right to move him to a cheaper home. However, you could challenge this as this has been his home for a substantial amount of time and any move could be detrimental to his health. You may need to be prepared for a fight, think about your local MP and other routes; are
the other residents being asked to move too?
Alternatively if the local authority are not prepare to make the additional contribution, the family can pay a third party top up in addition to the amount the Local Authority would pay, to keep your brother at the current home; however, be aware that this is an open ended agreement, with possible long term financial commitment implications, for your brother’s lifetime.
20 Manraj // Nov 11, 2009 at 11:15 pm
Hi, my grandmother is coming to live with us (the house is in my father’s house) she is unable to walk to even get to the toilet, has kindey failure, diabetic, and high B.P. and suffered from breast cancer, are there any procedures for this?
21 RICHARD STEWART // Nov 15, 2009 at 5:16 pm
My Mother is a resident in a BUPA HOME. She currently receives state health funding of £106 per week. She is being assessed soon and if the findings agree that she should get full funding can she recieve this if she remains in the Bupa Home or would she have to move to an NHS HOME?
22 ASH // Nov 17, 2009 at 8:52 pm
my dad has severe dementia. understands no words, cannot wash himself, wets himself, needs medicen given to him, cannot communicate, puts anything in his mouth to eat and is always trying to abscond from his assesment center he is at. very sad. will he qualify for nhs continuing care? he also has 1 to 1 nursing as he tries escaping constantly!! he is currently under DOLS. thanks for feed back, ash
23 Alison // Nov 18, 2009 at 11:28 pm
If you get assessed and awarded for continuing care does your relative lose all their pensions? My father has DWP and a private pension which we might need for his house running expenses if we get fully funded continuing care. He has Parkinsons, mixed dementia, has severe behaviour problems, agitation, hallucinations, limited cognitive ability, unable to feed, refuses medication, food and drink, needs sedation when unmanagable, doubly incontinent and deteriorating day by day. I used the tools and believe his condition may warrant continuing care. We know he would want to be in his own home for his ending days but suspect NHS continuing care won’t fund this expensive route? Keeping the pensions might help, can you advise.
24 Andi // Nov 29, 2009 at 8:46 pm
My father may need to go into full time care he suffers from early stage Alzhiemer, is diabetic insulin controlled, registered blind and early stage parkinson my mother has recently died who was his main carer will he need to sell the house to fund this, my brother still lives there has he has a learning disability and would have nowhere to live and need a home
25 M Borisova // Dec 7, 2009 at 5:44 pm
Could you please let me know what I need to do to be able to provide “continuing care” to people in their own homes? Do I need a contract and if yes what else I need to do?
Please help me to help more people who need US!
Kind regards
26 Dee // Dec 10, 2009 at 11:44 pm
My 91 year old Mum went into residential care 10 weeks ago after a spell in hospital, she has severe dementia, she has no savings & was in a housing trust flat.I have just been informed I have to pay all but £21.90 of her pension to the council, surely this cannot be expected to pay for hair, toileteries,chiropody & clothing , I am retired & recieve no pension myself so cannot help financialy . Can I do anything about this.
27 jenny // Dec 14, 2009 at 12:27 pm
My grandmother recently had a severe stroke, we do not want her to go into a nursing home and to remain in her own home where family visit daily. She can fund some of the estimated cost of ‘live in carers’ but is there any funding that she is intitled to.
Thankyou
28 admin // Dec 15, 2009 at 9:55 pm
Hi Manraj – Your Grandmothe may be eligible for assistance with things like stair lift etc around the house – ask the local authority for an assessment and they may be able to help with a grant depending on her assets. It is likely she would be eligible for Attendance Allowance – apply to the DWP (Department of Work and Pension) – lower rate for assistance required day or night and higher rate for assistance day and night
29 admin // Dec 15, 2009 at 9:56 pm
Hi Richard – If your Mother gets full continuing care then all costs are met by the NHS – they would need to agree where this care was to be, but if she has been in the BUPA home for some time you would have a good argument not to move her, as this could impact on her health.
30 admin // Dec 15, 2009 at 9:57 pm
Hi Ash – It sounds to me as if this is high need EMI (elderly mentally infirm) care and may not receive continuing care but may be due Registered Nursing Care Contribution – ask for an assessment from the NHS, the care home can probably help with advice regarding whether they think your Dad would be eligible. Continuing care is granted for individuals in very poor health or with unstable conditions and from what you have said, I suspect this will not apply.
31 admin // Dec 15, 2009 at 9:58 pm
Hi Alison – The NHS pick up all costs – but this may not be at your Fathers home – so personal pensions and State pension would continue. Request an assessment by the NHS to see if he qualifies and then discuss where the care could be provided. Be aware that the continuing care benefit can be removed if health improves or stabilises.
32 admin // Dec 15, 2009 at 9:59 pm
Hi Andi – Your brothers disability may mean that the house could be disregarded for the purposes of your father’s assets which may take him close to the £23,000 level at which the Local Authority will assist with his funding.
Get the Local Authority involved for a financial assessment, which will advise you whether the local authority can fund or he needs to self fund
- and therefore you need to select a care home that is affordable and hopefully one he could stay at in the future should his assets reach the £23,000 level and local authority get involved. Of course, you can sell the property to fund for his care – but as soon as your brother no longer lives there, it would become part of your father’s assets and the value must be used to fund his care. If the property is disregarded, there is an asset there to be passed on to beneficiaries, if this is your father’s wish.
33 admin // Dec 15, 2009 at 10:00 pm
Hi M Borisova – If you mean the high level of nursing care that is required to individuals granted full NHS funding, I would suggest that you contact your local PCT in this regard. Continuing care is usually granted for individuals in very poor health (over and above those requiring nursing care) or who currently have unstable conditions, and therefore the level of care would be very high indeed and may not be possible in their own homes.
34 admin // Dec 16, 2009 at 12:23 pm
Hi Dee – As your Mum has assets below £23,000 your mother will be funded by the local authority. However, her State Pension and any attendance allowance will go towards the cost, as you have discovered, with the exception of £21.90 per week personal allowance which is deemed to be sufficient for the type of needs you have outlined. I am afraid there is nothing that can be done about this, maybe family members and friends could buy toiletries and clothing for xmas and birthdays etc.
35 admin // Dec 16, 2009 at 12:23 pm
Hi Jenny – Your Grandmother should receive Attendance Allowance (apply to Department of Work and Pensions DWP) lower rate (£47.10 per week) for care day or night and higher rate (£70.55) for care day and night. This is non means tested Nursing care has to be provided by (or in an enviroment with) a registered nurse and so it is unlikely that the Nursing Care Contribution (£106.30 per week) would be payable in her own home, however you could ask your local PCT She should also be assessed by the local authority/social services to check out the level of care needed and there may be a grant for work around the house, if required ie grab bars, stair lift etc.
36 Jamie Whitehouse // Dec 30, 2009 at 8:26 pm
Hi all,
Since the completion Johnson, Roe and Eyton-Jones cases in September 2009, it seems that the existing websites that provide support on challenging PCT’s on NHS continuing care funding have ceased to be maintained. I have started a new support page at http://www.serveronecare.com and I would ask everyone for their support.
I intend to publish the assessment forms for each authority in england, once I have received copies so that everyone can see the huge differences in how the national policies are being applied. I also have started a case database of all the cases that are taken to the ombudsman for determination, or are appealed.
I have added a link to this website to my homepage, and I would be very grateful if you would be so kind to return the favour to help spread the word.
Many thanks
37 admin // Jan 10, 2010 at 4:24 pm
I have moved this discussion to our forum, as this seems a better medium for a discussion, not realising that this would be so popular as a post – this is here – http://www.careathome.org/homecareforum/showthread.php?tid=10
38 Helen // Jan 23, 2010 at 11:18 pm
My mother was discharged from the E.M.I. ward of a local hospital two and a half months ago. after a three month stay following a stroke. She has vascular dementia, is doubly incontinent, cannot walk and only stands to be washed when two carers assist. The Senior Nurse Manager on the ward told me that she would need 24hr nursing care, however I have moved to her home as her 24hr carer with homecare coming in twice daily to toilet, wash, dress her etc. Mum is being charged weekly for this, having been assessed by the local authority. I get no respite unless I am prepared to pay what I consider to be far too much – I am a pensioner on pension credit and have a still semi-dependent young son . My mothers condition is deteriorating but the hospital has said that there is nothing more that can be done and that she is on the appropriate medication for her condition. My mothers behaviour can be unpredictable, I find her in various states of undress, her incontinence creates massive problems when she removes her pads and needs to be watched virtually all the time. Her sleep patterns vary so that sometimes she is awake in the middle of the night and I find it difficult to balance her laxatives in order balance her constipation problem, with various doctors and district nurses having differing opinions and suggestions. Is my mother eligible for N.H.S. funded continuing healthcare, and if so how does this apply when the patient is at home?
Is it worth going to a specialist solicitor for advice and do you think they would take on my case? If Mum is eligible for N.H.S. funded continuing care would I be able to have a live-in nurse with me attending on the persons days off?
I really hope you can help me with answers to these questions….Thankyou.
39 admin // Jan 25, 2010 at 9:17 pm
I have moved this discussion to our forum, as this seems a better medium for a discussion, not realising that this would be so popular as a post – this is here – http://www.careathome.org/homecareforum/showthread.php?tid=10
40 Susan // Mar 22, 2010 at 11:51 am
My father has vascular dementia, is double incontinent and cannot walk due to a fall in the hospital. He requires 2 to 3 carers to assist him for all personal care. He is partially deaf and his cognitive respones are worsening, difficult to understand his speech at times. He has been hospitalited for over a year and they now wish to move him to a nursing home. Should he not be entitled to Continuing Care? If not, He has around £5000 in savings and owns his own home. He s in receipt of £47.10 attendance allowance and his Government pension and a very small private pension. Is there any further assistance he would be entitled to?
41 admin // Apr 7, 2010 at 10:21 am
I would suggest arranging full assessment regarding the continuing care (which may have already been done) – this is given only in very extreme cases, or where the health situation is unstable, so it may not be granted in this case, but it is definately worth asking for an initial assessment and then re-assessment if his needs change. If continuing care is granted then NHS pays for all costs (attendance allowance would then cease and State Pension would go towards these costs, with the exception of personal expenses allowance – new rate of £22.30 per week)
I assume that he is widowed with no-one currently living in his home – in which case this would be included as an asset and therefore as assets will be in excess of £23250, he will be due to pay for his own care, assuming continuing care is not granted.
He should get higher rate Attendance Allowance (the sum you have quoted is lower rate) so re-apply to DWP (Department of Work and Pensions). New rate for new tax year is £71.40 per week higher rate and £47.80 per week lower rate.
If nursing care is required – and is sounds like it from what you have said, then there is a contribution towards nursing care from NHS – new rate is £108.70 per week.
42 winney // Jun 9, 2010 at 10:22 pm
My Mother has been granted continual care, does this mean her state pension will go towards paying for the care home.
43 Denise // Jul 9, 2010 at 10:43 pm
My uncle had recently died which means that my aunt who suffers from alzheimer’s has had to be moved into a nursing home. The social worker has straight away said that she has to sell her home. A few months ago she was kept in hospital for weeks because the car that she was travelling in was involved in an accident, even though she was unhurt she they kept her in because they felt that my uncle could not cope with her and because of her mental and physical problems. Would she have been assessed for continuing care before she was discharged. if so how do I see the assessment that the hospital done . When my uncle went into the hospice before he died, my aunt was sent to a nursing home by social services because she needs nursing care.
44 Helen // Jul 29, 2010 at 6:47 pm
Can I charge my mother weekly for being her sole carer, thereby reducing her savings to the amount allowed in order to avoid my local authority taking her savings should I be unable, any longer to care for her?
I have been sole carer (her needs have been assessed as requiring nursing care (but apparently not the type the N.H.S. pay for) for nine months without a break and feel abandoned and ignored by the N.H.S., I come up against a brick wall whenever I ask for respite and am told to ask the local authority social services. My social services are happy to provide a weeks respite but only for £500 plus per week and I don’t want my mother to have to pay this. I am told of other people in similar situations to me having a week every eight weeks where their relative is taken into respite free of charge by the N.H.S., I am after all saving them thousands of pounds by providing my services free of charge. My mother has vascular dementia, is doubly incontinent, on a special mattress in a hospital bed here at her apartment. She has C.O.P.D., heart problems, osteoporosis and is only six stone with major constipation issues that require regular intervention by a district nurse.
Anyone in a similar situation? Can anyone help me?
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