Francina
October 30, 2016 at 2:01 pm
Hi,
A family member made an official complaint to the CCG about their Continuing Healthcare provider in March. They finally received a reply last week. The reply report was jointly written by the CCG and the provider they complained about. Is this correct? Naturally, the provider defends all their actions and blames 3rd party agencies for the errors.
Chris-G
December 22, 2016 at 8:18 pm
Francina, court cases indicate that a council is responsible for the safety errors of its contractors so errors made by others employed by a CCG are in legal fact, the CGS errors and they retain responsibility. The very law establishing CCGs also states that fact. (Standing rules regulations) will inform)).
Angela Sherman
November 1, 2016 at 3:10 pm
Francina - that report doesn't sound very transparent or impartial to me. If you have concerns about the provider and they're actions are putting someone at risk (your relative?) you could raise a safeguarding concern with the local authority. These links may help - AgeUK: http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS78_Safeguarding_older_people_from_abuse_fcs.pdf?epslanguage=en-GB?dtrk=true and Care Quality Commission: https://www.cqc.org.uk/content/safeguarding-people
Rachel Keetley
October 19, 2016 at 12:53 pm
Hi
I work in palliative social work and I am increasingly hearing of nursing homes that are charging clients a 'lifestyle choice' payment over and above the fees which NHS Continuing Healthcare pay to the nursing home. To my understanding this is not legal as it is in essence a top-up, but the local Commissioning Support Unit seem to be condoning it now. Any thoughts?
Angela Sherman
October 25, 2016 at 10:08 am
Rachel - we are hearing a lot of that too. To me, it's an illegal top 'by the back the back door'. (Continuing Healthcare is the responsibility of Clinical Commissioning Groups (CCGs), not Commissioning Support Units. All decision making rests with CCGs.)
Rebecca Ganz
October 18, 2016 at 2:03 pm
Hi Chris - thanks for that. Very helpful. If you push, how likely are you to jeopardise the 50% funding being recommended? Also, my gut is to get that ratified and then push hard. Any thoughts? Really appreciate the help as it's such a challenging area. Becks
Angela Sherman
October 25, 2016 at 10:06 am
Rebecca - if you've got the joint funding offer in writing then you can come back to them with that if they try to withdraw it. Chris's point is good - and many families feel that joint funding is often suggested by assessors as a way of denying full funding, even when a person's needs are beyond a local authority's legal remit. There's a section in the National Framework on joint funding. Be sure to appeal your case if you disagree with anything that's been done so far: http://caretobedifferent.co.uk/appealing-a-continuing-care-funding-decision/
Rebecca Ganz
October 17, 2016 at 3:39 pm
Hi there. We just had a 2nd Multidisciplinary Team (MDT) meeting as some evidence was needed. They are recommending joint funding of Continuing Healthcare (CHC) and the Local Authority. I'm hunting any useful information or hoping for any guidance about how this might work. Also, if they have seen the need for joint funding, how likely I might be in going for full funding as we are half way there....or if you 'push it' are you more likely to lose the funding you've already achieved (subject to ratification by the CCG). Thanks for any help, Becks
Chris-G
October 18, 2016 at 12:09 am
Push for full finding. If the nhs is prepared to part fund, then they must have found a reason...... That only reason is the Primary Health Need (PHN) that the whole malarkey is designed to discover. There are no grades. It is a PHN or it is not and only then is it the council 's duty to act and then charge for care. Also, bear in mind that the savings and assets rules will still apply even if the council only provides 10% of the care...... In many cases a 5050 split will still cost the patient several hundred pounds a week...... Don't fall for the smiles and assurances.
Denis Lockhart
October 1, 2016 at 3:54 pm
Thank you for reply concerning Christina. Your advice most helpful- no DLA will be lost as long as I am caring for her at home. I will now save more than £300 per month care costs.
Best wishes
Denis
Denis Lockhart
September 24, 2016 at 2:44 pm
I am a full time carer for Christina, who suffers from advanced Parkinson's, Lewy body dementia, incontinence etc. Thanks to your articles on the internet I applied for Continuing Healthcare (CHC) funding, and received confirmation of the award today. Thank you for your advice and information. However the letter says contact the Pensions Advisory Service to inform them. Does that mean that deductions will be made from her DLA to compensate?
Many thanks
Best wishes
Denis
Angela Sherman
October 1, 2016 at 12:05 pm
Denis - that's good news that you've secured CHC. Well done for persevering. Any deductions from benefits may depend on Christina's individual situation and which rate of benefits she receives. However, this may also help: http://www.rotherhamsendlocaloffer.org/Resources/myLife/library/Money/Understanding%20NHS%20Continuing%20Healthcare%20and%20Benefits.pdf and also the Benefits and Work website from a more general point of view: https://www.benefitsandwork.co.uk
Kay
September 12, 2016 at 4:16 pm
Hi
My father has vascular dementia and is in a nursing home. My mother was caring for him for several years after his diagnosis but due to a very aggressive episode we had no option than to call the NHS for advice, during late evening. In essence they said "wait until the morning or call the police and have him arrested". To cut a long story short he was admitted to hospital and then into a Nursing Home.
1 I had to fight hard just to get through the initial checklist stage and due to my persistence and the lack of agreement between me and the Community Psychiatric Nurse carrying out the checklist, in the behaviour category, a full assessment was carried out.
2 The social worker said that dad passed the Coughlan Test yet the CCG said that dad was not eligible for CHC funding but he was eligible for the Nursing Care element. Unfortunately the social worker could disagree with the findings but could not overturn the decision; only the family could appeal as dad did not have mental capacity. I didn't appeal on that occasion - it just seemed a mammoth task and you think that they must know what they are doing ????
3 Jump forwards and we have recently had our 3rd assessment but appealed the decision of the 2nd one just in time and said that we were appealing the 3rd one also as each one has confirmed ineligibility.
4 I set out a reasoning email and said that if a Local Resolution meeting was to be convened that I would wish to present a more thorough and robust appeal document.
5 The local CCG have suggested another assessment by means of Local Resolution. My feeling is that if I agree to another assessment now, that will just start the clock ticking again for another appeal (assuming their assessment will be the same as previous ones) and will not indeed be an actual continuation of the original Appeal against the decision made on 7 January 2016.
Question: Should I decline the offer of a further assessment and request a Local Resolution meeting to consider the facts from both the January and July assessments?
Many thanks
Kay
Angela Sherman
September 18, 2016 at 11:40 am
Kay - the NHS suggesting that the police arrest your father sounds truly shocking. The local dispute resolution meeting should address the previous assessment, not start a new one. If you succeed in your appeal, funding should then be backdated to shortly after the original Checklist; if you agree with a new assessment, however, funding would only be backdated to the start of this new process. So it sounds as though there are strong financial motivators in what the CCG is telling you - and that is not acceptable.
Cheryl carrington
September 9, 2016 at 6:32 pm
Hi
my son has multiple complex needs and has been receiving CHC funding for 3 yrs.he is 25 yrs old.
He lives at home with his family with the help of carers.
He has a respite element in his funding and we have always had to find the respite ourselves because they don't have anywhere local that can met his needs .
This means we usually get respite by sending him with carers to a disabled caravan or similar.
When they reviewed his careplan recently they said he will still receive respite In his budget but we have to pay for the travel costs to get him there and back and they also said they no longer pay for his food while at respite either. This means if we as his parents can't find this cost we won't get any respite.
They had paid for the total costs for the first three yrs of funding and the only reason I was told was simply that they don't do that now .
Is this right????
Angela Sherman
September 13, 2016 at 11:36 am
Cheryl - that sounds hugely frustrating. If the CCG has reduced funding in any way, they must be able to show how this relates to your son's care needs - not to their budgets. If the CHC funding has been reduced, the CCG should have carried out a proper review, at which the whole picture of your son's needs should have been considered (with your involvement and input) and your son's needs should have been reviewed in line with the CHC eligibility criteria, as before. They should have referred to the previous CHC assessment notes too. Ask the CCG for their written rationale as to how exactly they believe your son's care needs have reduced below the level of full funding.
Trish Mason
August 19, 2016 at 6:20 pm
My mother who has dementia had a stroke and has been in hospital for 11 weeks and has just been transferred to a nursing home, as she has completely lost her sight due to the stroke. we applied for CHC and after a battle received it they are now saying they will review after 28 days as she requires one to one care due to her blindness and other health problems. we think they will try and withdraw the CHC as they didn't want to pay in the first place, but luckily we knew all about funding. is this correct they can reassess so soon, we thought it would be 12 weeks
Angela Sherman
August 22, 2016 at 8:53 am
Yes, it's usually three months. Be alert to any attempt to remove the funding on the basis of 'managed needs': http://caretobedifferent.co.uk/continuing-care-assessments-2-frequent-mistakes-part-1/
Aleisha White
July 4, 2016 at 6:38 pm
Hi Jenny, if your relative does have to move (and this should only be because the current care home has stated that they are unable to manage the care needs - not because they are funded by CHC!), the nursing home will visit and carry out their own assessment of care needs.
Sharon
July 4, 2016 at 6:11 pm
Can someone please give me some guidance.
I am going through the process of a retrospective CHC assessment for my late Grandfather. Its a long story and the assessment should have taken place whilst he was alive but the NHS failed to follow up on the application and the family were not informed that an application had been made by the care home. Therefore, is there anyone who has been through this process who can help - to ensure that my late Grandfather receives a fair and accurate assessment.
Angela Sherman
July 11, 2016 at 10:04 am
Sharon - there are lots of people commenting on our website who have been through a similar situation. Keep chasing the CHC team for progress on your retrospective claim. The failure by the NHS to follow up on the previous funding assessment process should not be used against you in your case. It is their failing. Make sure you see a copy of any 'Needs Portrayal;' document that the retrospective team produce and that you are given the opportunity to comment on it.
Jenny
June 30, 2016 at 4:00 pm
Geoff, I do think that is the best course of action. If her condition has deteriorated significantly, then do everything you can to evidence this to show that she is beyond the remit of Social Services for her care, and that she should get NHS funded care - without top ups payable. get records from the care home and her main day time carers onside ready to show what help she needs. I can't recommend this forum and the ebook highly enough to help you prep for that.
Sorry to nag; Can anyone help me with their experiences of obtaining a post CHC agreed Care Plan? Should this come with the eligibility letter? Without it, I'm struggling to know exactly what care my relative needs, and why the CCG are keen to move him when the Community Nursing team could perhaps do what is required. If I need to find a nursing home they will surely need the agreed care plan? I'm curious, as a move to a nursing home would likely be more expensive than his current care home.
Angela Sherman
July 11, 2016 at 10:00 am
Thank you for your kind words about the blog and the website, Jenny. A care home should have a care plan in place for every resident (nursing or otherwise). If a person is receiving CHC then the NHS is responsible for funding their care, and the CHC assessment process identifies the care needs that any care provider will need to manage. The care provider must be able to show you a care plan, and the NHS - being responsible for your relative's care - must make sure this is in place.
Geoff Wingar
June 30, 2016 at 12:51 pm
She was assessed several years ago but her condition has deteriorated significantly since then. When she was assessed funding was denied. I will contact The NHS and see if I can get her assessed again - would that be the correct course of action?
Thank you
Angela Sherman
July 11, 2016 at 9:55 am
Yes - that's what you need to do.
Lucy Fryer
June 30, 2016 at 12:05 pm
PS. Our elderly relative has been physically healthy for several weeks and yet has been mouldering in the hospital for two months now!
Lucy Fryer
June 30, 2016 at 12:04 pm
Our elderly relative suffers from dementia and needs full-time supervision. She was admitted to hospital recently with an unrelated ailment from which she made a full recovery. Whilst she was in hospital, I insisted that the staff carry out an NHS Checklist process. I made sure that I, my husband, the hospital social worker, and the manager of our relative's day care centre were present at that Checklist assessment. We prepared well and the result of that Checklist process was two "A" grades - cognition and behaviour, so I assumed that our relative would now be put forward fir an NHS CHC assessment. The hospital social worker signed the Checklist. However I noticed that she had been unwilling to do a Checklist at all and was clearly unhappy about the resulting grading. I have been waiting for a date for the CHC assessment, and have been refusing discharge for our relative until it's been done. I now discover (six weeks later!!) that the social worker has never forwarded that Checklist on to the NHS CHC team. She now says she wants to do a NEW Checklist which reflects our relative's behaviour in hospital. I suppose this could work in our favour, but actually, I think she wants to redo it so that our relative is NOT then eligible for a full assessment.
Can you give me any advice on how best to proceed with this?
Angela Sherman
July 11, 2016 at 9:54 am
That sounds very suspicious on the part of the social worker, Lucy, and I can understand your view about this. Your relative should have been put forward for a full assessment immediately, and he/she should not be asked to pay any care fees until this whole process is complete. If he/she is moved to a care home in the meantime, the NHS is responsible for the care fees until a proper CHC decision is made. Make a complaint to the CHC team and also contact the Head of Adult Care at the local authority, as they are potentially in an illegal position now on account of the failure by the social worker to follow the correct process: http://caretobedifferent.co.uk/care-act-2014-helps-you-with-nhs-continuing-healthcare/
Geoff Wingar
June 29, 2016 at 8:05 pm
Thanks Jenny and Chris. My Mum is below the threshold. The Top Up is being paid by my Mum (rather through me) at the rate of 189 pounds per week - about 5 pounds over what she actually receives in pension. Funded Nursing Care pays directly to the home at 112 pounds per week. The local Authority pays the difference. I should point out that I negotiated a rate of 700 pounds per week with the private care home where she now resides. This rate is substantially less than they would normally charge. I have always been aggrieved that they take more than she actually takes in pension but I have been told that this is normal? I have been quite happy as it is better that the 3,800 pounds per month that she was paying directly - until the money ran out.
Any advice if this is correct would be very gratefully received.
Thank you, Geoff
Angela Sherman
June 30, 2016 at 10:23 am
As Jenny says, a decision about FNC is only made after an assessment for CHC.
Geoff Wingar
June 29, 2016 at 1:18 pm
My Mum has funding from a Local council who in addition take all her pension plus few pounds every week as "top up" so that the weekly agreed amount can be met with the care home. The care home also receives 112 pounds a week from Funded Nursing Care.
Should this Top up as outlined above be paid by my Mum and since the funding is coming from a local authority and not The NHS - or are they one of the same?
Any help here is appreciated.
Christopher Gallagher
July 29, 2016 at 10:25 pm
Geoff, She should be retaining at least £24 or 25 a week without the nursing home deciding how she should spend it. It is for personal use and not actual care use. I assume that this is the extra that they are taking.
Angela Sherman
June 30, 2016 at 10:22 am
Geoff - your mum shouldn't be paying the top up herself. Funding from the local authority is not the same as funding from the NHS. Has your mum been assessed for CHC?
Chris-G
June 29, 2016 at 7:14 pm
Geoff, who is paying the so called top up ? If it is for hair dressing and the like then that is understandable because your mum should be being left about 24 quid a week from her pension to fund that. If her savings are below £14,300 or so, then the council should not be taking it from that as far as I am aware..... Anyone else got any thoughts?
Jenny
June 29, 2016 at 2:13 pm
Geoff, I'd consider asking for a CHC assessment. FNC should be awarded after a full assessment has been done, and when a primary Health Need wasn't found, but there are nursing needs. So, I'm guessing she's on shared funding at the moment, which would make the top ups from her pension lawful. If it's been some time since she was assessed I'd be looking to make a case for fully funded CHC, and at least that way she'd still keep her pension.
The help you'll get from this forum and from Angela's excellent ebook will certainly help you.
Jenny
June 29, 2016 at 11:06 am
After a struggle my relative has been awarded 100% Continuing Healthcare (CHC) funding. None has been paid yet as they say he needs to be in a nursing home, not residential. The preferred nursing home to which he might be moved has mentioned top up fees are levied which I know is unlawful - although the National Framework Practice Guidelines does mention CCGs should set a rate that is appropriate within their area. Does that just refer to joint funding? If not surely that is at odds with Coughlan?
Second point. I've not received an agreed care plan, ever. Should this have come with the CHC eligibility letter?
John Garner
July 18, 2016 at 7:39 am
My wife who was given Continuing Healthcare (CHC) via a Fast Track package through the hospital in September 2012. I am in process of fighting to retain this for her. Her condition is far worse now than it was in 2012 at the time the fast track CHC was put in place and she was moved to a Nursing Care home where she is today. Friday 14th July 2016 she was admitted to hospital with suspected Sepsis. High temperature and and high irregular heart. I have to attend the CCG this Thursday to reaffirm that her condition is worse now. The stress I am feeling is terrible.
Angela Sherman
June 30, 2016 at 10:20 am
Jenny - your relative doesn't have to be in a nursing home to receive CHC. They can be in residential care or at home. CHC should be paid as soon as the funding decision has been made and it is not based on where that care is provided: http://caretobedifferent.co.uk/where-can-a-person-receive-nhs-continuing-healthcare-funding/ CHC cannot be topped up - as you suspected, this is unlawful; the funding must cover all care fees. You wouldn't necessarily receive the actual care plan with the eligibility letter, but there must be one.
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