Continuing Healthcare case study - Fast Track process
One of our reader’s, Nick, has shared his Continuing Healthcare case study – the Fast Track process for his father, who was admitted to hospital after a fall, and subsequently needed full time care.
(Nick prefers to remain anonymous at this stage because his father still needs care, and so this is not his real name.)
Nick’s story highlights some of the typical things that happen – and don’t happen – when a person needs to be assessed for Continuing Healthcare funding.
He continues…
“This is my experience of what happens when an elderly person goes into hospital. It reflects many of the points made on the Care To Be Different website.
My father, who is in his nineties and in the late stages of prostate cancer, was admitted to hospital after having a fall that caused two small fractures. He was initially put in a general ward but after a week moved to a rehabilitation ward.
There our first contact was with a social worker who immediately asked if we would qualify for means tested funding for my father’s care or if we would fund ourselves.
We were given a form to sign. She said she was recommending teams of two people coming in four times a day to provide the necessary care, which shows the level of support he needed.
During his second week at the hospital my father had a Continuing Healthcare Checklist completed. He scored one A and 3 Bs, so he did not get through this initial screening. We objected that this had been done without our knowledge or consent.
Initially our objections were brushed aside, but when we persisted it was re-done; this time he scored two As and five Bs, and so he had got through to the second stage. How can a procedure that is so subjective be of any value? The second stage would now be the full multidisciplinary team (MDT) assessment.
However, we were told by the person who completed the form that we wouldn’t qualify for funding.
I had been given the name of the team leader in the discharge department and I asked for a full MDT assessment. By this time they realised that we knew something about the process. At the same time my father needed enhanced pain control and it was decided to wait until that was under control before doing an assessment. This took a week. It then took another week to schedule an MDT assessment meeting. By this time he had been in hospital for five weeks, and his condition had worsened during this time.
The assessment meeting was set. I requested copies of the documentation in advance that would be used. Initially, I was told that paperwork would be available at the actual meeting. When I insisted on having it in advance, pointing out relevant paragraphs in the National Framework guidelines, this was provided (the evening before the assessment).
However, it comprised nothing more than copies of my father’s records from the folder at the foot of his bed, which we had run through already. We were broadly in agreement with the notes, but comments on food consumption were over-optimistic and not consistent with his weight loss. We put this down to the fact that mealtimes in hospitals are always a bit chaotic.
Continuing Healthcare case study – Fast Track process
We arrived at the appointed time and were told that the doctor wanted to see us first. A quarter of an hour ticked by, then half an hour. Finally we were escorted into a small room to be met by several doctors and a district nurse. There had been a change of plan. Rather than holding an assessment meeting they had decided to Fast Track my father in light of his steadily worsening condition. This would provide recognition of his condition and the Continuing Healthcare funding that we wanted.
We found a suitable nursing home where he is comfortable and receiving excellent care.
The story doesn’t quite end there, though, because we have been told (by everyone involved) that the NHS only pays up to £800 a week for Continuing Healthcare and anything above that we have to fund ourselves. I suspect that this may be open to challenge.
As an aside all the hospital staff we met were kind and sympathetic. This doesn’t give a picture of a group of uncaring bureaucrats conspiring to deprive elderly people of their entitlement. My impression is that the assessment is overly complicated, not really understood by staff and highly subjective.
Most patients have no idea what Continuing Healthcare is about and they accept whatever they are told. The ‘culture’ is that no-one qualifies, and so this is the starting point when an assessment takes place. I think it’s very sad that the NHS has come to this.”
We’re grateful to Nick for sharing his story, and there are no doubt thousands of families who can relate to his experience. If your relative has been Fast Tracked for Continuing Healthcare funding, please share your experience, good or bad.
My mother was Fast Tracked in March 2013. In a way my story is similar to the one aboe. She had been admitted to hospital in December 2012 with Appendicitis. Three bouts of pneumonia followed. After episode 2 I was taken to one side and told by the senior ward nurse that my mother needed to be in a nursing home and that I couldn’t be expected to care for her. A few days later an assessment was made – the nature of this assessment was unknown to me but I know a lot more now. After the assessment that I was not allowed to be part of, I was invited into a therapy room and told my mother did not qualify for Funded Nursing Care. I questioned how this could be possible as only the day before had my mother been taken off BiPap. The Assessor shouted at me that my mother did not need to be in hospital and then the second person in the room asked me how much money my mother had. I told her my mother’s finances were of no concern of hers. She asked me if I had Power of Attorney and if it had been registered with the Court. Again I told her it was nothing to do with her.
The next day my mother had a heart attack and I was called to her bedside. This was the third time. She was on Bipap again and close to death. Somehow she survived the night. The next day I asked the duty nurse if I should call in my sister from abroad. It was decided it would be appropriate. My sister arrived 48 hours later and we had an interview with the Consultant. At that stage we advised the Consultant that my sister is a Dr and suddenly efficiency took over. My mother was moved into a room off the main ward and it was agreed that the Liverpool Pathway would be followed. My mother was exceedingly week, not responding to treatment, not able to eat or take fluids.
A week later my mother was still holding her own. My sister had to return to The States so she said her final goodbye to my mother. The next day I received a phone call to tell me my mother was being moved to a nursing home. I was astonished that she was deemed to be well enough to leave the hospital. By now I had done a bit of research and knew of The Fast Track procedure existed so I asked for a Fast Track Assessment not knowing that this is supposed to give an automatic acceptance. Within 24 hours I knew that this had been granted and my mother was discharged into the care of the nursing home. Her journey wasn’t to end there in that the ambulance was stuck in snow for a few hours and my mother was re-admitted to the ward she had left just a few hours before. Interestingly she was taken straight onto the ward and did not go through the admission process again.
The next day she was taken to the nursing home. She survived and grew stronger but has not regained any level of good health. In July 2013 an INP assessment determined that funding may be appropriate. That MDT review took from July 2013 and was completed in May 2014. Funding was withdrawn.
This decisions is now being appealed by me on behalf of my mother. That is another story.
I feel for all people trying to get what is just for aging parents.I have attended two CHC assessments for my Mother 87, who is completely immobile, could only use one hand to be told she wasn’t sufficiently ill or disabled.this was during February. She is classed as self funding in a care home in Hogsthorpe, Lincolnshire. I had to sell to sell a small bungalow that Mum lived in ( impossible to maintain as I live in Spain) to top up the funding. It’s all about ‘the money’. For the 7 weeks, mum has been in the Pilgrim Hospital with pneumonia, now has a gall bladder abscess daring, flat on her back – not being hoisted into a chair anymore,therefore life is horrible for her. I am still paying for her room at the care home. CHC – not ill enough to help with funding? Frustrating, disappointing, as all I want is my Mothers entitlement and what is best for her. I have flown over to sit with her, but cannot live my life in a Hospital. Permanently worried and distressed for Mums future. Kindest regards Sandra 65
Julia/Sandra – your situations highlight how difficult this whole thing is – and in so many ways: distances travelled, the emotional impact, hidden financial agendas on the part of assessors, misconduct and maladministration, etc.
we have continuing care but still have difficulties getting care workers provided. The NHS Mgr does not care that provision is not being given.
I to am trying to fight nhs 4 chc for my mum and getting nowhere. Today a got a bill from social services demanding 5600pounds to be paid in 7 days, money I don’t have nor does my mum have. I took legal advice and was told not to pay. My health is bad due to all the worry and stress. This chc funding is enough to make you want to kill yourself.