How do you know if a Continuing Healthcare assessment should be done?
What’s the trigger point for getting your relative assessed for NHS Continuing Healthcare?
This is a question many people ask, and there are various ways to answer it. So how do you know if a Continuing Healthcare assessment should be done?
The following are all broad indications that your relative should be assessed for NHS Continuing Healthcare:
- your relative is in hospital and needs ongoing care after discharge; they must be assessed for NHS Continuing Healthcare before being discharged. This is made clear in the Care Act.
- your relative has health needs and is at home and needs care
- your relative has been receiving care for some time – and paying for it themselves – but no one has assessed them for NHS Continuing Healthcare.
- your relative is going into a care home or receiving full time care at home
- your relative was previously assessed but denied NHS Continuing Healthcare – but their needs have now increased
In these situations it’s vital that a proper decision is taken about who is legally responsible for paying care fees.
There is a very important distinction between local authority care and NHS care – the former is means tested, the latter isn’t. And that distinction does NOT depend on how much money your relative has.
It’s vital that families understand this before they pay a penny in care fees.
But how can you gauge whether your relative is likely to be eligible for NHS Continuing Healthcare – and whether it’s worth pursuing?
Keep these two points in mind:
1. You have nothing to lose by asking for an NHS Continuing Healthcare assessment. There are different stages to the assessment process. Don’t be put off by people within health and social care who may tell you it’s ‘not worth it’ or that your relative ‘won’t qualify’ or that a person has to be at ‘end of life’ or some such other nonsense. No one can say whether or not your relative should receive the funding until care needs have been properly measured against the NHS Continuing Healthcare eligibility criteria. Those care needs must also be viewed in the light of the legal limit beyond which a local authority cannot provide care – and beyond which any means test or financial assessment would be illegal.
2. You can look at the assessment criteria yourself (see below) and gauge how you think your relative will fare.
The fundamental point in all of this and the deciding factor in ALL NHS Continuing Healthcare assessments is whether a person’s care needs are primarily social care needs or primarily healthcare/nursing care needs. If the latter, the person should be fully funded via NHS Continuing Healthcare. This means no means testing, no financial assessment, no top up fees.
NHS Continuing Healthcare funding is assessed by and provided by the NHS, through local Clinical Commissioning Groups (CCGs).
NHS Continuing Healthcare eligibility does not depend on any specific diagnosis that your relative may – or may not – have. Nor does it depend on whether they are in a care home or in their own home.
How can you know in advance what the likely outcome of a Continuing Healthcare assessment will be?
You can look at the assessment forms/criteria yourself and ‘score’ your relative yourself, based on their care needs – to get an idea of how they would get on in an assessment.
- Take a look at the Checklist assessment form (or ‘tool’). (Click the link and you’ll find all the Continuing Healthcare forms/assessment documents, including the Checklist. There are 11 sections or ‘domains’ in the Checklist. Look at the example descriptions of needs in each one and score your relative A, B or C for each domain.
- Once you’ve done that, look at the scores required to get through the Checklist (see pages 7-8 of the Checklist form).
- If you believe your relative would ‘pass’ the Checklist, get the NHS Continuing Healthcare assessment process started as soon as possible.
Note: You can’t actually submit your own Checklist to the NHS; instead, it has to be done by a health or social care professional. However, by doing it yourself in advance – just for your own purposes – you’ll get an idea of what scores the assessor should write down and what the outcome should be. It means you can better argue your relative’s case.
The Checklist is stage 1 of the Continuing Healthcare assessment process; it does not determine whether or not your relative will receive the funding – it simply gets you through to stage 2, which is a full multidisciplinary team (MDT) assessment. Stage 2 uses a form called the Decision Support Tool. You’ll find the Decision Support Tool here – it includes the assessment criteria and scoring system (which is different to the Checklist).
You could go through the same process yourself for stage 2 of the assessment process – using the Decision Support Tool – and see how you think your relative would get on at that stage.
Supplying evidence for Continuing Healthcare assessments – what’s needed?
How keeping a diary helps in a care funding application and appeal
NHS Continuing Healthcare: How daily care notes can damage your case
How to stand your ground in NHS Continuing Healthcare assessments
Our mother had the checklist at the end of a 5 week hospital stay on a stroke ward (completed by senior nurse and family members) and this triggered the DST. She was discharged to a reablement unit in a care home with continuing health care for 6 weeks. This included daily physio and nursing care provided by the in-house nursing staff. After 6 weeks, we were told we had to start again with another checklist. This was done and in the nurse’s opinion, Mother didn’t score highly enough to trigger the DST. We disagreed on 3 of the domains, but were told firmly that she din’t require nursing care, just social care. She has dementia, cannot walk more than a few steps with a frame and two people supporting her, has skin issues and is dependent on medication for multiple health issues. She has been judged not to have mental capacity. We were told we could object if we wished . However, if we were successful in triggering a DST and then were successful with the DST, she would have to go to a Nursing home and would get a weekly amount to pay for nursing care. She would still have to pay for her care home fees as she has savings above the threshold. Four weeks later she is moving to another care home, although she really wants to go home. She has no physio now and it is up to family to keep her exercises going though we were told we could refer her for physio.
We agree that many of her needs can be addressed by social care, but without two people to help with mobility, personal needs etc, her needs become health needs.
Is it worth asking for another checklist?
Look out. Chris is having a bit of a long rant.
Regarding so called social care need within the National Framework.
“28.
Section 49 of the Health and Social Care Act 2001 prohibits LAs from providing, or
arranging for the provision of, nursing care by a registered nurse in connection with the
provision by them of community care services. ‘Nursing care by a registered nurse’ is
defined as ‘services provided by a registered nurse and involving either the provision of
care or the planning, supervision or delegation of the provision of care other than any
services which, having regard to their nature and the circumstances in which they are
provided, do not need to be provided by a registered nurse’.”
I would be intrigued to discover if the paltry Funded Nursing Care Component, (FNCC), paid in place of CHC funding actually covers the 24/7 per person cost of nursing care within nursing homes. If not then the needs of the patient are in fact more complex, intense or unpredictable than stated at MDT or the nurses would be able to do the work including the full administration tasks, delegating care tasks to carers, laying out medication and recording it, etc. etc. for every patient, within cost and time. Who knows, they might even have time to look in on the patient every day too.
To explain my logic; payments for accommodation that is seen as ancillary to the need for nursing by a CHC assessor, should not be being used to subsidize the allegedly minimal nursing care needs of the patient or the accommodation cannot be ancillary to the need for nursing care.
So how much nursing care does the FNCC actually pay for? Including holidays, sickness, pensions, employer’s National Insurance, salary and locum nurses, I doubt that it is eight hours out of a 168 hour week per patient that receives FNCC.
I also know that at one time there were hardly any residents in a 50 bed Nursing Home in receipt of FNCC whilst there were at least four nurses on staff, five if you include the R.N manager.
The current £150+ a week paid to three or four patients would not likely have paid the employment costs of five nurses now would it? I can feel a Freedom of Information request coming on.
National Framework. Page 50 & 51.
“2.3 Social care needs are directly related to the type of welfare services that LAs have a
duty or power to provide. These include, but are not limited to: social work services;
advice; support; practical assistance in the home; assistance with equipment and home
adaptations; visiting and sitting services; provision of meals; facilities for occupational,
social, cultural and recreational activities outside the home; assistance to take
advantage of educational facilities; and assistance in finding accommodation (e.g. a care home), etc.
CCGs should be mindful that where a person is eligible for NHS continuing healthcare the NHS is responsible for meeting their assessed health and social care needs.”
The services provided by social services listed above are available to all. People without illness are just as entitled to them.
Apart from gaining a place in a home, and their meals, both of my relatives did not require or gain any other of the described services described as being social care needs because of misfortune or due to some council initiative to help the downtrodden or dispossessed and generally healthy population, my relatives required care solely because they were ill.
The question that should be answered is; if the care required by a sick person is not co-incidental with any of a councils abilities to provide services for social care mentioned above then is it really the council’s responsibility to provide services that are not listed as their responsibility within the National framework?
Also. Should a sick person be self funding to pay for those unused services?
It is stated that the list above is not exhaustive…….. It should however, be relevant to the matter in hand and as such, anything missed out of the list above that is subsequently deemed by the NHS to be a social service, should be vigorously challenged.
I really don’t think that the NHS could come up with any more services that could be the councils’ responsibility and record them in the section above. As such, if they cannot corrupt to their advantage, a so called social need, on paper within the Framework then why are they getting away with it at MDT and decision making panels?
To explain that logic. One of the social services roles listed above can be “provision of meals”. The social services do not appear to have a duty to be responsible for actually feeding a person. Or don’t you think that the NHS would have taken advantage of that and listed that as a social service within the National Framework?
This list is a corruption of a social service’s duties so that the NHS can create the so called social care need that is not actually a requirement of the law that engendered the National Framework.
The MDT are only supposed to be identifying a Primary Health Need. To allow them to assess to discover a so called social care need is a travesty. The assessment process is not designed to discover a social care need. Especially as the NHS cannot even fully list and define such a need within the Framework.
I dare you to try at MDT, to approach the process from the other end. State what needs can be provided for by a council and you will have the NHS MDT member tell you that they are not there to assess the council’s role and responsibilities. (Yes, I did do it). Later of course they will usually tell you that the care needs are not the NHS’s but are the council’s because the needs are social care needs.
Have a go. Take those listed social service provisions apart and try to work out how they actually apply to your loved one and you might be surprised that many don’t apply at all. That being the case, how can your loved one only have a so called social care need?
Can anyone advise me how I go about appealing a CHC decision? I’m disgusted by the treatment I’ve received from Social Services and really don’t know which way to turn. Should I involve a solicitor? Thanks
Hi all!
My mum has been receiving CHC for about a year but has been advised that it will shortly be removed. She has two bank accounts – one containing the proceeds of the house she had to sell when a charge was put on it when she was funding her own care, the other is for her pension. She has resigned herself to the fact that the first account will be used to pay for future care but wants to spend the contents of the other one (around £5,000) before ‘they get their grubby mitts on it!) As her next assessment is less than a fortnight away, is she allowed to do this or will it be perceived as deprivation of assets? Thank you.
Sorry I’m afraid this is a bit of a rant, but I am at my wit’s end to know what to do next and have only just discovered Caretobedifferent.co.uk. I would appreciate any advice that anyone can give me.
My 99 year old mother has advanced Vascular Dementia, postural hypotension, angina, poor kidney function and arthritis. She was widowed in 2001 and managed quite well with me as sole carer for a few years after dementia was diagnosed in 2009. My husband and I retired in 2004 and when I found it too much trying to balance my life and look after Mum I employed a private care agency in 2012 so that she could remain in her own home and free up a bit of spare time for myself. I have had to gradually increase the hours of care to 93 visits per week because of numerous UTIs and falls and her complete inability to care for herself because of the dementia. Without our care she wouldn’t remember to eat or drink, take medication, use the loo, get dressed or do anything for herself. I was told at the time of her first Care Assessment (2013) that she would not qualify for NHS Continuing Care because her needs did not meet the criteria and in my ignorance I accepted this.
The Local Authority granted Direct Payments to spend on her care, which I have been receiving for the past couple of years (I have LPA) and these cover approx 50% of the care agency costs. The balance is made up of a Client’s Contribution from my Mum of £38 per month and a top up of £1000 per month, both of which are paid from her current account and are just about covered by her State Pension, Higher Rate Attendance Allowance and Pension Credit. I have now been informed that the LA will be reducing her direct payment by £270 per month, effective immediately, and that she will have to pay this herself. On disputing this, I was told it is because since her last assessment she now gets Pension Credit and is exempt from paying Council Tax because of her significant cognitive impairment, “so therefore she is much better off now than when you first completed her means-tested application for direct payments”. The fact that the cost of her outgoings has gone up significantly since then and therefore negates any benefits received seems to have passed them by completely. She owns her house and this is her only asset. All of her savings have been spent on her care over the past 7 years. If she has to find an extra £270 per month, this will leave her with only what remains in her current account – a few hundred pounds at best – to cover food, heating and everything else. At the moment I am paying for everything over and above this, including £100 per month for incontinence pants alone, plus chiropody, gardening, home insurance, shopping, etc. and I can no longer afford it either, as I have been retired for 11 years and my savings are being rapidly depleted. Were she paying rent or had a mortgage, that would be offset against the £270. The powers that be seem to be of the opinion that home owners have no outgoings. To date she has paid over £60,000 in care agency fees alone.
Worrying about how I am going to continue looking after Mum is affecting my health now and I am so lucky to have a kind and understand husband, but it is putting an enormous strain on us both personally and financially. The GP said 2 years ago that Mum required 24/7 care, but I can’t afford any more than the 124 hours from the agency that she is currently receiving in addition to my going in every day. The only way to fund her in a care home would be to sell her house, which I would be more than prepared to do except that I honestly believe her needs are primarily health and not social. I feel as though she has already been treated abominably, considering she worked from the age of 14 until she was 70, paying her Tax and NI, and has never asked for anything in her life, until I applied for Attendance Allowance when she was already in her Nineties.
I have asked for a revised Care Assessment and requested an NHS Continuing Care Assessment as well, but was told this week that they don’t know when she might get the Care Assessment because they are busy and have again been informed that her needs are not severe enough to meet the criteria for NHS Continuing Care. I am so tired of filling in forms, battling with faceless officials and having to fight for everything to which I feel she should now be entitled in what realistically are the last years of her life.
I live in dread of being taken ill myself, because without me fighting her corner, Mum would be just another statistic – left on her own she would collapse through dehydration, malnutrition or a horrendous fall – and what’s the betting that the LA and the NHS would then be rushing to the media to blame one another for their failure to care for yet another vulnerable old person!
Should I continue to press for an NHS Continuing Care Assessment, which she has never had, or should I just throw in the towel, put her home on the market and find her a lovely Care Home. I must admit I feel as though I am going to do the latter because I’ve lost the will to fight them any more.
Thank you – and sorry this is such a rant.
Thanks once again for taking the trouble to follow this up, Chris.
I went to see our GP this morning and honestly (naively?) thought he would be supportive. However, he was very defensive when I said I wanted Mum assessed for NHS Continuing Care and insisted that her primary needs were social ones, although he told me she should be in a care home now with 24/7 supervision. He said that any health problems she has are solely caused by old age, which is nonsense because she was still running her own home, looking after herself, cooking, going out and living a normal life until she had what I now believe to have been her first TIA in 2009 when she was 92. She was in her 95th year when her vascular dementia necessitated my bringing in outside care to help me. He said I had no alternative but to sell her house to fund her care because “there is no-one in a care home in this country who is funded by the NHS”! I used all the arguments detailed in Angela’s book to refute that claim, but he was adamant that Mum would not receive funding. He did, though, inform me that he had referred her for a MDT Assessment back in July. I knew nothing about this and I have had no contact from anyone trying to arrange such a meeting, which he said he would chase up. I wonder why he decided to make this referral in July, considering she has been self-funding her care since 2012 and he hasn’t seen her since February of this year. Unfortunately, I embarrassed myself by getting quite emotional whilst talking to him – more in anger and frustration than anything else.
I have told him that I intend to pursue this and to attend any MDT meeting that is arranged and I am going to ask my Care Agency Manager if she or one of Mum’s carers can attend as well. I just hope I have the courage to keep fighting, because I must admit I feel like throwing in the towel and hiding under the duvet at the moment.
An initial checklist was completed and submitted for my mother. Six items were scored at level B meaning a full assessment should be performed. However a faceless clinician reviewed the form and without contacting anyone concerned with my mother’s care or even the qualified referrer. They downgraded the scores on three items ensuring my mather does not qualify for a full assessment. Quite simply the system is corrupt.
Hi Annie. What i didn’t mention in my original post was that this checklist was a resubmission. The original one scored my mother with just 3 B’s due to an error made when the form was completed and also due to the care home supplying incorrect information regarding recent falls. The faceless clinician accepted the changes to those items but has now downgraded items which they originally accepted as level B. I can only assume they did this to ensure less than 5 B’s appear on the checklist and furthermore that they are incentivised to do this. Clearly corrupt. I am now going to employ a solicitor on my mothers behalf. I can’t really lose doing this as the cost will probably be less than one months care fees and if i lose then the local authority will have to start paying for my mothers care one month sooner. Hopefully you will hear something positive soon but……….
I have an issue with the CCG in that they have a very keen interest in my Fathers home care workers notes which are not by any means accurate, in fact, comments like “fine on arrival” are regularly repeated/copied. One would not think that my Father had a combination of advance vascular and Lewy body dementia. Yet these are the notes that have been previously used to refuse his CHC funding in preference to those of his doctors. We are paying privately for the current home care and I wondered if the CCG are entitled to these notes or not? The CCG sneakily rang the Head Office of the home care company and said I had given permission for them to view the notes which I had not!
Has anyone else had similar issues with CCG Assessors?
I am a social work assistant working in a busy community team, I feel the need to respond to various comments made in relation to social care workers & the involvement of my own personal & professional experiences when liaising with Continuing Healthcare(CHC)/CCG teams.
For the past 3 – 4 years I have battled, challenged and exhausted most of my free personal time off reading, gaining knowledge and utilising the CHC framework and regulationsin in an effort to initially, advocate and protect vulnerable adults and support their relatives. I am not alone in this crusade.
I consider myself to be an assertive and confident person, however without support from senior Local Authority (LA) managers, I find myself in a constant ping pong game. Yes, this is frustrating as I feel strongly about upholding the principles and duties of my role and as TRANSPARENCY appears to be the new buzz word, I pride myself of ensuring clear and accurate information is provided, although when dealing with the CHC process, health practitioners, hospital nursing staff and health specialists I am forced to accept rude, unprofessional behaviour and comments, (this includes informal and formal complaints), following polite requests made for completion of Checklists, outcomes/scores, medical information and suggesting options in terms of rehab potential, OT/physic involvement and ensuring Decision Support Tools (DSTs) take place to minimise risk and ensure safe discharges are planned appropriately.
In a majority of cases, even though DST’s are generally deferred, this results in further issues when challenging funding responsibilities and refusing to collate financial details or activating assessments on the individual’s finances.
I am exhausted and believe it should not be this difficult performing my role; consequently I am losing the battle and the person who is most affected is the individual I am trying to support.
Hi Annie
Sorry to read you are forced to prepare for a battle on your mum’s behalf, it saddens me that relatives who are trying to deal with their loved ones health conditions & providing support are placed in a position of defence & challenging authorities, rather than spending precious time with their families. I have read numerous articles, government guidelines & health/social care future objectives, the common thread appears to be the need to demonstrate & focus on PERSON CENTRED practice & ensuring carers are fully involved with the assessment process & offered appropriate support….I have yet to experience these ideals however, I am forever hopeful.
I intend to continue my crusade & push for fairness rather than cost implications.
I wish you a stress free & successful CHC journey.
Apologies for the length, but this is the short version. Any advice gratefully received.
We are trying to obtain fully funded CHC for our 94-year-old Mother.
Following a stroke in April she spent 5 weeks in hospital then 10 weeks in reablement. She presents with multiple health issues and is currently in a Care home.
We challenged a negative checklist and are now preparing for a DST
Prior to the DST meeting we would welcome clarification on a couple of points from anyone out there who has more experience than we have.
Our starting point is that if Mother is only in a Care home because she has multiple health needs. If she were at home, where she wants to be, her needs would require 24-hour care and at times, she would need 2 people. Left alone, she would be back in hospital within a day
The assessor conducting the Checklist asserted that CHC could only be applied in a nursing home and asked if mother would be prepared to move (the current Care home does not offer nursing).
Our understanding is that that fully funded CHC can be applied in a residential care home or even at home. i.e. ‘Eligibility for NHS continuing healthcare places no limits on the settings in which the package of support can be offered or on the type of service delivery’.
Our question is therefore, – are there any particular circumstances that need to be met for CHC funding to be applied in a care home setting? (Apart from fast-track end of life care.)
The assessor repeatedly said, ‘your mother’s needs are not above the service provision of a residential care home’.
We accept that, in the main, her needs are being met in the care home. (Her needs are all health related i.e. dementia and cognition, mobility, stroke, skin problems, occasional continence issues and taking necessary medication, but these can become managed needs by competent care assistants). If she did not have these needs she would be at home – where she wants to be.
Could what she is saying relate to the following, although, we don’t totally understand what this means?
114. (p36 of the Framework)
‘There will be some individuals who, although they are not entitled to NHS continuing healthcare (because ‘taken as a whole’ their needs are not beyond the powers of a local authority to meet), but nonetheless have some specific needs identified through the Decision Support Tool that are not of a nature that an LA can solely meet or are beyond the powers of an LA to solely meet. CCGs should work in partnership with their LA colleagues to agree their respective responsibilities in a joint package of care, including which party will take the lead commissioning role’.
In addition, we would welcome clarification on the following statement, in particular, the phrase, incidental and ancillary as used in the following section of the Framework
1.3 (p50 of the framework)
‘However, local authorities can and do commission care in care homes (with or without nursing) where needs to be met include elements of ‘general nursing’ provided by healthcare assistants or care assistants. A local authority can fund this ‘nursing care’ provided it is both incidental and ancillary to the individual’s accommodation and of a nature that a local authority can be expected to provide’.
Hi
I work for the local authority and attend many DST’s, and I would advise you to familiarise yourselves with Primary Health Care criteria, managed needs, (framework clearly explains). Download National framework for NHS continuing healthcare & Decision Support Tool. The DST provides you with a guideline of health & medical conditions the CHC nurse will be focusing on during the health assessment.
Prior to attending any health meeting I read through all daily records completed by care staff & check the homes care plans, risk assessments, records relating to medication & general medical/health intervention; consent is given by individual and/or next of kin, this is dependent on capacity.
Reading the information gives you an indication of the responses the CHC nurse will receive from the care worker attending the meeting, however once you have read records if you disagree with specific details or believe the information does not reflect an accurate picture of your relative you need to challenge & question the care home, in addition confirm who will be attending the DST & arrange to discuss in detail the areas of concerns you have with them, remember the local authority worker & care home representatives should be aware of your mum’s health/care needs & be familiar with the DST process, they are not just making up the numbers, they should play an active role.
Anyone including the CHC nurse should request permission before reading a persons records.
I am involved with many individuals placed in both nursing & residential care homes, who receive CHC funding, if the person is settled & happy in the home they have the right to remain with ‘through the door’ nursing/health input, alternatively if the placement appears unsuitable choices & alternatives can be discussed to reach a decision that is the most appropriate for the person.
Lastly at the end of the DST I establish the recommendation the CHC will make, & ask they record my formal request for a copy of the DST (consent obtained prior to meeting).
Thank you for your advice. We are working through the Official booklets, so we are on the right lines. Thanks for the advice about care home records and care plan. At least they should be current, which was one of the criticisms at a previous Checklist meeting (not that things had improved at all.)
If our Mother doesn’t have capacity (she hasn’t) and my sister has financial PoA, do they have to interview Mother? She found this very stressful on previous occasions.
Prior to DST the CHC nurse will need to initially determine capacity (time specific) & secondly if your mum lacks capacity a Best Interest Decision is made, family should be actively involved in this process, along with care staff & local authority worker, ultimately the Decision Maker is the CHC nurse as they are leading the process.
The Decision is to identify if it is in the Best Interest of the person to progress DST, at this point family & any others can & do consider the appropriateness of the person attending & if their attendance would cause undue distress. If a 3rd party has POA (health & welfare) they have the authority in decision-making relating to health & welfare, (CHC may ask for a copy).
The outcome of capacity & best interest should always be recorded & reflected in DST document.
You have the right to formally record your comments, disagreements & areas of concern.
The DST is to determine eligibility , be aware the DST document will be submitted to ‘CCG Panel’ & their decision will be based on the quality & comprehensive information collated at the DST.
I have experienced, when attending a DST the CHC nurse passing the DST document to the attendees expecting signatures, I explain until the document is complete & not in draft form & I have read through the information & reflects an accurate account of the details, comments expressed I am unwilling to sign, I formally request at this point consent from person/family to receive copy, in addition I ask the CHC nurse to record the request/s for completed copy of DST.
Hope this helps.
Thanks to help from a clinical lead in the care sector i have now managed to secure a full assessment for my mother. There are people prepared to help but my word are they difficult to find! And i do know there are many caring professional people out there.
I’ve learnt quite a lot thanks to this web site among others but one thing does not make sense to me (actually there’s many more than one). Can someone explain to me how the checklist and DST are remotely legal? Many comments refer to care needs which require nursing and are therefore legally beyond the remit of a LA. The checklist requires e.g. five items at level B, but surely it would only take one item to be beyond the remit of the LA. What am i missing here!
Hi Chris G
If a person is considered to have capacity by the Continuing Healthcare (CHC) nurse, they must firstly be made aware of the reason the DST is taking place, & they agree to have the attendees present, secondly the person should be permitted & given time to ask questions & discuss their needs/ concerns. I can honestly say I have never attended a DST & the person leading the health meeting has indicated they leave due to personal commitments.
I consider this as inappropriate & if a CHH nurse or any other agency worker behaving towards an individual, in a manner that appeared to diminish or discount their right to voice their opinions or respond to comments would be unacceptable, the local authority representative has a role to play in the DST, not just to attend but to ensure the person & their significant others have the opportunity to express opinions, concerns etc. I am somewhat surprised the social worker chose not to advocate on behalf of the individual. Saddens me you & your family have experienced a negative situation.
Help!!
Could anyone clarify this
We have an Multidisciplinary Team (MDT) meeting and Decision Support Tool next week but have been told previously by a nurse assessor that our mother’s needs are not above the provision of a residential care home. We are aware of section of the Framework which deals with health need v social needs in particular section 3.3a which states that a person is considered to have a Primary Health need ‘when the nursing or other health services they require when considered in totality….. are more than incidental or ancillary to the provision of accommodation’. Can anyone give examples of what this means in practice, i.e. what is meant by incidental and ancillary in this context.
PS. She is already in a care home and her complex needs are increasingly being managed well most of the time, as staff get to know her and her needs.
My mother has been recently (6 months ago) diagnosed with Lewy Body Dementia. Until May this year she lived on her own, did her own shopping, cooking etc. but had been diagnosed with Parkinson’s a year earlier.
After a UTI, she was admitted to hospital with serious confusion, where she stayed for 11 weeks, during which time her mental and physical state rapidly declined.
She was assessed for care needs (with no prior warning) at the hospital and put into a nursing home at short notice. I have a copy of that report because I specifically asked for it.
Since admission to hospital, she has been wheelchair bound, doubly incontinent and catheterised.
Cognitively, she does not really know where she is and is unable to remember the names of her grandchildren, for example. Her communication is now very limited, rarely, if ever, even saying ‘hello’, ‘goodbye’ or acknowledging family or friends who visit.
Her original assessment awarded 4 ‘B’s and 7 ‘C’s, with a ‘C’ for communication! She has been in the home for 3 months and is self funding apart from Funded Nursing Care (FNC). We contacted the NHS CCG and requested that an assessment was done with a view to a subsequent full Continuing Healthcare (CHC) appraisal, and this was agreed to be done by the nurse who returned our call from the NHS regional authority.
On the agreed date the nurse never showed up, and my mother’s nursing home had been given no advance warning (apart from by myself) of their visit. Luckily, another nurse, who happened to be assessing three other residents for FNC, was eventually given my mother to put on her schedule for that day, and an assessment was carried out.
This assessment, unknown to me, then became the 3 month FNC appraisal. When, at the end of the meeting, this became apparent, I explained that we were seeking a route to a full CHC assessment, but the nurse repeated all the usual ‘No, your mother is not ill enough etc. etc.’
The new assessment gave my mother the same 4 ‘B’s and 7 ‘C’s just as before, despite the written notes taken down on the template reflecting our opinions as to her inabilities, hallucinations and whimsical answering to ‘needs’ questions etc..
A senior nursing home nurse was called in to the meeting with us to offer her opinions about my mother and counter-signed the report. Previously, another senior nurse from the home had told me that my mother should be a ‘B’ rating for communication on the template in her opinion, but she was not on-shift on that day.
Although my mother was dressed and readied for the meeting by the nursing home staff (at zero notice) she was not involved in the meeting.
How, and to whom, can I appeal against this survey, as apparently my mother does not meet even meet the criteria for the pre-CHC appraisal [the Checklist], and I have been told that I can not appeal against this?
Any other advice about her eligibility for CHC would be gratefully appreciated!
Hello Sheila,
it sounds like the same old story. I’m no expert as I’m new to the game, but consult the DoH document, ‘National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care’ , which I’m sure you have along with Angela Sherman’s book. I’m sure you can ask for another checklist to be done if you don’t agree with their findings. We did. But not sure how you stand if you’re already receiving FNC. The experts will tell you. I find the frustrating thing thing with this is there’s no one neutral that you can ask, as they all have an agenda.
We are at the Decision Support Tool stage but the recommendation went against us. We are planning to question their process for flaws before we get the confirmation as we believe there were a few. It sounds as if there were flaws in the way they treated your Mother.
The best of luck.
I wrote to the CCG in August (copying the letter to the GP, Social Services, LA, etc., etc., as advised, and using your excellent template letter) requesting a Continuing Care Assessment for my 99-year-old Mum and asking why one had not already been carried out. I received no response whatsoever, apart from a reply from the CCG over a month later telling me they had no record of her, which is nonsense! The GP was sympathetic, but said he thought I didn’t stand a chance! Two weeks after sending my letter, Mum had a very bad fall at home and was hospitalised for 5 weeks, during which time her Vascular Dementia, general health and incontinence worsened considerably, she became unable to walk unaided even with a frame and I was informed by a doctor that her kidneys were “shot”. Despite this they were desperate to discharge her. Mum couldn’t return home, as I couldn’t guarantee her safety, and she has no money left with which to increase the level of care to 24/7 in her own home.
I managed to find her a place in a lovely care home 15 minutes from me, but it costs nearly £1000 per week. Reluctantly, therefore, I have put her home on the market and the LA have agreed to pay 3/4 of the fees for the first 12 weeks under the Property Disregard Scheme. At least, once the house is sold, I know there will be enough money to pay for her to have good care until the end of her life, which is all I want.
I have been caring for Mum since 2001 when my father died, and haven’t had a proper break for 8 years since she was diagnosed with dementia. I am a reasonably healthy and positive 72 year old, but the past few weeks, with Mum in hospital, finding a care home, trying to sell her property, as well as trying to look after my husband and my own home, have been unbelievably stressful. Receiving the letter from the CCG was the last straw. I have reluctantly thrown in the towel before I, too, become a candidate for NHS CHC!!
I know I have let the side down, but I sincerely wish all of you good luck in pursuing your own claims.
Just had this from our lovely CCG ;
My reading is that XXX the person who does the assessment presents to panel has been given a predetermined outcome from the C ops and Finance Officer of the CCG. How can either an appeal or fresh Continuing Healthcare (CHC) process be heard impartially?
I refer to your request made under the Freedom of Information Act 2000 and the subsequent questions which were asked in relation to your funding at the public session of the Primary Care Commissioning Committee on the 21st October 2016.
It should be noted that as the response to this enquiry details your individual case, we will not place the response into the public domain as we would normally do under the FOI act. We felt it necessary to answer all of your questions as thoroughly as we could and to ensure that you received a single consistent response.
You requested a copy of the CCG policy for Continuing Healthcare (CHC) Funding. Having considered your request I am now able to provide the answers below.
Please provide a copy of the CCG policy for CHC funding:
The CCG has no separate policy on this matter. Decisions are made in accordance with the national framework for NHS Continuing Healthcare and Funded Nursing Care.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213137/National-Framework-for-NHS-CHC-NHS-FNC-Nov-2012.pdf
A) Please explain why a fresh CHC process cannot be undertaken while an appeal is in progress:
The National Framework does not mandate a particular process to be followed in assessing eligibility while an appeal against an existing decision is in progress. However, Regulation 21(2) of the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 requires the CCG to:
“take reasonable steps to ensure that an assessment of eligibility for NHS Continuing Healthcare is carried out in respect of a person for which that body has responsibility in all cases where it appears to that body that –
(a) there may be a need for such care; or
(b) an individual who is receiving NHS Continuing Healthcare may no longer be eligible for such care.”
The CCG are satisfied they have complied with this regulation in your case.
As confirmed in XXXXX email to you on 14 October 2016, your care needs have been formally reviewed up to the date of the CHC Panel decision on 19 July 2016, when you were deemed ineligible for CHC funding. The NHS Foundation Trust have kept the CCG updated with your care and condition, and the CCG remain of the view that your needs have not changed to the degree that would indicate a substantive change in eligibility, prompting the need for a further assessment at this point.
It has, however, already been confirmed that the CCG will assess you again post discharge from Hospital.
A review would only be triggered at 3 months if a person had already been deemed eligible for CHC or there was a significant deterioration in the person’s condition; neither of these situations apply to you.
B) Please explain why a fast track CHC can only be considered if the patient is in the last 12 weeks of life:
A Fast Track can be considered for an individual with a primary health need arising from a rapidly deteriorating condition which may be entering a terminal phase.
Such a submission should be supported by a clinical prognosis. Whilst there is not a prescribed time period for a Fast Track, the patient should be in a rapidly deteriorating terminal phase. Twelve weeks is therefore reasonable. It is the opinion of the consultant and the clinical team responsible for your care that you do not have a primary health need arising from a rapidly deteriorating condition. A Fast Track is therefore not appropriate at this point in time.
C) Please explain why a person who needs 24 hour nursing and is eligible for CHC funding must go into a nursing home against their wishes rather than have a nursing care provided in their own home:
The National Framework requires the CCG to consider patient preferences in organising care but acknowledges that financial considerations and risks to patients can and should be taken into account. The CCG Board in May 2014 approved a policy that guides decision-making on domiciliary care packages by consideration of the comparable care home costs for individuals, in order to ensure that limited resources are distributed in an equitable way when commissioning continuing care packages. However, as you have not been considered eligible for CHC, the policy is not applicable in this case.
Any queries or concerns, or if you are dissatisfied with the handling of your request please contact the Director of Communications & Public Insight.
Interesting video about Pamela Coughlan and same site NHSCARE.info has a PDF ‘Pamsday’ of her care needs which are the definition of Continuing Healthcare (CHC) entitlement – not Decision Support Tools or Multidisciplinary Teams. If your care needs are equal to or more than Pamela’s then you are entitled to CHC.
https://www.youtube.com/embed/YaMXowPWxis
URGENT advice needed please! My Dad is being discharged from an Acute hospital tomorrow. He fractured his hip after a fall at home. He has multiple health issues that are going to require 24/7 nursing. The hospital have recommended he goes to a rehab hospital but due to his massive decline in his mental state due to mixed dementia and having been in hospital for nearly 3 weeks, we’ve decided he should come home. He is desperate to come home and we are desperate to see him come home. I have asked the hospital to conduct a CHC checklist before his discharge. I know that he will definitely qualify for the CHC assessment & most probably funding. However the hospital keep trying every excuse in the book not to do it! They’ve now said they can’t do it till Monday and it will take them a few weeks to do?! I have seen the checklist and I know it would probably take less than 40 minutes to do! What is there problem?! They know I am not going to let my extremely vulnerable Dad stay in that place more than one second than I have too so there is no way I will be waiting for them to do it. They are effectively emotionally blackmailing us! Any advice would be very welcome.
As far as I understand, you can still have a Checklist assessment for Continuing Healthcare (CHC) in the community. Don’t rely on your GP knowing much about it though. Have a look at the CHC guidelines.
I had exactly the same experience with my elderly mother. You have the right to refuse the discharge until a care plan has been devised and an ongoing care package has been put in place, whether that be to home or to rehab. I said “no” to my mother being discharged and she remained in hospital for 5 weeks until all proper procedures had been undertaken. I have Power of Attorney, so don’t know whether or not that gave me added “clout”, but it was a senior nurse on the ward who told me that I could refuse to allow discharge. I also found the Social Workers attached to the hospital were extremely helpful. Richard is right; your strongest card is staying put, even though that is not what you want. J|anet is also right: GP’s are really not up to speed on the terms of the Care Act.
I wish you well and hope you achieve your aim of getting your father home soon with a proper care package in place.
Thank you so much for all your advice. It is so reassuring to know that there are so many people willing to offer support and advice on this highly emotive issue.
As it stands, we went ahead with discharging Dad on Friday. If we had allowed him to stay in hospital he most certainly would have died there.
However before he left hospital, we lodged a formal complaint regarding Dads discharge – stating that not only had they not followed their hospital discharge policy but they had not adhered to the Care Act 2014.
The hospital have already responded and apologised saying that they will oversee Dad having the checklist and assessment in the community. They have already said he will qualify!
I’ll keep you updated as to whether any of this actually happens!