NHS Continuing Healthcare and hospital discharge – the assessment game: Part 2

Published 21/12/2015

Please note: This article was published prior to July 2022, and some information may be outdated.

Getting assessed for NHS Continuing Healthcare funding while in hospital

These tips follow on from Sarah’s case study about her mum, and the attempts by the hospital discharge team to discharge her mum without the proper NHS Continuing Healthcare funding assessments.

Here in Part 2 we’ve included some vital tips to help you if you’re in a similar position…

If your relative needs ongoing full time care, they cannot be discharged from hospital until they’ve been properly assessed for NHS Continuing Healthcare funding. This assessment process determines who is legally responsible for paying for their care. It will be either the NHS or the local authority.

Local authorities provide social care and this is means tested; the NHS provides health and nursing care and this is never means tested.

The hospital discharge team might try to discharge your relative by saying he/she will be assessed ‘later’. Don’t let them do that. Some hospitals tell families they will ‘discharge to assess’. What they mean by this is that they will discharge the person to free up the bed, and then at some indeterminate time in the future they might possibly get round to doing the proper assessment for Continuing Healthcare.

Families often report that once a person has been discharged from hospital, the NHS suddenly has very little motivation to get round to doing the proper Continuing Healthcare assessments.

Insist on the proper NHS Continuing Healthcare assessment being done prior to discharge. Tell the discharge team that this requirement is set out in law in the new Care Act 2014, and any moves to discharge without following the proper process will be a breach of the law. The local authority also has a duty to alert the NHS to the need for a Continuing Healthcare assessment.

Never assume the care authorities are on your side. Sadly, he primary motivation of many assessors these days seems to be to find out where there might be some money. Families are often asked about their money at the outset. This is a serious breach of guidelines. At this point all discussions should be about care needs, NOT about how much money a person has or whether they have a house.

It should always be an NHS Continuing Healthcare assessment first and means testing second. Means testing should only ever be mentioned or carried out if your relative does not qualify for Continuing Healthcare.

Remember always that the ONLY thing that determines whether your relative receives NHS Continuing Healthcare funding is the extent of her care needs. It has nothing to do with their money, your money or anyone else’s money.

It’s always good to have someone inside the ‘system’ who is on your side, such as the ward sister in Sarah’s case study. However, remember always that such a person may also be ‘constrained’ by the system.

Read the original case study about hospital discharge and NHS Continuing Healthcare

Tagged Categories: Care homes and hospitals, CHC funding, Hospitals and discharge, NHS Continuing Healthcare

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16 Comments

Tracy Pollard December 6, 2019 at 10:37 am

Hi my father has Alzheimer’s vascular dementia and is in the last stages of the illness. He has been in a residential care home for 12 months, unfortunately a special needs assessment was carried out a couple of months ago due to his deterioration and we were told the carehome could no longer meet his needs, therefore he now required Nursing Care and we would have to find an alternative care home that could give him the Nursing Care he requires. Unfortunately a few weeks later my dad was found unresponsive by care staff and my dad had to be hospitalised. It was agreed by myself and his social worker that he shouldn’t return to the original carehome and to stay in Hospital until we found a carehome with Nursing Care. We did find an alternative carehome which provided this care and he was put on a list and would have to wait until a place became available for him. He has now been in hospital 4 weeks, I received a phone call on Monday (02/09/2019) to say a place has now come available at the Nursing carehome and my dad will be discharged from hospital on Monday 09/12/2019. I’ve had no proper communication from The Hospital regarding information for discharge. Should a care plan not be put in place first before discharge? My dad has not had any CHC assessment or any assessments at all since being in Hospital. I have asked and questioned nurses and the DR caring for my dad at the hospital that no assessment has been carried out, there answer was “done worry about it” happens and they told me don’t worry about it, I also asked his social worker the same question and her answer was when my dad settles in the new carehome a CHC meeting will then be arranged. I feel like I’m banging my head on a brick wall. I Would really appreciate some advice please if anyone can help with this matter.

Care to be Different December 10, 2019 at 1:37 pm

Hi Tracy - sorry to hear this. Why not call us for a chat - we may be able to assist. 0161 979 0430 Kind regards

Sharon June 26, 2018 at 12:11 pm

My mother had a significant stroke 9 weeks ago and we have now been told by the hospital that they can do no more for her and she now needs to go to a nursing home with 24 hour care. We have had a Checklist done for NHS Continuing Healthcare (CHC) and it has now been put through for the full Decision Support Tool, as her health needs are high - totally immobile, she has a PEG for feeding, double incontinent, low immune system following a kidney/liver transplant 20 years ago, history of UTI’s, I can go on and on! The Checklist was put through on Thursday afternoon and we had a email from the discharge nurse the following morning asking us to visit 2 nursing Homes as soon as we can. I then received a phone call an hour and half later from a different discharge nurse telling me I have to go and view the Homes ( which I told her I would do as and when convenient for me)! I made appointments to view the Homes the following Monday and before I’d had the first viewing the discharge nurse call me again to see if I’d viewed them! I then had another call from the nurse in charge of mums ward 3 hours later asking the same question! This morning I have received an email to say that the nursing home will go and assess mum and the CHC will fund the nursing home placement for 4 weeks until the full funding process has gone through. We have spoken to the care home who have stated that they will not assess mum and not accept her until they know where the funding has come from.
Am I right in assuming that my mum Should stay in hospital until the full assesssemt has been done?
Any advise is greatly appreciated.

Danni Wells February 7, 2018 at 4:59 pm

I had a call that the Checklist was done and my mum with advanced Parkinson's does not meet criteria for assessment for NHS Continuing Healthcare (CHC). I was only informed today. I asked why not updated. They are planning to have meeting with mum (she is still in hospital) but only tell me of this day before. Am I allowed sufficient notice??
She is in hospital and I insisted CHC be done.
I have Power of Attorney and have asked to have notes sent to me so I can read and a social worker calling saying medically fit for discharge. But because nothing is in place I am not allowing that I said.
She scored low yet long term she will get worse and needs supervision.
I had to fight to get my dad assessed and had nursing needs he died in hospital in the end.
Your site has been excellent guidance.
It is just such a brutal battle.

Barbara December 7, 2017 at 8:32 am

I managed to get a Checklist completed for my 90 year old aunt four weeks ago and she scored 2 'A's (Mobility and Nutrition - she has steadily lost weight over the past 18 months and now weighs 5 stone) and a number of 'B's. She also has double incontinence. After some pushing and with the help of Angela's e-book, I have now got a date for the Multidisciplinary Team (MDT) meeting to be held at her home on 4th January 2018.

However, my aunt was admitted to hospital yesterday because she was rambling and disorientated and a UTI was suspected. She was only treated for a UTI two weeks ago.

She lives with her 70 year old nephew and he has carers coming in twice a day to wash her and change her. He is struggling and his health is starting to deteriorate. She clearly needs 24 hour care to keep her safe. So...... should we insist that she stays in hospital until the MDT assessment is done (which presumably would now be at the hospital) and a decision is made about her ongoing care? Any advice would be very much appreciated.

Neil August 29, 2017 at 6:01 pm

Just some advice for others, be careful when the Discharge process in happening. My experience is that my local NHS cloaked the Continuing Healthcare Assessment process with a Discharge to Assess Screening Tool. They did not complete the Checklist Assessment in hospital but even though I continually asked to be at the process and was made to believe it was being completed. My Aunt was discharged and although she passed the Checklist stage at home she was not considered to have a primary care at the Decision Support Tool (DST) stage even thought she received 3 High ratings and 3 Moderate ratings across differing domains. The meeting was finished at 12.30pm today and i was told i would receive written confirmation from the panel that would review the completed DST. Today i received a call from the Care agency at 16.17pm advising that funding had been finished. I have had to urgently find the social services number to speak to someone before 17.00pm so that the ongoing care is not stopped. We will be paying for the care from today otherwise it will stop. This is because she was Discharged under the DISCHARGE TO ASSESS SCREENING TOOL held in hospital not the NHS Continuing Healthcare Checklist process.

Kim April 18, 2017 at 7:57 am

What happens if you have a Continuing Healthcare (CHC) Checklist performed which indicates that the person does not qualify for a Decision Support Tool (DST) and you (the family = patient's representative) disagree and wish to appeal this decision? Can they discharge the patient? And do we have to pay for care whilst the Checklist appeal is in place?

Also, should we be successful in proceeding to DST and then disagree and wish to appeal - what is the legal situation regarding discharge and funding?

It would be good to know the legal situation as we are going through CHC before discharge and already they have not invited us to participate (even though we have insisted we wish to participate and that we should as per their own guidelines) AND they have asked Mental Health to evaluate 4 of the domains (which they have involved us in) and that the discharge team will do the others domains at the hospital! (We also have an ongoing CHC appeal from December 2015!)

J Gibson January 31, 2017 at 12:36 am

Can an eldery person be forced into a care home following a stroke if they have to be hoisted or can care be provided at home to allow a loving couple to stay together? Both parties and their relatives are against them being separated. How much rights do people have to remain together and have care provided at home?

Angela Sherman February 8, 2017 at 10:44 am

This may also help regarding staying at home: http://www.which.co.uk/elderly-care/housing-options/domiciliary-care

Angela Sherman February 8, 2017 at 10:40 am

Reports we receive from families indicate that people are coming under increasing pressure to go into a care home, rather than having care at home. However, everyone should have choice - and it's vital to stand firm against any such pressure. You may want to have a look at some of the information on the AgeUK website, such as this page: http://www.ageuk.org.uk/home-and-care/help-at-home/finding-help-at-home/

Carol August 15, 2016 at 6:44 pm

Do the same rules apply if the person is going for short term care (rehab, not currently mobile) and how much say to you have in the choice of care home? Social services are trying to make my relative go to a care home, the opposite side of the city from where she lives. This will leave her isolated and with less visitors than she would have had if she is nearer home.

Angela Sherman August 22, 2016 at 6:28 am

Carol - if your relative requires intermediate or reablement care after, say, a hospital admission, she should not have to pay. This care usually lasts around six weeks.

Jenny February 8, 2016 at 4:50 pm

If a Checklist finds someone eligible to go through to the full assessment should that all be done and an answer received from the CCG before a person is discharged from hospital, or just the Checklist?

Angela Sherman February 15, 2016 at 6:14 pm

Hi Jenny - if a Checklist shows that a person requires a full multidisciplinary team (MDT) assessment, it means that no decision has at that point been reached about who is actually responsible for paying for care; that decision will be made after the MDT meeting. A person cannot be discharged into ongoing care without: a) a proper ongoing care plan in place, and b) a decision about who's paying. Also, the needs and risks that become apparent during the full CHC assessment inform what care will be required and what the care plan will contain - so they both go hand in hand.

Chris-G December 22, 2015 at 5:49 pm

An excellent summation from Sarah. I hope that she is handling this as well as her writing indicates.
Angela's tips are equally excellent and succinct. One point to watch out for: when one is refused CHC funding and then the council takes over, it is normal to receive forms requesting financial data. It is not at all unusual for the council to attempt to get the next of kin's data too. If they bother to explain, they often state that it is so that any benefits due are being claimed. They seldom tell you that it is a means test. That invoices for care will be generated.
At the moment I am trying (have been since Aug 2015) to get my mum's council record expunged. At every appeal we win and because it is stated that the needs are beyond those that a council can legally fund...... Question...... Why do they get to keep and continue to process the data? That is indicative of a serious Data Processing Act offence. Keeping the data enables the council to monitor bank accounts and sources of income and to extrapolate across years in expectation of the time that the patient's family gets fed up challenging and appealing. It gives them the ability to enquire as to what happened to a person's money even when that person was not (and after appeals might still not be) their responsibility.
My reasoning behind this is that the council has held financial data since 2009 on my mum and yet at no time has legally provided her care. Obtaining data, processing it, creating bogus invoices, statements, court threats etc. by virtue of holding data that it should not have obtained during CHC appeals, seems to be unwarranted, and data processing is expected to be done fairly and only done to meet a genuine need and for the stated reasons given.
In law, personal data is to be collected for one or more stated purposes. "So that we can ensure that you are getting all of your state benefits", is not why the data was collected. Processing it for any other reason becomes an expensive offence from then onward.

Angela Sherman January 27, 2016 at 11:14 am

Many thanks for your comment, Chris.