NHS Continuing Healthcare: How daily care notes can damage your case

In a previous article we looked at how vital it is to check the language used in Continuing Care assessment notes,  and how the language used by assessors in these notes can play down health needs and be detrimental to your case for Continuing Care funding.

In this article we now look at the perils of relying on the daily care notes written by care homes and care agencies.

Sadly many of these daily care notes are inadequate, and yet in any care funding assessment much of the ‘evidence’ that  counts towards your case for NHS Continuing Care funding comes from these daily care notes. If the notes are not good, they can damage your chances of care fees funding.

Why it’s vital to check the daily care notes in advance

The notes may be filled in in a hurry at the end of a busy day, perhaps by care staff or assistants who don’t have an in-depth knowledge of your relative’s care needs and state of health, and who won’t realise how these notes may be used in the future and the impact of the words they write.

For example, it’s not unusual in daily care notes to see the phrase, “Nothing new observed” written as the summary of a given day’s care. The fact that the care staff are experienced in dealing with a person’s care needs, and have carried out the care many times before, is being recorded as ‘nothing new’, and yet this masks the often substantial care and intervention required.

A Continuing Healthcare assessor may look at notes like this and give someone a lower assessment score as a result.

It’s very common for care staff to write comments such as “routine care”; it may be routine to them, because they are skilled at managing a person’s needs, but this should not in any way lead to a person being scored lower in an assessment! In fact, the National Framework for NHS Continuing Healthcare (the official guidelines for Continuing Care assessments) clearly states that a health need should not be marginalised just because it is managed.

Similarly, many families find that the care notes simply record the times of day when certain interventions took place, e.g. the time of a meal, but find that there’s a lack of any usable information about health needs, risks and problems.

Do the care notes match the Continuing Healthcare eligibility criteria?

In daily care notes there is often nothing that is directly useful when it comes to measuring someone’s needs against the Continuing Healthcare eligibility criteria – because the care staff or care assistants completing the notes generally have no knowledge of the criteria. Nor do they realise that their (usually hastily handwritten) notes will be used as the basis for such an important funding decision.

In an assessment it can then become a battle of words, with the family highlighting that the notes are incomplete or inaccurate, and the assessor keen to stick to what’s actually written down. And, of course, the care provider will also want to defend its record keeping.

3 things to help you in advance of a Continuing Care assessment:

• Familiarise yourself with the Continuing Healthcare assessment process – and in particular the Continuing Healthcare eligibility criteria – even if you’re not pursuing funding at this point. It will save you time and stress later. (There are 12 different aspects of health that are assessed – these are called ‘care domains’.)

• Ask the care provider to show you the daily care notes. Have a look through these from time to time, to make sure they reflect a full picture of needs in relation to Continuing Care – as if you were going to have to rely on them. Make sure they include the risks and day to day care needs in every care domain.

• If you hold a financial power of attorney for your relative and you are looking at the care notes from the point of view of pursuing funding, you are entitled to see these notes.

If your relative is having a Continuing Healthcare assessment and a member of the care staff is attending, make sure that person is someone who cares for your relative every day and knows their needs well. Inaccurate information provided both verbally and in care notes can lead to incorrect assumptions being made – right from the outset – which then lead to further problems accessing funding.

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