Paying for care between hospital discharge and a funding decision
Don’t let anyone means test you in hospital before a Continuing Healthcare assessment
If your relative is in hospital and you’re under pressure to have a financial assessment, this article will help you. It looks at who should be paying for care between hospital discharge and a funding decision.
Here’s a typical hospital scenario…
Your relative is in hospital and you’re under pressure from the discharge team to get them out. However, no one has done an NHS Continuing Healthcare funding assessment. You complain about this and you’re told the assessment will be done ‘later on’, after your relative has been discharged. Also implied is that your relative will pay for care in the meantime. You may also have come under pressure to have a financial assessment (a means test).
There’s a whole lot wrong with this scenario – and yet sadly it’s all too common. No one will have looked at who should legally be paying for care between hospital discharge and a funding decision for NHS Continuing Healthcare.
Let’s suppose you can’t fight the pressure from the discharge team and that your relative is discharged.
Who should be paying for care at that point?
The NHS Continuing Healthcare guidelines make it very clear who should be paying for care
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, page 25, paragraph 74:
“Where the Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.”
There are several points to note here about paying for care between hospital discharge and a funding decision:
First of all, a person in hospital who needs ongoing care should not be discharged from hospital without having been considered for NHS Continuing Healthcare funding.
Why?
- because the requirement for this is set out clearly in the Care Act
- because until a person has been assessed for NHS Continuing Healthcare funding, it’s not possible for anyone to say who is legally responsible for paying their care fees
The usual assessment process for NHS Continuing Healthcare has 2 stages. If a Checklist assessment for NHS Continuing Healthcare has been carried out (stage 1), and it indicates potential eligibility for Continuing Healthcare funding, there must then be a full multidisciplinary team assessment (stage 2). If a person’s ongoing needs are not yet clear, there may possibly be an argument to discharge the person and wait until their ongoing needs become more apparent before stage 2 is done.
However, this does not mean the NHS can simply hand the person over to the local authority for means testing,
The full NHS Continuing Healthcare assessment process could eventually indicate that the NHS does have a legal duty to fund all care; the NHS cannot offload this funding responsibility to anyone else in the meantime.
Upon discharge from hospital, if a person is means tested and told to start paying for their own care, the local authority may, as a result, be in an illegal position – because it may have taken responsibility for care that is beyond its legal remit.
No one should carry out any financial assessment (means test) until it’s clear who is responsible for paying. The health and social care authorities have no business asking about your relative’s finances during this time.
So it’s very clear who is responsible for paying for care between hospital discharge and a funding decision: the NHS is.
Why are elderly people so often wrongly charged for care?
What’s your experience?
I frequently come across this scenario whereby ward staff and LA staff collude to ignore what should happen with regard to CHC screening prior to discharge. I have had a number of cases in the last 6 months where there has been deliberate and blatant disregard of legislation.
The Care Act and Discharge regulations and the CHC Framework make it very clear that there is a statutory duty to screen for CHC in every case prior to discharge. That a CHC checklist must be used to do this, and that the person,family and or advocate must be made aware of the checklist process and must be invited to be part of this. That they must be given a copy of it and that they can challenge the content and outcome. A discharge cannot take place until the CHC screening has occurred. The ward cannot refer the case to Social Services until they have completed this CHC screening and Social Services can decline to take a referral if it hasn’t been done. The delayed discharges Act states that a case cant be classed as a delayed discharge until a CHC screening has taken place. The insensitive phrase of ‘bed blocking’ cannot be used either whilst awaiting a CHC screening. I have had a recent case where the family were insisting on a CHC checklist taking place in line with legislation and the ward manager said they don’t do checklists on their ward as it can take 11 weeks for this to get done and this would “block beds”, this is unlawful behaviour. Another case did a checklist in secret that was positive and should have led to a full CHC assessment but they kept this hidden and tried to discharge the patient without informing the POA of the positive checklist. I have another case where the ward did one checklist with the family that was positive, where advised by the CHC team to do another one. The 2nd checklist was also positive and were again advised to do a third one that surprise surprise was negative and this allowed them to move to a discharge without moving onto a full CHC assessment.
Angela is correct with regard to who pays for any ongoing care post discharge whilst awaiting a CHC screening or following a positive checklist a full CHC assessment. The Framework is clear, it is the duty of the NHS to fund all care whilst awaiting the outcome of a CHC process. So if they ward want to discharge whilst awaiting for completion of a CHC process then the ward pays until it is complete. I had a case where the ward had delayed doing a checklist then when it was done and showed the need for a full assessment they tried to get the POA to pay for placement in a nursing home. When I intervened they rushed through an MDT and completed the DST and recommended that the patient wasn’t eligible for CHC. They then again tried to get the POA to pay for the placement. I again intervened and pointed out that until the case had gone to a CCG panel that the ward must still pay for the placement. They eventually relented and agreed to pay for the placement until the panel made a decision 2 weeks later.
Be aware that ward staff are under pressure to avoid delayed discharges and they either don’t know what legislation states re CHC screening and funding care or will deliberately ignore the law. You have rights and you should stand your ground.
Good luck
Thank you both for this really good information. In direct relation to our problem could you tell me who pays when, following 12 months of CHC funding, the MDT review is now recomending withdrawl of CHC funding for my relation. We are of course appealing as her condition has, in our opinion, got worse. Who pays the care home fees from now until the appeal is heard?
I have previously asked for advice about my mother’s situation and you have all been really helpful. Last week I received a reply to a complaint I submitted to the NHS because my mother had been discharged twice in a short period of time with a canula left in her hand (that was the first discharge from our newly built emergency hospital), then on her second discharge (from our local general hospital), a butterfly needle was left in her leg, her dressing had not been changed and she had a catheter, which the nursing home was not made aware of. We have received apologies for these oversights. They have said that it is particularly disappointing that this should have happened when our mother was so frail and unable to alert staff herself because she was unable to communicate. On both admissions our mother was really ill due to pneumonia and she was severely dehydrated As she is self funding and has been since 2008, we asked for a CHC Assessment to be carried out. This was refused and we were told that this would be done at the nursing home if necessary. I included this in my complaint, asking why a CHC Assessment was not carried out when it is part of the discharge process. They have come back with: “Your mother was assessed in May 2015 and awarded nursing care in June 2015 (it was recommended that a further assessment be carried out in six months, but they refused to do this stating that they were giving priority to hospital assessments). During the Multidisciplinary Team Meeting where all healthcare professionals involved in your mothers care met to discuss her progress, there is a record of a discussion taking place regarding the possibility of repeating the CHC assessment. At this time the consultant in charge of your mother’s case felt that your mother’s condition had actually improved during her stay in hospital and that the nursing home were able to meet her needs, therefore it was deemed unnecessary at that time. However, should your mothers condition change and she became more unwell, she would then be able to have a fast track assessment at the nursing home.” – which is exactly what happened (at our request at the nursing home). They have apologised that this information was not communicated to us at our meeting with the consultant. They have also stated that our mother is recorded as having a safe swallow, when in fact she needed thickened drinks (and was prescribed stage 2 thickened milk drinks because of her swallow difficulties and because she had lost so much weight) because she coughed every time she drank and mealtimes took well over an hour. I’m wondering what the definition of safe swallow is, but if you can offer any help with regards to how I can respond to the reasons they have given for not carrying out a CHC Assessment, I would appreciate it. Angela – you did give me a link before, but that seems to be broken now. My mother died shortly after her second discharge after not eating for about three weeks and being hydrated by “sub cuts” which a friend had told me to ask for – they were not offered by any of the medical staff who were supposed to be helping our mother in her final weeks.
Hi Elspeth
I have answered your key questions and provided the relevant links to support any complaint you make re a failure to comply with the CHC Framework, Discharge Regs and the Care Act.
Regardless of what the MDT and the Consultant said there has been a reach of process:
Discharge regs & Framework state that screening using a CHC checklist MUST be undertaken prior to discharge).
A checklist should still have been done regardless of whether her needs had improved. It is a statutory duty to screen for CHC and is not for a Consultant to prevent this.
Re their view on Fast Track funding: In addition to screening for CHC as per the Discharge regs and Framework they must always be aware of the potential for eligibility for FT funding. As such they may well say they considered she wasn’t at that time on the ward, so would be correct in advising to review this if her health deteriorated and care needs increased. However without knowing the exact status of your mothers health and needs at that time, it could be that she was eligible for FT funding and they where failing in their duty to consider this whilst on the ward. Given that your mother passed away within 3 weeks of the last discharge it would seem likely, she was entering a terminal phase and had high level needs and that it was clear that they should have applied for FT funding. In which case this would be a further breach of process.)
It would seem that the Consultant played a lead role in all of this. I would question what training he/she has had on CHC and if they have when did they attend a refresher course? I suspect they have never been on any CHC training.
Re the swallowing problems, I would assume that prior to discharge there had been a SALT assessment which would be required to define the risks of aspiration and how best to manage and reduce risks upon discharge i.e. thickened fluids.
The fact is that if a checklist had been carried and it was positive then all ongoing care costs would be the responsibility of the NHS whilst awaiting the outcome of the full CHC assessment regardless of the fact that she may well have been admitted from a care home where FNC was being paid. It would seem that the main driver was to ‘obtain the bed’ as quickly as possible and they deliberately ignored their statutory duties. Sadly this is very common on many wards as they try to prevent in their words ‘bed blocking’. It is far easier for them to do this with self funding clients than those who rely on Social Care funding.
The Care Act also requires that Wards must refer all case to Social Services prior to discharge. BUT only after screening for CHC. Was your mother referred to Social Services? If not then this is another breach of process. See this link https://www.gov.uk/guidance/care-and-support-statutory-guidance/annexes
The key links to discharge regs are;
http://www.legislation.gov.uk/uksi/2014/2823/regulation/5/made
http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Documents/nhs-england-and-ccg-regulations.pdf
http://www.disabilityrightsuk.org/how-we-can-help/independent-living/care-act-resource-page
I read with avid interest all the stories and comments that have been made. My mom is being discharged from hospital, which I feel she shouldn’t be. I received a call yesterday stating that a nursing home has been found who will accept her (after doing an assessment) while another assessment is made. I have also been told that a ‘top up fee’ of £50 pw is required (I have no job, so that is another story.)
I feel I am in a losing battle scenario, I have made it clear that I have no funds available, my mom is in no fit state to be leaving hospital (AIR team says she is), that I would like a CHC assessment done (they say it will be in the nursing home).
I am going round in circles trying to find someone who will help me understand all the ins and outs of this system ……
Is it correct that they can move her from the hospital ( I haven’t signed anything). Mom cannot sign anything, she isn’t capable of this, and a test for CHC be done in the nursing home?
Thanks a million for your response. I know someone from Social Services was at the MDT meeting (we weren’t invited in spite of visiting the hospital every day). I believe Social services were involved because we raised our concerns about the nursing homes ability to keep Mam hydrated. They checked with the home who assured them they could. We could see that our mother was in the last stage of her life, but when we met with the Consultant she insisted that our mother was “bright”. We know Mam was eligible for fast track at that point and know we should have argued with them more, but we just wanted Mam back in her own room for the little time it was clear she had left. Luckily we managed to get Palliative care nurses for Mam when she got back to the nursing home and I can say that at least everyone stepped up to the mark on her return. Shame about the previous seven years. We will push this complaint even if our Mam won’t benefit, they might take more care in future.
In many hospitals there is blatant disregard of legislation and the CHC Framework. The Care Act of 2014 was implemented to prevent this happening. Many NHS staff and Social Care Staff have limited knowledge of their legal duties under the Care Act.
In summary my advice is;
It is a legal requirement to screen for CHC prior to discharge for someone with complex ongoing care needs. This must be by way of a CHC checklist and with the full involvement of the family/POA if that person does not have mental capacity or if that person wants to have them involved.
The ward cannot make a referral to Social Services until this CHC (checklist) screening as taken place. Social Services cannot accept a referral from the NHS until this has been done. They must refuse to accept if they are aware that a CHC screening has not taken place and refer the case back to the ward.
The delayed discharges regs do not apply whilst awaiting a CHC process so they cannot use the words ‘bed blocking’. They cannot serve a notice on a patient to leave without complying with legislation and doing a CHC screening/assessment.
If the checklist is ‘positive’ then there must be a ‘full’ assessment for CHC with a full MDT and completion of a DST. This would involve Social Services. The NHS remains responsible for all funding of care until the completion of a CHC process. So they can discharge but the NHS must pay for all of that persons ongoing care if awaiting completion of a CHC assessment.
If the checklist is ‘negative’ then the ward must refer to social services, and they (Social Services) must assess that persons ongoing needs and risks before discharge. Between Social Services and the NHS they must identify what the risks are and how their ongoing care can be met and write up a ‘care plan’ that meets their needs and manages risks. That care plan must be shared with the person and/or their family/POA prior to discharge. They must consult with the family/POA as part of assessing needs and writing up the care plan.
Social Services must assess what that persons ‘eligible’ care needs are and consider that persons ‘well being’ needs prior to discharge. They cannot ask about a persons finances until after they have assessed what care needs are. You do not need to divulge finances until after the care needs assessment. If you need time to gather financial information then Social Services must fund all ongoing ‘eligible’ care needs upon discharge until the financial assessment is completed.
Social Services must also carry out a ‘carers assessment’ under the Care Act prior to discharge.
The ward can only legally discharge a patient when they have complied with the Care Act, Discharge regs, delayed discharge regs and with the CHC framework. Local policies on discharge do not remove or override their legal statutory duties.
You can refuse to agree to a discharge if they refuse to comply with legislation. Make a note of the time and date any comments made to you by staff and ask for their name and professional body and point out that they are in breach of their code of ethics if they ignore the law. If they continue to ignore legislation and try to discharge then submit a formal complaint in writing ASAP and ask for the status quo to remain until the outcome of the complaint is known and until they have complied with legislation. If you feel that the patient is at risk of abuse, harm or injury as a result of their professional conduct then advise them that you wish to submit a formal ‘safeguarding’ alert and ask for an investigation of this potential abuse as per the Care Act.
My mum was initially granted CHC in November 2014 on the basis of a DST (results P zero, S zero, H 2, M 3, L 2 and N 4, however I have a second copy of the DST showing a change to the Communication domain from N to L).
Mum was reassessed in February 2016 with the following results (P zero, S zero, H 1, M 4, L 1 and N 5). On the basis of this assessment CHC is to be removed beginning of April and replaced by FNC. However, mum suffered a severe stroke February 17th is is now in hospital. I was advised by a doctor from the acute medical unit (AMU) that she probably would not survive but mum seems to have got better and was transfered to Ward 10. I have called Ward 10 on 21, 22, 23 and 24 March trying to find out how my mum was faring, clinically, only to be fobbed off with ‘fine’ and ‘doing okay’.
Today, 27th March – Easter Sunday, I received a call from Ward 10 that mum was going to be returned to the nursing home where she has been since October 2014 and that they had agreed to accept her.
My queries are:
1. I have had no contact concerning this matter other than a statement 24th March that mum would be staying in hospital over Easter. Should I have had more than an out-of-the-blue call from a nurse who knew nothing about my mum’s condition? Surely the nursing home should also have called.
2. I have had no notification from the discharge coordinator that this would happen. Should the discharge coordinator have contacted me?
3. Am I right in thinking that another DST should be completed before discharge from hospital? (mum’s primary healthcare needs may have changed),
4. Is the hospital trying to ‘pull a fast one’? I contacted the most senior person on Ward 10 earlier (obviously no doctor or discharge coordinator as it’s Easter) and made her aware of the Care Act 2014 (my understanding of what Bernie Crean has written) and the nurse said she would stop the discharge and contact the site manager (I’m not sure what role this person plays).
5. Am I doing the right thing as I feel that I have a duty of care towards my mum and would prefer her to be in the nursing home but I am aware that the issue of ‘bed blocking’ looms large and once out of hospital trying to get mum reassessed again so soon after the last reassessment in February may be difficult to achieve.
Any comments will be gratefully received.
Thank you for your replies. Since I wrote the plot has thickened. Chapter 1 you already know.
Chapter 2 (29/03/16) – Today I contacted the Discharge Liaison person who claims to know the procedure and may hold a Checklist meeting today. However, she could not explain why or who had agreed discharge on Easter Sunday, I then asked to see the Checklist which should have happened but lo-and-behold she could not locate one. She also confirmed she knew nothing about the discharge because it was Easter. I asked to speak to the doctor on the ward but whether that will happen today who knows. The final straw was her hiding behind the Data Protection Act when I asked to see the Checklist and associated paperwork completed for Easter Sunday discharge. She did agree that if the Checklist was positive then a DST would held but if I’m not physically present at the Checklist meeting because I live so far away and I’m only on the phone how can I be sure they do not slew the result to their benefit. They also know that full CHC funding ends tomorrow to be replaced by FNC from a previous DST re-assessment held in February (result confirmed by letter by CCG).
Chapter 3 (29/03/2016)- I was called and told that a Checklist had now been completed (I wasn’t invited to be there). The results of the Checklist were Mobility A, Continence B and the other 9 domains Cs. Based on these results mum would not get a DST and she would be discharged, probably later that day. I asked for copies of the relevant paperwork but was fobbed off with that would have to submit a formal request to the hospital as the FOI act applies. I don’t think that’s correct but I’ve yet to decide whether wading through the 431 pages of the Care Act 2014 Guidance notes to find chapter and verse will lead to insanity.
Chapter 4 (30/03/2016) – Sense has finally prevailed and a lady from Care Review Services has called me and after a review of the Checklist has reversed the previous decision and invited me to attend a DST meeting at the hospital on Monday 4th April. Now, before I accept the invitation, as I will be pitted against Care Review Services, the Complex Discharge Nurse and someone from Social Care, and as I feel I might be out-gunned I shall try my damndest to get someone who knows the inner workings of the NHS to hold my hand (?)
Keep your eyes open for the next rivetting instalment of Diddy Dave vs The NHS Behemoth.
This is a very interesting article but I wonder how far it would apply to a retrospective claim for funding, relating to a period that pre-dates the Care Act and National Framework, as in my mother’s case.
My mother was detained in a mental hospital under s.2 of the MHA in 2006. On the expiry of the detention period of 28 days she was released straight into a care home under a 6-month Guardianship order. The care home fees were paid from the proceeds of the sale of her house and she remained in the care home until her death in 2010. No checklist assessment had ever been done before I requested a retrospective assessment in 2013. The result of this is that NHS CHC funding was not granted and I am awaiting an appeal meeting..
Can you tell me how far the points made in the article apply to a retrospective claim such as mine?
Hi Peter
This is interesting. I acted for someone detained under the Mental Health Act. the situation is you are correct re the 28 days but the Act goes much further and is very specific re the time in detention and it is not measured in just days its Days, Hours & minutes. My client who should have received N.H.S. Fully Funded anyway, the N.H.S. & Local Authority were doing their usual, but by getting the right information (eventually, usual long hard struggle) it transpired that the 28 days was in fact 28 + some hours therefore those hours meant Full N.H.S. Funding from discharge.
Good morning. I wonder if anyone has a brief lists of “critical” questions I should ask at a Best Interests meeting please.
Hi Chris. Sorry for brief details. I have power of attorney and mum is currently on a section 3 in a local hospital. Next week there is a best interests meeting including psychiatrist, social workers, ward manager and other family members. I think the idea of the meeting is to establish whether my mum has capacity to make her own decisions. I have had a pre-meeting and i was uneasy when talk of funding was mentioned before any needs assessment has been done. Any help greatly appreciated and welcome.
Hi Jane
Best Interest (BI) is a term that originates from the Mental Capacity Act (MCA) is not directly linked to the CHC process. I have chaired many BI meetings in my time as a manager in Adult Social Services. See this link http://www.mentalhealthcare.org.uk/media/downloads/Best_Interests_Guidance.pdf
Note what a mental incapacity is.
Note Section 3;
who is the ‘decision maker’
What must happen before a BI is convened.
What is assessed.
What should happen before a meeting.
You may also want to research on google the mental capacity act.
Don’t be overawed by the meeting. Go prepared and if they are not holding a BI meeting in compliance with the MCA then say so. You have the right to a copy of the organisations policy on Mental Capacity and BI meetings, ask for a copy of it before the meeting. If you have POA for finance or welfare then you are the ‘decision maker’ not them.
good luck
Many thanks will read both of the suggested links before next Thursday. Have a great bank holiday weekend.
Hi Jane and Bernie. One additional question please. At the best interest meeting this week should the social worker that was involved in assessing my mother’s needs in July 2015 be present rather than a social worker who has never met my mother.? Many thanks.
It is my understanding that anyone that has completed documentation giving power of attorney can enact it any time they wish. So , having capacity to make decisions does not mean that an individual has to if they have appointed another to do that for them.
Firstly a huge thank you to Angela, this great website and the digital download How To Get The NHS To Pay For Care which I am constantly referring to.
Very briefly, after an initial misdiagnosis as a pulled muscle, my mother has been in hospital with repeated kidney infections for 6 months, which has led to a stay in HDU, delirium, falls, a broken shoulder, a bleed on the brain, ecoli, and a chest infection. She has one functioning kidney, which contains residue from stones and cannot be drained due to her age and health and so is at continual risk of further infection. She currently can walk only with a Zimmer frame assisted by 2 nurses, needs daily physiotherapy, has a catheter, a pacemaker and pernicious anaemia.
Delirium reduces her compliance with the nurses regarding nutrition, fluid intake and medication and also her ability to make the correct choices regarding her own safety, hence the falls. Her ongoing health needs are all related as if her fluid intake is not high enough and the correct medication not given, this increases the risk of infection, hospitalisation, delirium, falls, etc. Prior to going into hospital in November, my mother lived alone in her own house, still drove herself and went swimming a couple of times a week.
The hospital she is in is now looking to discharge her and my sister and I are researching suitable care/nursing homes as she is no longer fit to return home. We are now in the assessment process to basically decide who pays for my mother’s continuing healthcare. My mother passed the Checklist Assessment, only after I insisted it was done again in our presence as we were initially told they had already done this and she had failed.
This qualified her for a full assessment using the DST which we attended and were part of the discussion until being asked to leave the room whilst they did the scoring. Was that correct or should we have stayed in the room? On our return to the room were unofficially told she had failed by the panel but were not told how she had scored in any of the domains. I thought their duty is to pass on their findings to the Clinical Commissioning Group who actually make the decision and inform the relatives in writing. Is this correct and if so have there been clear breaches of procedure. We will be appealing this decision when we formally receive it if indeed it says she does not qualify.
Since the full assessment meeting (and we still have not had a formal decision) the social worker left two PFA 1 forms at the hospital for my sister and a very blunt handwritten note, which read:
“Sign both copies please + return one to wards staff. Refusing to agree to financial assessment will mean no financial assistance & full health costs will be chargeable to individual”
We have now decided on a care home and they will be assessing my mother on Monday, my sister is attending this assessment. My mother has had another kidney infection and has been back on antibiotics this week and yet they still want to discharge her. Please can you confirm that I am right in thinking that if she does get discharged to the care home the fees are currently the responsibility of the NHS as the decision process and appeal process have not been completed.
Hi There
I would be so grateful if you could please give me some urgent advice. My brother who is an acute paranoid schizophrenic was released from hospital under Section 3 of the MHA into a supported accommodation Extra Care facility after being in hospital for 6 years. Since he started living there in February this year it’s been a hellish time as shortly after moving in the cost of his rent rose dramatically (200%) and I’ve refused to sign the Tenants agreement and written lots of letters to object. We are still waiting for a Housing Benefit application to be processed which, anyway I think will come to nothing as my dad made the mistake of buying my brother a house (and putting it in his name!!!) 20 years ago in an attempt to give him a safe place to live. His care is being funded jointly be the NHS and the LA – but not his accommodation.
This is the situation now: I asked for my brother not to be discharged until this rent rise was fully investigated (we haven’t signed anything) . I engaged a solicitor for advice and we were finally able to obtain a CTP meeting to discuss everything. I was aware from friends of the existence of Continuing Healthcare and I asked a solicitor did she think my brother would be eligible. She said yes as he’s been under Section Three and will be subject to 117 aftercare. I went to this meeting confident my solicitor was going to ask for this funding to be considered as per my instructions. To my horror she contributed to the meeting hardly at all – and my brother was discharged from section 3 onto a Section 117 with me in total shock as to how things had gone totally against me and I had been whitewashed by one and all – and continuing healthcare hadn’t been requested .
Am I going mad or is my brother eligible for free accommodation? My solicitor says he is now free to live anywhere he likes – but in reality he would be unable to do that as the level of support he needs is so high and he has settled well into his accommodation. I’ve been told unless I sign the tenancy agreement asap my brother is going to be evicted. I’m so up against it as I’m a carer for two other people also. My daughter has a chronic illness and my father has terminal cancer and dementia. I am disgusted with the social worker as he has refused all attempts to contact him and the worry of all this has made me feel really ill. Many thanks Maggie
Hi Maggie
I’m surprised that your solicitor wasn’t as helpful as you hoped at the meeting and in advising you. Anyone eligible for Sec 117 will not require the CHC process to be applied unless they have a totally separate condition in addition to their mental health problems ( i.e. someone who might also have MS or arthritis or a spinal injury etc). Sec 117 takes precedence over CHC funding. As you can see from this link ALL after care services must be funded by Sec 117 funding Section _117_Aftercare _Factsheet-3.pdf
Rental may not fall under ‘after care’ but the issue of rent in supported living accommodation is confusing see what the fact sheet states;
5. Can I get free housing?
The rules about what housing you can get for free under section 117 are complicated. Normal housing that everyone should have will not be free but some specialist housing will be.11
The law is not clear about who will be able to get free housing under section 117.12 If your local authority says you are not entitled, make sure you challenge them as soon as possible.
5
Ordinary housing
Ordinary housing will not usually be free under section 117. ‘Ordinary housing’ means a house, flat or room that you rent from a private or social landlord.
Supported housing
Supported housing is housing where you get care, support or supervision. Your care and housing will normally be run by different companies. This housing is not the same as a ‘care home’.
You may be charged separately for your rent and care. A lot of local authorities will charge you for rent even if you are under section 117. But they should still pay your care costs under section 117 if they are not paid for by another scheme. The law is not clear about if these local authorities are acting properly by charging you rent.13 You can challenge your local authority by making a complaint or taking legal action.
Hope this is helpful. Contact MIND for further advice on 0300123 3393
Hi Bernie. Thank you so much for your reply to my query. I have heard from the LA today that our claim for Housing Benefit has been turned down (much as I always suspected). We are going to struggle through as a family (even though I’m a single mum) to top up the income he gets from the rental of his house so that his supported accommodation gets paid. I cannot bring myself to sell my brother’s house. It would break his heart and cause him huge emotional damage. It was bought because the LA could not provide any suitable place for him to live 20 years ago and he paid for it himself out of his benefits. It’s just obscene that the LA want to have the penny and the bun. He’s been ill for forty years and my mum and dad saved the LA thousands by their devoted care over those years. As you suggest, I am going to make a formal complaint and in addition, change my solicitor…….Thank you so much once again.
Hello,
My mother is currently in hosptal and now stable so looking at discharge. I have had a recommendation that Mum qualifies for the nursing component but not full CHC. The local authority are trying to be helpful and to find a nursing home. i have not had the CHC decision in writing although have informed the local authority I will appeal as soon as I do. They are now in discussion as to what will happen NHS/Local authority and waiting to hear? Not sure what to do as I do not think that they will allow Mum to stay while an appeal. The appeal will focus on the decision as Mum would meet the Coughlan test.
Could they just agree or would this carry on for several months too and fro. In the meantime what happens to Mum while this goes on. i have juts bought the online book and await arrival. New to this and its very sad to have to focus on this and any advice appreciated. Thanks
Hello again. My mum is soon to be discharged from hospital with section 117 care. However I believe the consultant at the hospital will lift the section 3 as soon as my mum is home. I have asked the consultant if a DST checklist has been done prior to discharge. Consultant says care will be funded through 117. There was a CHC application on-going before mum went into hospital awaiting a decision. I asked the Social Worker and Consultant to do a CHC checklist in parallel to the Section 117 in the event of the section being lifted. Mum still has the mental health needs and has behaviour problems just the same as she did prior to admission to hospital earlier this year. I have just received an email where the consultant is asking the Social Worker Manager what the rules are about CHC etc. Is this right that the hospital defers back to the SW for advice.? Any help much appreciated.
My Mother is 90 and has several medical conditions. She also has Dementia which is getting steadily worse with communication and the ability to take care of herself diminished. She has had several hospital admitions in the last 12 months for falls, a heart attack, small stroke and recently a fall when she broke her hip. My Mother was paying for her care in a care home but she was not getting adequate care so I have moved her in to my home. She has now dropped below the threshold for paying full care costs. The council rang me to arrange a financial assessment and I asked about a Continuing Healthcare (CHC) assessment they said it would have to be carried out after my Mom returned home from hospital as she would recover from her broken hip. So, my Mother returned home and the council pay for some of the visits of carers and we pay for extra visits. Who do we speak to to arrange a Continuing Healthcare assessment or is it too late?
Babs
Babs.
There should be a discharge process on the ward that must include screening for CHC via a checklist. However this can should be delayed if there is potential for rehab and for independence to be gained. See para 64 page 24 of the NF. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213137/National-Framework-for-NHS-CHC-NHS-FNC-Nov-2012.pdf
It would seem from your comment made by Social Services re a delayed CHC assessment and potential further recovery that the ward would not use a checklist. However as para 65 of the NF states ‘ In such situations, assessment of eligibility for NHS continuing healthcare should usually be deferred until an accurate assessment of future needs can be made.’
If your mother had rehab potential on discharge I would expect that she was in receipt of intermediate or rehab provision which should remain place until ‘ The interim services (or appropriate alternative interim services if needs change) should continue in place until the determination of eligibility for NHS continuing healthcare has taken place. ‘
It seems confusing as to what ongoing health support was provided and what Social Services have done with regard to process. There is a requirement to assess for CHC at the point your mothers needs became stable and known. Before Social Services can provide any services they must carry out a full assessment of need as per the Care Act ’14. As part of this Care Act duty they must assessment they must also consider eligibility for CHC and they must carry out a checklist. this is further indicated by the NF in para 67 ‘ Whenever an individual outside a hospital setting is having their health or social needs assessed or reviewed by a CCG or and the LA, consideration should always be given to whether their needs suggest that it might be appropriate to use the Checklist (see below) to identify whether or not there is potential eligibility for NHS continuing healthcare.’
I see your mother is receiving care funded by Social Services, have they actually visited to carry out a full Care Act Assessment of need. See this link re Care Act duties, sadly many Social Workers do not know of their legal duties re CHC and assessment. https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance#first-contact-and-identifying-needs
Note Para 5.12, 6, and 7.21.
From what you say, it appears that there hasn’t been a ‘follow up’ screening for CHC post discharge. Additionally Social Services have not complied with both the NF and their statutory duty under the Care Act to consider CHC eligibility in their assessment of need. I would advise that you contact the assessing Social Worker and advise that they had a duty to complete a checklist as part of their assessment and failed to do so. Request that they complete a checklist ASAP and back date this to the date of their original assessment.
It is also concerning that you are paying for care visits and Social Services only pay for some care. If your mother has eligible needs and her finances are below their threshold then Social Services should be paying for all of them. Unless their financial assessment calculated that your mother can partially fund her care.
Hope this helps.
PS: Be careful if you’re thinking of stopping paying for Social Care as this can cause added problems. It is better to try and get them to fulfil their legal duties under the Care Act and the NF with regard to CHC, you can always ask for monies to be refunded if you are able to obtain CHC.
Thank you for getting back to me so quickly -much appreciated. I think they’re trying to foist a joint package of care on us because they found out from my mum’s last (residential) care home she was self funded so I may be up against it in her behalf. I am going to fight it and try and get her paid for by the NHS for the last few weeks of her life at least, as there’s no way she could afford the fees for the place they’ve put her from what’s left of her money and I don’t want her moved from pillar to post.shes so frail. It’s a mess isn’t it? We’ve paid for her to go into a residential dementia unit as we thought it the best place for her- and it was initially – but I am now beginning to realise the residential home management probably kept her where she was far too long, getting their beleaguered workers to do more and more nursing, telling me she wouldn’t qualify for any nursing fees. Now she’s in a nursing placement where they are telling me she would have triggered ages ago!
Thank you again. May be back while I get through the next few weeks!
My 83 year old mom has been in hospital for almost 3 weeks following a severe stroke. They did thrombolyse her but unfortunately resulted in haemorrhage and swelling of the brain. She has no speech whatsoever, no understanding, paralysis on the right side and is unable to mobilise, is on mashed diet and thickened fluids although unable to feed herself and is doubly incontinent. They are also concerned about her low heart rate and has today been fitted with a 24 hour tape. They have said she needs 24 hour care and are pushing for her to be discharged to her home within the next two weeks with a package of care. They have today been to assess her bungalow for any equipment she might need. I have no problems regarding the care as I have 21 years experience of being a carer for the NHS and intend moving in with Mom to care for her. However I have asked for a CHC assessment as I feel she meets the criteria for eligibility, which to my knowledge has not been done. I have been asked to attend and MDT meeting next week to discuss her discharge. Any advice would be appreciated.
I have only just come across your website 5 months after my Dad was taken into a care home. We have a Multidisciplinary Team (MDT) Continuing Healthcare (CHC) assessment next week and I have only just realised how important this is. Please can you tell me where in the Framework or Care Act it states that a patient’s costs should be paid by the NHS on discharge if the Checklist has come out positive and the patient is awaiting a full CHC MDT assessment? My father who has advanced Alzheimers was sectioned and taken in to hospital as he had become non compliant with his full time carer’s attempts to keep him clean and healthy- he is doubly incontinent. My father was discharged to a care home from hospital on the 27th day of his stay in hospital (we feel to avoid him having to go to a section 3 and then he would have had all costs paid on discharge under 117 regulations.) We were immediately told that we had to start paying the care home fees as we would be self-funders. We have been paying extortionate care home fees since November last year and are hoping for a miracle at the meeting. How do you think we should proceed?
My 87 year old father has had 13 hospital admissions, 15 community treatment team visits and 5 falls in the past year. He has been in hospital for the past 3 weeks with stage 4 COPD community aquired pneumonia and congestive heart failure and is quite poorly. Dad has now agreed to a care home and following a Multidisciplinary Team assessment on Friday, the palliative care nurse is applying for Fast Track NHS Continuing Healthcare funding. I have a home in mind that is a residential home, with 4 palliative end of life care beds, but doesn’t have a nurse in the team. They are registered as platinum on the GSF framework and have a contract with the local CCG to provide end of life care. However, the palliative care nurse is saying that the home has to be a registered nursing home, for funding to apply. Is this correct please?
My Mother was being discharged from Hospital after being Diagnosed with Mixed Dementia.
There was no Care package in place for her. We asked for an Assessment for CHC and was told by the Social Worker she would not be entitled to it, we pushed and they agreed to the checklist which did suggested a full Assessment was needed, to do this they said my Mum would be transferred to a Nursing home for 2 weeks assessment and we would find out within 28 days. The first 2 weeks were funded by the NHS then the home gave us a bill for the following month. At this stage there had been no financial assessment done as we had refused to do so until we knew the outcome.
Exactly 28 days after the meeting I rang the CHC team to find out what the decision was to be told they had sent it out in the post but they sent it to the wrong address. My Mother was awarded FNC.
I am now in contact with the CCG trying to get a refund for care home fees for the 28 days as I’ve read that the NHS is responsible until we have the decision. They are adamant my Mother is not entitled to a refund. I don’t know where to go from here and would welcome any advice.
I work in community adult social care team, we work closely with hospital health & social work teams, in relation to hospital admission & subsequent discharge I would always request a CHC checklist and/or fast track considered once the patient is confirmed medically fit, however it appears a CHC health panel in conjunction with adult social care professionals have agreed CHC checklists would not be completed on behalf of a patient in a hospital setting.
I am somewhat confused as I have read articles, NHS framework & various health processes in respect of CHC & hospital discharge planning , the information indicates the CHC documentation should be completed prior to discharge & once the individual is medically fit.
I am at a loss as to how I can challenge this new updated system when both a health & social care panel have decided this is the way forward, I assume this progresses & speeds up discharge, although I doubt this adheres to the NHS framework or legally protects the patient.
Update on my mother (96). After falling and breaking hip; dislocating other hip in hospital 3 times and having operation to fuse hip the hospital came to discharge. My mother had lived alone in 2 storey cottage for many years. Hospital carried out “cognition check” and decided she was unsafe to return to her home (I agreed as I had explained that I thought she had dementia but had not been diagnosed – increasing memory loss; all gas and electricty taped off in house as she leaving them on; putting cans in microwave, etc). Hospital discharge indicated that she would be placed in a care home for 12 week period for interim assessment decision which it was stated would be paid for by local authority at which time there would an ongoing care assessment, a formal mental dementia assessment and a financial assessment for the future. “Long story short” I am now disputing with local authority who are trying to charge her for the 12 week interim placement. Dementia diagnosis was positive for mixed dementia. Fortunately I have LPA so control the financial side of things. Will have to sell her cottage to pay for ongoing care home fees anyway but annoyed at this “extra” 12 week charge being attempted.
My mother has been in hospital for 3 month (twice in intensive care). She is 80 years old and now has newly diagnosed Type 1 diabetes.
She can’t swallow and is therefore eating very little, she is immobile, cannot control her new condition and therefore her sugar levels are frequently soaring into the 20’s until the nurses administer her medication.
She is immobile (partly due to lack of mobility, partly due to lack of nutrition.)
She has a numbness around her face (tight band around her head, numb nose, numbness around her mouth)
The doctors feel it may be psychiatric.
She is in a convalescent hospital, but theY feel she is ready for discharge, I feel she should stay where she is, or if she has to go to a nursing home then have NHS CHC given the complexity of her issues
My Mother in law was transferred from hospital to a care home awaiting NHS continuing health care assessment. The assessment was eventually carried out & declined. We have now received an invoice from the local authority requesting £133.80 per week from the date of discharge from hospital until the assessment was carried out amounting to £630.77. Could you advise if we are required to pay this.