TIPS on assessing 'Altered State of Consciousness' in your Decision Support Tool

There are 12 Care Domains that are measured on the Decision Support Tool when assessing eligibility for NHS Continuing Healthcare Funding. One of these Domains is Altered States of Consciousness (ASC).

The DST describes Transient Ischemic Attacks (TIAs), Epilepsy and Vasovagal Syncope (fainting). General drowsiness and sleepiness would not normally constitute an ASC for the purposes of this domain.

The majority of cases will involve seizures or TIAs.

Epilepsy is not always something that a person suffers with from childhood; it can be something which occurs after a head injuries or stroke.

Other conditions that can look like epilepsy include fainting, or very low blood sugar in some people being treated for diabetes, or seizures that happen due to fear or recalling a traumatic event. These are known as non-epileptic seizures.

TIAs will often be historic and will be given a ‘Low’ level of need on the DST, or if still happening, possibly a ‘Moderate’ level of need – depending on the care needed to support the person during the TIA. If the TIAs are fleeting and need no specific care interventions, they may still be considered to be a ‘Low’ level of need.

What Factors Need To Be Considered For CHC Purposes?

For assessing eligibility for NHS Continuing Healthcare purposes, the diagnosis is less important than the care needs arising from the ASC/seizures. Most people having ASC/seizures will have a care plan. The care plan will be a valuable source of information as to what care is needed during ASC/seizure. Make sure that the ASC care plan is up-to-date and records all the care needs.

There are lots of possible symptoms of seizures, including uncontrollable shaking or losing awareness of things around you. In serious cases, during a seizure the person may stop breathing or they may have a heart attack. If this is something that has happened before during seizures it should be recorded in the care plan, along with the details of the equipment and instructions about how to manage the seizure. This is all information that will need to be recorded on the Decision Support Tool and will be relevant to the determination of CHC Funding.

In most cases, the main treatment for epileptic seizures is medicine to stop seizures. These are often prescribed as a daily dose and with this medication seizures can be so well controlled that the person does not have any more.

A person with well controlled seizures is likely to be given a ‘Low’ level of need on the Decision Support Tool as this would be described as ‘History of ASC but it is effectively managed and there is a low risk of harm’. This is because there has been no recent seizure and the care needed to manage the condition is to administer the medication, rather than any care that is more significant. Even if the patient is well managed with medication, they can still have the occasional seizure, as the condition can be hard to control. Depending on the severity of the seizure, activity it could fall into the ‘Low’, ‘Moderate’, ‘High’ or ‘Priority’ level of need. The full descriptors within the DST for ASC are noted below.

If ASC/seizures are still happening, as opposed to being historic, there are a variety of factors that will impact on the decisions taken for continuing health care purposes. These include:

• the length of time ASC/seizures last
• whether rescue medication is needed
• whether the person needs specialist equipment to assist with breathing or to restart the heart
• how often the ASC/seizures occur
• how long it takes the person to recover and what care is needed during that time
• whether there is any warning of the ASC/seizures
• whether the person can communicate with carers to indicate they have had or may have an ASC/seizure

In some people, seizures can be more difficult to manage and will not respond so well to medication. In these cases, there might be a neurologist who is overseeing the person’s care, ensuring that seizures are monitored and recorded, and that medication is adjusted until the right medication/s and dose is found. This can be tricky to get right. These factors should also be included in the CHC assessment.

Some ASCs/seizures are less intense than others. They may last for a short duration – a few seconds. The person might have a feeling that they are going to have a seizure. This is called an ‘aura’, and it can help people to keep themselves protected from falls, for example by ensuring they are sitting in a safe place, or they can raise the alarm to carers or administer medication to prevent the seizure. People with cognitive impairments are unlikely to be able to take such measures, and these facts will also be important to record in the DST.

Serious seizures can last for more than 5 minutes; others as long as hour. Clearly the longer the seizure, the greater the care needs for Continuing Healthcare purposes.

Some people need to have ‘rescue’ medication. This is medication given during or immediately before a seizure to stop it in its tracks. This medication needs a degree of skill in knowing when to administer it, and if given during a seizure, can be quite difficult to administer. This will also factor into the decision for eligibility for NHS Continuing Healthcare.

Some people recover from ASC/seizures more quickly than others, with some taking several hours to return to their normal selves, often needing the oversight of carers at intervals to check on their recovery. This should also be recorded and considered within the CHC assessment.

The DST considers monthly or less frequent episodes of ASC to be a ‘Moderate’ level of need, with more frequent episodes to be a ‘High’ level of need. However, if the ASC is occasional but needs skilled intervention, such as administering rescue medication or other clinical interventions, then it can be considered a ‘High’ level of need even though happening less frequently. If ASCs are happening most days, or do not respond to preventative treatment, and result in a severe risk of harm, this will be a ‘Priority’ need and should qualify for CHC Funding.

In conclusion, the key judgments to be made of the purposes of CHC Funding is the frequency, and severity of episodes of ASC and what the carers must do to care for the person and keep them free from harm.

Below are the descriptors given in the DST indicating the levels of need expected for different situations.  By considering the facts above you should be able to work out which level of need you or your loved one would meet:

For further reading:

TIPS on assessing ‘Behaviour’ when completing the Decision Support Tool for CHC Funding

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