Needs nursing care - is it worth applying for CHC?

[looviloo]

I met with the social worker and manager at dad's care home yesterday. It was a bit of a prickly meeting.

Positives: I now have a better understanding of the care home system, and the social worker confirmed that dad's current home no longer meets his needs. In her opinion he would be better living in an EMI residential/high dependency home (not nursing care, as advised by both the current care home manager and dad's GP). At least that narrows my search down.

Not-so-positives: The social worker was able to make this assessment after observing dad shuffle down the corridor with his walking frame. When the manager filled her in about recent hospital trips, one that followed a fall out of bed, she made a joke of it... a joke that only she found funny. It REALLY annoyed me and I told her so! Oops. This was in the first few minutes so didn't bode well for the rest of the meeting. She later made a derogatory comment about the care home itself, a place that has been excellent from our point of view. She was also of the opinion that dad was doing well, might be like this for the next 5 to 10 years, doesn't have any particular physical disabilities (apart from not being able to talk/walk etc!), wouldn't qualify for nursing care, might need to move again when/if dad deteriorates more, and so on and so on. In other words it's the same thing I've always come across... that dad is never ill enough. I suspect he'd have to be at death's door for adult social care to pay any attention to him.

Sorry if that sounds harsh, and I know there are people far worse, but I'm really tired of the 'it could be worse' attitude when it's obvious to anyone who knows or works with dad just how ill he really is.

This is turning into a rant :-/.

Of course the nub of it all is that he's self-funding. Money that he and mum scraped together over the years in the mistaken belief they would leave it to family. Sometimes I wish they'd just had a few fancy holidays instead (which they never did). At least it's paying for dad's care BUT it means social care wash their hands of dad and happily leave it all to me to manage everything. My old dad would have have hated this situation, it's not what he wanted. My new dad has no understanding of what's going on - I barely know him anymore. I hate to say it but I'm feeling more and more resentful.

I should probably say that we also have elderly relatives on my husband's side of the family too, and the stress of juggling it all is putting a lot of strain on everybody.

Sorry. If you read this far, thank you! I know I just need to knuckle down and visit more care homes. I'll give my head a good wobble and hopefully feel better. Don't know what I'd do without this forum... x

 

[looviloo]

I'm a bit embarrassed about my rant above now and hope it didn't offend anyone. It came from pure frustration :-/. Thankfully I've calmed down now and have since been to visit another couple of care homes.

The manager of one of them emphasised the importance of knowing dad's needs, and that's where I'm struggling. I think his needs are borderline - possibly high dependency but not quite nursing. So she said we should get a CHC assessment in order to make the right choices (even though dad's self funding). She almost implied that some homes would need this assessment in order for dad to be considered... has anyone else come across this?

So I'm still a bit confused/frustrated but hopefully heading in the right direction. I'm thinking of ringing dad's GP (who suggested he needs nursing care) to see if he can request a CHC assessment. The social care worker was unhelpful when I mentioned it to her (see above!), deciding that dad's needs were EMI residential within two minutes of seeing him (she didn't even meet him, instead she just watched him shuffle slowly & unsteadily down a corridor).

 

[lemonjuice]

I'm a bit embarrassed about my rant above now

Don't be. most of us have 'been there' at some point!

she said we should get a CHC assessment in order to make the right choices

She may be right in that to assess whether someone need 'Nursing Care' contributions, they have to complete the full CHC Diagnostic Assessment Tool and tese are only available in a Nursing Home as opposed to a Care Home.

 

[love.dad.but..]

Dad was self funding and was in a dementia NH for 3 years or so. I looked at dementia care homes and 2 dementia NH...dad had an unstable hernia hence why a NH we felt was required for continuous nurse led monitoring and a year in he required an emergency op . He also had controlled high blood pressure, water retention, a triple bypass heart history and of course medication. He was in latter part of moderate stage dementia.

Without looking back on your previous posts...apart from the dementia does your dad also have other medical needs requiring nursing? If not then not too sure why the GP would suggest a NH unless the GP is thinking ahead as the dementia declines and he anticipates something medically added to the mix. NH are more expensive so unless needed a good EMI dementia home would be able to help.

A good description from you of your dad's current needs and dementia presentation and their own thorough assessment should be enough...I have never heard of a home insisting on a CHC assessment before agreeing admission unless it is to do with obtaining funded nursing care but dad's was applied for after he became a resident although I have no CHC application experience other than dad being fast tracked at end of life but he died before it was agreed.

 

[Elle3]

I'm a bit embarrassed about my rant above now and hope it didn't offend anyone. It came from pure frustration :-/. Thankfully I've calmed down now and have since been to visit another couple of care homes.

The manager of one of them emphasised the importance of knowing dad's needs, and that's where I'm struggling. I think his needs are borderline - possibly high dependency but not quite nursing. So she said we should get a CHC assessment in order to make the right choices (even though dad's self funding). She almost implied that some homes would need this assessment in order for dad to be considered... has anyone else come across this?

So I'm still a bit confused/frustrated but hopefully heading in the right direction. I'm thinking of ringing dad's GP (who suggested he needs nursing care) to see if he can request a CHC assessment. The social care worker was unhelpful when I mentioned it to her (see above!), deciding that dad's needs were EMI residential within two minutes of seeing him (she didn't even meet him, instead she just watched him shuffle slowly & unsteadily down a corridor).

Hi looviloo, I'm just catching up on posts, now that I'm back from holiday. I totally understand your rant and frustration, you do seem to be getting a lot of mixed and confusing messages.

I've never heard of a CHC assessment being required before being admitted into a care home, as you know from my experience, dad went into his second care home and was in there 4 weeks before the initial CHC assessment was done by the SW, this was to allow him to settle there and for the care home to get a better understanding of his needs and gather evidence to support our application if we were going to apply for it. All this time he was self funding and would have continued to be if we hadn't applied for CHC and been awarded it.

Also, I would say that using CHC just to ascertain their needs to enable you to find the most appropriate care home, seems wrong. Applying for CHC and being assessed is more about trying to get the appropriate funding for a persons more complex long term care needs if it is required.

If you want to look at the CHC checklist yourself you can find them online and try and assess your own dad, our SW and the care home suggested we did this and write down evidence against each point, then you can add up the scores yourself, this might help you understand your dads needs better, but I can't promise that.

Any care home you apply to should visit your dad, look at his care plan and carry out their own assessment and then they should provide you with honest advice and feedback as to whether their home is suitable for your dad and if they could meet his needs. You will probably only need to get advice from a couple of homes to get a better understanding of what kind of home your dad needs. I found some care homes more helpful than others though.

Regarding nursing/residential I can't remember if you have said if your dad is on any medication that has to be administered by a nurse (due to it's complexity), if not then he shouldn't require nursing care, just residential. If he does take medication that has to be monitored and changed accordingly then he would need nursing care, probably your GP can help with this.

Care seems such a minefield sometimes, I'm just glad I've got across the other side unscathed. I hope you do to, it does take time though, but try not to worry, we are here for you.

Elle x

 

[looviloo]

Don't be. most of us have 'been there' at some point!

She may be right in that to assess whether someone need 'Nursing Care' contributions, they have to complete the full CHC Diagnostic Assessment Tool and tese are only available in a Nursing Home as opposed to a Care Home.

Thank you! Everything is just buzzing around my head at the moment :-/. Yes, the FNC component is the reason I wanted to pursue the CHC funding, not necessarily the CHC itself. Although, given his deterioration he'd almost certainly reach the criteria.

Dad was self funding and was in a dementia NH for 3 years or so. I looked at dementia care homes and 2 dementia NH...dad had an unstable hernia hence why a NH we felt was required for continuous nurse led monitoring and a year in he required an emergency op . He also had controlled high blood pressure, water retention, a triple bypass heart history and of course medication. He was in latter part of moderate stage dementia.

Without looking back on your previous posts...apart from the dementia does your dad also have other medical needs requiring nursing? If not then not too sure why the GP would suggest a NH unless the GP is thinking ahead as the dementia declines and he anticipates something medically added to the mix. NH are more expensive so unless needed a good EMI dementia home would be able to help.

A good description from you of your dad's current needs and dementia presentation and their own thorough assessment should be enough...I have never heard of a home insisting on a CHC assessment before agreeing admission unless it is to do with obtaining funded nursing care but dad's was applied for after he became a resident although I have no CHC application experience other than dad being fast tracked at end of life but he died before it was agreed.

I think the GP was being quite vague in his assessment of dad. Unfortunately the term 'nursing home' seems to have been used loosely. I need to talk to the GP directly, and plan to do that next week. Dad had a triple bypass too, and heart valve replacement, and is therefore on various drugs. But I don't think any of it needs nursing care as such.

I understand that homes do their own assessment but have been told several times that some homes are only too happy to accept a resident (especially if self funding) and soon after realise they cannot cope with them after all. Maybe that's why it was suggested dad had a CHC assessment before moving, as a kind of independent way of assessing his needs.

I suspect that the manager of his current care home, as fantastic as she is (we have a good relationship), wouldn't welcome a CHC assessment while he's still living there because of the additional work it might cause? So I feel a bit trapped at the moment, having to make decisions without knowing the full picture. I guess I need to accept nothing can be perfect and if dad needs to move again then so be it!

Hi looviloo, I'm just catching up on posts, now that I'm back from holiday. I totally understand your rant and frustration, you do seem to be getting a lot of mixed and confusing messages.

I've never heard of a CHC assessment being required before being admitted into a care home, as you know from my experience, dad went into his second care home and was in there 4 weeks before the initial CHC assessment was done by the SW, this was to allow him to settle there and for the care home to get a better understanding of his needs and gather evidence to support our application if we were going to apply for it. All this time he was self funding and would have continued to be if we hadn't applied for CHC and been awarded it.

Also, I would say that using CHC just to ascertain their needs to enable you to find the most appropriate care home, seems wrong. Applying for CHC and being assessed is more about trying to get the appropriate funding for a persons more complex long term care needs if it is required.

If you want to look at the CHC checklist yourself you can find them online and try and assess your own dad, our SW and the care home suggested we did this and write down evidence against each point, then you can add up the scores yourself, this might help you understand your dads needs better, but I can't promise that.

Any care home you apply to should visit your dad, look at his care plan and carry out their own assessment and then they should provide you with honest advice and feedback as to whether their home is suitable for your dad and if they could meet his needs. You will probably only need to get advice from a couple of homes to get a better understanding of what kind of home your dad needs. I found some care homes more helpful than others though.

Regarding nursing/residential I can't remember if you have said if your dad is on any medication that has to be administered by a nurse (due to it's complexity), if not then he shouldn't require nursing care, just residential. If he does take medication that has to be monitored and changed accordingly then he would need nursing care, probably your GP can help with this.

Care seems such a minefield sometimes, I'm just glad I've got across the other side unscathed. I hope you do to, it does take time though, but try not to worry, we are here for you.

Elle x

Aww thanks Elle, appreciate your reply and concern. I am finding it confusing, more so than the first time dad moved when his needs were simpler. Maybe I need to accept that a CHC assessment might be better done in the next care home, wherever that will be.

I've looked at the CHC checklist and even a month or two ago felt that it would trigger a full assessment (conservatively 5 Bs, possibly 1 A in there too). And he's deteriorated more since then. Sadly it's happening quite quickly. I learned just today that he's quickly becoming incontinent and needing regular pads (this is since last week!). He had two falls yesterday, nothing too serious thank goodness, but he hates the pads and tries taking them off. Hopefully he'll get used to it.

The falls are a concern because of his warfarin. Also a raft of heart related tablets, but nothing that specifically needs a nurse to administer it, not yet anyway.

My feeling is he needs at least a 'high dependency' level of care and so far the dementia homes I've been to haven't had a high enough staff ratio for me happy about leaving him being there. You're right, it's a minefield. I just need to keep looking.

 

[looviloo]

Gosh, it seems ages since I started/updated this thread!

After much searching I've finally found dad a new care home (dementia residential & nursing), which is a big relief. In the process of looking, several homes stated that dad needs to be 'assessed' by Social Services prior to moving. So I've been going around in circles, calling adult social care and dad's mental health nurse. The nurse has been helpful but always refers me back to SS. Social Services take messages to pass on to the care worker assigned to dad but never ring me back. Aargh!

Until yesterday...

A carer in the new care home suggested that dad's current home should ring SS directly. Of course!!! So the manager of dad's current home did just that and within a few minutes of calling, dad was referred for a full assessment! So... it seems that the trick is to have the care home (or GP, presumably) request the assessment.

Can anyone explain to me, please... because I find this bit confusing... but does a 'full assessment' refer to a SS care needs assessment, CHC assessment, or both? I keep asking the care homes I'm visiting, but no-one seems clear about it.

 

[Louise7]

Difficult to know for certain what the various homes mean by a 'social services assessment' if they don't know themselves! As your Dad is self-funding it seems likely that they mean a CHC assessment, although this is not strictly a 'social services assessment'. Mum moved into 2 different nursing homes recently (long story!) but neither of these requested a 'social services assessment' before they would take her. An initial CHC checklist had been completed at that stage, which indicated a possible entitlement to FNC, but the full DST assessment had not taken place. They just came to see Mum and conducted their own 'needs assessment'. If your Dad got through the initial CHC checklist then a full DST assessment should be conducted, usually with input from social services and family during a multi disciplinary team (MDT) meeting. The meeting should identify your Dad's care needs and whether he is entitled to any funding (either full CHC or FNC). If your Dad's current home have contacted social services and a referral has been made for a full assessment maybe they can shed some light on what type of assessment they and social services discussed?

 

[looviloo]

Thanks Louise7 . I think you're right, and the homes must be referring to a CHC assessment. A couple of them said that their residents usually arrive with FNC in place, which in at least one case was an absolute requirement before they would contemplate doing their own assessment. Not all of the homes needed this though, as you've found out from your own experience.

I'll ask the manager at dad's care home again about the assessment referral, but from what she's already said I'm guessing she's not clear either. Did I read (or imagine?!) that some local authorities roll the different assessments together? The person the manager spoke to said they would liaise with her, and myself too, so hopeful I can clear this up when I speak to them.

 

[Louise7]

Did I read (or imagine?!) that some local authorities roll the different assessments together?

If someone requires LA funding and has passed the initial CHC checklist then social services may use the DST meeting as a way of establishing someone's care needs (without conducting a separate assessment). In the case of your Dad though, who is self funding, I can't see why there would need to be a separate social services assessment of his needs as there would be no point.

I sympathise with everything being confusing - it seems so difficult to get the information you need or to know who to speak to when in this position!

 

[Elle3]

Hi, from my experience a SS full assessment is exactly that done by Social Services, they will assess your dad’s needs, review the care plan, do a special interests assessment if you are looking to move your dad to a different care home, they will look at if a DOLS needs to be applied for and an assessment by the Elderly mental health team, a review of meds etc. If you want them to consider doing an initial CHC assessment to see if your dad is eligible for funding then you will have to ask them for one. They can agree to pay the nursing element of the care (FNC) until this assessment is done, for us they continued to pay it until the full CHC assessment was done and dad was found eligible.

Our SW said she would do the initial CHC assessment when he had been in the new care home for 4 weeks, to enable dad to settle in and the Care home to get to know dad and gather evidence for the assessment, which is key to getting a good result.

Also, again from my experience getting SS on board is always quicker when someone in authority refers them, ie the Police, GP, Care home, although saying that I did manage to get them on board quickly for my dad as I explained it was a safe guarding issue and I was worried for his safety, so he was urgently referred. He was already known to them though which may have made it easier.

 

[looviloo]

Well, our situation is still ongoing. Thanks for all the replies... it helps to read the experiences that others have had.

My OH took the reins because I've been so stressed about it all, and he spent yesterday on the telephone ringing various people. He managed to arrange a care assessment by social services for my dad (who is still living in his original care home for now). This will be fast-tracked and should happen next week but will only be what they call an 'independent assessment', and will help facilitate moving dad to appropriate level of care in another home. Even though myself and OH asked repeatedly, SS have taken 2 or 3 months to get to this point and resisted all attempts to do the next assessment level ('intermediate') which would include referral for CHC assessment, if appropriate.

However, OH also rang dad's GP, and in the view of the GP dad should be assessed for CHC. So the GP is contacting SS directly to request that the assessment is 'upgraded'. I'm not holding my breath, but am keeping everything crossed we can now get somewhere with all this.

How any lay person can ever work out such complicated (and sometimes secretive) care systems is beyond me. Everyone we've come across (apart from the GP) has been defensive and obviously working to their own agenda. I understand why - funding - but it causes SO much stress to people who are already suffering. Even a little bit of honesty would help!

As I see it, part of the problem comes from the complexity of older age coupled with dementia. Dad is a reasonably compliant dementia patient (although he has lately been showing signs of mild aggression), so the psychiatrist and SS indicate that he needs residential dementia care. But his medical needs are complex and intensive, so his current care home manager and GP see him as needed nursing care (with or without dementia related care). And I think that's where the issue lies.

Thanks if you've read this far! It helps to write it down

 

[stanleypj]

CHC is a lottery. In many areas it's very rarely agreed. In others it's more common.