Not sure if I originally found the link on TP, but I've just watched the following, very informative talk: Social Care Law Lecture Series - NHS Continuing Health Care & Law by Professor Luke Clements.
Gx
CHC (Continuing Healthcare) support thread
- Thread starter stanleypj
- Start date
Hi can i ask..my mum gets chc social worker advised us not to pay top fee...but home are saying we need to as its 3rd party top fee!@
I wonder if this link will help you
https://www.alzheimers.org.uk/get-support/legal-financial/care-home-fees
CHC has to pay what it takes to pay for care without a top up, if they can find somewhere that can do that then that's the rate they will pay. If you want somewhere over and above that then you'll have to pay a top up same as people who are LA funded.
If a home won't accept the CHC rate then either you have to pay a top up or move to somewhere that will accept the CHC or LA rates, if the home takes someone CHC or LA funded at a lower than normal rate then we're back to the old argument about self funders subsidising "government funded" residents whether it be CHC or LA they're paying less and let's not drift into that well worn old argument on yet another thread.
The home should be saying "if you want to stay here, we won't take the CHC/LA rate of funding so pay a top up or move out" because that's what it amounts to in essence.
Neither LA nor CHC funding is a blank cheque to stay in the poshest homes and let you stay there when the LA/CHC start to fund care, so if the home won't take the money the LA?CHC are offering then it's top up or ship out.
The social worker may well be right in telling you not to pay a top up as it's an open ended commitment to pay whatever the care home fees go up by and the differential between the care homes price rise and the LA/CHC annual rise, which can be considerable.
The home are wrong when they say you "need to as it's a 3rd party top up fee" they should tell you that first party top us aren't allowed (other than section 117 funding) and so the only way to get back the difference between their set rate and the LA/CHC rate is to ask you to pay a top up to make up the difference.
A lot of homes won't take LA funded people these days and it's only a matter of time before CHC funding goes the same way, homes will only take self funders or people who can be topped up, then the government will have a problem on their hands as demand is already outstripping supply and it's only going to get worse with an aging population and the LA's won't be able to find homes that will accept their rate so they'll have hospitals full of "bed blockers" at massively more cost to the NHS which is another branch of...government.
There's currently no joined up thinking, the NHS want people out of beds they don't need to be in, the LA wants to pay the least possible so it's cheaper for them to leave people in an NHS bed and the CHC people just don't want to pay anything to anyone if they can avoid it.
A couple of nights in an NHS bed cost as much as a week in a care home but the LA don't have to pay the NHS so they want to keep you off their books for as long as possible (although there is a theoretical mechanism by which the NHS can charge the LA but it's never used) and CHC could be used to keep people out of the NHS but they don't like giving money away it's easier for them to wait until you qualify for hospice (mainly charity based) care and leave you as an NHS problem, doesn't cost the CHC anything.
The NHS has become the dumping ground to keep other government department spending down irrespective of the fact it's the most expensive alternative and until someone does some joined up thinking it isn't going to change.
K
Hi k,
I am fighting for chc now. You seem to know the system well. Qualifying for chc is a matter of law and not NHS policy. Getting chc funding is a nightmare. To try and stick to the point, does not a patients well being come into play, you just can't move someone from their home. Article 8 of human rights. This can seriously effect a person with dementia and the NHS has a duty of care. And an authority can't say we will not pay. Is this not called fettering of a discretion? I was under the impression that you are not obligated to provide top ups for a relative.
More people are claiming chc as they become aware of the secretary of states fraud and it is this. In 1948 the promise from government was free health care to everyone irrespective of income from cradle to the grave. Hence the creation of the two major statutes NHS and social services statutes. Chc is supposed to cover 100% of all care costs by the NHS. The law has not changed in essence since then. Ref LUKE CLEMENTS LECTURE SERIES on chc and social care on YOUTUBE. I cannot stress how informative this man is. Also the government can afford it as the figures suggest that chc costs 0.5% of the national budget. The difference between chc funding from the NHS and social services funding is that SS funding is means tested chc is free at point of delivery.
For a lot of information on CHC go to ************ her you will find the founding campaigner who set the precedences in law for CHC care. Her name is PAMELA COUGHLAN who had a long campaign against the local Devon authorities in the court of appeal and wone.
I am fighting for chc now. You seem to know the system well. Qualifying for chc is a matter of law and not NHS policy. Getting chc funding is a nightmare. To try and stick to the point, does not a patients well being come into play, you just can't move someone from their home. Article 8 of human rights. This can seriously effect a person with dementia and the NHS has a duty of care. And an authority can't say we will not pay. Is this not called fettering of a discretion? I was under the impression that you are not obligated to provide top ups for a relative.
More people are claiming chc as they become aware of the secretary of states fraud and it is this. In 1948 the promise from government was free health care to everyone irrespective of income from cradle to the grave. Hence the creation of the two major statutes NHS and social services statutes. Chc is supposed to cover 100% of all care costs by the NHS. The law has not changed in essence since then. Ref LUKE CLEMENTS LECTURE SERIES on chc and social care on YOUTUBE. I cannot stress how informative this man is. Also the government can afford it as the figures suggest that chc costs 0.5% of the national budget. The difference between chc funding from the NHS and social services funding is that SS funding is means tested chc is free at point of delivery.
For a lot of information on CHC go to ************ her you will find the founding campaigner who set the precedences in law for CHC care. Her name is PAMELA COUGHLAN who had a long campaign against the local Devon authorities in the court of appeal and wone.
Well, this is all very interesting!
My husband had his own named Social Worker, because of his violence to me, and as things progressed, she could see how frail he was getting, and stated that he definitely needed Nursing Care. She practically dragged a group of " the appropriate people" to our house one afternoon, because she was very concerned about the unpredictability of his behaviour. They sat watching him for three hours, asking questions, watching me feed him, and enjoying my tea and cookies.
At the end, they said nothing, and the Social Worker told me that they wouldn't consider CNC because I was looking after him too well, and I thought I might get a letter telling me that.
I still haven't heard anything, and once the Social Worker realised that we would be paying for everything, she dissappeared of the scene and we've had no more phone calls or visits from her.
Ok, I thought, life is too short for this hassle, and thought (Sorry, folks) sod the lot of them, and I would just put up with the shouting, unpleasant monster, and look after him myself, with the help of our lovely carers.
Good luck to those of you with more patience!!!!
Love
Gill xx
My husband had his own named Social Worker, because of his violence to me, and as things progressed, she could see how frail he was getting, and stated that he definitely needed Nursing Care. She practically dragged a group of " the appropriate people" to our house one afternoon, because she was very concerned about the unpredictability of his behaviour. They sat watching him for three hours, asking questions, watching me feed him, and enjoying my tea and cookies.
At the end, they said nothing, and the Social Worker told me that they wouldn't consider CNC because I was looking after him too well, and I thought I might get a letter telling me that.
I still haven't heard anything, and once the Social Worker realised that we would be paying for everything, she dissappeared of the scene and we've had no more phone calls or visits from her.
Ok, I thought, life is too short for this hassle, and thought (Sorry, folks) sod the lot of them, and I would just put up with the shouting, unpleasant monster, and look after him myself, with the help of our lovely carers.
Good luck to those of you with more patience!!!!
Love
Gill xx
I think you are right @fortunecooky2 on many accounts. Even before a CHC checklist has been completed I have been told my Dad may have nursing needs and may need to be moved to a nursing home, and that he will only ever qualify for CHC if he is in a nursing home (which I know to be wrong). If we ever get to the stage of being awarded CHC, I will be arguing the case that any move would not be in his best interests and indeed detrimental to his wellbeing.
I found the lecture you mention above SO useful especially in understanding how all of this goes back to law and any guidance is just that (ie an interpretation to help guide through the process...or not in many cases!!!).
Good morning everyone. Sorry in advance for the long post.
I had a CHC meeting for my father yesterday. Felt really nervous about it beforehand, like I had been swatting up for a test or a job interview. I thought about posting here beforehand to get some advice on what makes for a successful case but, on reading this entire forum from the beginning (I didn't quite get through all 37 pages, I'm afraid), I realised that there is no set answer. Some people with similar stories seem to have been successful, whilst others with loved ones who seem to be worse off than my father have been unsuccessful.
But, I had to try. And so I did lots of research beforehand, watching the Prof Clements video, reading up on past similar cases, and trying to match the wording in my father's case to the supposed buzzwords (complexity, unpredictability, etc) and statutes/guidance.
Well, I came out of the process feeling disappointed. I forgot to mention every point I had written down and I have been told to wait for up to 28 days for a decision in the post.
This might seem premature to be considering an appeal, but I'd like some advice from others on this, if possible.
Firstly, would anyone recommend going down the route of employing an advocate? My way of looking at it is that if it saves money in the long run, then it would be worth it if we were successful in gaining the funding. Or is this route best to take before an appeal (in which case I will have to wait another year)?
Secondly, I'm wondering if I can appeal against how the procedure went. The nurse at the NH where my father is resident is on my side, but she was totally distracted throughout the meeting as yesterday she was juggling 3 roles as chief nurse, manager and receptionist rolled into one! She kept answering the telephone throughout the meeting and buzzing people in...
Then, there was the social worker. She was the very first person to speak in the meeting. The first thing she asked me how much my father had in savings! She actually waited with pen poised for me to answer. I did not. CHC funding is not supposed to be means tested and I was fuming that this should set the tone for the rest of the meeting. It was again the last thing she asked me about before she left.
I'm also surprised by the CHC nurse. My father, who is in the later stages of Alzheimer's, had a CHC funding assessment carried out a little over a year ago. In the "Cognition" category he scored Severe, and rightly so, as he is a risk to himself and others and completely dependent on carers. But, yesterday, the nurse wanted to score him as High! It's the only category I am confident he is Severe in. Fortunately, even the SW disagreed with her and she reluctantly settled on Severe. I did wonder if she appreciated my father's needs at that point. I wondered again in the "Medication" category when she tried to downgrade him to Low as his medication needs are currently well managed. Again, fortunately, the rest of us disagreed and she changed it to Moderate.
On top of all of this, I was a little disappointed that the SW and CHC nurse did not meet my father until after the meeting and, even then, it was literally for less than a minute to say "hi". That's all they said, then left. I had to wonder if the decision had already been made before even seeing him.
Personally, I am feeling like a bit of a failure. I'll wait and see what the outcome is, but I'll fall off my seat if we have been successful!
I had a CHC meeting for my father yesterday. Felt really nervous about it beforehand, like I had been swatting up for a test or a job interview. I thought about posting here beforehand to get some advice on what makes for a successful case but, on reading this entire forum from the beginning (I didn't quite get through all 37 pages, I'm afraid), I realised that there is no set answer. Some people with similar stories seem to have been successful, whilst others with loved ones who seem to be worse off than my father have been unsuccessful.
But, I had to try. And so I did lots of research beforehand, watching the Prof Clements video, reading up on past similar cases, and trying to match the wording in my father's case to the supposed buzzwords (complexity, unpredictability, etc) and statutes/guidance.
Well, I came out of the process feeling disappointed. I forgot to mention every point I had written down and I have been told to wait for up to 28 days for a decision in the post.
This might seem premature to be considering an appeal, but I'd like some advice from others on this, if possible.
Firstly, would anyone recommend going down the route of employing an advocate? My way of looking at it is that if it saves money in the long run, then it would be worth it if we were successful in gaining the funding. Or is this route best to take before an appeal (in which case I will have to wait another year)?
Secondly, I'm wondering if I can appeal against how the procedure went. The nurse at the NH where my father is resident is on my side, but she was totally distracted throughout the meeting as yesterday she was juggling 3 roles as chief nurse, manager and receptionist rolled into one! She kept answering the telephone throughout the meeting and buzzing people in...
Then, there was the social worker. She was the very first person to speak in the meeting. The first thing she asked me how much my father had in savings! She actually waited with pen poised for me to answer. I did not. CHC funding is not supposed to be means tested and I was fuming that this should set the tone for the rest of the meeting. It was again the last thing she asked me about before she left.
I'm also surprised by the CHC nurse. My father, who is in the later stages of Alzheimer's, had a CHC funding assessment carried out a little over a year ago. In the "Cognition" category he scored Severe, and rightly so, as he is a risk to himself and others and completely dependent on carers. But, yesterday, the nurse wanted to score him as High! It's the only category I am confident he is Severe in. Fortunately, even the SW disagreed with her and she reluctantly settled on Severe. I did wonder if she appreciated my father's needs at that point. I wondered again in the "Medication" category when she tried to downgrade him to Low as his medication needs are currently well managed. Again, fortunately, the rest of us disagreed and she changed it to Moderate.
On top of all of this, I was a little disappointed that the SW and CHC nurse did not meet my father until after the meeting and, even then, it was literally for less than a minute to say "hi". That's all they said, then left. I had to wonder if the decision had already been made before even seeing him.
Personally, I am feeling like a bit of a failure. I'll wait and see what the outcome is, but I'll fall off my seat if we have been successful!
Hi
Thank you for letting us all know how it went and from reading your post I have to say my experience so far is very similar , I don’t want to hijack your thread but like you I was also under the impression that a decision would be made within 28 days, we’ll guess what it’s now nearly 3 months and I haven’t heard a thing, after many ignored emails etc I finally discovered the reason for this, the person dealing with Dads case decided that he probably wouldn’t be eligible for Funding so did not submit the application, now we are having to go through the DST process again , things have moved on since the original meeting . I hope you hear soon and if your application is refused please don’t give up , it may be worth getting somebody in the legal profession on side
Hi, thanks for sharing.
You will get some positive and a lot of negative replies regarding this assessment but the main thing I will say is don’t give up and read up and get to know the procedures and framework guidelines as much as you can. We have to keep fighting and not just excepting being pushed to ‘social needs’ when it should be CHC.
Being asked about funds, especially in front of witness is not exceptable so this gives you grounds right away for a complaint.
Secondly, these assessors don’t really know the person they are assessing so they rely on the homes care plans and feedback so if the home is supporting you with this (which I would question because they like self funders) then you should stand a good chance.
It can take months so don’t hold your breath!
Keep posting
You will get some positive and a lot of negative replies regarding this assessment but the main thing I will say is don’t give up and read up and get to know the procedures and framework guidelines as much as you can. We have to keep fighting and not just excepting being pushed to ‘social needs’ when it should be CHC.
Being asked about funds, especially in front of witness is not exceptable so this gives you grounds right away for a complaint.
Secondly, these assessors don’t really know the person they are assessing so they rely on the homes care plans and feedback so if the home is supporting you with this (which I would question because they like self funders) then you should stand a good chance.
It can take months so don’t hold your breath!
Keep posting
Hi. Thanks for the replies.
sixy74, that's awful they haven't got back to you yet. It's so sad that we are being treated this way. I hope you have more luck the second time around.
Theresalwaystomorrow, I think you are right that the only way to be successful on cases where it could go either way is to read up as much as possible. Though I also wonder if the 'arguing' is best reserved for appeals. I don't know.
Thanks for reading and taking the time to reply.
sixy74, that's awful they haven't got back to you yet. It's so sad that we are being treated this way. I hope you have more luck the second time around.
Theresalwaystomorrow, I think you are right that the only way to be successful on cases where it could go either way is to read up as much as possible. Though I also wonder if the 'arguing' is best reserved for appeals. I don't know.
Thanks for reading and taking the time to reply.
Oh, Amanda, what a time you had!
This is all such nonsense, isn't it, and I think if an MP stood up and said that his plan was to sort out this CHC, that MP would get millions of votes!
In the meantime, some of these people need what my dear,sweet natured ( not!!!) , father in law used to call "a boot up the jacksy"
Sorry, again, everybody, meant to be humerous!
Keep going, everyone and good luck
Love, Gil.
This is all such nonsense, isn't it, and I think if an MP stood up and said that his plan was to sort out this CHC, that MP would get millions of votes!
In the meantime, some of these people need what my dear,sweet natured ( not!!!) , father in law used to call "a boot up the jacksy"
Sorry, again, everybody, meant to be humerous!
Keep going, everyone and good luck
Love, Gil.
My MP is brilliant, not sure if I can name him.
He’s totally behind this CHC, he has been arguing the point for a long time, he says CHC is available out there for those who need it, he’s aware that needs are being classed as ‘social’ not CHC and that’s where the argument starts. Not just being diagnosed with dementia / Alzheimer’s gets CHC, it’s where the total needs of care come into it, that’s why when it gets to the stage of nursing / 24hr care that’s where CHC should kick in. Or we appeal and keep fighting.
He’s totally behind this CHC, he has been arguing the point for a long time, he says CHC is available out there for those who need it, he’s aware that needs are being classed as ‘social’ not CHC and that’s where the argument starts. Not just being diagnosed with dementia / Alzheimer’s gets CHC, it’s where the total needs of care come into it, that’s why when it gets to the stage of nursing / 24hr care that’s where CHC should kick in. Or we appeal and keep fighting.
Just an update regarding our request - in Jan last year - for Mum's DST assessment to be reviewed on the basis that the assessor did not follow the CHC National Framework. Family & social services were not informed of the DST meeting/completion and the assessor stated on the DST form that family 'were unable to attend but agreed with the domain marking'. The DST contained numerous errors and it appears that some of the content had been cut & pasted from someone else's assessment (references to a person with a different name from Mum). After various half-hearted attempts by the CCG to arrange a meeting to discuss this we have received no further response to emails since June last year. A formal complaint about this has resulted in an apology in respect of 'systematic communication failures' and a thank you for bringing this to their attention..........
I hope this has been put in the best place in this forum
NHS Continuing Health Care Appeals, and Complaints
Just to relate an additional thing which you might consider doing …
In brief – after you have appealed, and after you’ve established that the appeal is lodged and will eventually be dealt with – you could also put in a separate complaint about the actual DST document you received.
In my relative’s case (in May 2018) a DST decision said she wasn’t eligible for NHS CHC. The DST document produced was extremely shoddy. It was full of errors, inaccuracies, and in places points were poorly expressed and (still) require clarification. The list of errors ran to approx. nine pages and included things like the wrong admission date to hospital, and incomplete details of the DST Team at the meeting.
In June (2018) I put in an appeal – this is lodged and is still waiting for the Appeals Nurse to produce a folder of documents etc. for a panel meeting that might be held in Feb/Mar (2019).
In about Nov. (2018) – when it was clearly established that the Appeal was progressing [slowly!], and after discussing the problem of the shoddy document with the Appeals Nurse, it was her suggestion that I put in a separate formal complaint about that document which was produced following the NHS CHC DST Meeting in May.
No news yet – I don’t know how long this specific complaint process might take.
NHS Continuing Health Care Appeals, and Complaints
Just to relate an additional thing which you might consider doing …
In brief – after you have appealed, and after you’ve established that the appeal is lodged and will eventually be dealt with – you could also put in a separate complaint about the actual DST document you received.
In my relative’s case (in May 2018) a DST decision said she wasn’t eligible for NHS CHC. The DST document produced was extremely shoddy. It was full of errors, inaccuracies, and in places points were poorly expressed and (still) require clarification. The list of errors ran to approx. nine pages and included things like the wrong admission date to hospital, and incomplete details of the DST Team at the meeting.
In June (2018) I put in an appeal – this is lodged and is still waiting for the Appeals Nurse to produce a folder of documents etc. for a panel meeting that might be held in Feb/Mar (2019).
In about Nov. (2018) – when it was clearly established that the Appeal was progressing [slowly!], and after discussing the problem of the shoddy document with the Appeals Nurse, it was her suggestion that I put in a separate formal complaint about that document which was produced following the NHS CHC DST Meeting in May.
No news yet – I don’t know how long this specific complaint process might take.
The whole process seems very drawn out! To clarify, a complaint was raised about the standard of the DST form. A subsequent complaint was raised about the lack of any meaningful processes to deal with this complaint. It has now been accepted that there were failings in addressing the original DST complaint, but there has been no mention of what is being done to deal with the original complaint. The CHC assessor worked at the hospital and as there is a separate complaint investigation currently ongoing with regards a number of serious failings and safeguarding issues it may be that the DST complaint is being looked at by the hospital. I think we'll have to wait for the hospital response to see whether the issue has been properly addressed or not.
I rang dad's care home today to ask for them to arrange for dad to have an assessment for CHC but they said they don't do this but the dementia nurse at my dad's GP is going to call on Monday. I don't know where I get the strength from however I have worked out that dad has at least a year before his savings reach £23500 without pensions and benefits. I suppose at 54 I must consider the prospect of losing my home.
MaNaAk
MaNaAk
Hello everyone!
My father in law has vascular dementia and we applied for the CHC (Hampshire). He already lives in the nursing home, because it was impossible to keep him at home. After the meeting with NHS team, we were refused for the finance. He was assessed as severe in Cognition, High in Food, Mobility, Communication, and Behavior, Moderate in Continence, Skin and Drug Therapies, Low in Psychological Needs. No needs in the other domains.
Now, even that he scored only one severe, I believe that he should be entitled to CHC. Even in DST tool, it's written where there is a severe level combined with needs in a number of other domains the careful consideration must be given.
I understand that he wasn't assessed as badly as many other people on this forum, but still, they don't want to fund him... That's a very sad practice by NHS... I will keep my posts updated on the progress...
My father in law has vascular dementia and we applied for the CHC (Hampshire). He already lives in the nursing home, because it was impossible to keep him at home. After the meeting with NHS team, we were refused for the finance. He was assessed as severe in Cognition, High in Food, Mobility, Communication, and Behavior, Moderate in Continence, Skin and Drug Therapies, Low in Psychological Needs. No needs in the other domains.
Now, even that he scored only one severe, I believe that he should be entitled to CHC. Even in DST tool, it's written where there is a severe level combined with needs in a number of other domains the careful consideration must be given.
I understand that he wasn't assessed as badly as many other people on this forum, but still, they don't want to fund him... That's a very sad practice by NHS... I will keep my posts updated on the progress...
