A Beginner’s Look into…CHC (Continuing Health Care)
- Thread starter Chemmy
- Start date
I had evidence... CT scan and Xray and.... ignored!!!!... nil needs for those I was producing evidence for because no evidence at 'that moment in time or very recently'
I think that these decisions are open to interpretation by each PCT unfortunately and you do have to be 'lucky' with the professionals supplying the evidence. We were.
Think that's right Jan. I kept a record of all Dads UTI's, chest infections, hospital admissions and changes in Medication since he was officially diagnosed over 2 years ago. The Community Matron said it was invaluable at the panel and it would have taken a lot of work on her part to secure some of this information as departments can sometimes take forever releasing information.
Dads GP also prints us out a health summary on request so we can update our records and the panel saw evidence of dates coinciding with ones on our own sheet.
UNPREDICTABLE is another key word.
If we can sort this out Chemmy they will have to award CHC for a lot more of our loved ones. Well done for starting this thread x
Funny that - my husband had 3 UTIs during the few months he spent at the hospital where they applied for CHC funding too! None since he's been in the nursing home though so less chance of that catergory now then. He also had had an unhealed amputation with MRSI in the wound at the time of application, a necrotised area on his remaining heel, now healed- the result of a pressure sore, other areas vulnerable to pressure sores ,stage 3 kidney disease, now stage 4, insulin-dependent diabetes, peripheral artery disease, severe anaemia, totally reliant on hoisting after the gangrene, doubly incontinent - oh and dementia, now severe! I somehow think that I am wasting everyone's time by reapplying!
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"If a picture paints a thousand words..."
I found the diagram on the DoH websitefor the DST very useful so I've drawn up a version we can use here for easy reference
So from what Winda, Saffie and Jan have just said:
Box 7M = double incontinence
Box 7H = double incontinence with complications such as regular UTIs
I realise it's not as simple as that, and it depends on the assessor etc etc, but at the moment I've NO idea whatever what all the scores actually relate to in a real life situation and if, between us, we can fill in a few of these boxes with actual examples, I feel we will have made some progress.
What I don't want to do is to stop anyone applying for CHC - these are not definitive findings - but they may shed a light on why it is so difficult to secure funding and possibly help some prepare their case.
To date we know:
Winda's husband scored 3 xH, 3 x M, 2 x L and 3 x N and was refused funding.
Caroline's mum scored 2 x S, 4 x H, 3 x M and 2 x N and received funding
Securing evidence to show the panel also appears to be paramount.
Now what do they mean by 'unpredictability'? I always assumed that meant aggressive outbursts, but does it apply to categories other than 3. psychological and emotional needs?
I found the diagram on the DoH websitefor the DST very useful so I've drawn up a version we can use here for easy reference
So from what Winda, Saffie and Jan have just said:
Box 7M = double incontinence
Box 7H = double incontinence with complications such as regular UTIs
I realise it's not as simple as that, and it depends on the assessor etc etc, but at the moment I've NO idea whatever what all the scores actually relate to in a real life situation and if, between us, we can fill in a few of these boxes with actual examples, I feel we will have made some progress.
What I don't want to do is to stop anyone applying for CHC - these are not definitive findings - but they may shed a light on why it is so difficult to secure funding and possibly help some prepare their case.
To date we know:
Winda's husband scored 3 xH, 3 x M, 2 x L and 3 x N and was refused funding.
Caroline's mum scored 2 x S, 4 x H, 3 x M and 2 x N and received funding
Securing evidence to show the panel also appears to be paramount.
Now what do they mean by 'unpredictability'? I always assumed that meant aggressive outbursts, but does it apply to categories other than 3. psychological and emotional needs?
My understanding of unpredictable is unexpected, e.g. aggressive outburst without a known trigger, so it cannot be predicted. Some outbursts you can see them coming, e.g. loud noise can pre-empt shouting, but sometimes they will just hit out, possibly due to hallucinations of similar, but it cannot be expected.
That's it in a nutshell, Saffie. I'm not applying for Mum - yet - but I'd like to be in a position to identify if there's a realistic chance of receiving the funding some time in the future, as I'm sure would others.
That's how I saw it, Jan, as my perception from reading posts on the forum is that people who have been sectioned seem to stand a better chance of scoring high in category 1 behaviour and (I presume?) categories 3 and 11.
And this would explain why, once the dementia has progressed and the person has become, say, less mobile and less able to hurt others, the aggression is sometimes deemed to be manageable again and the CHC funding can be withdrawn.
My husband was prone to aggressive outbursts. He would shout at people telling them to go away, tell people they were ugly bitches/ugly etc. He would also at times hit out at people. This was all witnessed in the hospital but at his assessment it was decided that his behaviour was predictable and measures could be put in place to minimise these outbursts with good management.
Once in the NH the staff were very careful as to where my husband sat and steering other residents out of his way if they thought there might be trouble. They also had to be constantly reassuring him. The result has been that my husband settled well and apart from when approached for personal care he hasn't, on the whole, shown much aggression.
So I tend to think they were right in this case.
Just wanted to add that my husband was sectioned at the start of his hospital stay but it was removed after a few weeks.
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Saffie, I am amazed that your husband didn't qualify. It really makes me think that I am wasting my time by reapplying.
Well, the lady from the AS support group did think he had slipped through the net so I am applying - both retrospectively and forward - but with all the thousands applying for only retrospective funding, I'm not holding my breath for a result! she also said that my county are not good with the funding. So you go for it Winda, your's may be better. I haven't received any acknowledgement of my letter of intent so not sure what happens now.
Was he given meds to control the aggression?
What was his score in the behaviour category - was it one of the Highs or a Medium?
He was given Risperidone and Trazadone to control his aggression
His behaviour score was high.
What I find puzzling (amongst other things), is how we keep being told on here that a 'managed need' is still a 'need'. And yet, when it comes to the assessment it doesn't seem to be taken into account at all.
For example, I was told by the Senior Nurse the other day that although my husband does suffer from constipation from time to time, it would not be a consideration in his assessment because it can be controlled by meds.
I just wonder when it would be taken into consideration.
For example, I was told by the Senior Nurse the other day that although my husband does suffer from constipation from time to time, it would not be a consideration in his assessment because it can be controlled by meds.
I just wonder when it would be taken into consideration.
I wonder if she means it will most likely score an H or an M, in the same way his 'managed behaviour need' scored an H once it was controlled by meds. And if that is the case, it wouldn't help him achieve one of the higher scores (P or S) that seem to tip the balance in favour of funding.
I guess before he was given the meds for his aggression, he would have scored higher than an H for behaviour - perhaps he would have scored and S or a P then? - so if the meds work, it becomes a 'managed need' and consequently that reduces the chance of getting funding. That sort of makes sense.
All only conjecture on my part, of course
It would be interesting to establish if a 'managed need' generally scores H or below. Anyone else out there want to look at their assessment sheet and tell us about the scores?
It's funny that 'managed needs' i.e. needs managed by medication don't count as, surely, so many things fall under that catergory but are nevertheless medical conditions.Even aggression can be controlled with the right amount of medication even if that means sedation - not that I'm suggesting that is good at all. The correct dosage of any medicine is again important and needs to be 'managed'.
A need that warrants being addressed by a trained, professional medical person, is surely one that justifies continuing healthcare funding. I've put it in small letters because that is what the payment is supposed to be about - continuing healthcare and that is what so many of our relatives need. Their reasoning is beyond me!
A need that warrants being addressed by a trained, professional medical person, is surely one that justifies continuing healthcare funding. I've put it in small letters because that is what the payment is supposed to be about - continuing healthcare and that is what so many of our relatives need. Their reasoning is beyond me!
I wonder if the key point might be in what they mean by the phrase 'do not count'.
If 'managed needs' score H or less, then they are taken into account in the assessment (as in Winda's example) but they won't score highly enough to make a difference in reaching a positive decision, ie, the 1 x P or 2 x S threshold required, so in that case, I can see why someone might say they 'do not count'.
Taking your point about
Does that make sense?
I'm not trying to justify these decisions, just trying to get a handle on why they are made. If I was a member of the panel sitting making the decision, trying to interpret the rather ambiguous guidelines with limited funds, then this is probably the sort of reasoned approach I would take.
It ties in with what Fiona (Fifimo) said on another thread a few days ago - her local panel seems to have adopted the view that nursing (rather than carer) input is necessary for funding to be granted. Care staff can probably deal with carefully 'managed needs'; but nursing staff may be required for those cases where the unpredictability scores are higher (S & P)
Clearly not all panels are deciding cases on this basis, as we know it can be awarded to people in their own homes but I can see why some might - it makes the decison much more clear-cut. Whether they are right to do so is another question for another thread.
If 'managed needs' score H or less, then they are taken into account in the assessment (as in Winda's example) but they won't score highly enough to make a difference in reaching a positive decision, ie, the 1 x P or 2 x S threshold required, so in that case, I can see why someone might say they 'do not count'.
Taking your point about
- if the need is managed by meds then it's the consultant who prescribes, but he doesn't actually have to administer them - that can be done by the social care staff. If however, the aggressive behaviour requires regular supervision by a specialist psychiatric nurse, say, then I would see that achieving a higher score in the assessment (an S or P) and would argue that funding should indeed be awarded.
Does that make sense?
I'm not trying to justify these decisions, just trying to get a handle on why they are made. If I was a member of the panel sitting making the decision, trying to interpret the rather ambiguous guidelines with limited funds, then this is probably the sort of reasoned approach I would take.
It ties in with what Fiona (Fifimo) said on another thread a few days ago - her local panel seems to have adopted the view that nursing (rather than carer) input is necessary for funding to be granted. Care staff can probably deal with carefully 'managed needs'; but nursing staff may be required for those cases where the unpredictability scores are higher (S & P)
Clearly not all panels are deciding cases on this basis, as we know it can be awarded to people in their own homes but I can see why some might - it makes the decison much more clear-cut. Whether they are right to do so is another question for another thread.
Hi,
My father is doubly incontinent and also only scored moderate.
I now believe that he should be a high as he is catheterised and also has an inability to urinate caused by an enlarged prostrate that subsequently causes severe urinary retention. The catheter frequently blocks (every 5-7 days) and he frequently suffers from severe constipation and impacted bowel to overflow, that needs daily managing with medication and frequent changing of incontinence pads which he gets on prescription.
The assessing nurse actually argued that as he was constipated he could not be incontinent!
For most it appears that the double incontinence is quite easily managed with pads that need changing, and a catheter that needs changing every 12 weeks and the collection bag emptying when needed, and so incontinence usually isn't that much of a problem, and so doesn't get the high score?
