CHC (Continuing Healthcare) support thread

[Timeout]

Hello,
Yes, mum is self funding. The social worker from the LA was present and although previously she has been very positive about our chances, today she didn't speak up so much. I think she felt a bit downtrodden by the overbearing nurse assessor.

Mum does get FNC which is something I can't get my head around. They tell me mum needs to be a in a NURSING home due to her needs. She gets FNC due to her needs yet she doesn't have health needs that would qualify for CHC.

The nurse assessor told us that we could carry out all the tasks that mum needs doing for her, that she doesn't need any direct nursing input. So why does she get FNC then? I was going to ask but didn't want them to decide they were going to take that away too!

I reminded them that CHC could be awarded in any setting, it didn't have to be a nursing home or hospital, that it should be awarded on the fact that mum has health needs arising from her diagnosis (they said that it wasn't awarded on diagnosis - I know that. They tried to twist everything I said).

I explained we felt that all of mums needs totalled up to her having a primary health need, the fact that without intervention she would die within days but no, all she needs is social care - help with activities of daily living.

It's disgusting.

 

[geum123]

I agree with Stanleypj.

It's just a classic example of people who are either ignorant or who deliberately choose to 'reinterpret' the guidance in order turn away people who should qualify.


Timout, I do hope you appeal.
You are correct in all that you have said.
I think they hope to wear you down.
It's scandalous.

 

[stanleypj]

I just came across this. I kept the link in my bookmarks it seems. I don't think it has been posted on this thread and it is very relevant:

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=398

 

[geum123]

I remember the Volunteer Support Group.
however I don't know if they still operate.

I am doubtful.

 

[stanleypj]

Yes thanks. It appears that they don't operate any longer. The fact sheet would seem to be out-of-date.

 

[nitram]

stanleypj
Just sent two PMs about the support group.
You will only see the first as your mailbox is full.

 

[Spiro]

Nitram, I'd be interested in knowing the reason for its demise.

 

[nitram]

"Nitram, I'd be interested in knowing the reason for its demise."

See
http://forum.alzheimers.org.uk/show...ement-Notice&p=1217908&viewfull=1#post1217908

 

[Spiro]

She said 'everyone has health needs - if she had severe enough health needs she'd be In hospital'

As if a hospital wouldn't be desperate to send her back to a nursing home.

Due to the pressure on beds, the medical staff would be keen to stabilise her asap, so she would be medically fit for discharge.

I would ask the nurse assessor when she was due to revalidate.

 

[geum123]

"Nitram, I'd be interested in knowing the reason for its demise."

See
http://forum.alzheimers.org.uk/show...ement-Notice&p=1217908&viewfull=1#post1217908

Thank you for that info Nitram.
I had wondered what had happened to them.
What a great shame.
I seem to remember one person getting some sort of award.

 

[mydiamondmum]

Qestions about CHC check list (hope I am posting in the right place)

Hi dear fellow carers.

I am about to go down the path of applying for NHS CHC for my mother.

Thanks to the help from forum members I have a lot of useful links and pdf’s to give me further information about this.

But I would like to check if my understanding on a couple of points agrees with your experience or understanding if you have done this before.

Firstly for the initial check list, in order to go on to the next stage to have the full assessment it is my understanding that one would need either 2 A’s or 5 B’s it that right? Or would you need both 2 A’s AND 5 B’s ?

My other question is, according to the BEACON helpline the assessment should be carried out on the bases of how the user would be if they were not in a care home.
For example my mother would not eat or drink properly or take any medication if at home but will do so if prompted by care home staff, but even then will fib and hide medication in her nighty.

So as I am running though the checklist myself to see what scores I would give her (I do fully realise it is not myself who would be doing it) if at home for those points I would give her an A but in the care home I would assess her as B for those points.

Hope that all makes sense.

 

[LYN T]

I can only replying using my own experience of getting CHC for my late Husband. Pete got 2A's on the checklist so he automatically got put through to the next stage. He also get a number of B's but it was the A's that counted.

When the records are checked I think that in Pete's case they only looked at the CH records-mind you he had only been in the care home for a few months. I'm not sure if they would take an opinion into account with no proof. By the way I'm not saying that I disagree with your scoring but EVIDENCE is everything to the CHC team.

The CH team are having to prompt your Mum for food/drink/meds so that makes me think that your Mum has a need that is being managed. CHC guidelines state that a MANAGED NEED IS STILL A NEED. Therefore, I would stress to them that your Mum would not manage without Carers intervention. Have the CH recorded your Mum hiding meds? I hope so as this could have a knock on effect as to what score she should have for cognition and behaviour. (not understanding she needs the meds (cognition) and possibly behaving in a way that could make her ill (behaviour).

I'm sorry to ask this rather intrusive question but has your Mum any behaviour problems such as aggression or agitation? What Domains do you think your Mum will get an A?

XX

 

[mydiamondmum]

Thank you for your reply LYN T, that is very helpful.

Mum used to just not take the medication and needed a nurse to wait and ensure she would take it when at home.

One of the care home nurses told me about her hiding her medication I am not sure if she has recorded it, I will visit them to see that our notes are in agreement.

I do have evidence by written reports from an NHS social worker and proof that she refuses help from carers visiting her home and that she had 12 hospital admissions due to self-neglect in the year leading up to her care home placement.

I am not sure about the ‘Altered states of conscious’ part I don’t really understand what they mean by that so not sure how I would mark her.

She is not aggressive although was in the early part of her condition, but is a bit childlike and will simply refuses to eat or will have a couple of mouthfuls and will refuse certain required health.

But in my opinion she should be awarded an ‘A’ in the following sections of the check list Behaviour, Cognition, Psychological/emotional needs, Mobility, Nutrition – food, and drink, Continence, Skin (including tissue viability)

Thank you again for your input
xx

 

[LYN T]

Hi

Have you read post #10 (nitram) very useful links. On #12 I gave a couple of simple examples of how certain types of symptoms can over lap on several domains.

My initial response to your latest post is as follows. I'm afraid that I am going to have to refer to my late Husband (that's all I know)

Behaviour-A is usually awarded if there is aggression or agitation. Even then it's quite often only awarded if it's agreed the behavior is 'unpredictable, intense, complex'. Because your Mum is 'childlike' it's unlikely that an A would be awarded (but not unheard of) BUT as she is not eating very much, and doesn't seem to realise that she needs to, or take her meds, I would assume she would score A on Cognition (I'm also assuming your Mum has been judged as having no capacity? )

Psychological/emotional-is she anxious? Weeping? My late Husband had a B for that even though he had Bi-polar (extreme highs and lows). I think that is a tough domain to get an A; a person would have to be trying to commit suicide or asking to die (Sorry), although by refusing food your Mum could be assessed as wanting to die because she has had enough of her life (sorry again-it's tough isn't it)

Mobility. Is she still mobile? If so does she fall? If she isn't mobile then, perversely IMO, she probably would get a low score as she isn't at risk. What she could be at risk from if she is bed/chair bound is poor skin viability. Does she have a skin condition or has she had bed sores?

Continence? Is she doubly incontinent? If so does it affect her skin? Skin tears and bed sores have to be pretty bad to get an A.

Nutrition? Does she need to be fed? Is she losing weight for no reason?

Have a think about the above but please read the posts I've pointed out-especially no 10. The links are good as guidance.

Altered states of consciousness-I think (but not sure myself) that refers to maybe seizures/epileptic fits/medical intervention needed regarding oxygen etc.????? I hope someone will explain that.

Love

Lyn T XX

 

[nitram]

"Altered states of consciousness-I think (but not sure myself) that refers to maybe seizures/epileptic fits/medical intervention needed regarding oxygen etc.????? I hope someone will explain that."

I think that as a general term ASC can apply to things like delusions and halucinations, the concious mind is not functioning correctly.

It's meaning with reference to CHC appears to be more restrictive.
https://elderlylaw.wordpress.com/20...e-the-domains-altered-states-of-conciousness/

Some CHC assessors write their own definitions, I recently helped a friend through a DST, there was a psychiatric team report which said the person had 'severe cognitive impairment', this counted for nothing as it was a different way of judging cognitive impairment!!!

 

[LYN T]

Thanks nitram

Pete was assessed as having 'no needs' ( I didn't query that). He had severe hallucinations and delusions. CHC is indeed restrictive!

'Severe cognitive impairment' counting for nothing!!!! That takes the biscuit!

XX

 

[d4109125]

ASC is generally related to episodes of trance like periods such as those encountered by mini strokes (TIAs). Psychosis - hallucinations and mental health episodes generally fall within the first 3 domains.

 

[mydiamondmum]

LYN T , nitram, d4109125,

Thank you, you have given me more of an incite now as to what is meant in the check list.

LYN T, you mention #10 and #12 I don’t know how to link to those mentioned #’s I have tried entering them in the search box but it is linking.

I don’t know if mum has been judged to have no capacity but I know that she doesn’t and would not take care of herself at all if left alone. I do have POA.

She can walk short distances with a walking stick but. Her legs and feet are in a very bad way, she has no leg drainage and they are extremely swollen and the leg ulcer clinic said she is in danger and cream needs to be applied twice a day. (she would not have the mental or physical ability to do this herself) her feet are extremely bad and she will scream if anyone touches them the skin in coming off and her specially made shoes by surgical appliances no longer fit due to increased swelling.

She is in danger of an infection due especially to her foot problems and I worry that the care home has enough time to give her the foot care that she needs. She refuses chiropodist, but her behaviour is unpredictable.

She has a history or falls and urinary infections.

She was always a big lady in the past and loved her food, but in the 18months or so leading up to her care home placement she lost about 4 stone due to no longer wanting to eat.

Nitram your link is very useful.

Thank you all xx

 

[nitram]

"LYN T, you mention #10 and #12 I don’t know how to link to those mentioned #’s I have tried entering them in the search box but it is linking."

Go to bottom of screen where it says 'Page x of x' and click on 'first', you will then be at post #1 and can work your way down to #10 and #12.

For other posts just try different pages until you get in the correct area.

In post #10 the AS link has gone AWOL and I can't edit the post as it is outside the edit time-frame.

Here is an NHS flowchart showing the discharge procedure that should be followed.

http://www.nhs.uk/NHSEngland/keogh-...guides/background-docs/76-CHCmythbusterv3.pdf

 

[stanleypj]

I was wondering how others who have CHC funding and a personal budget are finding the business of keeping track of the spending. I'm a bit frustrated. Every week I email the hours worked by carers to our accountant who transfers the money to the carers' accounts. Of course the vast majority of the budget is spent like this but there are some other expenses. I could keep a running total myself but I thought that was one reason to have an accountant who is, of course, paid for. I've asked a couple of times for updates on how much spent/how much left but the figures she sends back haven't been helpful as they do not relate to the whole of the annual budget. I've just emailed my contact person about this and she has been very helpful previously.

I would be most interested to hear about other people's experiences.