CHC (Continuing Healthcare) support thread
- Thread starter stanleypj
- Start date
It's a very long thread and if a member is in a hurry they might find it useful to go to the top of any page on the thread, click on 'search thread', enter a keyword, eg cognition, and click on 'search', they will then get all posts where cognition is mentioned.
Hi just a note to say I've removed a number of posts from this thread as they broke our rule about not posting on political subjects here on Talking Point.
I understand that this topic does head towards political discussion on occasion, but could we be careful and steer away from that so the focus is supporting people with their questions on CHC.
Thanks everyone
I understand that this topic does head towards political discussion on occasion, but could we be careful and steer away from that so the focus is supporting people with their questions on CHC.
Thanks everyone
Post # 277
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!!!
Final score
Common sense 1 - Incompetence 0
Decision now reversed, CHC granted.
Return match in 3 months.
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!!!
Final score
Common sense 1 - Incompetence 0
Decision now reversed, CHC granted.
Return match in 3 months.
Hi all, signed out of this thread in January as MIL put on end of life care. Must've forgotten to tell her though, as she's still with us.
CHC funding originally granted in August 2014 after we employed an advocate. Following various reviews, a new one was instigated in January 2016 but cancelled because MIL was not expected to live much longer. DST then negotiated with nurse assessor and we got: Severe for cognition:High for communication and mobility: of the other domains 5 were medium, one low and three no needs.
CHC funding has continued.
"A primary health care need is assessed by looking at all of the care needs and relating them to the four key indicators summarised below:-
The CCG came to this decision because Mrs XXX's health care needs were complex, intense and unpredictable and Mrs XXX's primary health care needs outweighed the need for social care and therefore met the Continuing Helathcare criteria."
CHC funding originally granted in August 2014 after we employed an advocate. Following various reviews, a new one was instigated in January 2016 but cancelled because MIL was not expected to live much longer. DST then negotiated with nurse assessor and we got: Severe for cognition:High for communication and mobility: of the other domains 5 were medium, one low and three no needs.
CHC funding has continued.
"A primary health care need is assessed by looking at all of the care needs and relating them to the four key indicators summarised below:-
The CCG came to this decision because Mrs XXX's health care needs were complex, intense and unpredictable and Mrs XXX's primary health care needs outweighed the need for social care and therefore met the Continuing Helathcare criteria."
Reimbursement of Fees
How often do CCGs try and pay significantly less than the amount they are supposed to reimburse following a final decision that an individual was entitled to NHS Continuing Healthcare and that care home fees were paid incorrectly by an individual or their relatives for a previous period of care?
I know there can be disagreements about the amount of interest that a CCG should pay in addition to the care home fees that must be reimbursed. But I am not talking about the interest element.
Do CCGs often try and pay less than the principal amount that they should repay? And if they do, are there any tips and tricks to persuade them to pay what they actually owe?
How often do CCGs try and pay significantly less than the amount they are supposed to reimburse following a final decision that an individual was entitled to NHS Continuing Healthcare and that care home fees were paid incorrectly by an individual or their relatives for a previous period of care?
I know there can be disagreements about the amount of interest that a CCG should pay in addition to the care home fees that must be reimbursed. But I am not talking about the interest element.
Do CCGs often try and pay less than the principal amount that they should repay? And if they do, are there any tips and tricks to persuade them to pay what they actually owe?
I just informed the head office of the care home that as from <date> the contract was retrospectively with the PCT (now CCG) and asked for repayment of all fees from that date.
It worked I got a cheque by return, the fact that I had nicknames of Mr Email and Mr Spreadsheet may have helped. Three months of keeping everything shipshape via email was viewed with delight, horror, or amusement by various members of management and staff.
It worked I got a cheque by return, the fact that I had nicknames of Mr Email and Mr Spreadsheet may have helped. Three months of keeping everything shipshape via email was viewed with delight, horror, or amusement by various members of management and staff.
Thanks Nitram
But my understanding is that usually it is necessary to seek reimbursement from the CCG. So what to do in those circumstances?
It may or may not be the usual approach but it's the one I took and it worked.
As I saw it I wanted all I had paid reimbursed, as there was a period on FNC followed by a period on CHC which was then back dated to the start of FNC I could see it taking ages for the PCT and care home to sort it out.
You can but try
As I saw it I wanted all I had paid reimbursed, as there was a period on FNC followed by a period on CHC which was then back dated to the start of FNC I could see it taking ages for the PCT and care home to sort it out.
You can but try
Dear Fellow Carers,
Your opinions would be appreciated.
Please forgive me if I am not using the correct terminology as I am new to this and I am dyslexic and sometimes struggle to find the correct words.
This week we had the 1st part of the NHS chc funding checklist.
It was done in a small room with just me and the lady from the LA care home support team.
I did not think that it would take place with just the two of us, as I expected there would be some advocate there for support they told me at the care home the day before the meeting that there would be a social worker present. A week before the meeting a nurse who knows my mum well at the CH she that my mum should qualify for sure, as mum would definitely not be able to look after herself away from the CH and even there she will hide medication and refuse treatment for certain things.
But no, there were just two of us. I asked her if she was marking this on the basis on mum being at the CH or how she would be away from it. She said she was doing the assessment based on how she is doing at the CH.
I told her that ****** has informed me otherwise. She said, I am not here to argue with relatives, I do not come to your job and tell you how to do that.
It was apparent as she was going through each point that she was marking my mother as low as possible she was dismissive of anything that I added to the discussion and when I said I don’t agree with your markings she said that relative’s opinion is of no interest to me.
The result according to her was 3 B’s and 8 C’s.
I will be complaining and appealing and have since learned a lot more about my rights thanks to the dementia helpline and have been reading through many pdf’s on the subject thanks to the helpline and your replies on the forum.
Can I just ask your opinions as to whether you think the following will add weight to my complaint and appeal or if it is just irrelevant to it?
These are notes from mum’s Placement Review that was carried out last year this was from NHS social worker at the time.
It states that my mother has ‘cognitive and mobility difficulties which have made it unsafe for her to live in her original flat as she was subject to wandering and at risk of serious falls and presenting herself for inappropriate hospital admission or contact the police due to distress. She is likely to attempt the stairs without supervision and wander placing herself at risk as a result.’
I would like to add that I do not think that she was presenting herself inappropriately as she was having falls and getting one uti after another due to self-neglect and the fact that they kept sending her home with a useless care plan as she would not accept strangers turning up at her home to help her with care.
Best regards
Your opinions would be appreciated.
Please forgive me if I am not using the correct terminology as I am new to this and I am dyslexic and sometimes struggle to find the correct words.
This week we had the 1st part of the NHS chc funding checklist.
It was done in a small room with just me and the lady from the LA care home support team.
I did not think that it would take place with just the two of us, as I expected there would be some advocate there for support they told me at the care home the day before the meeting that there would be a social worker present. A week before the meeting a nurse who knows my mum well at the CH she that my mum should qualify for sure, as mum would definitely not be able to look after herself away from the CH and even there she will hide medication and refuse treatment for certain things.
But no, there were just two of us. I asked her if she was marking this on the basis on mum being at the CH or how she would be away from it. She said she was doing the assessment based on how she is doing at the CH.
I told her that ****** has informed me otherwise. She said, I am not here to argue with relatives, I do not come to your job and tell you how to do that.
It was apparent as she was going through each point that she was marking my mother as low as possible she was dismissive of anything that I added to the discussion and when I said I don’t agree with your markings she said that relative’s opinion is of no interest to me.
The result according to her was 3 B’s and 8 C’s.
I will be complaining and appealing and have since learned a lot more about my rights thanks to the dementia helpline and have been reading through many pdf’s on the subject thanks to the helpline and your replies on the forum.
Can I just ask your opinions as to whether you think the following will add weight to my complaint and appeal or if it is just irrelevant to it?
These are notes from mum’s Placement Review that was carried out last year this was from NHS social worker at the time.
It states that my mother has ‘cognitive and mobility difficulties which have made it unsafe for her to live in her original flat as she was subject to wandering and at risk of serious falls and presenting herself for inappropriate hospital admission or contact the police due to distress. She is likely to attempt the stairs without supervision and wander placing herself at risk as a result.’
I would like to add that I do not think that she was presenting herself inappropriately as she was having falls and getting one uti after another due to self-neglect and the fact that they kept sending her home with a useless care plan as she would not accept strangers turning up at her home to help her with care.
Best regards
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I think the attitude of the person who did the checklist was completely unacceptable. She was, frankly, quite rude to you and I don't blame you for complaining.
I think you are coming up against the issue that many of us find hard to come to terms with. Whilst we don't know enough about your mum to be sure, she may well have the kind of problems that we might think are 'health needs' but, sadly, are often identified as 'care needs' which don't qualify a person for CHC funding.
So the quote you mention at the end might, I suspect, be regarded as referring to care needs that are quite capable of being met in a CH. Please don't think that I'm agreeing with this interpretation and by all means bring the quote up in any complaint/appeal but I'm suggesting how they might dismiss the quote.
I'm sorry I can't offer anything more positive. Maybe someone else can.
I think you are coming up against the issue that many of us find hard to come to terms with. Whilst we don't know enough about your mum to be sure, she may well have the kind of problems that we might think are 'health needs' but, sadly, are often identified as 'care needs' which don't qualify a person for CHC funding.
So the quote you mention at the end might, I suspect, be regarded as referring to care needs that are quite capable of being met in a CH. Please don't think that I'm agreeing with this interpretation and by all means bring the quote up in any complaint/appeal but I'm suggesting how they might dismiss the quote.
I'm sorry I can't offer anything more positive. Maybe someone else can.
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Stanleypj, thank you your reply is a great help. It all helps me to start to understand how it all works. I have a long way to go, but bit by bit with help from people who have already done the journey I will gain more insight.
Looking back I was not really well prepared for the checklist interview so I need to learn a lot more. I know there is a lot of pdf’s available and slowly I am working my way through the entire vast amount to read.
In the meantime, to gather more info or evidence that will support my application on behalf of my mum, I guess I am entitled to see the notes about my mum that they have at the care home.
The nurse who I spoke to the week before told me that they were there to act as my advocates. That being the case I don’t know why I wasn’t included in the initial meeting that the assessor had with the CH manager while I waited downstairs.
Another thing, it seems to me that although I am told by nurses and care workers at the home that mum is not eating she only likes milk and toffees and that she will hide meds in her nighty etc. I am not sure if they record all these things. I know that I find her quite often in wet trousers, and it is noted that she won’t ask to when she needs to go and that is surely a skin issue and she had a very nasty infection in December which is not fully documented it seems and the assessor said I can’t read the writing.
Sorry to waffle on.
Thanks again, and any opinions and comments are appreciated as it all adds to me beginning to understand the process.
Best regards
Mydiamond mum
Looking back I was not really well prepared for the checklist interview so I need to learn a lot more. I know there is a lot of pdf’s available and slowly I am working my way through the entire vast amount to read.
In the meantime, to gather more info or evidence that will support my application on behalf of my mum, I guess I am entitled to see the notes about my mum that they have at the care home.
The nurse who I spoke to the week before told me that they were there to act as my advocates. That being the case I don’t know why I wasn’t included in the initial meeting that the assessor had with the CH manager while I waited downstairs.
Another thing, it seems to me that although I am told by nurses and care workers at the home that mum is not eating she only likes milk and toffees and that she will hide meds in her nighty etc. I am not sure if they record all these things. I know that I find her quite often in wet trousers, and it is noted that she won’t ask to when she needs to go and that is surely a skin issue and she had a very nasty infection in December which is not fully documented it seems and the assessor said I can’t read the writing.
Sorry to waffle on.
Thanks again, and any opinions and comments are appreciated as it all adds to me beginning to understand the process.
Best regards
Mydiamond mum
I don't know if you have seen the Decision Support Tool (DST)
https://www.gov.uk/government/uploa...upport-tool-for-NHS-continuing-healthcare.doc
The grading criteria in the various domains are far more detailed than the checklist, studying them will give you some idea of what evidence you should be collecting.
https://www.gov.uk/government/uploa...upport-tool-for-NHS-continuing-healthcare.doc
The grading criteria in the various domains are far more detailed than the checklist, studying them will give you some idea of what evidence you should be collecting.
Assessment for continuing healthcare
Dad has been in a CH assessment bed for about 6 weeks. His first assessment, about 3 weeks ago had to be stopped after the first section (behaviour) in the Decision Support Tool as his social worker had no idea that he'd been hitting staff members.
That first assessment was appalling! My brother (who has paranoid schizophrenia) was with me and they were pushing for dad to come home. When I explained that it would be impossible, because of my brother's condition (and frankly I don't think my health would stand it either) the social worker said "well it's not up to you, it's your dad's house, not yours, and if we think he can go home with a care package in place, that's what we'll do"...nice
Well we've been through the assessment again. He's severe for cognition, at high risk of falls and is still quite aggressive at times and waddya know? He's not eligible for CHC.
Nobody has officially diagnosed him but we strongly believe that he has vascular dementia and since new years day can't hold a conversation, doesn't know me or my brother, is incontinent, gets up 2 or 3 times and night and falls because he can't walk and they're putting him (today) in a residential EMI with one nurse on at night for 11 patients.
I spoke to the nurse in charge of the unit he's been in up to press and she tells me that if the residential EMI unit can't cope with him then they will ask for him to be reassessed and they'll look at CHC again but a lady I spoke to Age UK said it's more difficult once they've been declined unless you appeal straight away?
Dad has been in a CH assessment bed for about 6 weeks. His first assessment, about 3 weeks ago had to be stopped after the first section (behaviour) in the Decision Support Tool as his social worker had no idea that he'd been hitting staff members.
That first assessment was appalling! My brother (who has paranoid schizophrenia) was with me and they were pushing for dad to come home. When I explained that it would be impossible, because of my brother's condition (and frankly I don't think my health would stand it either) the social worker said "well it's not up to you, it's your dad's house, not yours, and if we think he can go home with a care package in place, that's what we'll do"...nice
Well we've been through the assessment again. He's severe for cognition, at high risk of falls and is still quite aggressive at times and waddya know? He's not eligible for CHC.
Nobody has officially diagnosed him but we strongly believe that he has vascular dementia and since new years day can't hold a conversation, doesn't know me or my brother, is incontinent, gets up 2 or 3 times and night and falls because he can't walk and they're putting him (today) in a residential EMI with one nurse on at night for 11 patients.
I spoke to the nurse in charge of the unit he's been in up to press and she tells me that if the residential EMI unit can't cope with him then they will ask for him to be reassessed and they'll look at CHC again but a lady I spoke to Age UK said it's more difficult once they've been declined unless you appeal straight away?
Most chance of success on appeal is on non compliance to guidelines.
For instance, a common way of reducing the scores is to use a majority decision and not the highest grade given by a member with a note of 'who thought what', see notes at front of DST. This lowers the score passed onto the panel.
I view the DST members as the experts on judging medical needs and think that they should abide by the guidelines, they are experts in different fields so it is reasonable that their views my differ.
I regard the panel as the people with the chequebook who endorse the findings of the DST.
Were you at the DST?
For instance, a common way of reducing the scores is to use a majority decision and not the highest grade given by a member with a note of 'who thought what', see notes at front of DST. This lowers the score passed onto the panel.
I view the DST members as the experts on judging medical needs and think that they should abide by the guidelines, they are experts in different fields so it is reasonable that their views my differ.
I regard the panel as the people with the chequebook who endorse the findings of the DST.
Were you at the DST?
Botticelliwoman, I sympathise. I am not in position to advice as I am new to all this myself and trying to figure it all out, but it doesn't help when you get comments like that.
One thing I am finding though it is very important to keep a paper trail. In my recent assessment for my mum, the assessor said to me 'relatives opinions are of no interest to me' we were alone.
I will make sure I have an advocate with me next time.
I am sure you will get a lot of good advise on this forum.
Best regards
One thing I am finding though it is very important to keep a paper trail. In my recent assessment for my mum, the assessor said to me 'relatives opinions are of no interest to me' we were alone.
I will make sure I have an advocate with me next time.
I am sure you will get a lot of good advise on this forum.
Best regards
