My mum has FTD and has had a new specific diagnosis of Primary Progressive Aphasia. She has been extremely agitated, violent to her CH staff and in danger of being asked to leave the CH as they no longer could meet her needs. The care home manager suggested we apply for CHC as her possible next move could be to a psychiatric ward or specialist nursing home. The District Nurse came and did the initial assessment and now someone from CHC is coming on Monday? I’ve only had a passed on message and know little about them. What is their role likely to be? what will happen at the assessment? should I be present? What will happen next? Mum has recently been put on antipsychotic drugs and she is currently much calmer and less violent - what impact will this have on her CHC assessment?
CHC visit
- Thread starter Redlib
- Start date
I personally don’t have an experience of CHC so I wondered if this NHS factsheet would be helpful
https://www.nhs.uk/conditions/socia...-work-and-benefits/nhs-continuing-healthcare/
https://www.nhs.uk/conditions/socia...-work-and-benefits/nhs-continuing-healthcare/
Hi Redlib,
My wife has been on the receiving end of two CHC assessments and has been awarded funding on both occasions. The first meeting will be quite long and I suggest that you are there to provide input to the meeting. Our first meeting was 2 1/2 hours long. The first part will look at the situation giving personal context which is where your knowledge will be particularly useful. After this there are specific criteria that are discussed and assessed which feed into the decision making process. You will be advised at the meeting what the likely decision will be but it is independently verified though unlikely to change You will receive a copy of the assessment and a letter notifying the decision. If funding is awarded then you will have to do nothing the NH should just pick it up.
My wife is on anti-psychotic drugs and this helped with the assessment as it is clear that medically she needs support.
Good luck with the assessment but be prepared to fight her corner and not let them play down any of your concerns.
My wife has been on the receiving end of two CHC assessments and has been awarded funding on both occasions. The first meeting will be quite long and I suggest that you are there to provide input to the meeting. Our first meeting was 2 1/2 hours long. The first part will look at the situation giving personal context which is where your knowledge will be particularly useful. After this there are specific criteria that are discussed and assessed which feed into the decision making process. You will be advised at the meeting what the likely decision will be but it is independently verified though unlikely to change You will receive a copy of the assessment and a letter notifying the decision. If funding is awarded then you will have to do nothing the NH should just pick it up.
My wife is on anti-psychotic drugs and this helped with the assessment as it is clear that medically she needs support.
Good luck with the assessment but be prepared to fight her corner and not let them play down any of your concerns.
My dad had Advanced dementia and had challenging behaviour and was on medication to calm him. He was assessed for CHC funding and received it for scoring severe for Behaviour and Cognition and High for Communication and Drugs. I attended the CHC meeting along with the Care home nurse and the Social worker, my dad also sat in the meeting with us. The meeting took approx 2-3 hours. Having lots of evidence of behaviour etc helps when going through each of the criteria, the more the better, the care home had been gathering this in preparation for the meeting and I and the Social worker also had some evidence. He continued to be awarded funding at the 3 months review which took less time but was still about 2 hours, we again bombarded them with evidence to help our case.
Good luck.
Good luck.
Thank you for your replies. Does anyone have any examples for what counts as severe cognitive problems and behaviour? I don’t want to miss out examples that are relevant. I’m presuming the time mum tried to climb over a kitchen counter to slap a staff member counts as severe but what about cognition? Mum will sometimes stand in her own room and not recognise it, can’t understand how to put on her coat, couldn’t understand when a staff member asked her to sign a card for another resident etc. Because we’ve been dealing with this disease for so long I feel I have forgotten how far down the well we have fallen.
Hi, yes it is hard to think of everything, we live with it for so long, we tend to take to just accept it all as normal, but I was advised by the Care home and the Social worker to write down everything for each of the criteria I could think of and then bullet it and thin it down. So this is from what I wrote and my experience of the CHC review and what was in the report written for my dad.
For a Severe in Cognitive impairment, here is what it said on the report for level of need:
Cognitive impairment that may, for example, include, marked short-term memory issues, problems with long-term memory or severe disorientation to time, place or person. The individual is unable to assess basic risks even with supervision, prompting or assistance and is dependent on others to anticipate their basic needs and to protect them from harm, neglect or health deterioration.
For Cognitive problems this is what I wrote as evidence in preparation for the meeting, the nurse at the CH also had written evidence to contribute:
- No awareness of day or night.
- Lives in the moment cannot remember things within a few seconds of being spoken. He has no short term memory and long term memory is poor, he confabulates memories (I gave examples).
- Has no awareness of needing to be changed if clothing becomes soiled.
- Cannot understand or comprehend simple questions or instructions, such as do you want a cup of tea or coffee, or can you sit down or get up
- He is emotionally troubled due to believing I'm his wife and not knowing I'm his daughter.
This is some of things that were written in the report as justification of a Severe score:
- He has no short term memory
- Long term memory is very variable, bordering on poor, when he could talk and make sense more he talked about memories that are in fact untrue (they wrote examples which I gave them).
- He has repetitive behaviour, he constantly wanders around the unit and tries to enter one room in particular at every opportunity (CH staff gave this as evidence). He is not orientated to time, place or person. He sometimes thinks that his daughter is his wife.
- Although he sometimes appears to understand simple things, he cannot retain this or communicate with an appropriate response.
- He can follow very simple instructions with guidance, however staff have to be mindful that this could set off his aggression. Staff have to assess his mood daily and act accordingly. Staff will do the action first and then he may follow suit, he appears to respond to visual prompts better than verbal.
- He does not understand personal care, he is easily agitated if staff try to help.
- Does not make simple choices, he will answer yes to anything.
- His daughter undertakes more complex decisions like health and finance.
- Staff state he would not say if he had pain, he just shows more agitation, so staff have to look for non verbal signs along with clinical signs to help diagnose issues.
- DOLS in place.
- Known to LLAMS team, medication was altered due to inappropriate behaviours.
My dad also scored Severe for Behaviour. I and the Care home had lots of evidence for this criteria. But just to help you this is what it says on the report for level of need for Severe:
"Challenging" behaviour of severity and/or frequency that poses a significant risk to self, others or property. The risk assessment identifies that the behaviours require a prompt and skilled response that might be outside the range of planned interventions.
I wont write the full list that was used for justification for his behaviour. But to summarise my dad was very challenging and unpredictable the unpredictability of his behaviour seemed to be what mattered most in the final review. His aggression was sometimes unprovoked and there was not always a predictable trigger so he couldn't easily be managed. Also he sometimes wasn't tolerant of the other residents and staff and this could put them at risk. If you want more examples let me know.
Hope this helps.
