Continuing Healthcare DST assessment

[miggie]

Some 5 months after the completion of the CHC checklist on discharge from hospital , referring my Mother for a full assessment, the "powers that be" have, at last, got round to carrying out the DST asessment. This took place at the care home where Mum has been for the past 12 months.

Present at the meeting were a member of the CHC team who had previously observed Mum for approx 30 mins, a psychiatric nurse who has never met Mum (nor asked to meet her), a senior carer from the home and myself and my brother.

After a 2 hour discussion going through all the domains, my mother scored 4 high, 4 moderate, 2 low and 2 none.

We were asked to leave the room whilst the team discussed the findings, were called back in after only a few minutes and were told Mum does not qualify for CHC funding.

Irrelevant of the fact that we recorded that we do not agree the scores in two areas (we, and the home, believe Behaviour to be "Priority" and Psychological to be "High"), when reading the DST guidelines "Establishing a Primary Health Need" paragraph 31, it states that "A clear recommendation of eligibility to NHS continuing healthcare would be expected where there is a number of domains with high and/or moderate needs".

As Mum scored 8 out of 12 domains with high and moderate we would have thought that she would fall into this category but we were told in no uncertain terms that we were not interpretting the guidelines correctly and the team's decision was correct.

Any advice, comments or experience of these matters much appreciated.

 

[Saffie]

I am really sorry Miggie, I have no advice except appeal. The volunteers of the AS Appeal team of are very competent.

What I do have though is sympathy with your position as your post has reinforced the dread in my stomach about the checklist for my husband on Wednesday! I know what his need are but I'm not even sure that the staff in the nursing home will agree - they certainly can't recognise when he is in pain - and they are the one with the evidence -or lack of! I will be surprised if it even goes to full assessment as it didn't when the hospital applied 2and 1/2 years ago.

You sound as though you had plenty of support for your opinions so I would appeal.
good luck.

 

[BeckyJan]

Hello Miggie,
This gives you (an anyone else needing them) details of the Alzheimer's Society NHS Continuing Care Volunteer Support Group:
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=398

They helped me considerably when I needed to appeal although there is still much groundwork to be done oneself.

It is worth getting in touch with them.

 

[crazyfish]

Some 5 months after the completion of the CHC checklist on discharge from hospital , referring my Mother for a full assessment, the "powers that be" have, at last, got round to carrying out the DST asessment. This took place at the care home where Mum has been for the past 12 months.

Present at the meeting were a member of the CHC team who had previously observed Mum for approx 30 mins, a psychiatric nurse who has never met Mum (nor asked to meet her), a senior carer from the home and myself and my brother.

After a 2 hour discussion going through all the domains, my mother scored 4 high, 4 moderate, 2 low and 2 none.

We were asked to leave the room whilst the team discussed the findings, were called back in after only a few minutes and were told Mum does not qualify for CHC funding.

Irrelevant of the fact that we recorded that we do not agree the scores in two areas (we, and the home, believe Behaviour to be "Priority" and Psychological to be "High"), when reading the DST guidelines "Establishing a Primary Health Need" paragraph 31, it states that "A clear recommendation of eligibility to NHS continuing healthcare would be expected where there is a number of domains with high and/or moderate needs".

As Mum scored 8 out of 12 domains with high and moderate we would have thought that she would fall into this category but we were told in no uncertain terms that we were not interpretting the guidelines correctly and the team's decision was correct.

Any advice, comments or experience of these matters much appreciated.

Hi Maggie,
Sorry to hear your story but it doesn't surprise me.
It is all down to opinions unfortunately not facts.
You are quite correct to quote the nat framework as they are the rules that they should be abiding by .
But they seem to disregard them when it suits.
Ask for a full written explanation as to why your mum didn't qualify considering her score and that the guidelines clearly state someone with those scores must be considered for full funding.
Also ask for a full explanation as to what a primary health care need is.
If your mum is ill and this is clearly the situation .
Then your mum like everyone else is entitled as a statutory right to free NHS care at the point of need.
No assessment or criteria is needed as there is no enactment stating this is the case.
They are trying to get out of their responsibilities of paying for care by passing the buck to the SS or forcing someone to self fund.
Ask help from your SW if they are any good as its their responsibility to help you achieve funding as they don't want the possible burden of funding your mothers care falling on their rate payers when it's not their problem.
Make them perfectly aware you are prepared to go down the appeals route.
Do not sign ANYTHING or agree to anything.
Write to your local MP ask for him to get involved as this CCG is not obeying the nat guidelines or the law.
Stand up for your mums rights and fight them all the way.
It can be tough going but you can win.
Make sure you get every response in writing insist on it.
Good luck.
Mick

 

[grobertson62]

Appeal we did and it was 3rd time luck

 

[miggie]

Thank you for your advice. When we receive the official paperwork we will most definitely appeal. Doubtless they will take weeks to send the notification whereas they managed to make their decision of non qualification for chc funding in less than 10 minutes!

 

[jenrab91]

CHC assessment

Thank you for your advice. When we receive the official paperwork we will most definitely appeal. Doubtless they will take weeks to send the notification whereas they managed to make their decision of non qualification for chc funding in less than 10 minutes!

Hi, My mum has been in a care home for 2 years and we are paying full fees from the sale of her flat. Her case went to Panel last Thursday and I am waiting to hear but I received all their reports, etc prior to Panel and they recommended that she does not qualify for Healthcare funding. I think it is a disgrace. She has Alzheimers and vascular dementia and has not been able to walk or stand for 20 months. She has to be hoisted bed to chair and chair to bed, fed, washed, and all personal care as she is unable to do anything for herself. I have read so many documents and basically if the person has behaviour problems/angry/difficult to deal with etc they score more but these are not nursing needs as they only give them more medication to make them calmer. I am sure the answer from the Panel is going to be negative but I am going to appeal. As you say they make their minds up in 10 minutes without even knowing the individual. I look forward to hearing how your case goes. Keep in touch.

 

[crazyfish]

Hi, My mum has been in a care home for 2 years and we are paying full fees from the sale of her flat. Her case went to Panel last Thursday and I am waiting to hear but I received all their reports, etc prior to Panel and they recommended that she does not qualify for Healthcare funding. I think it is a disgrace. She has Alzheimers and vascular dementia and has not been able to walk or stand for 20 months. She has to be hoisted bed to chair and chair to bed, fed, washed, and all personal care as she is unable to do anything for herself. I have read so many documents and basically if the person has behaviour problems/angry/difficult to deal with etc they score more but these are not nursing needs as they only give them more medication to make them calmer. I am sure the answer from the Panel is going to be negative but I am going to appeal. As you say they make their minds up in 10 minutes without even knowing the individual. I look forward to hearing how your case goes. Keep in touch.

Hi,
You say your mums case went to panel.
Has she had a FULL CHC assessment?
If so were you involved and what were her domain scores?
If you could expand your thread we may be able to advise.
Mick

 

[jenrab91]

Full CHC Assessment

Hi,
You say your mums case went to panel.
Has she had a FULL CHC assessment?
If so were you involved and what were her domain scores?
If you could expand your thread we may be able to advise.
Mick

Hi Mick, Yes she had a full CHC assessment and I was involved. Reports were received from a social worker, Community Psychiatric Nurse from specialist mental team for older people and a consultant psychiatrist for Older People.
I have received a call from Community Psychiatric Nurse just now to say that the Panel feels she does not meet the criteria for CHC at this time. However she will be looked at again by a professional from physical health side. I asked if I would receive a full written explanation as to why she did not qualify and he said I would be receiving this from the Panel. He also said the Panel carries out fresh scoring themselves from the reports they read so until I receive their paperwork I do not know what they scored but she is totally immobile and has no idea of time or place and has to be fed, etc. It appears that because she has no behavioural problems (she is the sweetest kindest natured lady even with this cruel illness) she does not qualify. I will appeal once I have the necessary paperwork. I have contacted a solicitor (Hugh James) and am awaiting their advice as to whether they feel I could win an appeal and have sent them all documentation so will await papers from Panel and solicitors advice before I continue. The system is just so unfair.

 

[crazyfish]

Hi Mick, Yes she had a full CHC assessment and I was involved. Reports were received from a social worker, Community Psychiatric Nurse from specialist mental team for older people and a consultant psychiatrist for Older People.
I have received a call from Community Psychiatric Nurse just now to say that the Panel feels she does not meet the criteria for CHC at this time. However she will be looked at again by a professional from physical health side. I asked if I would receive a full written explanation as to why she did not qualify and he said I would be receiving this from the Panel. He also said the Panel carries out fresh scoring themselves from the reports they read so until I receive their paperwork I do not know what they scored but she is totally immobile and has no idea of time or place and has to be fed, etc. It appears that because she has no behavioural problems (she is the sweetest kindest natured lady even with this cruel illness) she does not qualify. I will appeal once I have the necessary paperwork. I have contacted a solicitor (Hugh James) and am awaiting their advice as to whether they feel I could win an appeal and have sent them all documentation so will await papers from Panel and solicitors advice before I continue. The system is just so unfair.

Hi jenrab,



You don't actually need a solicitor until you have completed the appeals process.
If that fails and you feel your case is strong enough then a solicitor such as Hugh James may be the way to go but at this early stage I wouldn't waste your money.
And as for meeting CRITERIA I have said in previous threads as far as I am aware unless someone can tell me different NO British citizen has to meet any sort of criteria to receive free health care at the point of need.
If this was the case then everyone receiving care should have to meet this criteria.
There has never been any enactment since the 1948 act came into place stating that Criteria can be applied to determine health care.
Ask them to explain when the law was changed to allow this.
Don't be surprised that you dont get an answer.
These are just NHS rules not the law.
And yes the NHS think they are above the law and try and disregard it.
Mick

 

[Saffie]

I have received a call from Community Psychiatric Nurse just now to say that the Panel feels she does not meet the criteria for CHC at this time. However she will be looked at again by a professional from physical health side.

If your mother's case is being looked at again regarding the physical element of her needs, I would be inclined to wait until this is completed before approaching a solicitor as it seems that the application has not been absolutely refused.
There is no way my husband would even have passed the checklist without his physical needs being taken into account as he is not much of a problem behaviour wise. I have no idea who will present reports at the actual assessment, if it ever happens, as he has no SW, no CPN and hasn't seen a psychiatrist since it was decided he had to go straight to a nursing home from the community hospital - and he only saw him then on admission.

 

[geum123]

he Panel feels she does not meet the criteria for CHC at this time. However she will be looked at again by a professional from physical health side.

Hi jenrab,
I don't see how they managed to do a full assessment without the "physical health side" since that would have impact on all of the other criteria. Sounds most dubious to me.

It appears that because she has no behavioural problems (she is the sweetest kindest natured lady even with this cruel illness) she does not qualify.

If they have told you this then they are misleading you.
Pamela Coughlan (bench mark for NHSCC) didn't have any behavioural problems, but did have health needs.

http://www.youtube.com/watch?v=YaMXowPWxis

I have contacted a solicitor (Hugh James) and am awaiting their advice as to whether they feel I could win an appeal and have sent them all documentation so will await papers from Panel and solicitors advice before I continue.

I used them for my Dads retrospective case, and won.

 

[Saffie]

don't see how they managed to do a full assessment without the "physical health side" since that would have impact on all of the other criteria. Sounds most dubious to me.

I agree. I think there has been some misunderstanding somewhere along the line. CHC can be reviewed again after a few months if there has been a significant change, so perhaps it is that to which the CPN was referring. The very wording of the assessment is interpreted as health care - of whatever kind - so has to include physical as well as mental, health needs.
The fact that behavioural issues with dementia are so difficult to manage does give that a high priority with the assessment but other factors cannot be ignored.
(I hope!)