Nhs continuing care appeal - advice on "altered state of consciousness

[Happyone]

Hi All,

I am looking for a bit of advice regarding an appeal on NHS continuing care that is due on Thursday.

I am struggling with the "altered states of consciousness" section. My MIL is Stage 6 alzheimers. She is in a nursing home. She has days when the staff struggle to keep her awake on some days, on other days she is awake all day. It does not depend on whether she has slept the night before and you can never tell when this extreme sleepiness is going to occur.

On these occasions, staff have to put her back to bed. She is then very very difficult to rouse, to the degree where we have been asked to go and see her (normally this occurs when agency staff are working and they do not know my MIL therefore become more concerned that the regular staff).

No one seems to know the reason for this happening and put it down to the dementia (although she has cancer which is contained at present).

My question is, could we use this as an "Altered state of consciousness" or just use it within the extra section at the end of the assessment?

Any input would be gratefully received.

Many thanks,

Sunflower

 

[BeckyJan]

Hello Sunflower,
I think you are really better to discuss this with a GP, senior Nurse or CH Manager. I found this website which gives a description of 'altered state of consciousness' and its possible your Mother does not come in that category.
http://study.com/academy/lesson/altered-states-of-consciousness-definition-examples-quiz.html

If in doubt I would put a note in the section referring them to your notes in the general section, then at least you are bringing it to their attention. (This is assuming you are completing the forms when normally it is a Nurse/Social Worker/MH team member who would complete this). I agree though it is a good idea to prepare your own version of the Decision Making Tool.

PS I hope the assessment goes well without too much hassle for you. Remember though to take notes and if necessary appeal. Let us know how it goes.

 

[Marianne]

If MIL is sleeping for long periods of time during the day causing care staff to have concerns this should definitely be added in the ASC category. When she is sleeping during the day, is she missing meals/drinks, have you spoken with the manager/GP about this, has her medication changed.

My father died in 2007 suffering from dementia, cancer and diabetes, he also started sleeping during the day and falling into diabetic coma due to lack of food/drinks but in my dad's case it was due to the manager of the home giving him antipsychotic drugs which I found had not been prescribed.

Needless to say CHC was granted for the whole of the time my dad was in care..
Good Luck

 

[Saffie]

I'm not sure of the rights and wrongs of this but the senior CHC assessor who carried out my husband's checklist said that the 'altered state of consciousness' section referred to suffering fits/seizures, whatever you choose to call them, not sleepiness.
My husband sleeps for most of the day and night but she said this is not what it means.

 

[Marianne]

I'm not sure of the rights and wrongs of this but the senior CHC assessor who carried out my husband's checklist said that the 'altered state of consciousness' section referred to suffering fits/seizures, whatever you choose to call them, not sleepiness.
My husband sleeps for most of the day and night but she said this is not what it means.

I hate to say this but they lie. I was upset when I realised they lied, how can you possibly discuss assessments with someone who you know will lie if they see you are getting the upper hand. Not only did the assessor lie but before any meeting which were always held at the care home she would meet with the manager, social worker, CPN and anyone else they invited in the managers office to make sure they were all singing from the same song sheet.

 

[Saffie]

I don't know about this but the senior assessor who carried out my husband's checklist only met with myself and the nurse on my husband's wing. The manager wasn't even in the home and I don't have either a CPN nor a SW for her to have spoken to.

 

[Happyone]

Many thanks for your responses, they are much appreciated.

MIL went into a nursing home last year - admitted straight from hospital following a fall where sher broke her hip. We were "told" at the time that there was "no way" she would qualify for NHS funding, even though during her time in hospital they had to reassess as they originally said residential then changed their mind their mind to nursing home. She wanted to go home and a capacity assessment decided she didnt have the capacity to make that decision and a "best interests" decision was made. She continues to have all decisions made on a "best interests" basis. My hubby has an enduring power of attorney.

She was then assessed after 3 months (in January) and the nurse assessor actually told me my MIL had no real issues even with cognition !!! Apparently this was because the assessor witnessed her saying "yes" to a cup of tea!!! We knew nothing about NHS funding at the time, but we have learnt SO much since. We appealed the decision and on Thursday another nurse assessor has agreed to meet with us. This is because she had "reviewed" the documentation, agreed with the original decision and was sending it to a "closed panel". We INSISTED she speak with us first to get our views although we realise she has probably already made up her mind but we are not going down without a fight this time.

Many thanks again for your input.