Altered States of Consciousness - What are they?

[Maaarrghk]

I am currently appealing against a decision to deny my Mum CHC.

One part of the DST/Checklist that has always puzzled me is the part about Altered States of Consciousness.

I can find a few references that point at things like epileptic fits and fainting, but always thought that hallucinations and a person acting/speaking as if they were in a completely different situation to the one they are in would also be seen as altered states of consciousness.

As an example, my Mum (when she was more able and her sight and hearing better than they are now) would often think that whatever was on TV was actually going on right there in the room she was in. There were episodes where carers had switched the channel to Jeremy Kyle or some such twaddle (accidentally I hasten to add) and Mum would be screaming at the half-wits on the show to get out of her house. This went as far as her sometimes throwing things at the TV and on one occasion a carer arrived to find her trying to throw the TV out of the window.

Would such episodes as these count as altered states of consciousness?

Can anyone provide any other examples that could be described as altered states of consciousness?

 

[Rheme]

Re CHC Assessments I believe this to be TIA's, Strokes, being unresponsive, etc.

 

[Saffie]

I was told that this meant seizures.



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[nitram]

Have a look at

http://www.glasgowcomascale.org/

 

[canary]

I understood it to mean being in a coma or unresponsive after a head injury, stroke, permanent vegetative state etc

 

[Spamar]

Agree with canary.
You often see it the TV programmes like Trauma Doctors. They get the subject to A&E and say GCS14 or whatever. Unless your parent is comatose, don't think it's important for CHC

 

[nitram]

Cumbria publish a list of 'Prompts for NHS funded Continuing Health Care'

Altered States of Consciousness (ASC) Domain
Has the service user had any Tia’s? (Transient ischaemic attacks)
Has the service user had seizures?
Are they on any medication to control seizures?
Has the service user had any Vasovagal attacks?
Do they have Vasovagal syncope?
Where there are episodes of altered states of consciousness do care plans
exist?
Does medication have to be given and if so how is this administered?
Rectal diazepam is a skilled task.
Is the service user in another consciousness and unarousable at times?
Do medications for seizures etc cause drowsiness and increase risks in other
areas i.e. mobility and falls?
Do episodes of ASC impact on other areas of care i.e. service user is so tired
after an event that they need to sleep for long periods. This can impact on
nutrition, hydration and tissue viability.
Has the service user had any episodes of altered states of consciousness?
(Head injuries that result in a loss of consciousness should be considered
under a History of ASC and marked at a minimum of low)
Following a serious head injury is the service user at risk of developing
seizures?

http://www.cumbria.gov.uk/eLibrary/Content/Internet//327/882/4023210358.pdf

 

[Saffie]

I am currently appealing against a decision to deny my Mum CHC.

One part of the DST/Checklist that has always puzzled me is the part about Altered States of Consciousness.

I can find a few references that point at things like epileptic fits and fainting, but always thought that hallucinations and a person acting/speaking as if they were in a completely different situation to the one they are in would also be seen as altered states of consciousness.

As an example, my Mum (when she was more able and her sight and hearing better than they are now) would often think that whatever was on TV was actually going on right there in the room she was in. There were episodes where carers had switched the channel to Jeremy Kyle or some such twaddle (accidentally I hasten to add) and Mum would be screaming at the half-wits on the show to get out of her house. This went as far as her sometimes throwing things at the TV and on one occasion a carer arrived to find her trying to throw the TV out of the window.

Would such episodes as these count as altered states of consciousness?

Can anyone provide any other examples that could be described as altered states of consciousness?

As demonstrated by Nitram's last post, these are all the things others have posted but not what you considered to be altered states of consciousness.
Where the above are concerned, the person is perfectly conscious and they are simply symptoms of dementia and I'm afraid are not considered relevant where CHC funding is concerned.
(I think the NHS would be bankrupt if they were!)

 

[LYN T]

I can find a few references that point at things like epileptic fits and fainting, but always thought that hallucinations and a person acting/speaking as if they were in a completely different situation to the one they are in would also be seen as altered states of consciousness.

My OH was awarded CHC but in the ASC box he had 'no needs' (I did agree). He also had hallucinations etc as you outline above. Your best bet would be to get the checklist/DST scores and see how the most severe ones have an impact on the other domains.

Good luck with your appeal

Take care-keep fighting

Lyn T XX

 

[Saffie]

I have to add that my husband did suffer seizures towards the end of his life but becasue he was on medication for them, which was assumed was helping them, they didn't qualify either.

 

[MerryWive]

My MIL has some minor seizure type events where she passes out for up to a few minutes, throws up and empties her bowels all together. Sometimes called a vaso-vagal episode. These were included under ASC in her CHC funding.

 

[Saffie]

Sorry, I didn't mean to imply that the seizures weren't considered as ASCs, just that he didn't qualify for CHC funding.


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[Spamar]

As it happens OH had today what I would call a fit, but one of the nurses called a TIA. He was sitting in a chair, suddenly started throwing his legs and arms around, eyelids shut, eyes rolled up, came out of it in a few seconds, no memory of it. I don't think it's going to affect CHC review whenever it happens, but interesting. Never seen a TIA like that before.

 

[Saffie]

I agree with you Spamar, that the signs sound more like a seizure though Dave's lasted some time but I know they can vary.
Dave was sent to hospital as an emergency and was in Resuss by the time I got there so I guess was pretty bad. He was fully monitored and had another one after returning from a brain scan. As the consultant said to me, it's terrifying seeing someone suffereing a seizure when being monitored - all the machines went beserk!

The thing is that medication can help to prevent another if it was seizure so they should refer it to the GP.
If your OH has another perhaps they might do so. I thought that with a TIA, you just lost consciousness for a varying time but not that you thrashed around with eyes rolling as with a seizure.

 

[Maaarrghk]

Thank you all for your replies. Much appreciated. Looks like I'm on a non-starter with that particular domain, but there are still another 11 to go at.

 

[Spamar]

I agree, Saffie. I've seen quite a lot of TIAs now, but not like that. I will check with a gp when I see one. Don't think it's worth meds to stop seizures at this stage. He's been taken off donepezil and Memantine this year as he's in last stages. Like all, he has good days and bad days, funnily, he was on a good day!