Appeal for Continuing Healthcare!!

Discussion in 'ARCHIVE FORUM: Support discussions' started by Susi T, Apr 29, 2008.

  1. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Hi there everybody, haven't been on for a while, although I have been dropping in now and then!!

    Dad's case has been to the Continuing Healthcare Panel and has been rejected, I have made the decision to appeal. The
    decisionwas made back in January, due to a miscommunication with social worker, my intension was to just give up and carry on without. Social worker requested upto date info to take to panel in regards to nursing Care, when the info came back there were notes that I thought were relevant to an appeal. I just want to do anything to help Dad, if I can't care for him on a dat to day basis I want to make sure he is having the right care.

    Has anybody had any experience of appeal? I took social worker with me today for what I had thought was an overview of Dad's notes (message left on answer machine stated this), however, it was expected that a reassessment was to be done and I was to sign it today!!! Needless to say the social worker and member of assessment team could not agree on any issue!! I am to be faxed the assessment and make any changes i think are valid then go and sign report on Friday.

    I rather think this is a battle between Health and Social Services! Some of you may think why take Social worker in any case. I took her as I thought we were looking at Dad's notes, hopefully to give us some help with appeal.

    I would welcome any advice, the medical terms and jargon really do lose me along the way!! Sorry to go on and on!!

    Thanks to you all

    Susi
     
  2. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
  3. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Hi Connie

    The assessment is going to be faxed to me tomorrow, social worker has asked for copy to look at, I can add my own comments and views, once this is done I am to then sign it so it can go to panel again.

    Although the Assessment hospital have looked after Dad really well, he should have only been there for 6 weeks at the most for assessment, however, he had complications 2 days after his review in November,he has been fitted with a catheter since then, chest infections and falls have been quite regular events. Obviously the Unit wants the bed (don't all hospitals)!!
     
  4. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Susie, I meant the original forms they turned you down on.

    Then you can check each indivual section to see where you think your score can be raised. That way you clarify what section you are appealing against.

    Unless you feel that you have new grounds following a new assessment. Wishing you all the best, just don't give up.
     
  5. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
  6. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Thanks Connie, yes I have got the last report, I thank you for your advice, however, I think I am on a no win case all of the interpretation of criteria etc. is doing my head in!! I will not give up though. Susi
     
  7. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #7 Margarita, Apr 29, 2008
    Last edited: Apr 29, 2008
    I was wondering why they turn your father down also .

    As I have ask for mum to have Continuing Healthcare so she can go into a nursing home as she has very challenging behavior .

    you should read the link connie gave ( thanks connie ) , as it show what criteria is needed for the person who is asking for Continuing Healthcare to have . I do no it says challenging behavior is one of them .

    so read what the criteria is & see if your father falls into any of them .

    you could also make sure they take into consideration your father Psychological & Emotional Needs.


    as that is what I said to SW make sure she write in the Psychological part of it

     
  8. chip

    chip Registered User

    Jul 19, 2005
    400
    Scotland
    Susie, If its any help. My husband also got turned down in December last year. Was put into a Nursing Home after only 6 weeks they were struggling with him due to falls, infections etc. He needed one to one care and they couldnt give that. They also don't like it if they fall on other patients. He was also back and forth to different hospitals. Which is not ideal for Dementia sufferers. He is now in continuing care and very frail also has another infection and isn't eating or drinking and on constant watch.They have to take in to account not the condition but the symptoms and condition of the patient. As Dementia can deteriorate rapidly or slowly this seems to confuse the system. Also no two sufferers are the same so how can they tell what tomorrow /next week will bring. Good luck in fightening it.
     
  9. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Hi Chip

    Dad has had falls and infections (urine and chest) since beginning of the year, myself and social worker agrre that his behaviour is an issue, however, the assessment representative seems to think his behaviour is predictable!!! Nothing I have experienced with Dad and his dementia is predictable!!!

    The criteria is so complex as far as I am concerned, why they cannot speak in laymans terms is beyond me, I think they try and blind people with science!!

    Thanks for your comments Chip, I am determined I will fight this to the bitter end!!!

    If my Mum was still with us she would probably have given up by this stage however, I am going to do my best for Dad.
     
  10. CYN

    CYN Registered User

    Jan 4, 2008
    702
    east sussex
    successful appeal

    Susie,
    My husband was self funding for the 6 months that he was in 3 different homes.

    Three days before he died there was a meeting around his bed with me present,the decision was made that he did not meet the criteria for continuing care.

    I of course appealed i did not use a standard letter that can be downloaded which you then put your personal details on,

    Instead i used my own words as to why his care should have been funded.He had several health problems apart from vas dem.

    I received a letter stating that they would pay in retrospect for palliative care.

    It's a long story but in the end they refunded all of the homes fees for the full 6 months.

    So my advice to anyone is to take them on. I also had interest paid on the money but only because i asked.

    Cynthia
     
  11. Helena

    Helena Registered User

    May 24, 2006
    715
    Suzi T

    go to www.************

    and contact them they will help you with that appeal
     
  12. Clive

    Clive Registered User

    Nov 7, 2004
    716
    #12 Clive, Apr 30, 2008
    Last edited: Apr 30, 2008
    Hi Connie.

    Would I be right in saying that you need to first look at the "CHECKLIST" to see if there is any chance of your loved one obtaining NHS Continuing Healthcare BUT it is the more detailed "DECISION SUPPORT TOOL" (from the same site) that the Panel use to make the final decision to agree (or reject) the application for NHS Continuing Healthcare.

    It is the marks from the Decision Support Tool that are required to assess why you have not received NHS Continuing Healthcare. You need a Priority or two Severe needs, or a lot of high needs before you can pass.

    Clive

    PS. Don't give up.
     
  13. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Yes you are right Clive.

    You have to get a high enough score on the checklist before they will even consider you for Continuing Care.

    Then if they turn you down they have to let you see in what area and why, in order for you to appeal against the decision.

    You can then check the criteria against the Sept 2007 document.
     
  14. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Thanks Connie and Clive, I have just checked Dad's assessed level of needs, he has 1 high, 3 moderate, 6 low and 2 no needs. I have started to wonder if he should have been refered or not in the first place. However, as far as I am concerned his condition has changed since the last assessment.

    Bit of a blonde question here, do the assessors mark the level of needs or do the panel??
     
  15. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Think it is the panel Susie, but not completely sure.

    Seems to be a bit of a minefield, this whole area of obtaining Continuing Care, but must be worth your best shot.

    Again, wishing you well.
     
  16. Clive

    Clive Registered User

    Nov 7, 2004
    716
    Hi Susi

    Though everyone is supposed to be assessed the same way I don’t know if they are. I will tell you my experience.

    In my case all the information was gathered from the GP, Consultant, hospitals, A & E, Residential Home etc by a “Summary Nurse” who produced a booklet. In the booklet there was a “Care Needs Profile” for each of the 11 domains (health areas).

    This “Care Needs Profile” booklet was handed to the members of the multidisciplinary Panel at the Panel Meeting. I had received a copy two days before the Panel meeting. I was then allowed to give my opinion of the “Care Needs Profile” booklet to the Panel before being told to go home. After I left the members of the Panel were expected to read the “Care Needs Profile” and record a score for each domain (Priority to No Need). The Panel then decide from the score if NHS Continuing Healthcare, or NHS funded Nursing Care, or nothing should be offered. They post the answer to you.

    The score you have seen is too low for you to automatically get NHS Continuing Healthcare at this time. But now you know the score and how it is calculated you can try to argue for a higher score in each domain.

    My guess is that one has to aim for a minimum of one Severe and four High to stand a chance.

    Don’t give in. You will succeed one day.

    Clive

    PS. I always keep my MP informed about my negative experiences with the NHS. They are the only people who can get the system changed.
     
  17. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Clive, thank you so much for taking the time to outline your own experience.

    I am sure it will be of great help to anyone contemplating going down this route.
     
  18. barbara h

    barbara h Registered User

    Feb 15, 2008
    96
    county durham
    Hi susie

    I am susan s sister who's thread connie refers to about us fighting for our mam's funding. When they reassessed my mam her 'score' still wasn't high enough but with the help of her consultant they decided to put a footnote on the end of the report stating that my mam's condition was unstable and unpredictable.They also pinned the doctor down to a prognosis as to how long she expected mam to live which she said six months. Since then mam has picked up quite a bit with no further mini strokes or anything so we are expecting that in three months or so we will have to start again going through the awful assessment process.

    Good luck with your appeal and do not give up.

    barbara h
     
  19. Susi T

    Susi T Registered User

    Jan 12, 2007
    64
    Leamington Spa
    Thanks for your reply Barbara, I did have meeting today with the Ward Manager at the assessment hospital, I had really had enough today, I have read the assessment, and have been liasing with Dad's social worker all the way along. As I am fighting Dad's case on my own, his only surviving relative apart from myself is his sister and although she supports whatever I do she is totally oblivious to the complexities of the wording and interpretation of these reports which I swear are all meant to wear you down.

    Sorry to go on, back to today, I have signed the assessment with the comments that I do not agree with the content and I will send an addendum to the Panel address for Monday. Looking on the black side, if Dad is refused on Monday I don't think I will be able to carry on, it is really stressful and at the moment is taking over my life, however, perhaps today is just an off day to me. I am fortunate that I have the expertise and guidance of Dad's social worker, I know at the end of the day she is covering her bum!!! (Or should I say Social services bum)!!! Between us I think we can put my points across without having to sit down and deliberate over the word "predictable"! I personally think Dementia and predictable are words that are worlds apart!!!

    I will endeavour to do what is right for my Dad.

    SusiXXXX

    I cannot imagine what it is like for a person in latter years who chooses to take this path.
     
  20. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london

    I know what you mean , it’s a terrible state of affairs , my Social worker was telling me that my mother would not get it , because she need to be on drip .
    Then I thought of you how you can’t even get it , so how mum going to get it , challenging behavior or what every , she won’t get it, but am still getting the SW to go for it .

    Don’t give up, don’t let the F%%ker get you down, all you can do is your best & that’s what you’re doing.

    Wishing you all the best of luck
     

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