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Applying for NHS Continuing Health Care

Discussion in 'I care for a person with dementia' started by Nancyf68, Aug 16, 2015.

  1. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    My dad has mixed dementia and has been in a CH for the past 15 months. Recently we were advised by the care home that he would require nursing care due to his challenging behaviour and that we should now apply for NHS continuing health care due to his needs. SS have completed their assessment and put him forward to NHS who will be completing another one this week. Can anyone give me any advise on this? Dad was falling frequently until this week when he has been unable to get out of bed and he is frequently aggressive.
     
  2. Patricia Alice

    Patricia Alice Registered User

    Mar 2, 2015
    179
    We failed to get CHC for mum, our meeting was last Friday, my sister attended because I was at work. We was put forward for it by mum's psychiatrist / CPN. My sisters had to fill in a questionnaire about mum and then scored into categories (I believe). Mum scored 2 moderate and one bad and no severe as the nursing home she is in can cope with her behaviour as she can still walk, talk and feed herself.

    If you dad is has major problems in walking, dressing, washing, feeding, aggressiveness then he may qualify. It is worth going for it as you may be OK.
     
  3. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    Thank you for responding. Dads care manager completed his first assessment 3 weeks ago he scored 4 severe 4 bad and 3 moderate out of the 11 questions. Since then he had lost the ability to stand (although we are not sure if this I temporary due to a TIA). I'm not sure whether this latest development wil go against him as one of the severe was risk of falls.
     
  4. canary

    canary Registered User

    Feb 25, 2014
    9,337
    Female
    South coast
    To get CHC you need 2 severes, so if it looks like he would have got 4, then if the one for falls is downgraded due to less risk of falls, that still sounds like you have a good chance.
     
  5. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    They marked down 3 of the 4 severest to highs. Very frustrating as we're basically making recommendations on what he needs but saying not severe unless they are in place! Everyone agreed that he needs one to one care and to stay where he is but the only way to do that is through NHS CHC! It is going to panel next week but they didn't seem hopeful.
     
  6. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,963
    North East England
    There is only on phrase which springs to mind and bears repeating..... A MANAGED NEED IS STILL A NEED.

    I've put this into shouty capitals so that you can put it into shouty capitals to the CHC panel.:D
     
  7. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    You can argue whether the down-rating was justified.

    I've downloaded the NHS Continuing Health Care Checklist and Decision Support Tool and done my own scoring of Mum on it. I'm gathering objective evidence now to support those scores.

    The evidence for us includes:-

    - the hospital's own detailed Nursing Care Needs Assessments (I asked for copies). These alerted us to problems we'd coped with without being fully aware of them and the fact that Mum had had falls even in the safe hospital environment while she was being attended by a carer or nurse every time she moved out of her chair or bed

    - the paid carers' records at home listing self-harming, non-compliant, occasionally violent behaviours

    - Mum's recent admissions to hospital because of falls and bowel and urine infections

    - the number of medical appointments and checks made because of UTIs and the difficulty experienced in clearing these infections

    I'm in the dark about how full my evidence has to be. I also don't know how the provisional diagnosis of basically inoperable - but possibly slow-growing - will affect the decision. A worry I'm not even prepared to think about yet is whether any nursing home within my frail Dad's reach by public transport would accept someone with the high attendance and care needs that my Mum has.

    Call me naïve but I was surprised no-one mentioned that Mum might be entitled to NHS funding of her care at the Best Interests meeting in hospital. Even the Social Services representative didn't mention it. The impression the family was left with was that as Dad thought they'd enough money to self-fund the only possible outcome was for us to fund Mum's care down to the level at which Social Services funding kicked in.
     
  8. canary

    canary Registered User

    Feb 25, 2014
    9,337
    Female
    South coast
    Thats really bad AC [​IMG]
     
  9. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,561
    North West
    #9 stanleypj, Aug 21, 2015
    Last edited: Aug 21, 2015
    I started a thread on CHC recently:

    http://forum.alzheimers.org.uk/showthread.php?84449-Prof-Luke-Clements-Continuing-Health-Care-Lecture

    It might be of interest. Whether you get it or not seems to be a bit of a lottery but it's well worth looking into and trying to prepare for, particularly if the people putting the case forward do not sound confident.

    Please feel free to PM me with any questions as you prepare for the meeting. I am in no way an expert but I have learnt a little about the process.
     
  10. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    THANKS Stanley both for the link and offer of advice. I'm very grateful and will PM you after we get the results of the CT scan Mum's having on Monday.
     
  11. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    Thanks for the sympathy, canary. I've no idea about the motives for not telling us about CHC - those at the meeting may not even have thought about the possibility - but I was disappointed they didn't.

    The fees at the only nursing home Dad can get to are £1200 a week!
     
  12. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    Thank you Stanley. We have been told that we cannot attend the panel meeting on Wednesday but that a senior social worker will be there. I called again on Friday as felt very much that the original reason for requesting CHC was lost by the person carrying out the assessment. In short the reason for requesting was that the CH could not managed dad there as things stood. ALL agreed that it was best for him to stay there as a move would be detrimental to his health and that he needed one to one care but they could not recommend CHC for it! Will just have to see what happens next and prepare for an appeal!
     
  13. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,561
    North West
    Don't quite understand. Were you present at the first meeting? Was it the one where various people who know about your dad go through the Decision Support Tool and make a recommendation to the NHS?
     
  14. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    Yes the last meeting included the care home manager, social services care manager, CHC team and the family. Apparently the CHC team would normally put in a recommendation at the end of the meeting which they put forward to panel. However the assessor stated she felt it was too close to make a judgement and would refer it to a senior officer before submitting to panel this Wednesday.

    One thing they said they would like to see if some form of sedation for dad when he becomes challenging. This has been discussed with his GP who refused as would increase the chances of falls, also the ch staff are not qualified to give injections and would have to call in district nurses each time!
     
  15. katek

    katek Registered User

    Jan 19, 2015
    191
    Hopefully the panel will take notice of the GP, and as you say, the ch staff are not qualified to give injections anyway. The answer is a more suitable placement with specialist dementia staff, ideally funded by CHC.

    My father has challenging behaviour, and after many months in an assessment unit, he was moved to a specialist NHS Unit with a staff ratio of 1-3. The staff are either mental health nurses or dementia trained carers. It is so much better the dementia residential home where he was self-funding until they could no longer cope with him once his behaviour became more severe. Because it is an NHS unit, all the patients receive CHC in order to be there. My father scored his two Severes in Cognition and Behaviour, but it is the latter in which it is very hard to prove the difference between 'High' and 'Severe'. I hope your father's needs will be sufficiently recognised in order to secure CHC, and that more suitable care can be found for him.
     
  16. katek

    katek Registered User

    Jan 19, 2015
    191
    #16 katek, Aug 23, 2015
    Last edited: Aug 27, 2015
    The motives are money, sadly. CHC is a potential massive cost to the NHS, so they try to avoid it wherever possible. However, most people do at least get a chance to be put forward for the assessment -skewed as it is in the NHS' favour - but in your case you were not even informed about what is your right by law. That is outrageous and deserves to be taken further - your local MP perhaps.
     
  17. Nancyf68

    Nancyf68 Registered User

    Aug 16, 2015
    14
    Thank you Katak. I will contact SS again tomorrow and make them fully aware of what the GP has stated. It sounds as if the type of place your father is at would be ideal but I'm not sure there is one close by where we live. one of the reasons they have stated he was high rather than severe on behaviour was because the ch said they can leave him and try again later and that although he frequently had to miss scheduled personal care this was probably about 3 times a week. We were then told mark down as not everyday! Leaving him everyday as I'm sure anyone would agree would be neglect!!

    Having just watched a lecture on u tube mentioned earlier in this thread it would appear they cannot turn him down on the basis of only getting one severe and that the assessment should not be used to "score" the patient. Worth watching.
     
  18. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,561
    North West
    Yes, it should not be a mechanical totting up of scores.
     
  19. katek

    katek Registered User

    Jan 19, 2015
    191
    The fact that your father is having to miss personal care should be counting in his favour, not against him!! My father's moods vary but when he is bad he can need up to three people for personal care e.g changing his incontinence pads, and because they are skilled they can do it. Leaving someone is unacceptable and could have a detrimental effect on other areas of his health e.g skin breakdown. You should raise that point at appeal if he does not get CHC.

    And your point about only scoring one Severe is true as well (I have both seen that video and read a lot around the subject). Pamela Coughlan would not have even scored one Severe!!! CCGs bank on the general public not knowing anything about the legal background (and let's face it, why would we until we're actually involved with CHC and research it?) - and use this to their own advantage. It is up to us to fight for our relatives on their behalf.
     
  20. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,561
    North West
    Absolutely right katec. We were lucky in that the members of the panel all seemed to have decided already in Sue's favour but I was still glad that I had prepared for it as well as I could, in my circumstances, so that I could have made the case myself if I'd needed to.
     

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