CHC Assessment

[AndySW]

Hello

My first post here but just to say I have found the information on this site and on the forums very helpful. So a big thank you to everyone who has contributed

Mum (who we have recently moved to a Residential Home bless her) has just had a CHC assessment using the DST, overall I think the scoring was about right. I don't know much about the process but I have emailed the CHC support group on this site to ask advice on whether or not it is worth the torturous processs of appealing . (I suspect not in Mum's case but I'll wait to here back.)

Anyway, maybe this has already been done somewhere else but I thought it might be rather useful to build up a record of assessment scores along with the decision, whether the case has been successfully appealed etc. This might be useful for people appealing their case.

Here were Mum's scores along with the decision below.

Scores
Behaviour – Normal (I agree with this – mum is very placid luckily)
Cognition – Severe (I agree with this)
Psychological Needs – Low (Not sure, expected this to be higher, but I am not sure what they look for)
Communication – High (I agree with this)
Mobility – Medium (Expected a high here but I probably don’t know enough about it, some days Mum won’t walk or needs 2 carers to move her to another room, other days she uses a frame with one carer helping her)
Nutrition – Food and Drink – Medium (I agree with this)
Continence – Medium (I agree with this)
Skin – Medium (I agree with this)
Breathing – Normal (I agree with this)
Drug Therapies and Medication – Medium (I agree with this)
Altered States of Consciousness – Low (Probably right but not completely sure)
Other Significant Care Needs – Not discussed

Decision Summary:
Mrs X requires twenty four hour care in a residential environment. She is severely cognitively impaired and cannot make any decisions or choices for herself. All her needs are anticipated. She requires the assistance of one or two carers for all activities of daily living and mobilising. She needs feeding all diet and fluids, is doubly incontinent, has vulnerable skin integrity and all medications administered. There is no regular community nurse/RGNinvolvement. Senior carers and managers monitor and review her needs on a regular basis. Mrs X's cognition has deteriorated rapidly over the past two to three weeks, she no longer recognises her sons or has any interest in the world around her. However, her needs are not intense, complex or unpredictable and are well managed within a residential home setting. She does not appear to meet the eligibility for NHS continuing healthcare at this time.

All the best
Andy

 

[BeckyJan]

Hello Andy:

You have done well to keep this record .

Even if an Appeal is not thought worthwhile now you must keep an eye on things and at any time you can ask for a further review/assessment. Please record anything you think is likely to contribute ie. falls (as this will increase the mobility rating).

Let us know how you get on.

 

[florence43]

Hi Andy,

You have very much done the right thing in keeping these records, and I wonder, actually, whether it is indeed worth appealing.

One of the two most important tips I got from Talking Point about the CHC assessment was the phrase : "A well-managed need is still a need". I quoted this at least once in mum's assessment. It really sums up the basis of the funding. The principle behind CHC is that the NHS pay for treatment of health needs, including care home fees. No doubt your mum has paid taxes all her life to support her health needs throughout life...childbirth, operations, x-rays...all of it funded by the NHS. She now has dementia, which is a disease of a pretty vital organ: the brain. It's a brain disease, and it brings with it very serious health needs. Whether they're managed well by the staff is neither here nor there in terms of funding. The needs are still high, and they bring with them high risks to her health.

The second thing I learned was that it was ok to disagree. I'm not sure if you were present for the assessment, but I urge anyone who's got one coming up to be there. Much of the framework is based on interpretation and semantics, on actual written sentences/descriptions set out in categories. My mum was inbetween two categories on more than one occasion, and I had be warned that when this happens it is accepted and expected that you ask to have it noted that the family member disagrees. My sister and I attended, we discussed why we disagreed with any one score and if the assessor still wouldn't budge, we politely asked that it be noted that we disagreed and the reasons why.

Your mum's scores don't sound unlike my mum's and the only difference was that my mum couldn't stand at all, and she was doubly incontinent, but I have to say I was troubled by the assessor's conclusions and scores. I wasn't too hopeful and was ready to appeal before leaving the meeting! However, she got it first time. And so she should. My mum needed 24 hour care. She was totally dependent on others for her daily needs. She wasn't aggressive and she could breathe fine. But she had a terrible brain disease. If she'd broken her arm, the NHS would pay for her treatment. If she had a heart disease, the same. Why not a brain disease?

I think you should consider an appeal, or at the very least, monitor all the scores and how they change in your mum then get the assessor back out when they change for the worse.

And definitely be there if they do another one...ready with disagreements, and a little skepticism!

Best of luck

 

[AndySW]

Thank you both for the encouraging words, you make some very good points. I was indeed at the assessment, what a tiring process! I argued a number of the points and managed to get them increased in a couple of cases, but mostly I just seemed to annoy the nurse taking the assessment

Once I have recharged my batteries (selling mums house also, nightmare!!) I will consider an appeal. You make a very good point about dementia being a disease of the brain.

I'll send an update if I learn anything that I think might be of use to anyone

All the best and thanks again
Andy

 

[florence43]

Good for you, Andy!

Sounds as if you did the most you could anyway. Sorry, I didn't realise you were there too! I know the feeling about feeling like an irritation in the meeting! Our poor assessor could barely get a word out before I butted in with an "alternative take on the matter"!

Do re-charge! I know the pressures, and you need to look after yourself too.

Any more advice or help...you know exactly where to come!

Take care!

 

[Saffie]

Were these scores those given by the nurse when completing the assessment or the final ones given by the PCT? I ask this because I agreed with every score given by the nurse - and they were , in the main, higher than these, - but nearly every one was downgraded by the PCT. My husband also has multiple physical health problems as well as the Dementia.I didn't challenge the decision as their letter told me that i could complain about the process (which I agreed with ) but not about the conclusion!

I wish you luck!

 

[Contrary Mary]

Hello Andy and welcome to TP.

My mum was recently assessed for CHC funding and received it, even though she was at home at the time. Sadly, various problems occurring more often mean that it is now beyond me, even with a lot of help, to keep her at home with me on my own most of the time.

I have to say I had a very good and sympathetic assessor.

The first thing that she said to me was to tell her how it was on a bad day. With what you say about her mobility, this might be a domain that is underscored, although my Mum only rated a moderate (at the time) and could barely move, even with two carers.

The second thing the nurse said was that it was not impossible to get CHC at home even though at the time Mum didn't have the district nurse or anyone calling regularly. It just made it a bit more difficult to make the case.

Mum's scores were one severe (cognition), 3 highs and 6 moderates.

With Mum's lack of cognition, psychological needs were difficult to assess but they took into account her long history of depression and anxiety, and that she is on medication.

With altered states of consciousness, they took into account that she has vascular dementia and has had a few fits over the years because of this.

Apart from the summary, have you been supplied with the assessment of each domain? Also, have you got any correspondence from any medical person which might help. I gave Mum's assessor copies of any correspondence I had to back up what I was saying. She also saw that I kept quite detailed notes of Mum' s condition and frequently quoted from them.

And, of course, it is, sadly, a degenerative condition, so don't give up.

Hope this helps
Mary

 

[geum123]

Hi Andy,
I'd also say don't give up.

I also would have said that if your Mum has Severe in Cognition and High in Communication she should have High in Psychological Needs as her needs will need interpretation, therefore intense and complex needs.

I found it helpful to note down what would happen if needs weren't met.
In this instance, depression, possible social isolation.
Good luck.

Geum xxx

 

[AndySW]

Were these scores those given by the nurse when completing the assessment or the final ones given by the PCT? I ask this because I agreed with every score given by the nurse - and they were , in the main, higher than these, - but nearly every one was downgraded by the PCT. My husband also has multiple physical health problems as well as the Dementia.I didn't challenge the decision as their letter told me that i could complain about the process (which I agreed with ) but not about the conclusion!

I wish you luck!

Hi

They sent me a copy of the completed DST that we did with Mum, it was word for word what I was expecting. I am not too sure of the process, so maybe this document at this stage is just the nurse's opinion and like yourself, when it goes to the PCT panel they will have a super time downgrading it a little more!

It is a real help to be able to vent frustrations to others who have had the same experiences.

All the best
Andy

 

[BeckyJan]

Have you heard from the Volunteer Support Group yet, Andy? I am sure they will help you through any Appeal process, they were excellent with me.

 

[Tilly_Mint]

Chc?

Hi
sorry if this is in the wrong place but we are new to all of this. Can I just ask what is a CHC assessment. My F in Law is in, what we thought, is a temp care home after being in hospial and now they are talking about selling his house and him staying there. Is CHC something we should ask about? He doesn't want to be there, he keeps asking to go home and, with a decent care package we are cconvinced he could manage.

 

[BeckyJan]

Hello Tilly Mint:

Continuing Health Care is when the PCT pay for all care because the person's health meets the necessary criteria. It is very complicated but you may find this factsheet helps you to understand 'who pays for care':
http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=125

In fact we usually advise people to ensure that an assessment is done prior to a sufferer leaving hospital. If you feel he may meet the needs then please ask for an assessment - the SW is usually (but not always) the first person to arrange such an assessment.

Once you have familiarised yourself with the Factsheeet we can give you more information about the Checklist and Support Tools which are used to determine the level of need.

Best wishes