1. Expert Q&A: Living well as a carer - Thurs 29 August, 3-4pm

    As a carer for a person living with dementia, the needs of the person you care for will often come before your own. You may experience a range of difficult emotions and you may not have the time to do all the things you need to do. Caring can have a big impact on both your mental and physical health, as well as your overall wellbeing.

    Angelo, our Knowledge Officer (Wellbeing) is our expert on this topic. He will be here to answer your questions on Thursday 29 August between 3-4pm.

    You can either post questions >here< or email them to us at talkingpoint@alzheimers.org.uk and we'll answer as many as we can on the day.

CHC (Continuing Healthcare) support thread

Discussion in 'Legal and financial issues' started by stanleypj, Sep 22, 2015.

  1. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
  2. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    The reviewer will have applied the principles of an initial Checklist assessment for NHS Continuing Healthcare to ascertain whether or not your claim warrants further investigation. Assuming it does, the reviewer will complete a document called a Needs Portrayal and should then apply to your case the eligibility criteria contained in the Decision Support Tool form. This is the form used in all full assessments for NHS Continuing Healthcare funding.

    http://caretobedifferent.co.uk/retrospective-claim-for-care-fees-rejected/
     
  3. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    Is that filled in by the panel? So the Needs Portrayal Document does now show recommended ratings?

    In 2009 seven domains were rated as low or no needs. I've phoned to ask what the breakdown between them was and am waiting for a call back.
     
  4. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    No experience of retrospective claims but I believe that a 'needs portrayal document' should list the person's needs at the retrospective review date for consideration by an MDT using the DST.

    You have to argue these retrospective needs on the grounds of historic evidence and then ensure that the DST is correctly implemented.
     
  5. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I've had a callback and it seems that the previous Decision Support Tool showed breathing, behaviour, skin integrity and psychological and emotional needs as no needs and altered states of consciousness, nutrition, drug therapies and medication as low. At the time of this assessment she was bed bound, doubly incontinent, and couldn't feed herself. If it wasn't for the ratings on cognition and communication I would have thought they'd been reading someone elses notes!
     
  6. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    Using evidence from contemporaneous care home documents, and any other sources, what DST grades would your consider to be correct?

    Do these grades significantly differ between the 2009 and 2016 versions of DST, read the appropriate notes/guidelines when doing this.
     
  7. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    The needs Portrayal Document does refer to care home documents and I will be going through them to find the context of those quotes and if there's anything I can add. There is no reference to hospital records but I think it's possible that she wasn't admitted to hospital in the last 15 months but will also check that.

    It's frustrating trying to do this without being able to see the NPD or DST for the previous assessment.

    I'm not confident of a positive outcome, given the ridiculously short deadline we are working to. However, if we do have to appeal we will already have done a lot of research and will hopefully be able to access all the relevant documents.

    As far as the grades are concerned, I don't think there are any domains where 'no needs' should apply. However, I realise that I have to provide evidence of that.

    Thanks again for your help.
     
  8. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    Any notes of GP visits?
     
  9. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    Yes, but minimal. For the period in question (June 2009-September 2010) the GP came out on a few occasions, the last one being 10 days before her death. There are a few references to these visits in the NPD, so will check those against the GP records.

    I had sorted most of the paperwork into folders by type - care home records, hospital records etc. However I am now going to extract everything prior to the dates under consideration and put it to one side until such time as it is needed.
     
  10. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I've spent most of the afternoon going through the hospital records. I can't find anything for the 15 month period that is being assessed, so it may be that she had no admissions in that period.

    I have, however, found a page of somebody elses hospital records, which isn't good!
     
  11. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    The care home should have a record of any transfers to A and E and/or admissions.
     
  12. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    #492 noelphobic, Aug 24, 2016
    Last edited: Aug 25, 2016
    I've got a feeling that she didn't go to hospital in that time frame but will check the nursing home records tomorrow.

    They've given us 10 days to respond and I think 10 weeks would be more realistic!
     
  13. Ihtl

    Ihtl Registered User

    Jan 19, 2016
    83
    Does anyone here have any experience hiring/working with a solicitor for this process? I've seen it mentioned several times by people (with varying levels of success) and I'm unsure if it's a route we should head down. And if it is, when we should look to hire a solicitor, exactly what it is they could help with?

    Can anyone offer any input?
     
  14. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    "... when we should look to hire a solicitor, exactly what it is they could help with?

    Can anyone offer any input?..."


    From previous posts I think you are soon to undergo the DST process, to help with this you would need to instruct a very specialist solicitor.

    The help you need does not need a solicitor, you have to be convinced of the need to collect evidence of your Dad's medical needs in each of the domains. You are in the best position to do this.

    You then need somebody conversant with the process to attend the meeting and, as a person with no emotional entanglement, argue your case in detail.
     
  15. Kaatt

    Kaatt Registered User

    Sep 5, 2016
    9
    #495 Kaatt, Sep 9, 2016
    Last edited: Sep 9, 2016
    Hi, my dad had a DST assessment done in hospital 8 weeks ago ( he is still there). He has been awarded nursing care funding but refused CHC. He is completely bed bound, needs 24/7 care, stage 3 kidney disease and high risk of aspirating.... He is currently on IV antibiotics... About his 10th dose in last 5months. How does one qualify for CHC? When he is medically fit he should be moving to a nursing home.
    Any advice would be greatly appreciated.
     
  16. Ihtl

    Ihtl Registered User

    Jan 19, 2016
    83
    Thank you Nitram, I'll take this all on board.
     
  17. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    "How does one qualify for CHC?"

    Assuming England or Wales.

    By establishing a primary medical need.

    This is usually done by scoring either a priority need or two severe needs in the matrix on p12 of the DST tool, a primary need can also be established by a single severe and a host of other medium or high grades and a lot of argument often based on interdependence. Exceptionally several high grades can also qualify.

    If you do your own scoring in each of the domains applying the criteria on p23 onward what scores do you get? How do these compare with the scores awarded at the meeting?
    When assessing the needs only use information that you can support with evidence from health records - GP, care home, hospital,carers,...

    >>>DST TOOL<<<https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/528272/Decision_Support_Tool_Amended.docx
     
  18. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    Hi Kaatt, First question is who did the CHC Checklist, what evidence did they rely on and were you able to contribute to the assessment?

    Our experience was that the hospital CHC Checklist on Mum was done by a generalist nurse on his own, without any family input, and done so badly that the official CHC assessors threw it out.

    The official CHC checklist was better done but the nurse assessor reached some bizarre decisions on Communication etc that we challenged.
     
  19. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    #499 nitram, Sep 9, 2016
    Last edited: Sep 9, 2016
    "Hi Kaatt, First question is who did the CHC Checklist..."

    It does not matter who did the checklist because Kaatt said "Hi, my dad had a DST assessment done in hospital 8 weeks ago..." meaning that the checklist decision was a full DST assessment.

    It is the DST process and decision that has to be appealed against.
     
  20. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    You're probably right nitram but wouldn't the DST be largely based on the CHC checklist?

    If the "foundation" has been incompetently done then surely there's a risk that the DST team won't have realised some / much of the factual material on which they're basing their decision is actually wrong / incomplete?
     

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