CHC (Continuing Healthcare) support thread

[nitram]

The checklist has 3 possible outcomes, no action, award FNC, assess for CHC via a DST.

If the result is a DST the panel assesses all the evidence anew and in greater detail.

" ...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?..."

This is possibly a basis of an appeal against the decision, it has nothing to do with the evidence used on the checklist, the checklist is history the resultant DST is what matters.

 

[Kjn]

I have another dst meeting to attend , the nurses feel dad needs residential care and according to their discussions he could qualify for the nursing element .
What does that mean? Nursing care rather than CHC paid for by nhs.

Previous dst at different hospital just wanted to send him home.

With last meeting we had no idea was dst and what was involved, the result seemed set for what they wanted .
I'm not sure how to handle this one.

 

[Kaatt]

Thank you for your reply, I will go through the paperwork with family. Any advice is always welcome.

 

[nitram]

"...the nurses feel dad needs residential care and according to their discussions he could qualify for the nursing element .
What does that mean? Nursing care rather than CHC paid for by nhs..."

They are probably referring to FNC (Funded Nursing Care)

https://www.gov.uk/government/news/nhs-funded-nursing-care-rate-for-2016-to-2017

 

[Kjn]

Thanks nitram
Do you know if there is a list? Or something to show what would qualify someone for fnc.

 

[nitram]

If an assessment does not result in a primary medical need but indicates that the person has nursing needs of a type and/or level that cannot be met by the district nursing service FNC can be granted to enable the person to receive residential nursing care.

https://www.gov.uk/government/uploa...unded_Nursing_Care_Best_Practice_Guidance.pdf

 

[Kjn]

Ah, thanks nitram . What a star you are.

 

[Ihtl]

The GP called a couple of weeks ago to arrange an appointment after "receiving papers from the council". We had the appointment today and it was all related to the CHC assessment. He asked loads of questions and said he'd send the form back to the CCG along with copies of some of the letters from the consultants.

Seems we're slowly inching towards the DST process.

 

[Kjn]

Well it's a start lhtl

 

[Ihtl]

Well it's a start lhtl

It is. I'm trying to put together some statements from the carer agency and the day centre that he used to attend as well.

 

[mydiamondmum]

.

Advice please. I am preparing a case for another check list. I want to make sure that I am understanding this at would appreciate any comments or guidance.

As I understand it the crucial thing is whether their needs come under nursing care or social care.

For example my LO is in a care home as she has Alzheimer’s and was admitted to hospital 12 times in a 6 month period due to self-neglect mainly because she is unaware of her illness would not accept carers at home and would send them away.

She would not look after herself with regard to washing eating drinking as she thought she was doing these things but wasn’t. Also as she often thinks she is many years younger than her age would go out without a walking stick and have a fall.

She is also in danger of being taken advantage of financially. Making multiple donations to cold callers and on one occasion she went to the bank with a neighbour in the pouring rain in her slippers drew out some money unnecessarily and the money was never seen again. The council has informed me that she doesn’t have nursing needs but surely she does if it is dangerous for her to live by herself due to self-neglect and the refusal to allow carers in. I think that the reason the LA say that she doesn’t have nursing needs it so that they can set the amount they will pay for a care home lower.

It would not be safe for her to live at home on doctors’ advice, and that is because of her illness Alzheimer’s. Surely if she needs to be in a care home because of her Alzheimer’s that mean she needs nursing care? Or am I missing something?

Also she has bad leg and foot odemas that require applying cream and bandages age she needs a nurse to do this.

Any comments appreciated even as to what arguments they could use to against this apart from the obvious that it is now managed as she is in care home but that I do not accept as ‘The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS continuing healthcare eligibility.”

 

[nitram]

"Surely if she needs to be in a care home because of her Alzheimer’s that mean she needs nursing care?"

Not if all she needs is help with daily living, this does not require a nurse to be available 24/7. The district nurse can visit to do the ongoing dressing of wounds.

If a healthcare need is managed to the extent that the management has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required the need does not score in the DST.

The crucial thing is to prove a primary medical need
This is done by assessing medical needs in each of the domains on the grounds of complexity, nature, intensity, and unpredictability.

You need to work through the first the check list and then if you think you have a chance the DST. Remember you have to have evidence to back up your scores.

 

[mydiamondmum]

Thank you for your reply nitram. I know it is no easy task but hopefully I will be better prepared this time and I do have a lot more evidence as I now have the hospital records and will apply for the social services records.

I see your point about the district nurse for the Oedemas and if it was just that then certainly that can be treated at home.

My LO was one of the most independent people you could meet and was still going swimming every day in her early 80's but once the Alzheimer’s really set in she is no longer mentally safe to look after herself due to the Alzheimer’s which is an illness and therefore as an illness that affects your mental state to the extent that you are not safe to live alone then surely that is a nursing care requirement?

That's what I can't quite get my head around.

But as you rightly say you need evidence and hopefully I should be able to produce document evidence. It will be documents prior to the care home admission as the CH notes are appalling illegible, contradictory and slap dash.

 

[nitram]

"...an illness that affects your mental state to the extent that you are not safe to live alone then surely that is a nursing care requirement?"

If you had the time to look after her and keep her safe could you?

Are you a trained nurse?

A carer, preferably with dementia awareness training, is all that is required.

EDIT

It will be documents prior to the care home admission as the CH notes are appalling illegible, contradictory and slap dash.

Make sure you have them all to hand.
They might pick on one of the contradictory entries, you can then quote the contradictory statement.
If the notes are that unreliable you can also argue that they should be ignored if they seem to be winning

 

[mydiamondmum]

Thank you nitram,I will note what you said about making sure I have it all to hand.

As for your questions, my LO had a small 1 bedroomed council flat. I put it to the LA at one stage that if they provided her with a 2 bed then I could possibly move in to take care of her. They were not prepared to do that and I am not of an age where I can make do with the sofa I have my own health issues. She could not live with me as my accommodation as it is entirely unsuitable for her.

No I am not a trained nurse.

When you say that ‘A carer, preferably with dementia awareness training, is all that is required.’
Yes that would be fine if the carer was staying overnight which is her most dangerous time. I don’t know if that council provides such a service and if they did and got her suitable accommodation to facilitate the carer staying overnight then that would indeed be a solution.

When I say the most dangerous time I mean that at night when she was alone she would get very distressed as she couldn’t remember when she last saw someone or what day/month/year it was or why she was feeling pain from her arthritis and how old she was or what her life story was. She would say she was fine when I phoned her but late in the evening she would end up calling the police or an ambulance or just going to hospital.
So all very complex.

 

[jaymor]

If your LO is thought to need residential care within a home then an assessment will determine what type of home.

If a nursing home is needed then there is NHS Funded Nursing Care at present around £112 per week if I remember right. Again payment will depend on the assessment made. This is paid to the nursing home.

To qualify for Continuing Health Care is far more complex and far more health needs than you mention have to be present. It is worth checking to see if you feel there are more health needs than you mention.

 

[nitram]

My meaning was that a carer, not a nurse, in a residential setting may be sufficient, you haven't as yet said anything that indicates a nursing home would be required.

Funded Nursing Care (FNC) is currently £156.23/wk paid directly to the home, the fee quoted by the home may be discounted by this amount. There is an incentive for the home to quote the full cost and then discount it by the FNC as the FNC could reduce next spring leaving the resident to pay the reduction.
https://www.gov.uk/government/news/nhs-funded-nursing-care-rate-for-2016-to-2017

The requirement for FNC is one outcome of the CHC checklist, others are do nothing, assess for CHC using DST.
https://www.gov.uk/government/uploa..._data/file/213141/NHS-CHC-Checklist-FINAL.doc

The flowchart for the whole process is:-
http://www.iewm.net/wp-content/uploads/2012/10/12-09-24-updated-CHC-flowchart-for-PCTs.pdf

It's an old but still valid chart, for PCT read CCG.

 

[mydiamondmum]

Thank you Jay and Nitram for your help and advice.

It is all a bit too complicated for me. My LO's LA has not provided me with any information and doesn't seem to be aware of any of the government guidelines themselves, there is an ombudsman case pending about this.

Fortunately I have found help on this forum and Alzheimer's Society help line and other orgs and I have an advocate from Carers UK who is helping me prepare a case once I have got all the notes together.

 

[Kjn]

Due to dads recent behaviour issues and having twice gone through the checklist and one dst, the social worker is now asking for a new checklist to be done , round 3 .

 

[jakiflora]

wandering

My Mums mdt meeting for chc is on wednesday. Been waiting since GP completed checklist on 18th July. Not quite within 28 days!
Mum has been self-funding in EMI Residential carehome for two years. She was wandering miles from home, night and day, and was considered to be in great danger.
Since she is still mobile and still tries to get out of the home I was wondering if this could be used in the behaviour domain. She is kept under a DOL in a locked facility, but could I argue that this is a managed need?
Sadly she is now doubly incontinent, has no cognition or speech.