CHC (Continuing Healthcare) support thread

[nitram]

Just noted

We had an assessor come to do a review which has now been put off till the end of January to see how my mother responds to a change in her medication.

The review date has been changed giving the OP a chance to request a checklist as part of that review.
Change of medication opens up the 'a well managed need is still a need' debate.

 

[stanleypj]

Good point. It's hard to see how her response the medication could actually make any difference to the way her needs are assessed or therefore to the outcome of the review.The need would still be there even if the new med an improvement in terms of treating it.

 

[nita]

Thank you for the replies. Is it the case that a new checklist is completed for every review? I thought they were just going by the original checklist but it makes sense for it to be done again to see if there have been any changes. I get the feeling that the assessor was not going about it the right way. I shall email the NHS CHC people and see if they will send me the checklist - which should have been completed?

 

[nita]

Another problem I have is that Mum's pain has been "managed" over the past year by a team of palliative care nurses, one of whom has now retired. As far as I know, there is no paper trail - at least I have no documentation. I think I should see about getting this as different things have been tried over the past year, without any ultimate success. I have also given feedback to the team on different methods of taking the meds - timing, etc. - and the assessor is querying this as I don't have the evidence for what has happened. Also, she is going by labels on medication given by repeat prescription by our GP in January which has since altered, i.e. it is not taken 4 hourly but as required. She nearly brought me to tears - I felt I was being grilled and the implication was that I had not followed the correct procedures.

I have rang the GP countless times but it never occurred to me to ask for the labelling of the drug to be altered. This should have been the responsibility of the palliative care team but I don't think the doctors take much notice of their letters even when they do write to them. I have had several problems with the GPs not giving medication which has been prescribed or altered by the hospital consultants in the past and needs to be on repeat.

 

[nitram]

I would not stir things about what should have happened, I would just state that you expect a checklist to be completed at the start of the formal review whenever that might be.

A checklist now may be considerably different to one at the end of January or whenever they decide to start the process. Even if end of January is pencilled in it could well be put back because of the Christmas/New Year break causing a backlog of new requests.

 

[nita]

Thank you, nitram. It may be that the assessor was doing the checklist when she was tapping away on her computer. She seemed to be going through the various domains. Should she have been letting me know what scores she was giving?

I feel I had a very helpful assessor for the first assessment, not so much this time. What experiences have other people had?

One good thing, I have just rung the doctor and asked for a medication review so as to get them involved (they tend to say that the palliative care nurses know more about pain control than they do). I can't believe they are actually going to come out and see Mum but I am told someone will ring me to arrange it next week.

Mum isn't exactly at "end of life" but the nurses have been assessing her for over a year as she has such intractable pain.

 

[nitram]

You could try getting an historic medication regimen from the palliative care team and query whether or not they are allowed to change the dosage from a set dosage to PRN (as required) without reference to the prescribing GP.

Also ask for any future changes to be confirmed in writing, maybe email, tell them that you are under pressure from the CCG to justify the dosage you have been giving as it different from the prescription. Leave them to sort that out with the GP.

 

[nita]

Thank you. I am seeing one of the nurses on Monday and will ask her for this documentation.

 

[Worried Nurse]

If I can be of any help...
A checklist is a screening tool to see whether an individual could be eligible and therefore as your mother is currently eligible, I can't see any reason for this being undertaken at all. If necessary following the review the assessor feels it is appropriate, the DST could be completed, by a MDT. The purpose of the review should be two-fold, the paramount concern being whether the current package of care is meeting needs, the second being whether eligibility needs to be re-considered or not. I'm disappointed to hear that it wasn't fully explained and that it left you distressed and anxious. I hope they provide you with reassurance and your mum gets all the help she needs.

 

[nita]

Worried nurse, thank you for explaining the purpose of the review. I get the feeling I was being prompted to say that Mum's needs were now being met or at least should have been, following the suggestions made at the first one. This was to do with trying a new medication regimen. However, the circumstances changed in that Mum was hospitalised after that review - she had opiate intoxication. Since then everything has gone back to square 1. So it is all a bit complicated and I don't think she appreciated that.

It could be, in these circumstances, that the DST needs to be done again. Is it obligatory that this is completed by a multi-disciplinary team or can one person alone carry it out? Sorry, I probably need to recap on the rules. I couldn't find much by googling about reviews after funding has been granted.

 

[Worried Nurse]

The DST can only be completed by a MDT of at least 2 professionals, preferably one health and one from social care disciplines. The only purpose is to consider eligibility. There's no reason however that the assessor shouldn't call a MDT professionals meeting if there have been difficulties meeting her needs. I wish you all the best.

 

[2jays]

I get the feeling I was being prompted to say that Mum's needs were now being met [cut]

A managed need (a met need) is still a need so theoretically shouldn't have any impact on the final decision.

xx


Sent from my iPhone using Talking Point

 

[stanleypj]

On this thread there are links to two petitions which members may be interested in.

 

[AlsoConfused]

Signed both.

 

[stanleypj]

Same here. The Parliamentary one has a long way to go but I think all these attempts to raise the issue are very important.

 

[stanleypj]

I'm posting about this in case anyone else has/has had a similar experience. I am just in the process of getting reimbursed for the several thousands that I've spent on care whilst waiting for the CHC Personal Health Budget account to be set up and for money to be paid into it. The accountant who administers the account has just informed me that once she has made the repayment this week the amount left in the account will be considerably less than she believes it should be. She thinks an error has been made and that the amount that has been paid into the account for the first period (they obviously don't pay the annual amount all in one go) is simply wrong. She and others are on the case and I expect it will be sorted out.

But, as you may imagine, it's just another little worry. I always feel that we are very fortunate compared with many who are equally deserving. But it's certainly not plain sailing. I can see the possibility of my having to revert to making payments from our own funds (and then asking for another refund), given that everything takes much longer than it's supposed to and the PHB was only finally set up when I asked why it was taking so long. I can't help wondering how people who are not financially secure manage.

As it happens, I've been quite conservative in the way I've spent money so far and all the advice has been to go for as much as we need and make a case if needs increase.

 

[nitram]

"I can't help wondering how people who are not financially secure manage."

No idea, but I think it is worth pointing out that the problem only arises with a PHB and care at home.

The majority of people awarded CHC are care home residents and not directly involved in any cash transactions. It is the care home that suffers from the late payment which inevitably leads towards increased fees and unless the CCG and LA increase their tariffs it is self funders and those paying LA top ups who will suffer.

 

[stanleypj]

Thanks nitram. As it happens, I just heard a news item about the prospect of LAs not being able to pay even the current fees and this despite the claimed 2% increase in council tax they can now make. It was suggested that eventually self-funders might revolt (not sure how) when the bill they are picking up continues to increase.

The accountant has just got back to say that the CHC people have acknowledged that they have messed up the funding and will pay the outstanding amount in January.

 

[AlsoConfused]

The accountant has just got back to say that the CHC people have acknowledged that they have messed up the funding and will pay the outstanding amount in January.

Now why doesn't that surprise me?

I believe the statutory deadline for processing CHC claims is 29 days and it's achieved in 5% cases

 

[Fluffyval]

Recent CHC DST

Hi, my OH was assessed in November 2015 by Bradford MDC (LA) as possibly requiring CHC funding after I asked for him to be reassessed under April 2015 regulations. (Previously he was DSTd in hospital in April 2015 and refused full funding although he got funded nursing care (FNC))

He got A in behaviour and A in cognition so was deemed eligible for NHS full funding by 28th but I still do not know whether or not he will get funded for one to one care. I do know that Bradford CCG have a system of three levels of NHS care and that my OH has been assessed as needing the 'highest' level (c£800).

I cannot find any details about levels of CHC funding, only that if someone is assessed as needing full funding they will have the necessary care, including social care, paid for by the NHS. Has anyone else heard of these levels please or is it a Bradford thing.

Thanks