CHC (Continuing Healthcare) support thread

[nitram]

FNC can only be paid to a registered nursing home, it is paid direct to the home.

 

[Louise7]

I think one issue could be that the social worker put a plan in for care at home with 4 visits a day.

However this was not working for my dad of 85yrs who has lost weight because of the stress so as a family and with my mum's agreement it was decided that a nursing home would be best.
At the time of the CHC assessment I was asked what the current arrangements were so it may be that they will argue that nursing funding is not applicable?
even if I agree with the scores given do you think I can appeal on the basis of nursing funding?

I'm a bit confused - you mentioned in an earlier post that 'money is no issue', so why is a social worker involved? If your Mum is self funding and you think that she needs a nursing home can you not place her there yourself? Once she's been in the home a while you could request a new CHC assessment and she will probably be much more likely to qualify for FNC then as the staff will be able to evidence exactly what her care/nursing needs are and help you through the assessment process.

The way that the CHC appeals process works is that the appeal needs to be in respect of the CHC eligibility decision and you could spend months going through what can be a tortuous and lengthy process and still not get an eligibility decision in respect of FNC. It's possible to receive an FNC eligibility decision whilst not actually in a nursing home but it will only be paid when in a nursing home, and as has already been mentioned it is paid directly to the home.

There's nothing to stop you submitting an appeal but you can place someone in a nursing home without them being in receipt of FNC, and then submit a claim later - nursing homes are happy to take in self funders whether they are receiving FNC or not.

 

[nitram]

A nursing home will take a self funder and if they decide the level of nursing required is high enough will ask for a check list to be performed, if FNC is awarded the home will get the funding as a contribution to the nursing care, it is extremely unlikely the fee you are charged will be reduced.

 

[Shedrech]

ho @ancistrus
you did mention that 'we will pay' ... however, fees should be paid only from your mum's finances ie her income and savings/assets plus half any shared savings/assets .... and if those are below a certain level, the Local Authority will begin to contribute, but only for a care plan they have agreed (and they have a policy to keep someone in their own home if at all possible, with, generally, a maximum care plan of 4 home care visits before they will agree a move to residential care) .... this may be what is involved as you mention Social Services and that your family arranged the move into residential care and chose a nursing home

Paying for care and support in England

Paying for care can be worrying to think about. With the right information and support, you can better understand your options and make the right decisions for you. Read the different ways to pay for care, and the amount you might be expected to pay.

www.alzheimers.org.uk

if a family want

if a family want more than the LA agree to, then possibly the payment of third party top-up fees can be arranged ... paid by family, not from your mother's finances

of course, if your mother has savings well over the threshold and a good income, she will self fund, and family can make arrangements as they wish

from what you mention, the reason the care home are saying your mother needs to be in a nursing home/section is for the care of bedsores, which generally won't trigger FNC or CHC funding of itself, so is their inhouse policy .... eg my dad had sores at one point treated by staff supervised by District Nurses in his care home (not a nursing home as no nurses on site/on staff)

 

[nitram]

Variable and unpredictable nursing needs to the extent that the 24/7 availability of a nurse is required can be considered a criterion of FNC.

Treatment of bedsores can be carried out by the community nursing service whether the person is at home or in a care home, 24 hour nursing availability is not required..

 

[Lirene]

Variable and unpredictable sounds just as my husband was. In hospital for 7months and spent more time at the nursing station as couldn’t take their eyes off him due to his unpredictable behaviour. He cannot walk, has advanced Parkinson’s, dementia plus other and varied co-morbidities. He was refused CHC three times stating his needs were not complex enough, he was refused by three nursing homes as he was too complex and he needed overnight one to one care funding for which was also refused. Nursing staff were astounded he was refused they had never known anyone with his complexity being refused previously. This was late January, early February this year. The NHS etc,. needed the beds they knew what was coming - COVID-19, an insider told me. I was told he would die without 24 hour care so I brought him home, and certainly yes I am appealing the decision. Prayers for everyone xx

 

[Shedrech]

hi @Lirene
don't know what to say ... ridiculous ...
have you come across this ... may help
Making sense of CHC | Alzheimer's Society

 

[Lirene]

Many thanks. Prayers xx

 

[LocalResident]

Hi again,

Yes I did get the decision letter and the scores.

I think one issue could be that the social worker put a plan in for care at home with 4 visits a day.

However this was not working for my dad of 85yrs who has lost weight because of the stress so as a family and with my mum's agreement it was decided that a nursing home would be best.
At the time of the CHC assessment I was asked what the current arrangements were so it may be that they will argue that nursing funding is not applicable?
even if I agree with the scores given do you think I can appeal on the basis of nursing funding?

+=+=+=
CHC and Complaints that you might eventually choose to take to The Parliamentary and Health Service Ombudsman (PHSO)– an important point of law …
“ The Act of Parliament that gives the PHSO powers sets out its role is to investigate injustice or hardship, arising from failings. Therefore, it would only look to consider complaints of service failure if it can see there has been injustice or hardship caused as a result ”

A serious complaint was made against a NHS Trust/CCG about an incredibly shoddy DST document which was poorly prepared and full of errors which said a person was not eligible for CHC. [Lots of evidence was provided].
Then subsequently the person (my mother) was awarded fast tracked CHC very shortly afterwards – there was no financial disadvantage.

So, after trying for two years to get the PHSO to criticize the NHS Trust/CCG for producing an appalling DST document – where the CONTENT was wrong in many places, I’ve had no success at all. The errors included, for example, wrong dates, and a wrong attendance sheet for the DST meeting. Also, documents including GP letters were referred to, which I didn’t see.

The decision by the PHSO (given by the PHSO’s Operations Manager), not to deal with my complaint, means those who prepared the DST document have got off scot-free.

From my experience, I suggest that the Parliamentary and Health Service Ombudsman, will NOT deal with a complaint unless – as the law says, an injustice or hardship is caused as a result.

This info about the PHSO might help those who are attempting to challenge a NHS Trust/CCG.
It's such a sorry state of affairs. I've told my local area's independent Health Watch about this.

 

[feralcole]

Hi all

I have just come across CHC this afternoon...never knew it existed. My mum was discharged from hospital a week ago after breaking her hip, we've been told we'll get 6 weeks of free care, but then the situation will be assessed. No one has mentioned CHC to us, all that has been said is that Mum's needs will be assessed to determine level of ongoing care needed.

Obviously Mum's dementia has worsened during her 3 week stay in hospital, and mentally she is not in a good place (constantly frightened and confused), and her mobility has been reduced to shuffling a few steps with a frame - and to complicate her recovery she also suffers from vertigo so her mobility has never been good anyway, she is at risk of falling all the time (hence the broken hip). She's pretty much bed-ridden at the moment, with a nurse coming in 3 times a week to treat bed sores. We also have 2 carers come in 3 times a day to help my Dad with giving Mum medicine and personal care.

The 6 weeks of NHS care comes to an end at the end of January, so it seems it might be worth looking at CHC. I am just dreading the process! Any tips greatly received!

 

[kindred]

Hi all

I have just come across CHC this afternoon...never knew it existed. My mum was discharged from hospital a week ago after breaking her hip, we've been told we'll get 6 weeks of free care, but then the situation will be assessed. No one has mentioned CHC to us, all that has been said is that Mum's needs will be assessed to determine level of ongoing care needed.

Obviously Mum's dementia has worsened during her 3 week stay in hospital, and mentally she is not in a good place (constantly frightened and confused), and her mobility has been reduced to shuffling a few steps with a frame - and to complicate her recovery she also suffers from vertigo so her mobility has never been good anyway, she is at risk of falling all the time (hence the broken hip). She's pretty much bed-ridden at the moment, with a nurse coming in 3 times a week to treat bed sores. We also have 2 carers come in 3 times a day to help my Dad with giving Mum medicine and personal care.

The 6 weeks of NHS care comes to an end at the end of January, so it seems it might be worth looking at CHC. I am just dreading the process! Any tips greatly received!

Yes, worth looking at. It is very very hard to get but worth a try. Main thing for you to do is to keep a record of all the times a nurse has been called or you have had to get a doctor. This funding is about needing nursing care as opposed to general support.
They will look at her level of communication, so keep a record of this, and whether she has changing levels of consciousness.
if her moods or behaviour is erratic, this will be looked at, as will mobility,
The main thing though is the need for nursing care.
Good luck!
Warmest, Kindred

 

[jaymor]

The assessment may say that CHC is not the level of care needed but there is funded nursing care where the NHS pay directly to a nursing home a fee to cover the nursing required if some level of nursing care is needed .

 

[petricola]

Hi!

Sorry - new on here!
Does anyone please have any experience of using companies to represent you for CHC assessment and appeal - I mean like Beacon for example?
I have no experience of such companies and am wondering if they can help and also how they are funded - I assume I have to pay them to manage / fight the case?
Any thoughts or advice much welcome

 

[Shedrech]

hello @petricola
a warm welcome to DTP
I wonder whethervthis may be of help

Making sense of CHC

Alzheimer's Society volunteers are supporting people through the complex process of continuing healthcare (CHC) appeals.

www.alzheimers.org.uk

 

[Louise7]

Welcome @petricola CHC can be very difficult to get, although some on here have been successful, but the appeal process can take a lot of time and effort with potentially still no positive outcome. Someone previously posted on here about how they had spent over £30k paying a company to help them to get CHC - the costs escalated with every telephone call, letter, document viewed - and the appeal was still not successful. The CHC process can be a minefield but there is free independent information/advice available and hopefully the above link will be helpful.