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CHC (Continuing Healthcare) support thread

MartinWL

Registered User
Jun 12, 2020
2,026
0
65
London
Remember that the CHC evaluation is about medical needs alone. It would not be relevant that two carers were needed for some care tasks, or half a dozen, if they were non-medical procedures like washing, dressing, etc. Search for the "decision support tool" online and work through it as a preparation.
 

Sarah22

Registered User
Sep 3, 2021
14
0
Remember that the CHC evaluation is about medical needs alone. It would not be relevant that two carers were needed for some care tasks, or half a dozen, if they were non-medical procedures like washing, dressing, etc. Search for the "decision support tool" online and work through it as a preparation.
Thank you martin

We got the call yesterday to say they will be assessing dad early January so need to get prepared .
The form that was filled prior to discharge from hospital suggested full funding based on dads scores but we are nervous that they will look to find reasons to overcome the original grading
Interestingly the CQC person wanted to do the assessment remote ( I’m sure because of covid )
We have pushed for a face to face as we think things can be lost in translation but are waiting to hear

Has anyone had experience of a teams assessment please

Many thanks
 

canary

Registered User
Feb 25, 2014
18,885
0
South coast
The form that was filled prior to discharge from hospital suggested full funding based on dads scores
Please remember that the form filled in by the hospital is only a preliminary checklist to see whether he may get CHC. The panel will be looking at everything in much more detail.
This is the checklist
And this is the decision support tool that the panel aught to follow in making the decision

As you can see, it is a much larger and more detailed document. The panel will be looking at 12 different domains (categories) and there are up to 6 levels of severity in each domain. In order to get CHC you need either one Priority need (the highest) or 2 Severe needs (the next one down). Not all the domains can score that high, though - for example Continence (one of the domains) can only score a High.

Although the document is long, it is worth reading - especially the definitions of the different domains and their levels.
 

Sarah22

Registered User
Sep 3, 2021
14
0
Please remember that the form filled in by the hospital is only a preliminary checklist to see whether he may get CHC. The panel will be looking at everything in much more detail.
This is the checklist
And this is the decision support tool that the panel aught to follow in making the decision

As you can see, it is a much larger and more detailed document. The panel will be looking at 12 different domains (categories) and there are up to 6 levels of severity in each domain. In order to get CHC you need either one Priority need (the highest) or 2 Severe needs (the next one down). Not all the domains can score that high, though - for example Continence (one of the domains) can only score a High.

Although the document is long, it is worth reading - especially the definitions of the different domains and their levels.
Thank you so much for this -it we’ll help us understand more .

So the scores given in hospital potentially could not reflect the panel scores , it’s such a worry as we would hate to have to move him given the time we had to wait to find a care home specific for dads needs , ( 6 weeks and out of county )

Is it worth liaising with the nursing home manager to assess how they would score dad prior to the meeting , or does that also count for nothing in the panels eyes ?

We feel the improvement he has made in the 2 weeks is based on how happy he is to be out of hospital and not reflective of his long term prognosis.
 

canary

Registered User
Feb 25, 2014
18,885
0
South coast
You can certainly liaise with the care home and ask for their opinion, but remember that they are not making the decision. Even if you dont get the full CHC, people who get as far as the panel will usually get the Funded Nursing Care component at least.

Also, they will not be looking at the long-term prognosis, they will only be looking at what he is like now as the funding will be regularly reviewed.
 

MartinWL

Registered User
Jun 12, 2020
2,026
0
65
London
Thank you martin

We got the call yesterday to say they will be assessing dad early January so need to get prepared .
The form that was filled prior to discharge from hospital suggested full funding based on dads scores but we are nervous that they will look to find reasons to overcome the original grading
Interestingly the CQC person wanted to do the assessment remote ( I’m sure because of covid )
We have pushed for a face to face as we think things can be lost in translation but are waiting to hear

Has anyone had experience of a teams assessment please

Many thanks
I had to go through this in the end by telephone. It was supposed to be on Teams. The Teams link did not work. It was an utter shambles. The Commissioning Group (who make the decision0 were so tied up in their own burocratic rules that we never got it sorted out and in the hold of anyone who knew how to resolve the problems, for some reason they could not show their faces and in the end it was done by telephone. They wouldn't agree to let me set up a Zoom meeting on absurd confidentiality grounds, we could not get anyone in their IT support department on the phone. Perhaps in hindsight I should have refused to go ahead with the meeting although I doubt it would really have made a difference. I would ask if they will do a video Teams meeting and if they won't, insist on face to face. It is hard to thump the table on Teams.
 

HelpInOut

Registered User
Oct 19, 2021
54
0
Remember that the CHC evaluation is about medical needs alone. It would not be relevant that two carers were needed for some care tasks, or half a dozen, if they were non-medical procedures like washing, dressing, etc. Search for the "decision support tool" online and work through it as a preparation.
"medical needs alone"
What about nursing needs?
As an ex nurse I don't classify administering inhalers, oral medication, eye drops and ointment, putting on prescribed support stockings , assessing continence, fluid intake or output as "social care", but nor is it medical care.
In a hospital setting the only person who can administer any medication whether oral , topical or inhaled is a qualified nurse.
I had a conversation the other day with a Social prescribing link worker .When I told him what we had going on with my parents regarding poor quality of care being provided by the private company contracted by our council to provide care and the disinterested repsonses from Social services, he very quickly shut me down and said "that all sounds more like medical care and assessments and not social care"
So which is it?
Is it social care at a cost of £18 an hour, or free nursing care?
I've just requested a re assessment by social services and asked for them to complete a CHC needs checklist.
I'm armed and ready for the rubbish I fully expect to be coming our way.
 

HelpInOut

Registered User
Oct 19, 2021
54
0
Potentially you might try an appeal because your social worker was out of line with the others and, you say, has not even met the person. I would be complaining in that situation. You could start by writing to the Director of Social Services asking for it to be done again.

You have to make your case under the framework of the decision support tool. If he took 100 pills a day that would count for nothing if they could be given by carers. But it sounds like you have a case so focus on the DSt criteria.

You have the option to appeal and also to complain to the local government ombudsman.
Ah, but it's not only about the administration of the medicines, it's about monitoring for side effects, interactions with other medication and effectiveness, especially for pain relief and sedatives/anti anxiolytics in the elderly.
An unqualified carer doesn't have the clinical skills needed to do that.
Worth looking at NICE guidelines/pathways for
prescribing in the elderly,
dementia treatment summary and
experience in adult social care.

Also Beaconchc website
I can't post the links as I don't have the required 10 posts.

If nurses are the only people who can administer drug therapy in hospitals, if someone has the same problems then that requirement shouldn't change. It should be about continuity of care.
 

canary

Registered User
Feb 25, 2014
18,885
0
South coast
've just requested a re assessment by social services and asked for them to complete a CHC needs checklist.
I'm armed and ready for the rubbish I fully expect to be coming our way.
Please see my post upthread which gives links to the checklist and Decision Support Tool
Please remember that the form filled in by the hospital is only a preliminary checklist to see whether he may get CHC. The panel will be looking at everything in much more detail.
This is the checklist
And this is the decision support tool that the panel aught to follow in making the decision

As you can see, it is a much larger and more detailed document. The panel will be looking at 12 different domains (categories) and there are up to 6 levels of severity in each domain. In order to get CHC you need either one Priority need (the highest) or 2 Severe needs (the next one down). Not all the domains can score that high, though - for example Continence (one of the domains) can only score a High.

Although the document is long, it is worth reading - especially the definitions of the different domains and their levels.
That way you will know what you are up against.
 

HelpInOut

Registered User
Oct 19, 2021
54
0
Please see my post upthread which gives links to the checklist and Decision Support Tool

That way you will know what you are up against.
Oh yes. Very well aware of what I'm up against. Another ticky box, subjective assessment . To be fair at this moment in time I'm more concerned that dad could be left without a care package in place because according the their email , phone call and the Social worker , the company contracted by the council are threatening to withdraw his care provision.
 

MartinWL

Registered User
Jun 12, 2020
2,026
0
65
London
"medical needs alone"
What about nursing needs?
As an ex nurse I don't classify administering inhalers, oral medication, eye drops and ointment, putting on prescribed support stockings , assessing continence, fluid intake or output as "social care", but nor is it medical care.
In a hospital setting the only person who can administer any medication whether oral , topical or inhaled is a qualified nurse.
I had a conversation the other day with a Social prescribing link worker .When I told him what we had going on with my parents regarding poor quality of care being provided by the private company contracted by our council to provide care and the disinterested repsonses from Social services, he very quickly shut me down and said "that all sounds more like medical care and assessments and not social care"
So which is it?
Is it social care at a cost of £18 an hour, or free nursing care?
I've just requested a re assessment by social services and asked for them to complete a CHC needs checklist.
I'm armed and ready for the rubbish I fully expect to be coming our way.
The division between social and medical care is fairly arbitrary and quite blurred.I asked a social worker if he would call a doctor or a social worker if he woke up one morning and his legs didn't work. He had no answer. But until there's a proper integration between health and social care that's the system.
 

HelpInOut

Registered User
Oct 19, 2021
54
0
The division between social and medical care is fairly arbitrary and quite blurred.I asked a social worker if he would call a doctor or a social worker if he woke up one morning and his legs didn't work. He had no answer. But until there's a proper integration between health and social care that's the system.
It may be for the purposes of the NHS trying to wriggle out of coughing up the ££, but in the real clinical world there's a very clear cut line between medical and social care and the two will never be integrated. The powers that be just need to be honest about what social care really is. How is medication administration remotely related to social care needs? If it was then they wouldn't include it in the CHC needs assessment tool. They're trying to say that if the health needs are of a low severity , then they're social care needs, but if they're severe enough or there's enough of them then they become health care needs, which is rubbish. I'd love to see a Doctors face if you asked him to go and help someone eat their lunch, even if they had a medical need which meant they were at risk of malnutrition eg they'd recently had a hand amputated or had no teeth.
The point I was trying to make was that not all nursing care is social care. If it is , then why do we have nurses at all? They're not employed to provide medical care. Nursing is a profession in it's own right. Of course nowadays we have the "on the cheap" medical care provided by very skilled Nurse Practitioners in primary and secondary care.
As recently as the 1980's qualified nurses were going in and bathing patients in their homes. Nursing care. Nothing's changed. Same people, same needs, same skills needed. Of course we now have healthcare assistants working in the community, but I've no idea what they do.
 

VickyT

New member
Jan 27, 2022
2
0
Hi - I'm new to this forum so hope this is the right place for this question. My dad had dementia and was in a care home for 10 years. We managed to get CHC funding for the final month of his life (he died last year) and that was only agreed after her died. I applied for retrospective funding going back only about 4 months - the timing was because that was when he had another major step down in health we were told to say our goodbyes, he was not interacting with us and was mostly asleep. The retrospective application has just been turned down and I want to appeal. At the moment I'm just doing a "compare and contrast" of the two DSTs. I think the sticking point is that in the retrospective application they key indicators (nature, intensity, complexity and unpredictability) they said all indicated there was not a primary health care need, whereas in the first one they were all judged as showing there WAS a health care need. They seem quite woolly requirements, and I wondered if anyone found any guidance on how to show there was a need, using these indicators? Or any advice on appealing a retrospective CHC decision would be great! Thanks
 

MartinWL

Registered User
Jun 12, 2020
2,026
0
65
London
Hi - I'm new to this forum so hope this is the right place for this question. My dad had dementia and was in a care home for 10 years. We managed to get CHC funding for the final month of his life (he died last year) and that was only agreed after her died. I applied for retrospective funding going back only about 4 months - the timing was because that was when he had another major step down in health we were told to say our goodbyes, he was not interacting with us and was mostly asleep. The retrospective application has just been turned down and I want to appeal. At the moment I'm just doing a "compare and contrast" of the two DSTs. I think the sticking point is that in the retrospective application they key indicators (nature, intensity, complexity and unpredictability) they said all indicated there was not a primary health care need, whereas in the first one they were all judged as showing there WAS a health care need. They seem quite woolly requirements, and I wondered if anyone found any guidance on how to show there was a need, using these indicators? Or any advice on appealing a retrospective CHC decision would be great! Thanks
This sounds difficult. Are you saying that that the most recent assessment shows fewer or lower level medical needs than the first one? It rather shows how subjective the Decision Support Tool is. But if I have understood you correctly the comparison of the two DST results doesn't help your case. You will have to prove that your dad's needs were medical needs in some other way and that may be challenging. If there is a lot of money at stake there are specialist solicitors around who may be able to review your evidence but it isn't going to be worth spending money on legal advice unless the sums involved justify it.
 

nitram

Registered User
Apr 6, 2011
25,500
0
North Manchester
the timing was because that was when he had another major step down in health we were told to say our goodbyes,
Do you have any proof of this?

In 2013 I had a fast track CHC backdated from 8th March to 17th February by quoting a statement made by a consultant in front of a registrar, nurse, my two daughters, and myself.
 

Shedrech

Volunteer Moderator
Dec 15, 2012
12,473
0
Yorkshire
Hello @VickyT
A warm welcome to DTP

My condolences on the death of your dad

This may be useful to you

 

VickyT

New member
Jan 27, 2022
2
0
Thanks for the replies, apologies for taking some time to come back to it.

The assessment for the last month of his life awarded funding (the meeting was actually after his death which I suspect helped, they knew there was a limit to the funding!)
The results from the retrospective review for the previous 5 months have him with only one "severe" (cognition) rather than the two they identified in his final month (cognition and mobility) As far as I could see his mobility was no different in his final month than it was for the previous 5 months (he was lying in bed, legs and hands contracted and not moving)
There are also very different interpretations of the key indicators ( nature, intensity, complexity and unpredictability) Its all such woolly language that its very hard to analyse.

I'll see if I can find evidence of being told to say our goodbyes - the GP said it to my sister I think but may have emailed

And thanks for the link to the potential of appeals help, I will follow that up.
 

Brizzle

Registered User
Mar 1, 2019
72
0
So after trying to ensure mum had a CHC checklist I was contacted yesterday for the first time by the CCG to say they had carried out the checklist with health professionals and asked for my input.

She is entitled to a full assessment and they want to do it this week in a hospital setting. Mum has been in hospital for nearly 3 months. She is currently on pathway 3 discharge to a Nursing home but no bed has been found for various reasons. My understanding was that ideally a full assessment should be carried out in a nursing home after a few weeks and that they should give you adequate notice so you can prepare fully for this important meeting. I am still waiting to get proxy access to mum’s medical records, surely a out of the blue lightening quick checklist assessment (which was not totally accurate although mum still passed) and just 3 days notice to a full assessment in hospital is not acceptable over such an important meeting where detailed evidence is required? Prior to this sudden contact nobody had kept me informed or given advance notice about anything to do with CHC. When people try to rush things through without following preferred protocol I get a little suspicious about what the motive might be.

What do people think ? I know some people have the opposite problem and seem to wait too long for a full assessment but surely with duty of care in mind they should have given me as mum’s POA more than a quick phone call and 3 days notice for something as important as this which requires detailed planning and presentation in order that you might succeed .
 

jaymor

Volunteer Moderator
Jul 14, 2006
15,156
0
South Staffordshire
When my husband had his assessment and he was awarded CHC with 1:1 care in a nursing home. He had CHC up until the day he passed away 4 years later. He also kept the 1:1 care for almost 3 of those 4 years.

As a family we’re we’re invited to attend a meeting at the assessment centre he had been admitted to several weeks earlier. We had no idea it was a CHC assessment meeting. All the professionals who were part of his care were there and discussing his treatment, behaviour etc. We were asked our opinion of what they were seeing or did we see things differently. They brought up much more than I realised but I was a sole carer, like everyone else caring, just got through the day as best I could, certainly no time to analyse anything. At the end they said they had enough evidence to take their findings to panel. It was when I asked what panel they told me they thought they had enough evidence to say my husband required CHC.

So I attended the assessment not knowing it was an assessment so my answers were given without any prior knowledge of what was required. I can’t see how me having prior knowledge and time would have made any difference.

we were thanked for our input and the time we had spent there. The consultant who was there said they had to supply in depth and strong evidence to back up any high score they gave. Detail was paramount when it came to submitting the request.