CHC (Continuing Healthcare) support thread

stanleypj

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Dec 8, 2011
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North West
I'm no expert Fluffyval, but surely the A scores are from the initial checklist whereas the DST process which has to completed for the decision on CHC funding uses words, like 'severe' to describe the person's needs in the various domains. so has he been awarded CHC funding or is it some form of FNC still?

I've not come across different levels of care in relation to CHC funding though I suppose the amount of funding will differ depending on a person's needs

What time period is the £800 you mention supposed to cover?
 

Fluffyval

Registered User
Dec 5, 2013
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You are right i should have said severe, pardon me.
The 800 ish is weekly.

Bradford Council CHC Rates

Continuing Healthcare Rate I £569.73
Continuing Healthcare Rate II £643.02
Continuing Healthcare Rate III £800.66
Funded Nursing Care £112.00

I don't understand how there are levels of CHC funding
 

nitram

Registered User
Apr 6, 2011
30,488
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Bury
"I don't understand how there are levels of CHC funding"

The cost of any care package depends on the ratio of nurses/carers per patient and the skill level of the nurses/carers required.

At one end of the scale is the need for experienced carers maybe with a nurse available 24/7 and at the other end are conditions which require 24/7 one to one attendance of highly trained mental health staff.

Compare the costs of a stay in hospital, ITU is more expensive than HDU which is more expensive than just being in a ward.
 
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2jays

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Jun 4, 2010
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West Midlands
Mum has a CHC assessment on the 29th

Have had a letter notifying me of this meeting.

There is a paragraph that states:

"It should be noted that Continuing Health Care has a duty to consider the best use of resources for the population of [county] whilst meeting the health care needs of all individuals who are eligible for continuing healthcare"

Does anybody understand what what means?

I think I know what that means.... But would appreciate others thoughts


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AlsoConfused

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Sep 17, 2010
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I'd interpret that as meaning - "you may have to fight to keep your loved one where they currently are, if it's cheaper for us to move them elsewhere".

As CHC assessments take so long people are normally well-settled into their care long before the first award is made, it seems a hollow threat to me.
 

2jays

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Jun 4, 2010
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West Midlands
I'd interpret that as meaning - "you may have to fight to keep your loved one where they currently are, if it's cheaper for us to move them elsewhere".

As CHC assessments take so long people are normally well-settled into their care long before the first award is made, it seems a hollow threat to me.

Yeah.... I thought that's what they meant

Yet ANOTHER battle is on the horizon for me I guess

We have been self finding for 4 years. Over 2 of those years at existing care home without any input at all from "those here to help" outside of the care home.

Positive thinking..... After 4 years, mum suddenly has a social worker who will be at the CHC meeting

Positive thinking, because I positively know..... the day of the meeting will be the first time this social worker will have met mum

As far as I and the care home are concerned, mum will score 2 A's and 3 B's

Watch this space to see what "they" score mum as.......











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stanleypj

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Dec 8, 2011
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North West
I suppose it's also worth remembering that, whatever it means, if it isn't supported by what the law says, it would be very hard for them to justify their actions by simply referring to that statement.
 

stanleypj

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Dec 8, 2011
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North West
Re the SW 2jays, I had only met the SW once prior to the assessment. I didn't realise that this was going to be the case but I managed to give her a lot of info about Sue that supported the case and, at the assessment she simply repeated everything I had told her. This was very helpful.

Have you had the chance to brief the SW?
 

2jays

Registered User
Jun 4, 2010
11,598
0
West Midlands
Re the SW 2jays, I had only met the SW once prior to the assessment. I didn't realise that this was going to be the case but I managed to give her a lot of info about Sue that supported the case and, at the assessment she simply repeated everything I had told her. This was very helpful.

Have you had the chance to brief the SW?

The only "contact" I have had is from the person who arranged the date for the meeting and this letter. Only verbally told who will be at this meeting apart from assessor.

To be honest, I've had so much on my plate with other family members issues, I've not given this CHC situation much detailed thought. The care home started the application, they mentioned to me they were going to do so, and did I agree. I agreed thinking it wouldn't get as far as this point..... (Head in sand)

Manager of care home feels mum will score necessary "points" but not in the areas that would result in the need for a move from this care home, into nursing care. and they have no hidden agenda by applying for CHC, ie wanting her to move, they just want what's best for mum. CHC would mean they could allocate a 1:1 for mum, without the extra carer also being used within the care home. Made sense at the time....




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rageineden

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Dec 14, 2015
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The only "contact" I have had is from the person who arranged the date for the meeting and this letter. Only verbally told who will be at this meeting apart from assessor.

To be honest, I've had so much on my plate with other family members issues, I've not given this CHC situation much detailed thought. The care home started the application, they mentioned to me they were going to do so, and did I agree. I agreed thinking it wouldn't get as far as this point..... (Head in sand)

Manager of care home feels mum will score necessary "points" but not in the areas that would result in the need for a move from this care home, into nursing care. and they have no hidden agenda by applying for CHC, ie wanting her to move, they just want what's best for mum. CHC would mean they could allocate a 1:1 for mum, without the extra carer also being used within the care home. Made sense at the time....




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We have our MDT meeting on Tuesday. So far both the CCG and Hospital have done everything possible to stop us as power of attorneys from taking a full part in the process.

They both know documents are being falsified to keep the scores down. They both know the records are wrong such as wrong age/illness etc.

The hospital attempted to have a deprivation of liberty notice completed without our knowledge.

The coordinator told us even if we win we will only get a care home place not care in the home which is the most suitable route for our relative. We were told the CCG just don't do that under any circumstances. In the next breath she said the meeting had not been predetermined!

The social worker told us the council had a budget for what we have asked for but that his boss would laugh him out of the office if he asked to use it. He said they just want to get the NHS to pay for it all.

We have put formal complaints in writing showing in detail all of the above to the chief nurses/safeguarding team/social workers/CCG coordinator. Every complaint has been ignored.

Yet despite this they insist the meeting will take place.

They seem to work on how much pressure they can put you through to force you to give up. It seems they are happy to falsify documents and go to any length to not approve continuing care.

It is disgusting to think having paid into the system all his life our relative is being treated like a piece of meat in a game of internal politics.
 

ukelele lady

Registered User
Apr 10, 2014
18
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CHC being taken away

We are frustrated that CHC funding is being taken away from my MIL .
The MDT took 3 hours. When we came back into the room we were told that they had taken some time to come to a decision.
She has a history of pressure ulcers. She has had a stage 3 pressure ulcer since July . It has been infected and been treated with antibiotica .
The NHS community matron ,who was at the meeting as she's been advising the NH nurses how to care for the pressure ulcer, agreed with our thoughts that the ulcer wasnt healing. Strangely it was decided that if the recent swab taken as the ulcer is surrounded by a very pink area indicated an infection that the domain level should be High as it was presumed that the ulcer would heal from antibiotics. If the swab indicated no infection then the domain level would be Severe.
We struggled to understand such logic. We have always understood that MDTs can only be based on how things are at the time . We were surpised that the MDT's decision was based on an assumption that the wound would heal after antibiotics were given.
 

geum123

Registered User
May 20, 2009
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We are frustrated that CHC funding is being taken away from my MIL .
The MDT took 3 hours. When we came back into the room we were told that they had taken some time to come to a decision.
She has a history of pressure ulcers. She has had a stage 3 pressure ulcer since July . It has been infected and been treated with antibiotica .
The NHS community matron ,who was at the meeting as she's been advising the NH nurses how to care for the pressure ulcer, agreed with our thoughts that the ulcer wasnt healing. Strangely it was decided that if the recent swab taken as the ulcer is surrounded by a very pink area indicated an infection that the domain level should be High as it was presumed that the ulcer would heal from antibiotics. If the swab indicated no infection then the domain level would be Severe.
We struggled to understand such logic. We have always understood that MDTs can only be based on how things are at the time . We were surpised that the MDT's decision was based on an assumption that the wound would heal after antibiotics were given.

A managed need is still a need ukelele lady. :rolleyes:

Ask and argue:

What are they doing to ensure she has no pressure points now?
Her skin integrity is compromised, evidenced by past history.
She is at risk of infection, even if the swab doesn't show anything,
so still needs continual monotoring and evasive procedures for pressure,
infection and pain management.
She would also have to be monitored to see her reaction to antibiotics.

Don't get bullied by their decision.:(

I would appeal.
 

stanleypj

Registered User
Dec 8, 2011
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North West
rageineden:

The coordinator told us even if we win we will only get a care home place not care in the home which is the most suitable route for our relative. We were told the CCG just don't do that under any circumstances.

I believe that this would be unlawful. There's a principle that the setting of the care should not affect a decision whether to fund. It's the needs that matter, not the setting. I'll try and find the exact quote tomorrow.
 

geum123

Registered User
May 20, 2009
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This may help.
Invaluable booklet incidentally

http://www.sfe.legal/assets/media/NHS_CONTINUING_HEALTHCARE_BOOK_MARCH_2014.pdf

From Solicitors for the Elderly
Page 45

7. WHAT HAPPENS IF THE PERSON IS ELIGIBLE?
The CCG should inform the person in writing, giving clear reasons and the basis on
which the decision was made
167
. A copy of the completed DST should also be
available. The CCG must provide a care package that it thinks is appropriate to meet
the person’s need based on supporting outcomes identified in the care plan.
168
It is normally the CCG responsible for the individual’s GP who will be responsible
for funding the care.
169
Care can be provided in a variety of settings including:

A care home registered to provide personal or nursing care– the
person should be given a choice about the location of care home,
taking into account their needs and circumstances, however they
have no right to choose.

In a hospital – if the person is
in the final stages of a terminal
illness

In their own home – depending on the type and level of care
needed and whether their home is suitable or can be adapted,
which should be offered, wherever appropriate
170
.
The CCG is responsible for care planning, commissioning services and for care
management
171
.
The CCG is also responsible for monitoring quality, access and patience experience
within the context of provider performance.
172
7.1 Choice of care provision
There will normally be a range of options available for support. The starting point
for agreeing the package should be the individual’s preference. However, the
package of care provided will be what the CCG assess is appropriate for the
individual’s needs.
173
The National Framework states:
‘When deciding on how their needs are met, the individual’s wishes
and expectations
of how and where the care is delivered should be
documented and taken into account, along with the risks of different
167
The National Health Service Commissioning Board Groups
(Responsibilities and Standing Rules) Regulations 2012
168
Part 2 Paragraph 78.1 The National Framework for NHS Continuing Healthcare and NHS funded Nursing are 2012
169
Regulation 3(7) of the National Health Se
rvice (Functions of Strategic Health
Authorities and Primary Care Trusts and
Administration Arrangements) (England) Regulations 2002 (S.I. 2002/2375) as amended by S.I. 2002/2548, 2003/1497,
2006/359 and 2007/559 (“the Functions Regulations”)
170
Paragraph 56 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
171
Paragraph 108 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
172
Paragraph 109 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
173
Paragraph 167 The National Framework for NHS Continuing Healthcare and NHS funded nursing care 2012
50
types of provision and fairness of access to resources.’
174
If the person is living in a care home when the decision to grant NHS continuing
healthcare is made the person will need to discuss with the CCG, whether they can
continue to stay there. This is particularly relevant where the care home is much
more expensive than the CCG would normally pay to meet their needs. However,
the risks and benefits of moving the person, including the effect on their physical
and mental health would need to be assessed before a decision is made to move
them.
The individual should be advised of all the options and the benefits and risks
associated with each one. The model of support preferred by the individual may be
more expensive than other options. CCGs can take comparative costs and value for
money into account when considering the support to be provided but should consider
the following factors: -

The cost comparison has to be made on the basis of the genuine costs of
alternative models. A comparison with the costs of supporting a person in a
care home should be based on the actual costs that would be incurred in
supporting a person with specific needs in the case and not on an assumed
standard care home cost.

Where a person prefers to be supported in their own home, the actual costs of
doing this should be identified on the basis of the individual’s assessed needs
and desired outcomes. The willingness of family members to supplement
support should also be taken into account, although no pressure should be put
on them to offer such support.

Cost has to be balanced against other factors in the individual case, such as
the individual’s desire to continue to live in a family environment.
 

stanleypj

Registered User
Dec 8, 2011
10,712
0
North West
Yes, that's a very helpful post geum.

These were the final sentences of the Recommendation for Sue (which was accepted):

Their recommendation was that Ms Legg has a primary health need. The wishes are for her to remain in here home, surrounded by her personal effects and her memories.
 

geum123

Registered User
May 20, 2009
4,604
0
A managed need is still a need ukelele lady. :rolleyes:

re: A managed need is still a need.

From Solicitors for the Elderly see link above.


4.3 Principles of decision-making
Decision-making rationale should not marginalise a need just because it is
successfully managed: well-managed needs are still needs.
53
The same criteria and
assessment should be completed for someone who has mental health needs and the
assessment should, where relevant, include the opinion of a psychiatrist or other
mental health professional.
Only where successful management of a healthcare need has permanently reduced or
removed an ongoing need will this have a bearing on eligibility.
 

stanleypj

Registered User
Dec 8, 2011
10,712
0
North West
Thanks Geum - an important post that explains the facts well. We'll be able refer people back to this post in the future.
 

mrjelly

Registered User
Jul 23, 2012
314
0
West Sussex
Advice from

I found a web page that looks at the CHC assessment process from a different angle, putting more responsibility on Social Services to apply the Care Act 2014 and correctly apply the "local authority limits test". It seems that if the level of care needed is more than can be legally provided by the local authority then the NHS is obliged to provide the full CHC funding.

see http://caretobedifferent.co.uk/care-act-2014-helps-you-with-nhs-continuing-healthcare/

There is quite a lot of information to digest, but the advice is quite clearly laid out I think.
 
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geum123

Registered User
May 20, 2009
4,604
0
I found a web page that looks at the CHC assessment process from a different angle, putting more responsibility on Social Services to apply the Care Act 2014 and correctly apply the "local authority limits test". It seems that if the level of care needed is more than can be legally provided by the local authority then the NHS is obliged to provide the full CHC funding.

see http://caretobedifferent.co.uk/care-act-2014-helps-you-with-nhs-continuing-healthcare/

There is quite a lot of information to digest, but the advice is quite clearly laid out I think.

Why not use ALL the information at hand.
Neither rely on one method nor the other.:)
 
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missmarple

Registered User
Jan 14, 2013
204
0
I found CaretobeDifferent very useful in applying for CHC for Dad. Did not download their book or pay for the telephone service, I just used the website. I also emailed the founder and she was kind enough to get back to me and advise me for free.
 
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