CHC (Continuing Healthcare) support thread

Snooze1

Registered User
Aug 17, 2023
43
0
I’m waiting to hear about my husbands review of his CHC, I’m so confused by the whole process and to be honest a little worried. He has def declined since going into his NH but some things are the same. I want to be there but the manager has said it’ll probably over the phone with her. Thank you @ luggy for your post, I’m getting out all the information I correlated 6 months ago and go through it again just in case it turns into a face to face meeting……I just feel I want to be there to speak for my husband, I am his voice I feel. Good luck with the next step
 

Dave63

Registered User
Apr 13, 2022
405
0
1. CHC Nurse Assessor had only asked the care home for 1 months worth of records dating back to her review on 15.1.24. A common tactic adopted during Covid, to speed up the process due to a backlog of assessments at that time. Many ICB's have not reverted back to the 3 month pre Covid best practice protocol.
I can't believe the NHS can think a proper and fair assessment of needs is possible with a small four week snap shot. We also experienced similar and during the MDT I used the analogy that it's like trying to judge the quality of an art work through a straw - you're never going to see the whole picture.

3. Care home nurse announces that they do have some more recent charts, which she produces to the assessor and which corroborate the charts I had previously produced. Assessor gives them a cursory look, hums and hahs a bit, then announces that mum should be referred back to MHT and downgrades mum's Behaviour score from a High to a Moderate. SW was hovering, but opted to agree with assessor. Needless to say, I disagree. (Apart from that, the SW was fairly good).
So the assessor was happy to disregard your behaviour charts because they fell outside the 1 month review window but is happy to mark your mum down based on a speculative opinion on what 'may' change in the future. That (in my mind) is a flagrant abuse of process, the MDT should surely only be used as a method to assess current needs, not what may or may not change in the future - that's what CHC reviews are for.

4. Drugs - mum is already heavily sedated with various medications, but is still awake all night screaming. Therefore, meds are ineffective. Previously scored High. Not this time. Assessor requests that GP review mum's meds and recommends even more sedation. Announces that she cannot score this domain until mum's meds have been 'optimised'.
Optimisation is BS. We spent six months being refused a checklist assessment because mum was not medically 'optimised'. When I kicked up a fuss and asked to be pointed to the part of the National Framework which states a person needs to be 'optimised' before being assessed they responded with another refusal to assess until she was medically 'titrated'. This didn't change until we got mums MP involved.

Speculation on what may change in the future should not be part of the process - the National Framework is clear in that it's current needs which are important.

 

luggy

Registered User
Jan 25, 2023
205
0
I can't believe the NHS can think a proper and fair assessment of needs is possible with a small four week snap shot. We also experienced similar and during the MDT I used the analogy that it's like trying to judge the quality of an art work through a straw - you're never going to see the whole picture.


So the assessor was happy to disregard your behaviour charts because they fell outside the 1 month review window but is happy to mark your mum down based on a speculative opinion on what 'may' change in the future. That (in my mind) is a flagrant abuse of process, the MDT should surely only be used as a method to assess current needs, not what may or may not change in the future - that's what CHC reviews are for.


Optimisation is BS. We spent six months being refused a checklist assessment because mum was not medically 'optimised'. When I kicked up a fuss and asked to be pointed to the part of the National Framework which states a person needs to be 'optimised' before being assessed they responded with another refusal to assess until she was medically 'titrated'. This didn't change until we got mums MP involved.

Speculation on what may change in the future should not be part of the process - the National Framework is clear in that it's current needs which are important.

Wow @Dave63, so this 'optimisation' business is a thing! I'd never heard of this until yesterday and I have to say that it completely threw me, which I'm sure was the full intention of the assessor. I knew right from the first phone call that the whole thing was pre-determined. Even at that early stage, she said that the Behaviour domain (and associated meds) would sway the decision. When I started waving behaviour charts about which were going to scupper her plan, she deployed her 'optimisation' weapon. It also sounds like her idea of optimising mum is to sedate her into oblivion so that her behaviour decreases the intensity of her care. Words fail me (that is, printable words).

Thanks for the C2BD link. There's hardly a day goes by that I don't look something up on their website, but I hadn't twigged this article. I'll keep you posted.
 

Chizz

Registered User
Jan 10, 2023
3,559
0
Kent
Hi @luggy

luggy said:
1. CHC Nurse Assessor had only asked the care home for 1 months worth of records dating back to her review on 15.1.24. A common tactic adopted during Covid, to speed up the process due to a backlog of assessments at that time. Many ICB's have not reverted back to the 3 month pre Covid best practice protocol.

I agree entirely with @Dave63.
You need to specifically ask the CHC Assessor
- is it correct that an assessment should cover the 3 month period prior to the assessment to be within the "best practice" protocol?
- Why are you specifically choosing to not follow the best practice protocol? I'm interested to know and wish to make a note of your reasoning.

Best wishes
 

luggy

Registered User
Jan 25, 2023
205
0
I’m waiting to hear about my husbands review of his CHC, I’m so confused by the whole process and to be honest a little worried. He has def declined since going into his NH but some things are the same. I want to be there but the manager has said it’ll probably over the phone with her. Thank you @ luggy for your post, I’m getting out all the information I correlated 6 months ago and go through it again just in case it turns into a face to face meeting……I just feel I want to be there to speak for my husband, I am his voice I feel. Good luck with the next step
Ah, bless you @Snooze1 It's horrible that we all have to go through this. Unfortunately, the CHC process is incredibly complicated and they keep moving the goal posts. It's very corrupt.

Our relatives rely on us to speak for them and it's only natural that you should feel you are his voice.

I hope your husbands review results in a positive outcome and you don't have to endure a full MDT assessment.

Keep posting your concerns, questions and feelings on here xx
 

Dave63

Registered User
Apr 13, 2022
405
0
I’m waiting to hear about my husbands review of his CHC, I’m so confused by the whole process and to be honest a little worried. He has def declined since going into his NH but some things are the same. I want to be there but the manager has said it’ll probably over the phone with her. Thank you @ luggy for your post, I’m getting out all the information I correlated 6 months ago and go through it again just in case it turns into a face to face meeting……I just feel I want to be there to speak for my husband, I am his voice I feel. Good luck with the next step
Hi @Snooze1

If your husband is already in receipt of CHC funding and this is the three month or annual review then it's still possible for you to attend, you have that right and your husband has the right to a family representative present.

Mum had one prior to christmas and it was also over the phone, I attended with the nursing home staff and they put the call on speaker so we could all participate.
 

Snooze1

Registered User
Aug 17, 2023
43
0
Hi @Snooze1

If your husband is already in receipt of CHC funding and this is the three month or annual review then it's still possible for you to attend, you have that right and your husband has the right to a family representative present.

Mum had one prior to christmas and it was also over the phone, I attended with the nursing home staff and they put the call on speaker so we could all participate.
I didn’t think I could, this is the 1st review after 6 months…. I’m going to speak to his social worker,thank you @Dave63.
 

Dave63

Registered User
Apr 13, 2022
405
0
I didn’t think I could, this is the 1st review after 6 months…. I’m going to speak to his social worker,thank you @Dave63.
Here's a link to some info about CHC reviews which may help.

 

helpingpeggy

Registered User
Aug 6, 2019
62
0
Another question please: mum is awaiting CHC assessment. I rang and spoke to the lead CHC person in the local nhs and she said that, if mum was awarded CHC funding, she would have to be moved to a different care home as the one she’s in is not one that they contract with. I said that that can’t be right, since CHC funding can be paid to someone who is cared for at home and also that it’s clearly not person-centred! Anyone else got experience of this?
 

Chizz

Registered User
Jan 10, 2023
3,559
0
Kent
Hi @helpingpeggy
I can't answer you, but there have been a lot of posts on the forum about this, including arguments with LA and NHS precisely on this point, the outcome of which was, I believe that they had to set up a contract with the selected care home even though they hadn't dealt with them before. The argument LA and NHS put up is purely based on budgets.
You'll see that on this thread we're on, we're on page 56! so a lot for you to look up!
Stick to your guns. It's the provision of care for the PWD's needs as foremost focus.
Best wishes.
 

Dave63

Registered User
Apr 13, 2022
405
0
Another question please: mum is awaiting CHC assessment. I rang and spoke to the lead CHC person in the local nhs and she said that, if mum was awarded CHC funding, she would have to be moved to a different care home as the one she’s in is not one that they contract with. I said that that can’t be right, since CHC funding can be paid to someone who is cared for at home and also that it’s clearly not person-centred! Anyone else got experience of this?
Hi @helpingpeggy
The guidance regarding higher cost care home fees is detailed in the National Framework from para 303 onwards. It seems a tad presumptuous of the CHC person to be suggesting any moves prior to an assessment being carried out and without full knowledge of a persons needs. There's also a few things that need to be considered by CHC before moving a person to another home such as frailty and mental health especially if a person has been resident in their current home for some time.

Link to National Framework:
 
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luggy

Registered User
Jan 25, 2023
205
0
Another question please: mum is awaiting CHC assessment. I rang and spoke to the lead CHC person in the local nhs and she said that, if mum was awarded CHC funding, she would have to be moved to a different care home as the one she’s in is not one that they contract with. I said that that can’t be right, since CHC funding can be paid to someone who is cared for at home and also that it’s clearly not person-centred! Anyone else got experience of this?
Hi @helpingpeggy I have also come across this issue of contracts between care homes and the ICB, although I'm not fully au fait with how it works. Maybe the ICB have a good reason for not entering into a contract with a home because it has a poor CQC report and is in 'special measures', or for some other reason? When my mum was Fast Tracked for CHC funding, the Fast Track CHC team wanted to move her into a nursing home (mum's care home was residential, not nursing). My mum is severely frail and was very poorly at the time, and I was worried that the upheaval of a move would not be in her best interests, so the ICB agreed that she could stay where she was.

As it turned out, shortly afterwards mum's care home closed down and we had no choice but to move her - and it didn't adversely affect mum at all. I don't think she's even noticed that she has moved!
 

helpingpeggy

Registered User
Aug 6, 2019
62
0
Hi @helpingpeggy
The guidance regarding higher cost care home fees is detailed in the National Framework from para 303 onwards. It seems a tad presumptuous of the CHC person to be suggesting any moves prior to an assessment being carried out and without full knowledge of a persons needs. There's also a few things that need to be considered by CHC before moving a person to another home such as frailty and mental health especially if a person has been resident in their current home for some time.

Link to National Framework:
Thank you very much. Yes..very presumptuous. The care home we chose is a 5 minute walk from my brothers home so mum can have visits from him and grandchildren very regularly
 

helpingpeggy

Registered User
Aug 6, 2019
62
0
Hi @helpingpeggy
I can't answer you, but there have been a lot of posts on the forum about this, including arguments with LA and NHS precisely on this point, the outcome of which was, I believe that they had to set up a contract with the selected care home even though they hadn't dealt with them before. The argument LA and NHS put up is purely based on budgets.
You'll see that on this thread we're on, we're on page 56! so a lot for you to look up!
Stick to your guns. It's the provision of care for the PWD's needs as foremost focus.
Best wishes.
Thank you
 

luggy

Registered User
Jan 25, 2023
205
0
I can't believe the NHS can think a proper and fair assessment of needs is possible with a small four week snap shot. We also experienced similar and during the MDT I used the analogy that it's like trying to judge the quality of an art work through a straw - you're never going to see the whole picture.


So the assessor was happy to disregard your behaviour charts because they fell outside the 1 month review window but is happy to mark your mum down based on a speculative opinion on what 'may' change in the future. That (in my mind) is a flagrant abuse of process, the MDT should surely only be used as a method to assess current needs, not what may or may not change in the future - that's what CHC reviews are for.


Optimisation is BS. We spent six months being refused a checklist assessment because mum was not medically 'optimised'. When I kicked up a fuss and asked to be pointed to the part of the National Framework which states a person needs to be 'optimised' before being assessed they responded with another refusal to assess until she was medically 'titrated'. This didn't change until we got mums MP involved.

Speculation on what may change in the future should not be part of the process - the National Framework is clear in that it's current needs which are important.

Regarding the 'optimisation' issue (based on behaviour and meds), and only assessing needs based on just 1 months worth of records - after much thought, I've emailed the ICB and politely pointed out that had the assessor examined 3 months worth of clinical records, she would have spotted that mum had already been referred to the Mental Health Team and that mum's medication had been reviewed by her GP 3 times since November. I did point this out to the assessor during the MDT but she stated that she needed to have the recorded evidence before her.

In light of the above, which meant that the MDT has to reconvene to finish the assessment, I have politely asked the ICB to consider holding a new MDT taking into account 3 months worth of clinical records. It's worth a try, and if nothing else at least my concerns are recorded in writing for future reference, if needed.

So, we will wait and see.
 

Dave63

Registered User
Apr 13, 2022
405
0
I think asking for a new MDT and for it to based on the best practice of 3 months of evidence is definitely the best option (if they agree!).

As mentioned in the article below in the event of an ineligible decision and you then went to appeal they would not consider any new evidence outside of the period reviewed during the MDT.

 

luggy

Registered User
Jan 25, 2023
205
0
I think asking for a new MDT and for it to based on the best practice of 3 months of evidence is definitely the best option (if they agree!).

As mentioned in the article below in the event of an ineligible decision and you then went to appeal they would not consider any new evidence outside of the period reviewed during the MDT.

Still no decision on the MDT. We reconvened to consider the Drugs domain on 26/2 and although the ICB did not respond to my cheeky request to start over with a new MDT taking into consideration 3 months of clinical records (I didn't think they would), it was clear that they had spoken to the assessor who stated that she had asked the care home to provide more records dating back to the beginning of November.

At the start of our discussion regarding the Drugs domain, the assessor was aiming for 'moderate', but the descriptor did not fit. I encouraged her to read the 'high' and 'severe' descriptors and there was no doubt that 'severe' was the most appropriate. The SW was fully on board, so 'severe' it was - making 2 'severes' = eligible.

However, assessor announces that she and the SW were having to visit the care home for another resident a couple of days later, so she would ask the care home for more information. SW states 'I don't think we'll need to do that as we already have everything we need to make a recommendation.' I haven't heard anything since, but I fully expect that the assessor will have 'found' some evidence to downgrade.

I don't think I've got the energy to start over with another appeal. I've already got an additional retrospective period to appeal in the pipeline. I can't keep appealing for the rest of my life. Life's too short.
 

Kevinl

Registered User
Aug 24, 2013
6,352
0
Salford
Just chuck the house keys on the table and say you're going on holiday, they have a legal duty of care, you're doing it for love, no legal obligation for you. love just happens.
It's an ugly thing to say but threatening to disengage as I think it was called was a trigger point on their file.
Helped too that one of the assessors and I were student nurses together back in the 1970s.
Would I have walked, hell no, but patient poker is what it is, their money or yours. K
 

luggy

Registered User
Jan 25, 2023
205
0
Latest in our MDT marathon:-

Email received this morning from the assessor 'I have now sent the DST for verification. You will receive a copy and the outcome once the ICB has made a decision'.

My reply 'What was the MDT's recommendation please?'

Response 'We recommend that your mother has a primary health need, however the documentation provided did not match the verbal evidence so I am expecting to be asked for more evidence at verification'

So, it looks like the ICB may try and reject it. Or, the assessor has worded her recommendation in such a way so as to engineer a result. Mum scored 2 'severes' in the MDT, so I hope their reasons are exceptional, should the ICB decide to bin it.
 

luggy

Registered User
Jan 25, 2023
205
0
Latest in our MDT marathon:-

Email received this morning from the assessor 'I have now sent the DST for verification. You will receive a copy and the outcome once the ICB has made a decision'.

My reply 'What was the MDT's recommendation please?'

Response 'We recommend that your mother has a primary health need, however the documentation provided did not match the verbal evidence so I am expecting to be asked for more evidence at verification'

So, it looks like the ICB may try and reject it. Or, the assessor has worded her recommendation in such a way so as to engineer a result. Mum scored 2 'severes' in the MDT, so I hope their reasons are exceptional, should the ICB decide to bin it.
Well, still no update to report. I've not come across the situation where the ICB take so long to ratify an MDT decision. It's been about 6 weeks. I'm keeping my head down, as mum is still being fully funded. It seems to me that the ICB have possibly realised that the assessor's recommendation at review stage, for a full assessment, was wrong.

The retrospective review for another period of time is now under way. That will probably be long winded too, although I believe the govt issued new guidelines in December '23 which suggest that these reviews should be resolved within 12 months. We'll see.

An LRM, an MDT & the initiation of a retrospective review, all since xmas, has kept me fairly well occupied indoors. Once this terminal rain stops, I'll want to be outside.