My late Husband received CHC and I have to say that the input from his CH and their exemplary records helped no end-so I advise everyone to regularly read the notes in your loved one's file, especially if you have been advised of an 'incident'-make sure that it is written up fully.
CHC Funding is written about, and questions asked, on a frequent basis on this Forum; people often list the problems their LO is experiencing and as heartbreaking as it is to know someone with Dementia if the symptom is classed as 'low needs' or 'Social Care' then CHC will not kick in. Your LO will need 2 'severes' to advance to an assessment. For example if a person is incontinent that would be classed as 'social care'. If a person's incontinence causes skin problems that requires cream to be administered twice a day-that would probably be classed as 'low needs' if the condition is controlled. Even that is open to interpretation as the NHS mantra is 'a managed need is still a need' but quite often that is ignored and a score is given as 'no needs'. If the skin was broken or bed sores developed then perhaps the decision would be medium needs. If the bed sores were frequent, or infected, or continuous and were difficult to treat then the decision could possibly be 'severe'. However, a 'severe' score could be given in the 'behaviour' domain if the PWD was aggressive when treatment was given whatever level the skin problem/bed sore.
In another example I know of one person on this Forum whose late Husband had a leg amputated; on his CHC checklist his mobility did not receive a severe score even though his mobility was zero and he had to be hoisted from bed to chair etc. Puzzled? Yes, me too! The crux of the matter was that he was not violent/or aggressive when being transferred. My Husband was scored much higher -even though he had two legs to walk on! Why? Because he fell a few times and was very shaky when walking. The falls were not serious enough for Hospitalisation but he needed a Carer with him at all times-not just only for the walking but because he was a danger to other residents. There was concern that his aggression was out of control at times and, if left on his own, it was possible he could inflict harm on others. So, the walking problem had a knock on effect to other domains i.e. cognition (no understanding that he needed help to walk) and behaviour. Pete scored 'severe' in behaviour and cognition and 'high' for mobility.
The thing is when being awarded CHC funding it appears to be all about intensity/complexity and unpredictability. To use my late Husband as an example again-he could start the day full of smiles (although that was quite rare) then as soon as personal care started he was punching, pinching, trying to bite and screaming. The point being that sometimes he was ok-sometimes not. However, no-one managed to discover what the trigger was. Again this illustrated complexity/ unpredictability and intensity-adding to the 'severe' score in 'behaviour'
Now in case anyone thinks that I am voicing my own opinions on why CHC Funding should be/should not be awarded-I'm not. I think the standards are open to interpretation; not just variances between each CCG but also the way individuals 'read' the domains. It's a scandal -I have no ideas how it can be resolved but I hope this probably over simplified explanation may just help a bit.
Keep fighting everyone.
CHC (Continuing Healthcare) support thread
- Thread starter stanleypj
- Start date
Its an absolute scandal. I've been fighting hard for my mother and ended up receiving nursing care which is paid for. However, she still pays for the rest of her care which is insane. It seems impossible to receive CHC how poorly does one have to be. The whole system surrounding care homes boils my blood something has to change it's very wrong
Yes it is @maxy Taylor
The "system" is designed t pay as little as possible as slow as possible, if at all. It wouldn't be so bad, but many regions do not follow the rules and try and put applicants' families off. They're sometimes quite brazen about it too!
The "system" is designed t pay as little as possible as slow as possible, if at all. It wouldn't be so bad, but many regions do not follow the rules and try and put applicants' families off. They're sometimes quite brazen about it too!
Imagine going to the GP or A&E and being told you will only be given a certain amount of care and you'll need to pay for anything which is social in nature and despite the fact your head is hanging off your health needs are not really that bad.
Another CHC question I'm afraid.
Mum has a 3 month review coming up.
She was originally fast track discharged from hospital as they felt her health was rapidly deteriorating and awarded CHC without any fuss.
Mum had recovered from her pneumonia and had no other active illness. The consultant and doctor at the hospital did not explicitly say she was "end of life" but told me that due to her age (95) and refusal to eat in hospital that she had days, weeks or a few short months left.
Mum was moved to a care home and was given a bed on, what I presumed, was the palliative care floor but is actually called the nursing floor.
During her 5 wk stay in hospital she had decreased energy levels and slept most of the time. This lethargy and weakness continued during her first few weeks in the care home ,however, slowly, with better encouragement from the staff to eat mum began to eat more regularly and more often.
Her food intake is still less than when she was at home and she has lost a considerable amount of weight and was only 8.5 stone before all of this began
Although energy levels have improved significantly her mental health has deteriorated.
Her ability to communicate has all but disappeared and she is now doubly incontinent and immobile. She also suffers from AMD and is registered as blind (Severely sight impaired).
She has lengthy periods of agitation and this presented itself even when she was in bed. The last night in hospital she fell out of bed and so when she moved to the care home they had the bed rails up.
In the care home she would still manoeuvre around the bed at night in all types of strange positions which ultimately led to her falling out one night and banging her head. Since then, the bed rails have been dispensed with, the bed lowered to the floor and crash mats by the side of the bed.
To help combat the agitation she is given a sedative as and when needed but the staff feel she needs something else to help offset the agitation and make her more manageable.
Mum is not on any dementia medication.The feeling is that if they cannot succesfully make a medicinal intervention in her behaviour then she may well be moved to an EMI.
She's not aggressive but is at risk of falling out of her chair during her agitated phases.
Please can I ask what you think is likely to be flagged during her CHC review? I have been told during the phone call that mum is now not considered to be end of life and therefore her needs going forward need to be better assessed.
Thanks in advance
Mum has a 3 month review coming up.
She was originally fast track discharged from hospital as they felt her health was rapidly deteriorating and awarded CHC without any fuss.
Mum had recovered from her pneumonia and had no other active illness. The consultant and doctor at the hospital did not explicitly say she was "end of life" but told me that due to her age (95) and refusal to eat in hospital that she had days, weeks or a few short months left.
Mum was moved to a care home and was given a bed on, what I presumed, was the palliative care floor but is actually called the nursing floor.
During her 5 wk stay in hospital she had decreased energy levels and slept most of the time. This lethargy and weakness continued during her first few weeks in the care home ,however, slowly, with better encouragement from the staff to eat mum began to eat more regularly and more often.
Her food intake is still less than when she was at home and she has lost a considerable amount of weight and was only 8.5 stone before all of this began
Although energy levels have improved significantly her mental health has deteriorated.
Her ability to communicate has all but disappeared and she is now doubly incontinent and immobile. She also suffers from AMD and is registered as blind (Severely sight impaired).
She has lengthy periods of agitation and this presented itself even when she was in bed. The last night in hospital she fell out of bed and so when she moved to the care home they had the bed rails up.
In the care home she would still manoeuvre around the bed at night in all types of strange positions which ultimately led to her falling out one night and banging her head. Since then, the bed rails have been dispensed with, the bed lowered to the floor and crash mats by the side of the bed.
To help combat the agitation she is given a sedative as and when needed but the staff feel she needs something else to help offset the agitation and make her more manageable.
Mum is not on any dementia medication.The feeling is that if they cannot succesfully make a medicinal intervention in her behaviour then she may well be moved to an EMI.
She's not aggressive but is at risk of falling out of her chair during her agitated phases.
Please can I ask what you think is likely to be flagged during her CHC review? I have been told during the phone call that mum is now not considered to be end of life and therefore her needs going forward need to be better assessed.
Thanks in advance
Hi @spirituscorpus
Its all extremely frustrating and I can appreciate where you are at. The issue is that asking online is difficult to answer, because obviously no one knows fully your mums situation and what constitutes a 'primary healthcare need' in her situation. What I will say is that you do need to do some homework and look at the domains and then consider the four key characteristics:
1. Nature describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.
2. Intensity relates both to the extent (‘quantity’) and severity (‘degree’) of the needs and to the support required to meet them, including the need for sustained/ongoing care (‘continuity’).
3. Complexity is concerned with how the needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/ or manage the care. This may arise with a single condition, or it could include the presence of multiple conditions or the interaction between two or more conditions. It may also include situations where an individual’s response to their own condition has an impact on their overall needs, such as where a physical health need results in the individual developing a mental health need.
4. Unpredictability describes the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the person’s health if adequate and timely care is not provided. Someone with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.
So for example a good point to argue is that of cognition in someone with advancing dementia as severe, you then need to think how cognition impacts on the four key characteristics above. Repeat this for the other domains. It is also important to remember that well managed needs are still needs under the CHC guidance which is often conveniently overlooked by some ICB's, also the place of care is often argued as a reason to not grant full CHC funding, under the guidance this is irrelevant.
To be honest I'd had enough of having to fight mums corner and got an advocacy firm involved, which is costly but saved me a lot of time having to dig through a 1000 pages of care and GP notes and assimilate evidence. In the end when mums money was reimbursed the compound interest that was also paid covered most of the legal fees.
You've summed things up well there.It's sad isn't it people's bodies have broken down bit by bit because of a disease and you've got all of these hoops to jump through
Social worker has just met my mother for the first time prior to a forthcoming CHC meeting.
He seemed to be already leaning towards withdrawing the CHC funding and told me the threshholh is very very high.
I accept that but I felt a little unnerved that there already seems to be some preconception as to how the assessment will conclude rather than relying on the actual assessment itself.
Shortly after the meeting the social worker then met with nursing staff to discuss mum's medical/care record.
One thing that irked me was the social worker asking about mum's financial state and asking if me the house was in her name or not. The house was actually gifted to me several decades ago but he told me anything after 1984 and the local authority may try to claim.
I thought this line of questioning a little inappropriate as it should not be relevant to the care assessment of my mother.
If and when my mum fails to meet CHC criteria then I presume a completely different department will conduct the financial assessment.
My understanding anyway is there is no specific time frame for the local authority to pursue deprivation of assets but I found it clumsy and alarmist of the social worker to make those comments without asking me the circumstances of the property transfer
He seemed to be already leaning towards withdrawing the CHC funding and told me the threshholh is very very high.
I accept that but I felt a little unnerved that there already seems to be some preconception as to how the assessment will conclude rather than relying on the actual assessment itself.
Shortly after the meeting the social worker then met with nursing staff to discuss mum's medical/care record.
One thing that irked me was the social worker asking about mum's financial state and asking if me the house was in her name or not. The house was actually gifted to me several decades ago but he told me anything after 1984 and the local authority may try to claim.
I thought this line of questioning a little inappropriate as it should not be relevant to the care assessment of my mother.
If and when my mum fails to meet CHC criteria then I presume a completely different department will conduct the financial assessment.
My understanding anyway is there is no specific time frame for the local authority to pursue deprivation of assets but I found it clumsy and alarmist of the social worker to make those comments without asking me the circumstances of the property transfer
Wow. I wonder why 1984 would be significant.The LA must be gutted when a house is out of their reach.
Hi @spirituscorpus
I'm no expert, but you are right. The CHC should revolve solely around your mum's condition and the care/nursing/medical care she needs, and irrespective of where she is cared for.
Yes the criteria are tough - deliberately so from HM Govt's point of view (trying to save money if they can get away with it) - but her finances are irrelevant.
There are set rules - v long - of how the assessment should be conducted. You better refresh yourself. You will need to challenge things not done correctly at each stage, and ask - if appropriate - why the protocols / regulations aren't be followed, etc. You can, of course, and subject to fees being charged, get legal representation
Best wishes
Is your mum already in receipt of CHC funding or is he saying he doesn't believe your mum will be found eligible after the MDT?
The social worker appears to lack understanding about how the process works. Whether your mum would be in a position to self fund (or not) has no bearing on anything until AFTER the CHC process has completed and a decision has been made regarding eligibility. The purpose of the social worker within the MDT meeting is to ensure the local authority is not exceeding it's legal limits of responsibility with regard to the level of care it can provide. It is for the nurse assessor to decide, after reviewing all the evidence, whether or not there is a primary health need which will entitle a person to funding.
Assessing your mums financial situation, whether informally or not, is a clear breach of process. It's not a difficult process to understand - The CHC assessment should run its course... if found eligible his role is over... If found not eligible then, and only then, should he be conducting a financial assessment. If he doesn't understand that and he is making predetermined judgements regarding eligibilty then he is lacking the knowledge of how the process works and shouldn't be involved in the crucially important funding decisions during the MDT.
Peoples experiences with social workers will vary. We initially had a superb social worker involved with mums CHC application who really fought mums corner. Sadly she moved into another role part way through and the social worker who took over was.... well, lets just say chocalate teapot springs to mind.
Ok, so has your mum had an annual review and the assessor found a significant change in her needs and has determined a full MDT assessment is appropriate, is that correct?
Sorry for the delay in replying.
Mum was fast tracked to CHC and is now awaiting the 3 month review.
Mum is also awaiting a medication review with the mental health team's involvement as they feel she might benefit from some drug intervention.
The social worker said they cannot have the review meeting until mum has had her meds reviewed and is "stable".
I find this a little odd as the argument will then be that her behaviour/needs might be better managed but those needs will still very much be present. I am not sure why they need her to stabilise before conducting the review ??
Apologies for jumping in on this @spirituscorpus - on a positive note, the longer the delay for the review, the longer your mum will be receiving CHC funding. I was in the same position with my mum - as long as the funding is in place, sit tight.
The Social Worker is talking about your mum being 'medically optimised', which can be a major setback if someone is waiting for an MDT assessment to decide whether or not funding should be awarded and, in the meantime, they're paying for their own care. I'm sure @Dave63 will enlighten you with their own experience of this.
My mother was fast-tracked 10 weeks ago by a hospital consultant with weeks or months to live. She is bedbound and dependent on the nursing home staff for all of her needs.
I now worry about the three-month review being discussed here. Surely, CHC reviewers could not decide that she is dying less or that her care needs are less. Would the reviewers stop funding at this stage?
I now worry about the three-month review being discussed here. Surely, CHC reviewers could not decide that she is dying less or that her care needs are less. Would the reviewers stop funding at this stage?
I agree with @luggy.
Normally the 'optimisation' tactic, which is used to delay the process, works in the CCG's favour. However, as your mum is already in receipt of CHC funding the longer they delay the review the longer your mum continues to receive funding.
Just as an aside, being stable or optimised is not mentioned within the National Framework as a requirement for progressing the CHC process. In my opinion it's a very cynical ploy by CCG's to delay and bamboozle. When the CCG tried this with us I asked them to direct us to the relevant section of the guidance which sets this out as a requirement. Obviously they couldn't, what they did instead was reply saying mum wasn't 'titrated'. They must spend hours pouring over a thesaurus!!
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It certainly seems a ploy to me.
"Let's give an opportunity for the Mental Health Team to "stabilise" the patient and then we will assess how unpredictable their behaviour is after that......"
My understanding of the process is now starting to tie itself in knots.
If someone is fasttracked to CHC then does that mean they have had a full assessment of their eligibility prior to the funding being put in place (and usually when they are still in hospital awaiting discharge)?
My understanding was that the forthcoming assessment was the 3 month review and that under the National Framework........
"These reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is expected that in the majority of cases there will be no need to reassess for eligibility."
"It is expected that the most recently completed Decision Support Tool (DST) will normally be available at the review and should be used as a point of reference to identify any potential change in needs. Where there is clear evidence of a change in needs to such an extent that it may impact on the individual’s eligibility for NHS Continuing Healthcare, then the ICB should arrange a full reassessment of eligibility for NHS Continuing Healthcare."
Am I right in thinking that the 3 month review is an opportunity for the MDT to assess if mum's needs have changed in such a manner that CHC is no longer an option rather than her having to almost re-apply for eligibility?
It's a subtle difference but it IS a difference.
If a person's condition/health factors have not improved measurably (I think being end of life is irrelevant) then there are no changes to the factors which led to the patient being awarded CHC originally and it must continue.
On the other hand, if the MDT take a position prior to the review that CHC is temporary for 3 months and now mum needs to show that she is eligible this would sugggest that mum would have to be assessed as if she had never received a CHC assessment when she was in hospital awaiting the fasttrack discharge
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