CHC funding, is it worth applying?

[Katrine]

This may seem a strange dilemma, but I am contemplating a gift horse and wondering if I should beware. To give the context, MIL is in a small rural CH in a residential EMI bed. It is not our preferred long-term CH but it will do for now until her house is sold and she becomes self-funding. Today I received a letter from the manager enclosing a form to give permission for MIL to be assessed for Continuing Health Care funding. The CH has recently been registered for nursing care as well as residential.

From all I have read about CHC funding, I would not think that MIL would be eligible. She is not safe to live alone and has been assessed as requiring 24/7 supervision in a residential environment. She has been assessed as not having capacity to determine where she lives or how she is cared for because she doesn't understand her health and care needs. She has no underlying mental health issues apart from VasD and AD. She is mobile, although has started to be more unsteady and to have falls. She is reasonably continent but needs prompting for regular toilet visits and cannot locate the toilet without carer assistance. She eats well and does not require assistance with eating and drinking. She is able to wash and dress herself on a daily basis, but needs assistance to bath/shower and to wash her hair. She has lots of pills to take, which can be administered perfectly adequately in a residential environment.

So, why would I be wary of her having this assessment? I think that this CH has an agenda to get more funding as they are struggling to make ends meet at the moment. This would be why they would like CHC funding for MIL. They can't recruit more nursing staff until they get enough residents assessed as having nursing needs. It wouldn't make much difference to MIL's living environment because it is a small CH and residents all mix together.

However, as we plan to move her to another CH in a few months time, what would be the implications for the sort of environment she would be assessed as needing in future? The residential EMI units in our preferred CH would suit MIL very well. We would not want her to be living in the nursing wing where everyone has high nursing needs and/or challenging behaviour. I can't see how she could be assessed as having nursing needs and then live in the residential EMI area where there are no nurses.

And finally, if she is turned down for CHC funding, does this make it harder to re-apply in future should her needs change? Your thoughts would be much appreciated.

 

[BeckyJan]

Answering your last question, you can re apply for CHC as you wish. Our NH Manager said to me, do it and if necessary ask for another one every week. That would seem unreasonable to me but as your Mother's needs change then you have every right for a re assessment.

Personally I see no harm in letting the application go through. CHC can be given even when an applicant lives in a residential home or in their own home. They are required to do a nursing assessment at the same time as CHC but one can be given without the other. Obviously a nursing requirement adds to the 'severity, risk potentional and unpredictability' of a case.

 

[J W]

I would also let the assessment go ahead its your MIL right. we had ours and got turned down even though i would say my parent would be a little worse off than the description of your MIL, but it can be a bit of a postcode lottery who has a harder time of getting CHC than others.
I am reading up on the national framework for the time we ask for another assessment, but its so long and at times repetative and confusing terms ( to me anyway) that i have stopped looking at it for a while.Try reading up on things to get a understanding of what is required to gain CHC,there is a lot of info on these threads on the forum,

Good Luck.

 

[Katrine]

Thank you JW. I think the weird thing is that the CH seems to want to apply for CHC funding on MIL's behalf without involving us, other than to gain permission. This means that we won't have input into the application, but maybe that's for the best as they probably know how to tweak it to say the right things.

I don't think there's any chance she will get it. OH saw £ signs as soon as we got the letter because he's tasked with managing her modest capital assets to pay for her care. His sister keeps pestering him to apply for CHC funding for which she thinks her mum is a shoe-in because "she deserves it after all the work she did when she worked for the NHS". We keep saying it doesn't work like that, it's not a popularity contest.

However, if the CH want to give it a go, it seems like it can do no harm. Fortunately MIL is not upset by assessments as she doesn't really understand what is going on. She is very articulate and believes she gives a good account of herself. In reality her words are scrambled and you have to work hard to understand the underlying meaning, which is often very subtle. She hasn't lost her intelligence, just her processing power. What a frustratingly complex thing a dementia brain is, like a highly sophisticated machine that has been damaged by a power surge.

 

[Tigers15]

You are next of kin, not the home - therefore you can insist that you are present at the assessment.

The manager of the home where my dad is got the ball rolling for dad to be assessed for Continuing Healthcare: at the assessment the manager of the home was present, my sister, me, the social worker and the NHS professional (whose title I can't remember). Following the assessment dad was granted full CHC. As far as I am aware this doesn't mean that dad couldn't be moved to another home - something I hasten to add that I wouldn't want to do unless the standard of care at the home started to decline.

I say - go for it, but make sure you are part of the process, you are involved. Good luck.

 

[nitram]

The starting point for CHC is the same as for FNC (Funded nursing care)
https://www.gov.uk/government/news/nhs-funded-nursing-care-rates-increased-for-2013
this is paid direct to the care home with no reduction of fees to the resident.

The care home may be gilding the lily in order to get agreement to start the check list process.

 

[rajahh]

My understanding about CHC is that if it is granted this reduces the fees your mil would have to pay. So the home does not necessarily benefit. Of course I could be wrong.

 

[Katrine]

Currently the LA is paying under the 12-week disregard, but at the lowest rate they can get away with. This is less than a self-funder would pay for residential EMI. Those on nursing rate pay more, as is usual with most CH/NHs. The CH needs to recruit nurses but are hampered by having so few designated 'nursing' patients. They can't afford to pay for the extra nursing staff until they increase their regular income. I imagine that they are trying to put a CHC application in for every resident, hoping that a few will be approved.