Continuing Healthcare funding review and how to challenge it

[Romanacat]

My mother in law was awarded CHF around 18 months ago when she moved from one county to another (to be nearer us).

We have just had to go through a review, which took 3 hours, for various reasons:

The care home did not have the paperwork available
The nursing staff were not available and/or gave differing feedback
Although we have seen distress exhibited, no notes have been made in the nursing records
Although we were told by the nursing staff that she had refused medication and sometimes not had it until the afternoon, her records are written as "all medication taken, fine"

As a result of the fact that her care in this home is EMI and not basic, her exhibited behaviour is less; however, she is much more frail.

We have been told that due to the lack of demonstrable needs, it is likely the CHF will be rescinded.

Does anyone else have experience of this?

Thanks

 

[nitram]

"The care home did not have the paperwork available.
The nursing staff were not available and/or gave differing feedback "

This in itself is enough to warrant a complaint.
It might be a good idea to complain now before you are given the result, if they are minded to grant CHC it won't make any difference, if they intend to refuse you will have complained about the process before you were given the verdict.

Bear in mind that if your mother in law will become self funding if CHC is refused the care home will most likely benefit financially.

 

[stanleypj]

The medication problems not being recorded is also something that they need to look into. They have told you that you should expect a negative outcome. Give them as much to 'think about' as you are able.

 

[DivingDavey]

Are people aware of many dementia patients being awarded CHC?

We applied just over a year ago for my mother but were not successful - it' s hard to imagine how she could be any worse now.

She is doubly incontinent, hardly able to speak, her limbs have become very stiff, she can't stand so is hoisted in and out of bed etc. She usually eats her meals with her hands/help from the staff, but I still don't know if it's worth re-applying. The residential home she is in is really lovely and I am worried that if she is now assessed as nursing needs she will have to move to a less good home.

 

[stanleypj]

You may find this thread useful if you haven't come across it already.

It's hard for people to answer your question as I'm not aware of any source of precise statistics. People with dementia do get CHC funding but a lot get turned down or aren't even aware of CHC funding. It's clear that there is a postcode lottery and some CCGs are much less likely to approve funding than others. It helps if professionals are convinced of the needs and willing to push it. You could start by revisiting the checklist that was completed for your mum prior to the last application and seeing what exactly has changed in terms of her needs.

 

[DivingDavey]

Thanks very much, I'll do that.

 

[Kitten71]

Are people aware of many dementia patients being awarded CHC?

We applied just over a year ago for my mother but were not successful - it' s hard to imagine how she could be any worse now.

She is doubly incontinent, hardly able to speak, her limbs have become very stiff, she can't stand so is hoisted in and out of bed etc. She usually eats her meals with her hands/help from the staff, but I still don't know if it's worth re-applying. The residential home she is in is really lovely and I am worried that if she is now assessed as nursing needs she will have to move to a less good home.

My dad has Lewy body dementia and has just been awarded CHC after his third assessment. However, he scored highly because of his unpredictability and aggressive behaviour which may require specialist help should he have an unexpected outburst. This behaviour was brought about after he got sepsis and he has continued to have kidney infections ever since. I feel the CHC may be a short term thing as I can see improvements in his behaviour the longer he remains infection free. Why don't you have a look at the detailed assessment online and see if you think your mother would score highly in any of the sections? I think it's always worth reapplying and I have to say, I was most surprised that my dad got it. You say she may have to move care homes if she gets awarded it but have you enquired about paying top up fees? I'm afraid I don't know much about them but I've seen it mentioned on here so I'm sure you'd find some good advice