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Continuing healthcare vs Section 3, s117

Discussion in 'I care for a person with dementia' started by sl638e, Feb 12, 2016.

  1. sl638e

    sl638e Registered User

    Mar 30, 2009
    31
    London
    Hi all

    Does anyone have any experience with going through CHC and mental health assessments?

    This afternoon I'm due to meet with the staff at the mental health unit which has been caring for my mum. She was previously in residential care, but her bizarre and aggressive behaviour became too much for them to manage. She's now been in the mental health assessment unit for a few months and it seems pretty clear she'll need nursing care from now on.

    So today we're finalising paperwork for a continuing healthcare check, but the staff say they won't recommend her to qualify. The social worker also recommends that we don't push for CHC, as she says my mum would be better served by Section 3, s117 of the Mental Health Act, under which the NHS is obliged to fund her ongoing care on discharge from hospital.

    My main concern is to get some sort of funding for her care. We have a care fees annuity, but it only pays at the level needed for residential care. Nursing care in a decent home seems to be about double this cost, and we have no way of funding the balance.

    Can anyone give me any guidance on what I should ask for?

    Thanks! xx
     
  2. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,659
    North West
    This is a complex area, as you will be aware. I would say that it's worth trying all avenues and I wouldn't accept the suggestion that you shouldn't go through the CHC process because something as good as or better than CHC is possible. Surely both processes can be investigated simultaneously.

    You might want to have a skim through this thread in preparation for the CHC process:

    http://forum.alzheimers.org.uk/showthread.php?86059-CHC-(Continuing-Healthcare)-support-thread

    You might want to post your own questions an that thread too.

    Good luck.
     
  3. sl638e

    sl638e Registered User

    Mar 30, 2009
    31
    London
    Thanks! Yes, I'm definitely keen to pursue the CHC route, although the social worker seemed to think that care homes wouldn't be prepared to take my mum if she qualified. However, when I asked one home they were perfectly happy to accept her on this basis.

    I couldn't find anything on s117 in this forum, but the links about CHC are really handy, thanks. I'm not sure why s117 doesn't seem to be a route that many people take, particularly given how difficult the CHC process seems to be. (I've been through it once previously, but at that point my mum's needs were much less severe and she clearly didn't qualify.)
     
  4. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,659
    North West
    #4 stanleypj, Feb 12, 2016
    Last edited: Feb 12, 2016
    Watch that SW! Since the vast majority of people who get CHC are either already in care homes or go into a care home the SW is clearly wrong about that.

    Good that you've been through CHC already. That should help.
     
  5. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    You may have already read the link below that is from "Mind". Aftercare is also to be provided free but on the page about "who pays" it states (my bolding).....

    "The relevant clinical commissioning group or local social services authority must therefore fund all s 117 aftercare services. If someone chooses to make private arrangements for care, either in addition to or instead of, aftercare that should have been provided, it may be possible to claim repayment for this on the basis that the authority had failed to discharge their duties under Section 117. However, the authority or the court would be entitled to consider the reasonableness of the private arrangements and the level of reimbursement appropriate."

    Obviously depending on the T&C's of the annuity does this mean you could come to an arrangement with whoever ends up paying, NHS/CCG/LA, to continue to use the annuity as well as their funding to provide something better for your Mum?

    http://www.mind.org.uk/information-...ntal-health-act/who-is-entitled-to-aftercare/

    :)
     
  6. sl638e

    sl638e Registered User

    Mar 30, 2009
    31
    London
    Thanks, well according to the social worker, the answer to this is 'no'. Which is crazy, if it's true. It seems that it's an 'all or nothing' situation - either the local authority pays (£660pw) or you self fund. To put this in perspective, the annuity pays £740pw, and a nursing home I visited quoted me £1500pw.

    Information on the subject seems very hard to obtain, and (as mentioned above) I distrust what the social worker is telling me!
     
  7. LYN T

    LYN T Registered User

    Aug 30, 2012
    6,968
    Brixham Devon
    I take it your Mum has been sectioned under a section 2? Has she been moved to a section 3? -that is when s117 kicks in. You are right to be wary of the SW and her assumptions. Everyone is entitled to ask for CHC funding-whether they get it or not (even if they should:mad:) is a different matter.

    Your Mum has a right to appropriate care whatever the cost if she is awarded CHC or through s117. The CCG will do their best to get the cheapest care package but they will have to take into account various things to make it workable-i.e. being close enough for relatives to visit etc.

    Wait and see what the meeting comes up with today-do not agree to anything until you have had the time to consider what they propose. Also do not sign anything at this time.

    The best of luck to you

    Please let us know how you get on.

    Lyn T
     
  8. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    If the SW is saying "no" then she is wrong as even CHC can be topped up with "creative thinking" and from the quote it certainly seems possible with sec117. Maybe a change in SW is needed.

    That quote you have had is a tad eye watering.

    Good Luck.:)
     
  9. sl638e

    sl638e Registered User

    Mar 30, 2009
    31
    London
    Thank you! I THINK she's currently under section 2, but not 100% sure. Do you know if moving to section 3 is difficult to achieve?

    Yes, it certainly seems as though qualifying for CHC is like getting blood out of a stone, but I guess I should reserve judgment. (Don't even get me started on ranting that my mum has worked hard all her life (as a single mum) and paid her taxes and NI, while scrimping and saving, yet still she has to sell her home and pay out for her healthcare in old age... )
     
  10. LYN T

    LYN T Registered User

    Aug 30, 2012
    6,968
    Brixham Devon
    I know a bit about it because my late Husband was sectioned 5 times:eek:

    Pete was always sectioned on a 2. This is normal procedure and can last up to 28 days. If it is decided that more assessment/further observation is needed the patient is normally put on a section 3 this is what kicks in the s117. HOWEVER, (and I never understood this action) when Pete's section 2 ended at he was put either on a voluntary patient basis or a DOLS (deprivation of liberty safeguard). He wasn't allowed to leave BUT there was no section 3:confused: One of those times he was waiting to be placed in a CH but there was a problem getting a CH to accept him:eek: so I could understand the DOLs in that case. I expect others will be along to give more info.

    Good luck

    Lyn T XX
     
  11. tigerlady

    tigerlady Registered User

    Nov 29, 2015
    427
    I had a similar experience. My husband was sectioned under Section 2 and when the 28 days were up he was put on a DoLS order so that they could legally keep him in the assessment ward. I think going onto Section 3 means that the NHS must then legally fund any future care, so I think the DoLS is now given instead of a Section 3 so that they are not under any obligation to do this.

    However, after the DoLS was given I was under pressure to find a care home for him, but I couldnt find any that would take him. I found out that it was because when the care home managers read his notes, which contained records of his aggression, they decided they could not cope - and these were homes which stated they took people with dementia!

    My very good SW then arranged for the CHC DST, meeting, which I attended, and as he scored severe in cognition and behaviour, he was granted the funding, but it had to be a nursing home, where there is a higher number of staff. I realise how fortunate I was to get this funding, after reading all the heart-breaking stories of people who have tried and failed, but at the time I was in tears, as it was at that meeting that I heard the full extent of his behavioural problems, which had worsened during his time in hospital.

    It was still a problem to find a place for him due to waiting lists, and he did get placed in a horrible home, which seemed ok (and also I was desperate to get him out of the hospital environment) but I soon found out that the layout of the home, the level of care, and the awful food was not suitable, and after many letters and tearful phone calls to the In Reach team and the CHC people, he is now in a very good home.

    I wish you good luck xx
     
  12. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,659
    North West
    Thanks tigerlady. It's always good to hear of a successful CHC process (even though it took a long time to get your husband into a deceant NH).
     
  13. sl638e

    sl638e Registered User

    Mar 30, 2009
    31
    London
    Update

    Thank you all for your help and sharing your experiences.

    So, as it turns out, all this is irrelevant. They aren't recommending my mum for CHC (even though she appears to meet some of the criteria) and as she was held under Section 2 then DOLS, not Section 3, she doesn't qualify for s.117 either! My mistrust of the info from the SW was justified - although she told me previously that the Section 3 route was available, it turns out that an assessor visited my mum and decided she didn't qualify. I wasn't informed of this. :mad:

    So essentially I'm back to the self-funding route (assuming the panel rejects CHC, as it almost inevitably will). I now have to try and find a nursing home on our budget. It appears there are very few nursing homes around, compared to residential care homes, and a lot of them have poor CQC ratings.

    The SW did give me a tip - look for homes that offer both local authority placements and self-funded places. She says I should then be able to negotiate a reasonable price, because they will prefer to take my mum directly, as a self-funded resident, paying slightly more than she would if the local authority placed her. I haven't attempted to do this yet, so I don't know if it's true.

    It was interesting to note that the SW was trying to get the language in the submission to the CHC panel toned down, with regards to my mum's behavioural problems, aggression, etc. She explained that this will be important in getting a nursing home to accept her. It's an odd balance to strike - clearly the worse her behaviour appears, the more likely she is to get CHC. However, if she doesn't get it, she's better off if her behaviour appears less of a problem. <SIGH...>
     
  14. 2jays

    2jays Registered User

    Jun 4, 2010
    11,604
    West Midlands
    [sigh] your social worker, in my opinion, isn't giving very good advice towards obtaining CHC. A possibility towards getting a care home placement, but one that might fail due to behavioural problems, if your mum has them....

    IF my mum had scored severe in the behavioural part of CHC, she would probably have got it.

    Sorry not got much help for you, apart from gathering up the hair you must be pulling out and a hand hold as it is so difficult to deal with things, without the right information xxxxx


    Sent from my iPhone using Talking Point
     
  15. jaymor

    jaymor Volunteer Moderator

    Jul 14, 2006
    12,498
    Female
    England
    It is so wrong of the SW to suggest toning down anything. To get your Mum the right level of care in the right home then everything has to be as clear as possible to the person from a chosen care/nursing home to have a clear picture.

    If they have a fudged picture then they may say they can give the level of care only to find out weeks/months later you are asked to move your Mum because they cannot cope for what ever reason. This means you having the difficult challenge of finding another home in a given space of time and your poor Mum having to face another move to another unfamiliar place.

    Here's hoping for a not too traumatic move towards permanent care. I have trodden the path with a very good outcome, we needed nursing care for challenging behaviour, I wish you the same.
     
  16. tigerlady

    tigerlady Registered User

    Nov 29, 2015
    427
    I think its shocking that the SW "toned down" your Mum's behavioural issues.

    This could lead to a home accepting her, and then later asking you to move her because they cannot cope. In my husbands case, it was the reports of the nursing staff which backed up the "severe" in behaviour, and it was the reason that he had been turned down by so many homes previously. Therefore I knew, when he did get accepted, it would be with a home that was able to cope with him. In the home where he is now, I think most are on CHC funding
     
  17. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    Hiya

    Please go through TP's CHC funding thread in detail and think about the apparent misrepresentations / SW "misconduct" you've experienced. Once you're clear in your own mind what's gone wrong and what the impact these "mistakes" will have had, then please contact one of the organisations offering free casework advice.

    It seems to me the process hasn't been carried out correctly; the CCG may feel obligated to set aside the incorrect assessment and restart the process, alternatively you could appeal.
     
  18. theunknown

    theunknown Registered User

    Apr 17, 2015
    325
    What I'm starting to feel increasingly outraged about is the difference in experiences of those both suffering from, and dealing with, mental health problems. Would somebody dealing with a heart attack, a stroke, a blood clot, a concussion, cancer, high blood pressure, diabetes, etc, etc, experience such wide varieties in advice and care?

    This particular thread has helped me, because to some extent it explains the financial transaction I'm part of for my mum's care. I read in various places that if you're moved from hospital to permanent care then you're entitled to NHS funding, but that's very difficult to get. My mum was put on a mental health ward, and moved from voluntary admission to a Section 1, to a Section 2, and finally a Section 3. The Section 1 happened very quickly. Once the Section 3 kicked in I had to find a care home. When I was told that my mum would never live independently again I found a home close to me. I was told by the social worker at the hospital that my mum would be entitled to funding because of the Sec 3. There's no way I would have left her in the area she was in. The social worker said that the LA would pay the local fee, and if I wanted my mum to go somewhere else I should arrange a 'private' top-up arrangement, which is what I did.

    How is it that LA areas are being offered different funding options?
     
  19. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,783
    Salford
    I don't get this either surely getting S117 funding means the NHS have to pay for her care, CHC can (and lately regularly) can be withdrawn on the most dubious pretexts.
    S117 funding I would have thought would be the preferred route to take as unlike CHC it probably won't get stopped. In the future if someone tries to "redefine" your mothers needs and stop the CHC so you have to consider the risk of that happening.
    S117 funding can be stopped too but only when you don't need "aftercare" for the original section 3 order. "Aftercare" doesn't specifically define between nursing and personal care the way the CHC wording does so it's a lot harder to end because they can't say it's all personal care S117 says aftercare without the specifics of the CHC rules. Given the number of people having CHC withdrawn I would have thought the S117 would be the preferred route specially if you've been told you won't get CHC.
    K
     
  20. LYN T

    LYN T Registered User

    Aug 30, 2012
    6,968
    Brixham Devon
    S117 (being the result of a Section3) isn't a 'route' that someone can take for their LO in as much as that there is no 'route'-there is no application process. It's purely down to the Consultant who will decide what will happen after the Section 2 is about to come to an end- be that discharge, DOLS or Section 3.
     

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