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Deprivation of Liberty

Billy's Girl

Registered User
Oct 8, 2013
76
West Yorkshire
After being refused continuing care in May my OH has now received the result of his DOL assessment completed recently. This goes into detail about his health issues including the fact that his short term recall is 3 minutes and scored 28/28 on a six item cognitive impairment test. He is doubly incontinent, bed bound and he can only feed himself finger food. I have been given authorisation of his health needs. With the details of how incapacitated he is I cannot see why he was refused continuing care. In any event his funds will have reached the limit by October. Should this DOL affect a continuing care decision?
 

canary

Registered User
Feb 25, 2014
11,646
South coast
CHC and DOLs are completely different issues.
Dols is used when there has to be deprivation of liberty - in my mums case this is because she would go walkabout and be a danger to herself and others if she were not in a locked unit. The emphasis in the DOLS is safeguarding ie - to make sure that it is appropriate. It is standard for all the residents in a locked dementia unit.

CHC is an assessment to see what their needs are. The bar to get CHC is set incredibly high - there are 11 different categories (or domains) and you really need to score 2 severes in different categories, or 1 priority to get CHC. If you havent seen the definitions for these domains then google "CHC decision support tool" and you will be able to download a pdf which is a very long file, but tells you all about it and gives a table with all the domains and how to score them. If you think that he should score 2 severes then I would appeal, but TBH from what you have said I do not think he would get 2 severes.
 

KatharineB

Registered User
Aug 13, 2015
2
Bristol
Chc

I fought for 18 months to get CHC for my mum, who was completely dependent in a nursing home, syringe fed puree into the corner of her mouth, had to be hoisted everywhere and was - to be blunt - a vegetable. She couldn't speak. Even that state was marginal for CHC. I joked to the CHC assessors that it seemed you almost had to be dead to get CHC. It all hinges on the 11 'domains', as someone else said. Added to that, it's all to do the the 'complexity', 'intensity' and 'unpredictability' of the person's needs. So a well behaved predictable vegetable (like my mum) was borderline. However she would have got CHC if she'd been aggressive but a lot more capable, as that counts as 'unpredictable'.

What swung it for us in the end was a long standing arterial leg ulcer, which scored her high in the 'skin integrity' domain.

The CHC funding was reviewed in June, just a month before mum died, and we were once again borderline, as that ulcer had healed.

Good luck with the CHC. You do need to look at that decision support tool very carefully and you must be there when they do the assessment, to make sure they get it right.
 

Raggedrobin

Registered User
Jan 20, 2014
1,427
Agree DOLS is a completely different issue. It is very hard to get CHC, dementia is the poor relation when they decide who gets it. My Mum has consistently scored enough points for it but she still doesn't get it.
 

Beate

Registered User
May 21, 2014
11,902
London
Thanks for the link. There might be 11 domains but in only 7 of them could you even go up to a Severe. I know OH would score a Severe in Cognition and probably one in Communication, but that only goes to High. No wonder it's difficult to get CHC!
 

katek

Registered User
Jan 19, 2015
191
Thanks for the link. There might be 11 domains but in only 7 of them could you even go up to a Severe. I know OH would score a Severe in Cognition and probably one in Communication, but that only goes to High. No wonder it's difficult to get CHC!
Exactly. And post #3 by Katharine is a good example of what is considered 'borderline' despite the Coughlan Judgement saying someone with those needs should qualify.

Most people with AD who manage to get CHC do so by getting their second 'Severe' in 'Behaviour'. However, if they do not exhibit this extreme behaviour, there is not much hope. The criteria in the other 6 domains which have a 'Severe' level, are of a level such as being intravenously fed or having a tracheotomy needing skilled management, for example. Not many people would necessarily have those sort of needs.
 

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