DST meeting ......advice?

Discussion in 'I care for a person with dementia' started by katie1, Mar 9, 2015.

  1. katie1

    katie1 Registered User

    Aug 5, 2014
    122
    Kendal Cumbria
    We are attending a meeting this week (wednesday) in hospital where Dad is following a collapse almost two weeks ago, medically he is much improved, however his dementia is now much more noticeable. He has been given one to one since arriving because of his behaviour, agitation confusion and disorientation, however the ward he is now on is so short staffed that he is now supervised by security guards!
    The meeting is part of the NHS CHC funding using the DST(decision support tool) then I presume all the information gets discussed further before we find out a decision!! the thing is we don't want him in there much longer.....his needs are not being met, he has nothing to do, he is being "minded" by security guards, he is losing skills!
    Has anyone got any advice how we should prepare for the meeting....?
    I don't want any hold ups, I don't want anyone thinking I don't know anything about the process, I don't want any bull ****!! so what should we be aware of? what should we take with us? what should we ask? etc
    thank you
     
  2. Austinsmum

    Austinsmum Registered User

    Oct 7, 2012
    305
    Melton Mowbray
    You need to download the National Framework for CHC asap and start burning the midnight oil, it's quite a tome.
     
  3. katie1

    katie1 Registered User

    Aug 5, 2014
    122
    Kendal Cumbria
    Yep did that, I read all 140 pages of it, and made notes! thank you
    Just wondered if anyone else had been through the process and had any advice to offer?
    Thanks again
     
  4. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    Unfortunately not much will rush the process for your Dad. The CHC decision should not really affect whether he stays where he is or moves somewhere else. It will only decide who funds it.

    A best interest meeting with all involved is probably what you need and should not influence the CHC or vise versa.

    If you have read the categories and already decided where your Dad should be in each then do not waver from that and be prepared to give definite examples to justify it.

    Make sure your objections to any scoring is noted.

    No decision will be made there and then although the assessor should give you their opinion. It has to go off to panel, a week or so, which normally comes back as "No".


    Just to add I have read your other posts regarding the security guard. Depending on their training it can be well in excess of SIA standards and you never know they may well be a good source of information for the assessor on how your Dad behaves.

    I wish you and your Dad well.:)
     
  5. flossielime

    flossielime Registered User

    May 8, 2014
    201
    I am waiting for my dad's Chc assessment so I read your post with interest.

    I was wondering what 'in excess of SIA' means?

    I wonder if anyone knows if we (as next of kin) have any access to the medical notes? I suspect not.

    From what I understand it the nhs does not seem to share the 'evidence' with the defence and they then seem to be judge and jury too. This whole process seems a bit of a kangaroo court from what I see so far. But it is early days in my research in to it. Hopefully it will be fairer than it seems in the outside.


    Sent from my iPhone using Talking Point
     
  6. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    I mentioned that because Katie1 has been telling us that a security guard is being used on a hospital ward to "keep an eye" on her Dad. The SIA is a government body that regulates security guards and there is a set training regime to follow to obtain a licence.

    However the NHS can directly employ their own security staff and the training courses for that exceed the SIA standard especially when it comes to restraint & conflict management techniques.

    Not that interesting really and sorry if it caused confusion.:)
     
  7. katie1

    katie1 Registered User

    Aug 5, 2014
    122
    Kendal Cumbria
    I went on the security firm web site and the training is nothing to do with working in a hospital! They are keeping notes but I was told I couldn't see them because they were to cover themselves if something happened (like what I wonder??!!) and were the property of the company and the NHS! By the way SIA means Security Industry Authority
    We had the meeting today, it went on much longer than I had expected, but that was because I questioned everything. We were told that although on the face of it, it does seem like he might qualify for NHS CHC funding they need to do more assessments such as an OT report Speech and Language and get advice from a dietician because he has lost weight over the last couple of weeks.
    It was then explained to me that if he did get the CHC funding that this would only be paid to a nursing home not to a care home because he needs a high level of one to one because of behavioural issues which would not be safely catered for in a normal care home. They are saying that because he has shown signs of aggression he should be in a EMI unit in a registered Nursing home with mental health nurses.
    He has been supervised by security guards who are not dementia trained
    He is 85 with "rapidly deteriorating cerebral dementia"
    He was until the 27th February living in an idyllic Lake District Cottage surrounded by beautiful scenery on the side of a fell, going for two walks a day, with very few neighbours, no pavements, along a lane up a valley............he is now in a busy hospital ward, close to other people, not being permitted to go out of any doors, being marshalled closely by security guards dressed in black clothes, no wonder he is showing signs of aggression!!!
    There are no beds available in EMI/Nursing homes in our local town (although there are only 3 homes that fit this criteria) we do not want him to have to go to another home miles away, Mum is 83 and wants to visit him regularly, it would take up so much of a day and be too tiring for her. She has needs also! Surely it is better for him to be cared for nearer to home so that various family members can keep up contact?
    We have found a lovely care home in our local town that has a superb holistic view of those with dementia but they told us he could only do there is he was considered to be unsuitable for NHS CHC funding and qualified only for FNC which was about £190 per week which Mum could then top up (I said at this point that we were only there to discuss the NHS CHC)
    I think he does and will qualify for the NHS CHC but because of his cognition and behavioural needs and after all these other assessments we will be told that he can only go to a nursing home that has mental health nurses.
    However....what can a mental health nurse do that a fully qualified carer in dementia care cannot do? Is it to do with responsibility?
    They also said that only a qualified nurse could oversee a dieticians advice and ensure that care workers were implementing it so therefore a nursing home would be more appropriate.
    We want him out of hospital asap.....he is deteriorating fast in there, he looks awful, he is losing skills, he is frustrated and agitated (although this is part of the dementia it is made worse by being confined)
    I have no idea what to do next
    I wish he could go to the lovely care home we had identified, we feel sure he would be happy there, it has space so he could walk and wander whenever he wanted and staff who have a great understanding of dementia, and a high staff ratio
    But I fear it might now not happen
     
  8. jasmineflower

    jasmineflower Registered User

    Aug 27, 2012
    335
    Hi Katie1
    If it's any help, my mother in law received full CHC funding in a care home. You can even receive it if you are living at home. But, and this was a big but, she only lasted in the care home for 3 weeks despite their assessment of her and stating they could cope.

    The care home was not set up to meet her behavioural needs. Despite pressure pads on the floor and alarms etc she still managed to fall 19 times and break her wrist and also to A&E for a suspected hip fracture.

    In desperation we turned to the Alz Soc and the local support worker found her a great place in an emi nursing home.

    If they are recommending an EMI nursing home, I would seriously consider taking their advice, or seeking further clarification from them to avoid a big kerfuffle later and maybe having to move again within a few months as it was an incredibly emotional and distressing time.

    J x
     
  9. flossielime

    flossielime Registered User

    May 8, 2014
    201
    As mentioned before Iam in a similar position.

    My dad too needs one to one support. i have visited 3 EMI homes my area. None of them are acceptable to me and NONE of them could meet my dad's needs. He would fall if left in a bedroom on his own. Ok the bed mats/sensors etc would let staff know BUT he has already fell by then. And he would forget he had fallen and keep on doing it so it would be unfair on the other residents as the staff would be spending so much time at night sorting out my dad.

    Anyway I want my dad to come home with NHS CHC for this one to one support. The Social worker has been spouting all the RMN needed etc. I am holding firm at the moment. But we will wait to see if I can wear them down -all assuming he gets the funding.

    I found this on the NHS website http://www.personalhealthbudgets.england.nhs.uk/About/Stories/

    This gives examples of people getting CHC at home. I thought it might be particularly useful for you to have a look at Shaheema's story at the end.

    Good luck
     
  10. katie1

    katie1 Registered User

    Aug 5, 2014
    122
    Kendal Cumbria
    #10 katie1, Mar 11, 2015
    Last edited: Mar 11, 2015
    Thank you....however....
    No matter how much we love Dad, no matter how much we care.....and we do, so so much....we really couldn't keep him safe at home. The house is a stone built cottage on the side of a Lake District fell, no street lights, no pavements, along a winding lane, up a steep drive, beautiful scenery, idyllic one might say, except if you are 85 with rapidly worsening dementia,confused, disorientated, frustrated and scared with a wife of 83 who has poor mobility who uses sticks to walk and is worn out!
    He needs to be in a care home nearby in the local town, but we were told there are no beds yet. I have no idea what we do now.
    But I will think of something
    Also when we went today we found out that he had been given respiredone (no one had told us we found out quite by chance) but they were unable to tell us why, or if it had been effective and if it was to be given regularly. Im not sure about it.
     
  11. count2ten

    count2ten Registered User

    Dec 13, 2013
    186
    Having completed hundreds of DST's, my best advice would be to get a good no-win-no-fee solicitor experienced in NHS CHC funding. Yes, you can have CHC funding provided at home, 24/7 with properly trained qualified staff providing all the care, I know several colleagues who have commissioned this. Once in place it should be reviewed every 12 weeks but in my experience it is never withdrawn (there would have to be a huge improvement in physical and mental health to justify this). Most LA's and NHS commissioning bodies detest any sort of legal challenge (fear of losing and paying huge costs out of tax-payer's money), and also the fear of adverse publicity . There are several cases where the NHS has been taken to task by the judiciary and given a very sharp slap on the wrist for denying CHC funding where it is clearly eligible.
     
  12. flossielime

    flossielime Registered User

    May 8, 2014
    201
    Katie - I realise you dont want it at home but i thought it would illustrate that may be the system is more flexible than they are implying. Not sure if it is but it seems do from this.
     
  13. stu100

    stu100 Registered User

    Feb 4, 2015
    70
    Birmingham
    Hello I have got a financial assessment for man on Tuesday and have just read the CHC I have never herd of that should I try to get a CHC assessment if so how do I go about it? ?
     
  14. count2ten

    count2ten Registered User

    Dec 13, 2013
    186
    Anyone who is assessed by their local authority for their care needs should now also be assessed for NHS continuing health care funding (This is determined by a Decision Support Tool - DST - which will in turn indicate if a full CHC assessment should be undertaken to establish if someone is eligible for free NHS funding.

    The financial assessment is carried out by the local authority whose services are means tested. CHC funding, if eligible, is provided by the NHS and is not means tested. Talk to the social worker or contact Age Concern or your GP.
     
  15. stu100

    stu100 Registered User

    Feb 4, 2015
    70
    Birmingham
    Dod it matter if the financial assessment is done before CHC I will tallk to our SW
     
  16. count2ten

    count2ten Registered User

    Dec 13, 2013
    186

    Continuing Health Care funding is assessed and provided free by the NHS. It has nothing to do with the local authority's financial assessment which is carried out to determine how much, if anything, someone should contribute towards the services provided by that local authority. If someone is awarded CHC funding they will not have to contribute anything towards their care.
     
  17. stu100

    stu100 Registered User

    Feb 4, 2015
    70
    Birmingham
    Ok thanks for that I had never heard of it
     
  18. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    My Mom was in a busy acute ward when it was decided by SW and NHS that she "HAD" to go to a nursing home for ever more. I challenged that decision and what seemed to halt them in their tracks was this that I found in Age UK fact sheet 76.



    3.3 When facing permanent admission to residential care
    "Section 2 of the 2009 intermediate care guidance stresses that anyone facing permanent admission to residential care should have the opportunity to benefit from rehabilitation and recuperation at the end of their acute treatment and to have their needs assessed in a location other than a busy acute hospital ward."

    If you think your Dad might benefit from being out of that enviroment it could be worth trying.

    :)
     
  19. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    Age UK fact sheet 10 & 20 are worth a read if you haven't already done so.

    They are classed as to big to upload on here but a quick google will find them for you.:)
     
  20. nitram

    nitram Registered User

    Apr 6, 2011
    18,288
    Male
    North Manchester
    #20 nitram, Mar 12, 2015
    Last edited: Mar 12, 2015
    "Age UK fact sheet 10 & 20 are worth a read if you haven't already done so."

    For info a complete list of all AgeUk guides and fact sheets is >>>HERE<<<

    It acts as a useful index to the contents of the documents, just click on any that interest you.
     

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