Help needed with checklist for CHC

Discussion in 'Legal and financial issues' started by padmag, Jan 16, 2019.

  1. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    My sister and I had a meeting with the nursing home manager, she is nice enough but her first words were i don't know what we can really talk about ......One and a half hours later she changed her mind and was proposing definite 2 x A's for Mum in cognitive and communication domains, B's and a few C's which was surprising as I thought Mum was more borderline, but having read Mum's electronic notes (they weren't up to date, according to the manager) Mum is displaying high anxiety and refusing to cooperate, which makes sense as the care home where she had respite, said they could not take her on full time for this reason. It remains to be seen whether the assessor agrees with the manager.
    As Mum's incomplete notes showed Mum has more problems than we actually see on visiting her, I requested the notes be updated before the checklist meeting this following week, in case we are unaware of anything else. The manager clearly didn't know about Mum's problems (as she had not read her notes).
    Is it possible to request a copy of Mum's notes we both have POA Health and Welfare.
     
  2. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    We had the checklist assessment - Mum scored 2 x A's and the 2nd assessment is scheduled in 3 weeks' time. The assessor did try and downgrade each domain, but the care home manager did a good job in pointing out Mum also fitted the other higher scores. I am under no illusion that Mum will pass the next stage, however I will appeal and see how far I can go. The assessor did mention FNC but I think he shouldn't have as it seems that he is already making up his mind.My sister and I have considered getting legal help as Mum may be borderline. As POA's we have Mum's funds to use for this, I wonder if this is allowable?
     
  3. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    We have a meeting for the 2nd assessment for CHC on .5/02/19. I have asked several times to see Mum's care notes but have been told they are not yet written up. I have sent an email requesting to see them well before the meeting - no response. I called the manager today who more or less said she is too busy at the moment (I believe they are written up by the nurses ) I really need this documentation or have sight of it so I can present Mum's case effectively with evidence.. Has anyone had experience of this? I have thought about calling the CCG to rearrange if possible.
     
  4. Georgina63

    Georgina63 Registered User

    Aug 11, 2014
    954
    Hi @padmag
    I’ve recently been through a DST for my Dad. The CH was easily able to provide records (which I only asked for following the DST but with hindsight should have requested before as I felt vital info was missed out of meeting...long story). Our decision was non-eligibility but I will be appealing as the process left a lot to be desired.

    If you want to PM me I can give you some other pointers if it’s not too late before the meeting. Off the top of my head: Take someone with you to take notes and also get any other information/records you can access eg DOLs report, GP records etc. There’s a really good guide on the Beacon CHC website with lots of questions you can ask re each of the 12 domains. Understand the 4 key characteristics - they are very important.
    Interestingly it was suggested we would get FNC but that would involve a move to nursing home as current home is residential.
    Lots of luck, I hope it goes well and if I can help further let me know. Gx
     
  5. Elle3

    Elle3 Registered User

    Jun 30, 2016
    600
    I have been through the CHC inspection and the 3 month review with my dad. He was awarded the funding and it was agreed at the 3 month review that it would continue, so next review in 12 months.

    Regarding the documentation, I had to trust that the care home had their information in order as I hadn't viewed it as it's all kept electronically now. The staff input data on tablet/phones so it's updated constantly. But as well as their normal records dad's Social worker had asked them to keep an ABC chart, which they have continued to do. I have also kept notes on my phone under the notes section of all incidents that I am aware off.

    During the assessment, there was two representatives from the CHC team, the unit nurse and myself, plus my dad but that wasn't necessary he had just followed me into the room and they said it was OK for him to stay there, the Social worker said she would have attended too, but unfortunately had a prior meeting booked, so she met with the CHC team a couple of days earlier to provided her evidence and opinion. The team did try to talk to dad and ask him some questions, but dad is lacking in communication and cognition skills which in some way was also good evidence for those two domains.

    They asked me lots of questions regarding each domain and I was able to provide evidence from my notes and the unit nurse could also back that up with their evidence, which the team said they would like to see and take copies of. It also enabled me to prompt the unit nurse too to mention things as evidence. After each domain was discussed the CHC person would make a suggestion as to what they thought the severity was, ie Severe, High, Moderate, Low or No Needs and asked if we all agreed, she said she was open to discussion about each score but fortunately we all agreed with her conclusions.

    At the end of the meeting, the two CHC representatives counted up the scores and informed us straight away that they found dad eligible for funding and it would be referred to panel the following Monday. The Panel agreed unanimously. The Social Worker called me on the Tuesday to say funding had been awarded and she would be handing dad's case notes over to the CHC team. It was about 2 weeks later when I got the paperwork through informing me of their decision. However, due to the care home fees being more than the CHC rate, this had to be escalated to the CQC Deputy director for approval. So the actual paperwork and funding didn't come through for another 2 months, but it was back dated to the date of the assessment.

    I have been very lucky, because dad's care home has been very supportive and are quite experienced at dealing with the CHC team. There are quite a few residents in dad's unit that have funding. However I still need to prompt them sometimes as what they deal with and see as being 'normal' would not be tolerated elsewhere, they are a specialised dementia + unit so unpredictable behaviour etc is normal for them.

    Good luck with the assessment, fingers crossed. x
     
  6. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    Hello Georgina 63, I only saw your reply late last night thanks for answering, sorry you didn't get the CHC. I have done most of whsat you say, and my sister will be coming along too for support. What were your Dad's scores? Yes you must appeal as evidence is key, I have found this very rushed and have only had a scant look at Mum's CH notes on a small laptop that I could hardly read. It is so stressful as I am also a carer for my partner, i will be glad when today is over (meeting at 11am today) I will post the results later (although I know what they will be as Mum has 1 x severe and several highs, borderline in their eyes)
     
  7. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    Hello Elle3, good to hear you have been successful on behalf of your Dad. I thought the social worker had to be in attendance? I do have lots of evidence other than current nursing home - the previous home where Mum was (she had to move as they couldn't cope with her resistance to personal care, became aggressive) were very comprehensive in their notes and let me have a copy, whereas the current nursing home's notes are confusing and it seems like I am reading about someone else. I had to get the help of the CCG to contact the home to enable me to view Mum's notes - I asked the manager 6 times over 6 weeks, her reason that they were too busy caring to write all the notes up, although the carers input daily electronically.
    I don't have the full support of the CH manager her comment was 'you won't get CHC' and I feel that it is something she can't be bothered with (admin and meetings, preparation) I wil see how it goes today as we will have the deputy manager instead, hopefully he will be more forthcoming. I have completed a DST having in mind the 4 areas in each domain. Mum will have 1 severe and several highs (agreed with manager). What were your Dad's scores? It sounds like you were all in agreement with the scoring. I worry that my mind will go blank, but i've made lists of reasons, quoted Nat. Framework and case law. will let you know result later.
     
  8. Elle3

    Elle3 Registered User

    Jun 30, 2016
    600
    Hi Padmag, I don’t think the SW has to be there as not everyone has a Social worker involved. My dad’s SW would have been there but unfortunately on the date chosen for the assessment she had another appointment. But the Later life Social services team and the CHC team share the same office so she met with them a couple of days prior to give her input. I fully trusted our SW so didn’t have a problem with that.

    These were my dad’s scores:

    Cognition: severe
    Communication: High
    Behaviour: severe
    Continence: moderate
    Drugs: high
    Psychological & emotional needs: low
    Mobility: no needs
    Nutrition: low
    Skin: moderate
    Breathing: no needs
    Altered state of consciousness: no needs

    I think the key is to get 2 severes or at least one and quite a few highs. Also unpredictability is quite key. They may have other medical needs but if they can be managed and are accepting of care, then they seem to say they are not eligible but may get the FNC instead.

    If you have your notes in front of you, that should help you, use them to prompt the care home mgr if necessary, giving dates and staff names is good, because it can highlight things they may not have recorded but proves it occurred. I sat with the Care home nurse just prior to our meeting just to check she had everything and told her I had notes too.

    Personally I would avoid quoting national framework or case law until you get a feel for how it is going. Remember just to point out how just because one Care home can seem to manage, other care homes could not, it’s about expertise and experience caring for the person, not that the person has changed needs. For example, at my dad’s first care home they gave him meds every day to keep him calm because they couldn’t cope with him. But at the care home he is in now, they rarely give him the medication, not because he is any easier to handle, it’s because they deal with it differently. I pointed this out to the CHC team and they agreed to keep his score for drugs as high.

    Good luck, I hope it goes well.
    Elle x
     
  9. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    Well, what a gruelling day - meeting - seeing Mum- now home caring for Richard, my head is spinning!
    Anyway as I thought Mum isn't eligible, even though i fought very hard with evidence from hospital, previous care home (respite) and other evidence.
    Mum scored :-
    1 x Severe, 4 x high, 5 x moderate, 0 x Low, 2 x No need
    I tried to explain the inter related domains, but I'm afraid his eyes just glossed over, and several times I had to insist he put information down. I asked to complete section 18 which he said didn't exist, then changed his mind it did. I put lots of relevant information in there and why I didn't agree with his scores.
    The CH manaher was as much use as a chocolate teapot - when the assesdsor asked her for evidence she scrolled up and down on her computer then called her assistant to help, enough said. A social worker wasn't present -the assessor said this would work in our favour ? Didn't understand that. However, at the end of it all he said we had a very strong case. Confusing. I can see that your Dad scored 2 severes which may be why they granted CHC. One step at a time, I will await the completed DST then appeal, if I have the strength.
     
  10. Elle3

    Elle3 Registered User

    Jun 30, 2016
    600
    I am so sorry to read this padmag. It's such an exhausting day especially when you don't get the result you want or deserve. It also sounds like the CH manager has let you down by not being able to provide the evidence, but I have to agree getting severe on two domains does seem to be the key and displaying unpredictable behaviour helps too.

    Like you say wait for the DST report and if you think you disagree with any of their findings and you think evidence has been missed out which should have been included and could have changed a domain to severe, then I certainly would appeal, no harm in trying.

    Sounds like you need a glass of wine and a nice relaxing bath. x
     
  11. Georgina63

    Georgina63 Registered User

    Aug 11, 2014
    954
    Really sorry to hear this. It does sound very confusing. I have come across this definition...... ‘a clear recommendation of eligibility would be expected with 2 or more instances of severe’ it is also the case that ‘a primary health need may be indicated if there is one severe together with a number of needs in other domains’ (quoting from Age UK - Wales factsheet).
    As you say, when the DST arrives, it may well be worth an appeal which is what I am hoping to do. Take care. Gx
     
  12. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    I think it's a work in progress as they expect you to appeal, Mum may well be a borderline case, not that I want her to get any worse. She didn't know my sister and I today looked very vacant but she came round after a while a few seconds of a smile. Trying to think of it as a process not getting uptight about the outcome. I know I have to try for Mum's sake as it seems a good (v. expensive!) nursing home and I don't want her to move. Afraid I didn't have any wine,but found some sort of sherry (posh stuff that daughter ordered from Italy) bit sweet but hey ho did the trick!
     
  13. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    If you didn't have evidence of care home notes you were definitely at a disadvantage. When you appeal at least you should have more information and supporting evidence - perhaps you co uld agree with the CH manager on what scores you are both going to score before the meeting?
    I have also read do not leave any domain out especially the one called 'Other' as like in an exam if you leave out a whole section you may lose points or it may even be interrealted to another domain. I commented on the 'other' domain about Mum's extreme fatigue (up and about most nights), fluctuation in blood pressure when she refuses her meds, also the environment has some loud aggressive resiudents and Mum is timid and frightenend of them, adding to her anxiety. You may have already done this sorry if you have.
     
  14. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    I haven't received the official result of the DST yet, but I had a call from my sister saying that a social worker has been in touch and has the results of the DST. apparently she wants to meet Mum and go through her care notes (good luck with that we were barely given a glance on a tiny screen computer) as she thinks the assessor may have down graded some of her scores. At the DST meeting the assessor commented that as the social worker hasn't attended then he/she could not have any input going forward. The social worker told my sister that she (social worker) was busy on the day and could not attend and this is how they do it now. Its so confusing. I will ring the CCG today to get some advice.
     
  15. Georgina63

    Georgina63 Registered User

    Aug 11, 2014
    954
    It sounds like the DST should have been arranged on a day that the SW could attend. If relevant info has been missed out or process not followed that would give grounds to appeal. Why oh why is this made so hard?! Don’t give up! Gx
     
  16. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    Thanks Georgina63 it's true they seem to make up their own rules as they go along. I won't give up. I am waiting to hear from a solicitor if he can take on Mum's case as I am fully stretched looking after my partner who has dementia. Have you raise your appeal yet?
     
  17. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    I have just called the CCG, and managed to speak to the assessor who said that the panel will not look at the DST until they have the view of a social worker. I said to the assessor that he said at the meeting that the social worker could not have an input if they were not at the DST meeting. He denied this and I said I have it on my phone recorder as I record all meetings, to which he said 'well the rules have now changed' (what since a few weeks ago?). This is so unprofessional and as the social worker is not a medical clinician I don't see how she can make a judgement on Mum's care needs. Anyway I could go on but it goes to show the ducking and diving that takes place and making up their own rules. I have now followed up the 'no win no fee' solicitor in Cardiff and really hope he can take on this case for me.
    I don't really expect a response, but one is always good to hear other points of view, but I thought I would keep logging the process as a kind of diary, as it may help someone else in the future.
     
  18. Georgina63

    Georgina63 Registered User

    Aug 11, 2014
    954
    Hi @padmag

    We are still waiting for the completed DST report, which we were promised would be around 2 weeks after the meeting. We’ve been waiting over 5 weeks now. As soon as I receive it, I will be on the case! Good luck with the solicitor - I hope you find one that can help. Gx
     
  19. padmag

    padmag Registered User

    May 8, 2012
    228
    nottingham
    It's quite a while since I've been on this thread, but I find it useful as a log for what has actually happened with Mum's CHC case so far. Hugh James of Cardiff are potentially taking on the case on a 'no win no fee' basis - they have accessed all of Mum's care home and hospital records and DST results, along with detailed information from ourselves (my sister and I). We have an appeal meeting booked for 28th August and HJ are willing to attend on our behalf. I will update this thread as soon as I know more, as I think I will receive an agenda from CCG and will confer with HJ about what the process will be at the meeting.
     
  20. Georgina63

    Georgina63 Registered User

    Aug 11, 2014
    954
    That sounds promising @padmag. We are heading toward appeal later this month. We can compare notes! Gx
     

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