Needs nursing care - is it worth applying for CHC?

Discussion in 'I care for a person with dementia' started by looviloo, Jun 27, 2018.

  1. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    I know this topic has been talked about a lot, and I've looked through various threads but hope you don't mind me posting about what's happening with my dad. He's living in an excellent residential care home but his condition has deteriorated a lot - can hardly communicate any more, very poor mobility etc. He's 89. The care home manager thinks he'll be wheel chair bound very shortly, and his increasingly odd behaviour means he's needing almost constant supervision. It's so sad :-(.

    Yesterday he was taken to A&E for various reasons, underwent a CT scan, ECG, blood tests and more and they found nothing medically wrong. Just the dementia. They said his heart is strong and healthy (he had major heart surgery 15 years ago), and at 89 could live with this condition 'for quite some time'.

    It has reached the point where the care home can no longer meet his needs. The manager suggests we look for a more suitable place - a nursing home and/or dementia care specialists. I have a place in mind that I'll explore... but my question is, should we apply for CHC? Is this the right time? And where would be the best place to start? He hasn't been assessed for CHC before and is self-funding, but I'm concerned that the high costs of specialist care plus dad's potential to possibly outlive me (not a joke!) means his personal funds will run out.

    The move isn't urgent, the home can manage him for another 2 or 3 months, but if he keeps deteriorating at the same rate then it could be sooner.

    On a slightly different note, and this will probably sound selfish and whiny but I'm sure I can't be the only one... I'm SO tired. Weary. Managing dad's life is stealing a lot of well-being from my own life. I can't turn away from him though because the bonds are too strong, but this has been going on for 15 years now, and I'm in my mid 50s with serious health problems of my own. Yesterday was stressful, and he has another appointment coming up soon (with an eye specialist - we think he stuck the arm of his glasses in his eye and damaged the eyeball - we don't even know if he can see through that eye because he can't really tell us). I don't know how long I can keep dealing with this.

    Sorry for the long post but I have to tell you this. The reason for the visit to A&E (among other things) was that carers check on dad regularly in the night, and on one visit found him UNDER the bed! Completely under it, with just his feet sticking out! How he got there is anyone's guess because he can hardly walk these days. It's a worry because he's on warfarin, and he's getting covered in bruises. The home is reluctant to use bed rails (due to regulations?). I think they think he's becoming a danger to himself now.
     
  2. Jessbow

    Jessbow Registered User

    Its always worth a go, just be prepared that it might not be successful.
     
  3. canary

    canary Registered User

    Feb 25, 2014
    9,664
    Female
    South coast
    It certainly sounds like this care home can no longer meet his needs and it would be a good idea to look for another one and get his name down on a waiting list. One of the questions to ask the home is what happens when the money runs out? Will they accept LA funding? Will they want a top up? The cheapest places are not necessarily the worst. Mum was in a cheap dementia unit, yet her care was wonderful and they looked after her to the end.

    When you are thinking about CHC a good rule of thumb is - does your dad require a qualified nurse on hand 24/7?

    Things like feeding, dressing, personal care, hoisting, pushing wheelchairs, supervision and even supervising prescribed medication can all be done by carers. Unfortunately dementia needs are considered as social care not health care, so unless your dad requires a nurse on hand 24/7 he is extremely unlikely to get CHC - and even if he does he may only get the Funded Nursing Care allowance. My mum died from her Alzheimers and was never eligible for CHC, or even FNC
     
  4. lemonjuice

    lemonjuice Registered User

    Jun 15, 2016
    1,535
    England
    #4 lemonjuice, Jun 27, 2018
    Last edited: Jun 27, 2018
    Well although he probably won't qualify for CHC as you say
    and to qualify you do need to have a primary medical need. My mother was far worse than that in those last 3 years and each year although she scored highly on the assessment and was referred to panel, each time she was refused.

    If he moves to a NH as he deteriorates he could qualify for the Nursing Care Contribution and to do that they have to do the CHC assessment. It's not available in Care Homes and from your description I doubt he'd qualify at the moment but it's worth knowing about for the future.
     
  5. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    It's ok, I'm realistic, just exploring all options! Thanks.

    Thanks for reminding me of this.... I'll make sure to ask those questions. As i mentioned I have a place in mind but will consider all options, since it's over 3 years since I last looked around care homes.

    Thanks. You're right, under this criteria he probably doesn't qualify for CHC. Might be worth doing for Funded Nursing Care at some point though?

    So glad we have this forum. I understand it better now. I've read the blurb on the NHS site a few times, but you've summarised it in one sentence! Thanks.

    I'm going to explore this a bit more. And I'll add it to my list of questions when I visit the nursing homes.
     
  6. Elle3

    Elle3 Registered User

    Jun 30, 2016
    602
    If you can get the support of a Social worker and the care home behind you, it's worth a go.

    I'm currently going through the process and just waiting for it to go to panel for the final decision. We might not get it, but it's always worth trying, you never know.

    Regarding the Funded Nursing Care, from our experience sometimes the LA will fund this until any decisions have been made. My dad's SW agreed for the LA to fund it for the first 4 weeks in his new Dementia+ care home and has extended it for a further 4 weeks until the the CHC decision is made.
     
  7. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,365
    Kent
    If your dad is mobile enough to get himself out of bed ...bedrails could present a risk that he will injure himself trying to climb over them and fall from a greater height. They would need to carry out a risk assessment but an interim part solution which they did for dad who was at risk of falls...is to lower the bed as far as it will go to reduce the injury risk...that may also prevent him from having room to go under the bed

    Dad was awarded FNC within a few weeks at his NH...however unfortunately this was not deducted from his fees...some homes do some don't.
     
  8. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    Thank you Elle, and good luck with your own application (which sounds like it's going positively at the moment). I've just re-read your thread and our situations are uncannily similar. My dads main issues are also communication and cognition and I would be surprised if he didn't score the highest grade in both of those. He's also self-funding. I've run through the checklist for the initial assessment and conservatively estimate at least one A and four B's, which would lead to a full assessment. Can I ask how long the process has taken you? And did you contact adult social care yourself, or was this initiated through the care home? I'm going to approach the local authority myself about this, and will let the care home know and ask for their support. I'm hoping for two things really - a better understanding of my dad's care needs (I'd prefer this to be his last move), and perhaps the funded nursing care. I'm not at all hopeful about CHC itself but perhaps that might come in the future, if this downward spiral of health issues continues.

    I'm sending my sympathies with regards to the situation you're in with your dad, too, because I know how it is being unable to communicate. Even when other people couldn't understand dad (maybe a year ago) I was still able to have a conversation with him. But now that's all changed and we struggle a lot. And the cognition issue is just sad, isn't it? My dad drifts off a lot too. He asked about my mum the other day (I could make out the word 'mum') - she died 14 years ago. He desparately wants to see her :-(.

    The care manager has since lowered the bed - I guess she'd never thought that dad shuffling under the bed would be a problem. It's a mystery how he managed to do it, since he's barely able to move his legs these days. But the brain is a strange thing and maybe during sleep the parts of the brain (the bits that seem 'blocked' because of the dementia?) are somehow more active. I've been trying to reason it all! It's quite incredible really and a worry for the carers, who are checking on him regularly overnight.

    As for the bed rail, I think it was more a future contingency thing. I notice that none of the residents have bed rails, except perhaps one who is completely immobile. I agree with you, that a bed rail at this stage would just provide another danger.

    I don't understand this... so are you missing out on money that you (your dad) has been awarded?
     
  9. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,365
    Kent
    Dad passed away last year but had FNC for nearky 3 years. It is really up to each provider it seems. I assumed that as it was specifically awarded because of dad's medical need although paid directly to NH it would offset against his considerable fees but was told the home can legally absorb the award into their coffers to generally fund the home's nursing part of care for all residents presumably on the basis that nurses are paid more than carers! Didn't feel happy with that at the time felt a bit morally wrong especially as some homes pass it onto the resident and reduce fees but was stuck with it.
     
  10. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    Wow, yes, I can imagine how you felt about that at the time. It does seem unfair, though I suppose other residents who are not awarded it might need just as much care. It all seems very unpredictable. Thanks for highlighting that to me and I'll keep it in mind. Sometimes just knowing what questions to ask can help a lot.

    Also, sorry to hear about your dad... thanks for sharing your experience and helping others x
     
  11. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,365
    Kent
    I had the impression from the manager that FNC is awarded in all instances where a medical need is shown so I suppose it was true to say that even residents who had no medical need were still cared for by the nurses in the general day to day management of the home.
     
  12. Louise7

    Louise7 Registered User

    Mar 25, 2016
    994
    These are the things that I can't quite get my head around! It is possible to score highly enough on the CHC checklist to get through to a full DST assessment without having any specific nursing needs, for example scoring A for cognition and mobility. Once through to the DST checklist it seems that you automatically qualify for FNC regardless of whether there are any needs which require the attendance of a registered nurse or not. As things like feeding, dressing, personal care, pushing in wheelchair etc could be carried out by carers in a residential home - not just carers in a nursing home - where does the line between needing residential care end and needing nursing care start?

    There seems to be little financial benefit to receiving FNC, as most nursing homes don't appear to reduce their rates accordingly. Does qualifying for FNC mean that someone must go into nursing care, even if a residential home can manage the individual's needs? Nursing homes are usually significantly more expensive than residential homes so in these circumstances wouldn't you essentially be paying for nursing care that wasn't required? Just general thoughts rather than specific to the OP's post, although if the residential home are suggesting a move elsewhere because Dad needs almost constant supervision (rather than care from a registered nurse) moving to a nursing home will still not necessarily guarantee constant supervision.
     
  13. canary

    canary Registered User

    Feb 25, 2014
    9,664
    Female
    South coast
    I looked at the CHC checklist and to score an A in mobility requires more than just needing hoisting and pushing in a wheelchair. They are talking about spasms/contractures, causing pain on movement, being unable to reposition themselves in bed and a high risk of falls. It seems to me that the idea is that there is a high risk of injury present that requires a nurse to assess them and that it requires people who are highly skilled in moving/repositioning. Its the same for nurtrition - needing someone to feed you and it taking a long time only scores a B - what is required is specialist care for PEG feeding, intravenous nutrition, or specialist techniques because there is the likelihood of food aspiration. (I have paraphrased the details). The idea seems to be that to score an A requires more specialist skills than can be provided for in a residential home, though I am sure that there are some grey areas.

    You are right that in order to obtain FNC or CHC you have to be in a nursing home - because otherwise payment is being made for nursing care that isnt available
     
  14. Louise7

    Louise7 Registered User

    Mar 25, 2016
    994
    I think being at high risk of falls must be one of the 'grey areas' as presumably as long as the risk is effectively managed it wouldn't necessarily require more specialist skills than can be provided in a residential home?

    It would still be possible to get through the checklist stage without having any specific nursing needs though, so it just seems odd to me that FNC is automatically awarded to those who get through the checklist stage, whether they have any specialist needs requiring a registered nurse or not.
     
  15. nitram

    nitram Registered User

    Apr 6, 2011
    18,636
    Male
    North Manchester
    #15 nitram, Jun 28, 2018
    Last edited: Jun 28, 2018
    FNC is not automatic for those who fail to get full assessment or fail to get CHC at a full assessment
    Note the word 'consider' in the box I have coloured yellow in the Nation Framework Flowchart

    national-framework-for-nhs-chc-flowchart-1.jpg
     
  16. kindred

    kindred Registered User

    Apr 8, 2018
    2,126
    No, what happens is that, suppose the fee is £1000 a week, the NH say the fee is really £1115 or whatever the funded nursing care is, then they charge you the thousand. That's the usual way they do it. Gxx
     
  17. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,365
    Kent
    #17 love.dad.but.., Jun 28, 2018
    Last edited: Jun 28, 2018
    No that did not happen for dad at his NH..he was charged max NH fees ...dementia with nursing... on their scale and the FNC was accepted by the NH in addition to dad's fees. The fee scale I was shown was before they applied for FNC and not adjusted when awarded when I queried it...the refusal to adjust was firm with reasons given that they are not obliged to pass the award onto individual residents to directly benefit from the award. The year before dad died FNC was increased and applied retrospectively for around 3 months and that difference in extra lump sum the NH received wasn't passed on either. However dad's nursing needs whilst essential were minimal daily compared to other residents who may have had more complex nursing need demands but the NH set 1 band of fees regardless of hands on nursing hours needed.... without negotiation so tbh I think the NH was very profit/shareholder driven unfortunately...a business and fruitless to try to argue and possibly be shown the door!
     
  18. Elle3

    Elle3 Registered User

    Jun 30, 2016
    602
    Dad has an appointed SW due to me contacting Social Services back at the end of January as I was worried about him as he was burning his leg very badly on his electric fire but he did not understand that it was the fire that was doing it, he also kept saying it was OK when it clearly wasn't. When we met we agreed that dad could no longer live at home and he would have to move into a care home, he would be self funding.

    She provided me with information on all EMI care homes within the LA and I went to view a few and decided on one which was closest to my dads home, they came out did an assessment and agreed to take him. I contacted the SW and she provided the care home with dads care plan etc and when a room became available we agreed a moving in date of the 12 April. The SW kept in touch with me and the care home throughout this time.

    Within a week of dad being in that care home he had been reported to safe guarding twice and had broken several window locks, an emergency door and escaped for 3 hours. The care home contacted me and said they could not cope with dad and he would have to be removed. They also advised the SW. We then had a meeting the SW, the care home mgr and I and we agreed until we could move dad the mental health team would come in and do an assessment, and a nurse would be provided to give dad 121 care for 8 hours a day. It was at this point that the SW mentioned the CHC funding as a possible option as dad would require a care home that had a dedicated Dementia unit and could provide nursing care (for the meds that had been prescribed him), she provided again a list of homes for me to look at.

    It took almost 4 weeks for me to find a suitable care home with a Dementia+ unit that could take dad. I had to have a Best Interests meeting with the SW and a report was written with the options considered and why dad had to be moved etc. It was at this meeting that the SW agreed that this move to the new care home would initially be termed as 'respite care' for dad at the home and they would pay for the Nursing element for 4 weeks at which point they would then do the CHC Initial assessment, which would give dad enough time to settle into the new care home and for the home to record all evidence of dads behaviour etc against the ABC charts. She even got the care home to only charge my dad the LA funded rate and not the private self funded rate.

    Dad moved in to this Dementia+ unit on the 9th May. To be honest it was then that the care home spurred me on to make sure the assessment was done as they felt dad should qualify based on the fact all the other residents get it and he was no different from them.

    The CHC Initial assessment was actually done on the 13th June by the SW and he scored enough A's & B's to be referred and she agreed to continue funding the nursing element for another 4 weeks. She advised that once she submitted the paperwork which would be the next day, the CHC Assessment team have 28 days to visit, do their assessment and make a decision. This assessment was done on the 26th June (They rate against: Priority, Severe, High, Moderate, Low and No Needs) and they said as he scored High in Cognition and Communication which is the highest it can be and Severe in Behaviour (Priority is the highest for that) he was eligible and it would go to panel this Monday and that is were we are now.

    So technically I could say it only really took a couple of months to get to this point. So if you haven't already got a SW, I would suggest getting one, my dads has been fabulous and so helpful and supportive.

    The communication bit is tough. My dad has had a problem with communication now for almost 2 years, it has been very hard to have a conversation with him, especially as the cognition isn't there either, I've found myself having very strange and random talks with him in the past, mostly about the past and confabulated stories. It was easier though when I took care of him at home as we could talk about more day to day things and I could anticipate and work out what he was trying to tell me, but now that he is in the home, the conversation as totally dried up and I can't talk about certain things like his home just in case it triggers him trying to escape again. It just gets harder and harder so my sympathies to you to.
     
  19. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    You make a good point and I'm hoping an assessment will help me with this. I will probably call his psychiatric nurse (CPN) too, and ask for her advice.

    Dad's risk of falling is potentially fatal because he takes warfarin. And his mobility is decreasing steadily, sometimes on a daily basis. It's horrible to witness... yesterday the home moved him around in a wheel chair all day (even though they aren't set up for residents who are confined to wheel chairs - it's a small place, narrow doorways etc.). Today he was moving better, and on his own feet apparently. Tomorrow he might be worse again.

    The bit about 'pain on movement' is an interesting one because I doubt if dad would know if he was in pain anymore, or if he could bring it to someone's attention. It might take someone skilled to spot a problem.

    I don't know, but I'm assuming that nursing/dementia care homes have higher ratios of caring staff to residents? And anyone requiring more intense supervision is likely to need nursing staff on hand, to reduce the likelihood of hospital visits. Maybe that's why FNC is awarded, and paid directly to the home. I could be wrong though - it's hard to fathom the reasoning sometimes.

    I'm sure this chart is designed to put people off!

    From the reading I did today, I thought the FNC was supposed to be deducted from the care home fee, but that obviously doesn't happen in all cases. Some care homes might be bending the guidelines to increase their income.

    The Which? website says: The nursing care contribution is paid directly to the care home by the NHS. If your relative pays their own care fees, this amount should be deducted from their bill, although it might be the case that the care home will quote you a fee that doesn't include nursing costs, in which they are unlikely to pass on the FNC.

    And this from the Money Advice Service: If you’re paying all your own fees, which include nursing costs, the amount you’ll end up paying will be reduced by the NHS-funded nursing care amount.

    I wonder if it depends who requests the assessment (individual/family or care home)?

    Sorry for the long post again...
     
  20. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,365
    Kent
    That's interesting...too late for dad now and being ever so slightly cynical I can imagine dad's NH would have just increased the fees to then reduce them by FNC... but it will help others to know.
     

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