NHS CHC are hospitals supposed to inform carers and next of kin's about assessment

Discussion in 'I care for a person with dementia' started by mydiamondmum, Feb 5, 2017.

  1. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    I am sure I have read this somewhere before but have been trying to find it again so if anyone knows and can sign post me I would be grateful.

    As I understand it someone is discharged from hospital into a temporary care home placement as in my LO's case. she had advancing Alzheimer's was hallucinating, had multiple hospital admissions (12 in a 6 month period due to UTI’s falls and self-neglect ) and was under the leg ulcer clinic for bad Oedemas, from what I have read in the framework from what I understand they should have carried out a check list. But if they did I (her only relative knew nothing about it, was not informed)
    I think I have read somewhere in the past that they are supposed to do this assessment and involve relatives/carer.

    Can anyone help with my question?
    Thank you and regards
     
  2. nitram

    nitram Registered User

    Apr 6, 2011
    19,529
    Male
    North Manchester
  3. ElizabethAnn

    ElizabethAnn Registered User

    Jan 4, 2014
    189
    North Hampshire
  4. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    for section 76. of the framework it states

    '‘Whatever the outcome of the checklist- whether or not referral for a full assessment for NHS-continuing healthcare eligibility is considered necessary-the decision (including the reasons why the decision was reached) should be communicated clearly and in writing to the individual and (where appropriate) their representative, as so as is reasonably practicable.’

    Have just found that, in case it is of help to anyone else in the same situation.

    Also I someone has told me that if the NHS arranges transfer to a care home, then they are responsible for funding until a negative check list outcome ... does anyone know where I can find more details about that, I have tried google but not found as yet.
     
  5. ElizabethAnn

    ElizabethAnn Registered User

    Jan 4, 2014
    189
    North Hampshire
    Totally agree - I found all I needed FREE on the web site... lots of relevant links to the Checklist; DSR and the NHS National Frame Work - with pointers on what I needed to do at each step.

    rgds Elizabeth.
     
  6. ElizabethAnn

    ElizabethAnn Registered User

    Jan 4, 2014
    189
    North Hampshire
    I'm not sure this is correct... my understanding is that if the checklist recommended moving to the next stage (the DSR assessment) then the CCG is responsible for funding the relevant care...

    See Page 25 point 74 of the National Framework for NHS Continuing Healthcare and NHSfunded Nursing Care:

    https://www.gov.uk/government/uploa...al-Framework-for-NHS-CHC-NHS-FNC-Nov-2012.pdf

    rgds, Elizabeth.
     
  7. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    Thank you all so much for your helpful replies.

    ElisabethAnn I am getting a bit confused now may be you can help me understand.
    I have read page 74 but find it a bit too complicated.

    In my LO's case she was placed in a care home under the 'Winter Pressure Scheme' I knew nothing of her rights or procedures at the time and no one explained anything to me.

    As I understand it now, an nhs chc assessment should have been carried out before she was discharged and placed in a care home. I should have been involved in that assessment under their own guidlines

    when that temporary funding came to an end and funding was taken over by the LA again a nhs chc assessment should have been carried out before they started charging.

    That is my understanding, have I got that right?
     
  8. ElizabethAnn

    ElizabethAnn Registered User

    Jan 4, 2014
    189
    North Hampshire
    It was page 25 (point 74):

    74. Where the Checklist has been used as part of the process of discharge from an acute
    hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is
    not used, a full assessment of eligibility would otherwise take place), a decision may be
    made at this stage first to provide other services and then to carry out a full assessment
    of eligibility at a later stage. This should be recorded. The relevant CCG should ensure
    that full assessment of eligibility is carried out once it is possible to make a reasonable
    judgement about the individual’s ongoing needs. This full consideration should be
    completed in the most appropriate setting – whether another NHS institution, the
    individual’s home or some other care setting. In the interim, the relevant CCG retains
    responsibility for funding appropriate care.


    Unfortunately, I don't think that the NHS have any responsibility to cover CHC funding before the checklist, regardless of whether they should have performed it or not. Although I'd be delighted to be corrected on this...

    If the LA is funding your LO's care, I wouldn't be worrying too much about whether the LA or the NHS is paying as long as it's not your LO...

    I'm afraid I've never heard of the "Winter Pressure Scheme", so I can't comment as to whether or not that effects your LO's position...

    rgds, Elizabeth.
     
  9. nitram

    nitram Registered User

    Apr 6, 2011
    19,529
    Male
    North Manchester
    #9 nitram, Feb 5, 2017
    Last edited: Feb 5, 2017
    "...she was placed in a care home under the 'Winter Pressure Scheme' ..."

    Careful, technically she may not have been discharged.

    Some CCGs are experimenting with block booking several beds, maybe a whole floor, in a care home.

    They can get beds at around 50% of the cost of a hospital bed. They then move patients into these beds freeing hospital beds, if the NHS still provides the care I am not sure if the patient is regarded as having been discharged.

    The "Winter Pressure Scheme" could have been one of these schemes.

    EDIT

    Found a 2013-14 scheme
    http://www.chshealthcare.co.uk/services/hospital-discharge-schemes/winter-pressures/

    It distinguishes between discharge to step down and the later discharge from step down

    It's only an example others could work differently.
     
  10. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    nitram, thank you for that, I am still trying to get answers from the hospital who have conveniently lost details of my original complaint... and have only just a few days ago got a copy of the core assessment by the nhs social worker at the time. The only reason I got that was because I have an ombudsman case about the backdated bill and the ombudsman sent assessment to me.

    In that assessment my mother's medical conditions have been played down for example on the page about falls she has left this blank even though my mother had 2 falls while in hospital one in the observation unit while in hospital rendering her unconscious needing a brain scan and leaving her with a big bruise on her face.

    Also her leg Oedemas have been played down (the Grogan case)

    On the form where it states is a fully funded NHS Continuing Health indicated? she has answered no.

    It seems to me that this winter pressure scheme would be a way of not discharging a patient therefore not doing a chc assessment.

    I have looked at your link... I can't find anything about that relates to my question about the hospitals obligation on discharge if they go on the winter pressure scheme any thoughts?
     
  11. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    Mini Mental State Examination and NHS checklist.

    Does anyone know about this please?

    My mother had the checklist last May. I complained about the way it was carried out as the nurse was just marking my mother down on everything. This nurse is not usually involved in my mother’s care she just does the check list for the care home.

    There was just the two of us present in the room. I have POA. When I expressed my views about how she was marking the checklist she said ‘relatives opinions are of no interest to me’ After the check list, in which according to the nurse did not indicate a full assessment I said I would complaint about the way it was carried out and she said go ahead and complain.

    A month later I got the written up version back in which she had marked my mother down further also she had enclosed a MMSE (mini mental state assessment) she had completed this test on my mother without my authorisation or presence.

    She scored my mother 26 out of 30 for this test. Much higher than the full MSE carried out on diagnosis by a psychiatrist from the memory clinic.

    Some of the thing my mother got top scores for were spelling a word backwards. My mother would not have been able to do this even before she had Alzheimer's.

    After waiting some 10 months from my original complaint about the way this check list was carried out, I now have a reply back basically as we were alone in the room it was my word against the nurse involved and they have found in her favour and part of my complaint was about her carrying out the MMSE test without my presence or authority.

    Their reply is that they are confident that I gave authority for this test to be carried out. This is not true.

    Also I asked why this test was carried out as I far as I understand it that is not usually part of the check list.

    Their reply to this is that they are the tests specified on the ‘London Health Needs Assessment’ which is part of Continuing Healthcare Assessment.

    Has anyone heard of this, it is the first that I have heard about it unless I have missed something?
    Any comments please?
     
  12. nitram

    nitram Registered User

    Apr 6, 2011
    19,529
    Male
    North Manchester
    #12 nitram, Mar 2, 2017
    Last edited: Mar 2, 2017
    The ‘London Health Needs Assessment’ can be viewed on most London CCG websites, eg Barnet http://www.barnetccg.nhs.uk/Downloads/Your-Health/Heath Needs Assessment.doc

    In the cognition domain there is a question about MMSE/AMT

    At first sight the needs assessment is a good way of standardising the scoring in a checklist.

    EDIT
    The last two sheets are signatory sheets, have a read of the penultimate it has a section for person being assessed, or representative/carer/advocate, adding their views. If you mother lacks capacity you should have been given this to sign at the end of the meeting.
     

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  13. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    Thank you nitram .... that is very helpful indeed .. I was never given a copy of this and certainly did not give my consent to a test without my presence.
     
  14. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    nitram, can I trouble you again please? now that I have read more about the ‘London Health Needs Assessment' which apparently is done if the check list indicates that a full Continuing Health Care Assessment is indicated.

    But it is usual to carry out the MMSE for the checklist? the reason I ask is because the nurse carried out this MMSE on my mother without my authority or presence after she completed the checklist with me, although they are arguing that as I signed the consent form I was consenting to all tests (the nurse is claiming that she informed me that the MMSE would be carried out) this is a lie. I did not give any consent for a test to be carried out without me being present.
     
  15. nitram

    nitram Registered User

    Apr 6, 2011
    19,529
    Male
    North Manchester
    Any evidence or data can be used to support grades on the checklist. the CCG may have included it for conformity.

    You say you signed consent for 'all tests', this is different to signing for a list of specified tests.

    Many clinicians will not allow a carer or relative to be present while an MMSE is performed, the patient may look to the relative for help and/or the relative may prompt. This can invalidate the test.

    Am I correct in thinking that this checklist was carried out last May?

    If so you may be better off trying to get a new checklist performed rather than arguing about something that happened 10 months ago.
     
  16. mydiamondmum

    mydiamondmum Registered User

    Nov 10, 2015
    127
    Thank you for your reply nitram. No I just signed the normal consent form for a check list. But they are saying that the nurse explained that this test would be part of this check list and that she told me the MMSE would be part of the assessment. This is not true but it is my word against hers and they are taking her side.

    I find this frustrating because I know what the truth is. But I take your point and I will just put this down to experience and make sure that I have a witness present for any future assessments or meetings about anything.

    I have already learned the importance of this when it comes to dealings with the local authority.

    This whole experience since my mother developed Alzheimer's has been a big eye opener for me.
     

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