One-to-One Funding

[Sharp34]

Can anyone offer advice as to whether I can, and how I go about it, insisting that a panel of funding Commissioners put their decision, and the reasons for their decision in writing.

My mother has previously been diagnosed as suffering from both Alzheimer's and vascular dementia. Since November 2014 she has been detained in hospital, initially under Section 2 of the Mental Health Act and latterly under deprivation of liberty.

I found a care home on the 7th January 2015 who were prepared to accept my mother even though she requires round the clock one-to-one supervision. The homes financial quotation reflects this need and is, understandably, very expensive.

The Commissioners have agreed that my mother qualifies for CHC funding but won't agree to the one-to-one. Instead they insist on various 'care facilities/CHC independent hospitals' carrying out their own assessments. Not one has accepted that they are the appropriate place for her i.e. she is not violent; isn't taking anti-psychotic medication etc. Also, they are all outside of an acceptable visiting area. This pantomime seems acceptable to my mother's social worker and senior case worker but I have lost patience. So, 5 months on from me finding a suitable care home, my mother is still in hospital and I am now being told that she is blocking an acute bed.

Clearly the Commissioners have made their decision but won't put it in writing and, until they do so, I feel unable to Appeal a decision which I feel sure is based purely on finance and does not truly take into account her clinical needs.

 

[jaymor]

My husband was awarded CHC and we duly looked for nursing homes. The homes we found that were suitable all assessed him and said they could only take him if they covered 1:1 care. CHC knew he needed challenging behaviour care but until they had the nursing home assessments back would not commit to covering 1:1.

 

[count2ten]

Can anyone offer advice as to whether I can, and how I go about it, insisting that a panel of funding Commissioners put their decision, and the reasons for their decision in writing.

My mother has previously been diagnosed as suffering from both Alzheimer's and vascular dementia. Since November 2014 she has been detained in hospital, initially under Section 2 of the Mental Health Act and latterly under deprivation of liberty.

I found a care home on the 7th January 2015 who were prepared to accept my mother even though she requires round the clock one-to-one supervision. The homes financial quotation reflects this need and is, understandably, very expensive.

The Commissioners have agreed that my mother qualifies for CHC funding but won't agree to the one-to-one. Instead they insist on various 'care facilities/CHC independent hospitals' carrying out their own assessments. Not one has accepted that they are the appropriate place for her i.e. she is not violent; isn't taking anti-psychotic medication etc. Also, they are all outside of an acceptable visiting area. This pantomime seems acceptable to my mother's social worker and senior case worker but I have lost patience. So, 5 months on from me finding a suitable care home, my mother is still in hospital and I am now being told that she is blocking an acute bed.

Clearly the Commissioners have made their decision but won't put it in writing and, until they do so, I feel unable to Appeal a decision which I feel sure is based purely on finance and does not truly take into account her clinical needs.

Morning Sharp34, it sounds like the usual "one size fits all" response. Sometimes you have to get a bit legal, maybe consult a solicitor about challenging their decision. They invariably back down. Who decided your mum needs 1:1 supervision and what are their reasons for this decision? If it was an MDT/CPA decision and they are her assessed needs, then this is what should be provided on discharge. If she needs 24 hour care and she is not psychotic or a danger to herself or others then her needs could probably be met within a nursing home that has the level of expertise to support her. Even within a mental disorder home she would be unlikely to receive 1:1 supervision, and if anyone required this level of care I would argue that they are not medically fit to be discharged and their mental health should be stabilised before they leave the ward. Just wondering, if your mum was detained under S.3 at any time she would be entitled to free aftercare under S.117 - apologies if I'm stating the flippin obvious. No doubt there are others on here who will be able to give better advice but just wanted to pass my experiences on to you. Good luck, don't give up and don't be bullied - you and your mum have rights. Easy to say when you're in a stressful situation but this site is brilliant for giving people so many different viewpoints and an opportunity to weigh up their options.

 

[Sharp34]

Hello count2ten
Thank you for your comments and I apologise for the delay in responding to you . The first response to my request was to the effect that I should seek expert legal advice and contact details were provided. I think that this advice is well worth taking.

 

[Sharp34]

Up date by Sharp34

I contacted the solicitors recommended who, whilst sympathetic, were unable to help. Their remit is the "fight" for CHC funding and do not become involved beyond this point.

Matters have moved on since, but not for the better.

My mother is still in hospital (8 months now) and, of their own volition, the ward staff asked for an assessment to be carried out by an independent hospital in which some beds are commissioned by the local NHS trust. The assessor confirmed that the facility was not a suitable placement. To apparently overcome this obstacle the hospital changed my mother's status from a DOL's order to Section 3 of the MHA. The same assessor has now confirmed that the independent hospital have no alternative but to accept her because of this changed status..

At a recent Best Interest Meeting all the families concerns, regarding the independent hospital, were ignored with the decision being made that she will be discharged to that facility in any event.

Whilst I appreciate that she will now be vacating an acute bed, much to the present hospitals relief, I cannot believe the way in which such decisions are made with no regard to the families views. Looks like additional legal advice is necessary plus a trip to the local MP's surgery.

 

[SeniorAngel]

CHC assessments in somewhat of a mess

I sympathise with the OP. I myself have a situation going on at the moment with my 93 year old Mother in hospital who also has Alzheimer's. She was admitted to A&E early last week after complaining about chest pains, however nothing was found, but due to her confusion, she was moved to a ward, and she is still there now...

...then the problems started. Whilst on the ward last week, Mum became delusional with hallucinations (this is a regular thing - she normally lives alone) and what is worse, aggressive both verbally and physically to other patients and staff. I witnessed this myself, and have seen the same behaviour at home, but previously it had never been witnessed by a medical professional before. This was a very important moment because Mum needs better care than being at home. The incidents lead to emergency sedation by a consultant. During this, we were in touch with Social services who also had seen this behaviour and they agreed to seek urgent 1 to 1 care assessment funded by CHC.

This week, Mum was a lot better , being compliant and relatively calm.
Then I discover that despite a 1 to 1 procedure being in place, NO NOTES were made on her 'issues' and behaviour all last week by the Nursing team. They are obliged to make notes on Mum's care and condition every 15 minutes, and the Staff nurse brushed this off saying they would learn from their mistake!

All fine and well, you might think, but CHC assessments ONLY take into account these kind of notes! So, now we are in a position where medical and care notes have been made ONLY when MUM is calm i.e.this week! When questioned, they said their guidelines would make it difficult to write up the missing notes 'after the fact' even though the staff involved are still attending!

So now we have the prospect of Mum not being able to access her rightful and appropriate care due to the Hospitals misdemeanour!

To add insult to injury, I found out today that emergency DOLS (deprivation of Liberty) was put into place last week, yet they did NOT ask me for written permission as her registered Attorney, which contravenes the DOLS guidelines and Mental Capacity Act 2005. So we don't know what is going to happen next. I have made representation to the Trustees and PALS, but the gap left by these failures means that CHC funding have a big opportunity to wriggle out of pacing the appropriate funding!

It is patently obvious to me that many of the hospital staff have not a clue when it comes to Mental Health issues and the proper procedure.