1. sallyann

    sallyann Registered User

    Mar 8, 2007
    9
    :rolleyes:We have received news from our PCT that Mum will qualify for continuing care and that they arranging a place in a local care home. We are visiting it asap before accepting. i'm worried as it is not emi and mum is in an advanced state of AD. Are we entitled to ask for a different one if we don't like it?? Also what surprises us is that her situation with regards to funding will be reviewed in two months. I thought it would be six months. Is this just a ploy to get her out of hospital and then turn the funding over to us after two months or are we being cynical
     
  2. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,403
    Kent
    I would clarify everything before you sign anything, simple as that. You must safeguard yourself, in case the goalposts are moved.

    Good luck. xx
     
  3. glyn

    glyn Registered User

    Nov 23, 2006
    30
    Our review of mum's funding with the PCT was three months..I understood this was the norm. We are awaiting the outcome at the moment.
    You can of course move homes, we did, with full funding from the PCT. They have also stated that this will continue if we wish to move mother again.
    Surprised that your mum not going into an EMI unit, you will need to talk to the Home management and ensure they are fully aware of your mum's condition.

    Good luck,
     
  4. Clive

    Clive Registered User

    Nov 7, 2004
    716
    Hi Sallyann

    I think the reason you have not received many replies to your posting is because most of us have not made the progress you have with NHS Continuing Healthcare.

    It is sad that you need to wonder if you have been given this result to get your mum moved out of hospital, but I would agree with you that you need to be careful and progress with your eyes wide open.

    The “NHS-Funded Nursing Care Practice Guide 2007” does state that a review of eligibility should be undertaken within 3 months and then on an annual basis or more frequently if there is a significant change in health needs. I think this also refers to NHS Continuing Healthcare.

    As you know the NHS use a scoring system to decide upon eligibility for Continuing Healthcare. The rules are that you can expect to receive a clear recommendation of eligibility if you score one Priority or two Severe from the eleven domains they assess. As you said in an earlier thread your mum scored one Severe and four High therefore the assessor has decided four high equal one severe (at least). I think I would want to assemble as much information as possible about how the decision has been made, so that you can assess your chances of continuing to receiving Continuing Healthcare, before agreeing to your mum’s move.

    Incidentally, I do not recollect ever seeing a post before on TP that quoted a NHS Continuing Healthcare score. I hope more people post so that we can get a feel as to what level people have to decline to before receiving funding.

    Though my mum continues to wait for a decision to be made on her request for Continuing Healthcare I have already been told by the PCT that I should be aware that as AD progresses the health needs change and that could lead to Continuing Healthcare being withdrawn. The “for example” I was given was of a person who scored “Priority” due to challenging behaviour which could change to “no needs” as the disease progresses and they become weaker. (In fairness I was also told that other needs were likely to increase as the person’s illness progressed).

    I too was surprised that no mention was made of an EMI Home for your mum. Is this because the Care Home you are being referred to is a Nursing Home rather than a Residential Care Home? I would still expect it to have EMI status.

    Best Wishes

    Clive
     
  5. sallyann

    sallyann Registered User

    Mar 8, 2007
    9
    Thank you for your replies. We are treading very carefully as everything seems a bit rushed on their part. My father has visited the home they are proposing and said it seems satisfactory. He then received a phone call the next day for his opinion on the home, as his reply was positive they said they would move Mum in then - meaning today! We are not in agreement and said so as we have received nothing in writing regarding the continuing care,just a phone call last Friday!! Also their first point of contact is my sister not my father as we are trying to take the strain of the situation off him as much as possible. It all seems very rushed and i am worried that my mums extreme anxiety is not being taken into account, she is just a number to them. They probably would have moved her without one of us being present to help settle her. It was stated at the assessment that she wouldn't need emi care, probably as she is so passive now, but I still think they are ignoring her anxiety; so for the moment dont know what to do, will wait until we have seen something in writing.
     
  6. Natashalou

    Natashalou Registered User

    Mar 22, 2007
    426
    london
    I am very pleased to see at least ONE person has got this continuing care!! I didnt even know such a thing existed, when mum was in hospital I was just told she would be self funding with no sort of assessment whatsoever by anyone simply becuase they knew she owned a bungalow.
    Sadly I was too naive to know any better and just sole up and paid the fees. I do wonder now whether she would have qualified considering the state she was in..and after all the hospital said she was too frail to live by herself..I guess its too late now til her money runs out to get any more help!!
     
  7. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    Clive, as a daughter of a mum with AD, currently in a Care Home, I am concerned as to what happens if she worsens (she already has), but I didn't understand your post about Continuing Care, would you mind doing it in words of one syllable?

    Love

    Margaret
     
  8. Clive

    Clive Registered User

    Nov 7, 2004
    716
    Hi Margaret

    The following is an outline of what I was referring to. Sorry it is going to be long winded. It is just a layman’s view of the National Framework which is, in some ways, new and untested. I was referring to NHS Continuing Healthcare (CHC) which is when the NHS accepts that a persons health needs are so great that the NHS will pay the care bill even though the person is not in hospital. (The person could be at home, in a Residential Home or a Nursing Home). It is only of interest to people who do not have their fees paid by the Local Authority.

    My interest is that CHC is the only way, as far as I know, that a person suffering from AD, and cared for in an EMI Residential Care Home, has a chance of not having to self-fund their own health care.

    The Government has tried to make the system more transparent by telling all the English NHS Primary Care Trusts (PCT) to use the same assessment system from October 2007. In theory anyone being assessed for Care should now be checked using the same National Framework. I understand this should now be done for anyone being assessed to go into a Care Home, but I have no experience of this as mum is already in a Care Home and did not receive an assessment from either the NHS or SS.

    As the information the PCT should use to assess health care requirements is now recorded in a set way Carers should be able to ask to see the assessment results, and contest the data if they believe it is wrong. (The data used for mum’s CHC assessment had errors in it). Also carers should eventually be able to compare the various assessments of people in Care to see if the system is being applied fairly.

    The first stage in the process is a CHC “Checklist”. If you are in very poor health the assessor will tick enough boxes on the check list for you to be eligible to go onto the next stage. (If you do not get enough ticks it means you have to rely on the Local Authority to pay the cost of your healthcare which is Means Tested).

    The next stage is to have your needs matched against the CHC “Decision Support Tool.” It is difficult to describe the “Decision Support Tool” but basically it is another list of tick boxes. The experts have split a person’s health into 11 “domains” (These are Behaviour, Cognition, Psychological, Communications, Mobility, Nutrition, Continence, Skin, Breathing, Medication, and Consciousness.)
    Each “domain” is then split into “statements of need”, (Priority, Severe, High, Moderate, Low, or No Needs). Unfortunately all “domains” are not treated equally, and with some you cannot reach the “Priority” or “Severe” needs status.

    So take a simple example for the “Behaviour” domain. If the person’s behaviour is a serious risk to themselves or others their “need” would be “Priority”, but if they have no behaviour problems they would be classed as “No Needs”.

    If the ticks on the “Decision Support Tool” show that the person has achieved one “Priority”, or alternately two “Severe”, domains they will automatically receive CHC which means the NHS picks up the bill for Care even if the person is being cared for in their own home.

    If there are several “High” or “Moderate” ticks the “Decision Support Tool” is referred to a “Panel” of professionals who decide if, when all the multiple needs are added together, they are sufficient to warrant CHC. The “Panel” can also decide to recommend that a “Registered Nursing Care” payment is made instead, or reject the application saying there are no significant health requirements.

    Of course it is not quite that simple. For example it is not possible to achieve “Priority” status in the “Cognition” domain. Cognition is a major health concern for anyone having AD.

    Also health needs can change over time. A person who scored “Priority” for dangerous “Behaviour” could conceivable score “No needs” if they become weak and confined to bed and could then have CHC stopped.

    The concern that Sallyann has is that her mum has been granted CHC and the NHS will pay her NH fees until further notice. BUT the payment of CHC will be reviewed after three months and then each year (or more often). It is quite possible to speculate that a family could agree to their loved one being moved from a hospital to a Nursing Home having been assured by the NHS that CHC payment of fees has been approved, only to find that a very marginal change in health needs on arrival at the NH disqualifies the person from CHC after three months. No solicitor would allow you to sign a contract that was so loosely worded.

    Similarly one can speculate as to how a person already in a Care Home (like your mum) will eventually qualify for CHC. It is not in the Nursing Home’s interest to push for a client to receive CHC as it is unlikely that the NHS will agree to pay as much as a self-funder is charged. Similarly it is difficult to imagine the NHS encouraging people to apply for CHC when the NHS has a limited budget.

    I might be very very cynical but nothing I have experienced in the last 10 years has suggested that self-funders will ever get a fair deal.

    The above is my personal view of CHC. I hope I haven’t confused the issue any more.

    Clive
     

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