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