Query re which CCG would be responsible for paying for my dad's CHC if granted

[Fielder]

I have asked for my 94-year-old dad - who is due to be discharged from hospital soon to a nursing home for a 4 week assessment to include assessment for Continuing Health Care (CHC) - to be transferred to a nursing home near me. My father's local NHS CCG will be paying for the 4 week assessment, but I'm wondering whether it would be his local CCG who would continue paying for his CHC if he were to be granted it, or whether it would be my local CCG who would have to take over the payments. I ask this because the local nursing homes that I have been viewing over the last couple of weeks have all asked the same question and I'm not able to tell them (the hospital discharge team just brush me off and won't/can't answer this question and won't find out for me).

I'm travelling by car (a several hour trip) to see my dad in hospital today, so any replies to my query will be gratefully received and replied to later on - probably this evening or tomorrow morning.

Many thanks in advance to anyone who can advise.

 

[nitram]

My guess would be that the CCG which did the assessment could be responsible until the 3 month review by the other CCG when it would take over if CHC continued.

A problem which could arise is that the first CCG will only pay their rates which could be lower than the second CCG.

You could ask the gaining CCG what would happen although it may not want to discuss hypotheticals.

 

[Fielder]

My guess would be that the CCG which did the assessment could be responsible until the 3 month review by the other CCG when it would take over if CHC continued.

A problem which could arise is that the first CCG will only pay their rates which could be lower than the second CCG.

You could ask the gaining CCG what would happen although it may not want to discuss hypotheticals.

Thanks for that, nitram. Much appreciated.

 

[Bod]

Probably a good idea to plan for costs, if the CHC is turned down.

Bod

 

[Fielder]

Probably a good idea to plan for costs, if the CHC is turned down.

Bod

Yes, thanks for that, Bod...I've been planning for that eventuality, as far as I can atm. I applied to my dad's bank, under the property and finance lasting power of attorney that I have for him, 6 weeks' ago as he would be a self-payer if he doesn't get CHC. Apparently, this particular bank make it a policy of giving themselves a whopping 7 weeks to sort it out...I can only hope they don't take any longer than that.

 

[nitram]

As @Bod has said CHC may not be awarded.
Your dad is at the stage of the screening >>checklist<< which can result in CHC, FNC, or nothing following this >>flowchart<<.

Seven weeks to register an LPA is ridiculous.

 

[Fielder]

As @Bod has said CHC may not be awarded.
Your dad is at the stage of the screening >>checklist<< which can result in CHC, FNC, or nothing following this >>flowchart<<.

Seven weeks to register an LPA is ridiculous.

At the hospital where my dad is they no longer do checklists for CHC (they used to before covid) so the checklist will apparently be done in the nursing home no more than 10 days into the 4 weeks' assessment. I was told yesterday morning that my dad was 'optimised' for discharge to a nursing home, so when I visited him yesterday afternoon I was shocked to find him on an IV drip and unresponsive...Seems that when the discharge nurse was on the phone telling me that he was fit to leave, my dad was actually hallucinating, agitated and trying to rip his urinary catheter out, which has made his bladder bleed. (Sorry, I'm digressing from the topic, but just needed to vent a little, as everything's such a complicated roller coaster ride atm.)

Yes, 7 weeks is ridiculous - it's NatWest and I've seen online that others have had problems with them taking even longer than that. I've managed to get access to a savings account that my dad's got with Santander; they sorted it out in a couple of weeks, so at least I could get a counter cheque to pay for a few weeks' nursing home fees, albeit most of the nursing homes I've visited and spoken to want a direct debit/standing order set up first before they accept anyone...But, I guess, if he's already in a nursing home, having been paid for for a weeks by the NHS, perhaps the nursing home will accept payment no matter how it's made...fait accompli, kind of thing.

Many thanks for your help, nitram.

 

[nitram]

At the hospital where my dad is they no longer do checklists for CHC (they used to before covid) so the checklist will apparently be done in the nursing home no more than 10 days into the 4 weeks' assessment.

The process has been moved from hospital to block booked beds in care homes to allow a longer period of assessment and free up hospital beds.

If he requires IV he will not be discharged to a care home.

 

[Fielder]

If he requires IV he will not be discharged to a care home.

Good information, thanks. The IV was/is for dehydration/highish blood calcium levels. I guess if my dad remains unresponsive he'll continue to be on IV, but if he comes round and can drink and his calcium lowers to normal for a while, they'll try and discharge him asap when he's having a so called 'good day' (which is why I'm having quite a battle to get him transferred to my area if/when he is ready, as the out of area process slows things down too much for their liking). I expect the next thing they'll say is that he's unfit for travel and discharge him to a nursing home in his area. I don't want to cause a bed block unnecessarily but I do think that my dad would be so much better off near me so that I can keep a better eye on things. (In hospital they left him constipated for 5 days before doing anything about it, which contributed to his dilerium.) My dad's got all sorts going on to include secondary prostate cancer that's metastasized to his bones (which is releasing the excess calcium into his blood which is only adding to his confusion and Vascular Dementia) but the 'up side' to this (if it can be called an 'up side', given the circumstances) is that I've now managed, due to his cancer, to get the local palliative care team involved and they're talking about trying to 'fast track' him on to CHC and then I'm told it will be easier to have my father moved nearer to me (subject to it being okay for him to travel). Sorry, I've just vented yet again! (I think this forum is stopping me from 'losing it', so please forgive me.)

 

[nitram]

Although IV can be used in a care home under the supervision of the community nursing service the vast majority do not accept the risk especially if there is any risk the patient will fiddle with the drip.
Several nursing homes do not have IV competent nurses and as a nursing home cannot call on the community nursing service.

Getting the palliative team to sign a fast track is a good approach.

 

[Fielder]

Thanks for that, nitram. Would it be the same situation with feeding tubes too? Before he became unresponsive, my dad went through a period of having swallowing difficulties with liquids and some foods (when he was getting over pneumonia and sepsis) and tube feeding was mentioned at one point. I believe my dad would almost certainly fiddle with that too.

 

[nitram]

I doubt many care or nursing homes would accept a patient who consistently pulls a tube out.
Try not to think about what might happen, there's too many ifs and buts concentrate on getting CHC sorted either fast track or making sure you have an input to any DST.

 

[Fielder]

I doubt many care or nursing homes would accept a patient who consistently pulls a tube out.
Try not to think about what might happen, there's too many ifs and buts concentrate on getting CHC sorted either fast track or making sure you have an input to any DST.

Will do, thanks.

 

[yoy]

I have asked for my 94-year-old dad - who is due to be discharged from hospital soon to a nursing home for a 4 week assessment to include assessment for Continuing Health Care (CHC) - to be transferred to a nursing home near me. My father's local NHS CCG will be paying for the 4 week assessment, but I'm wondering whether it would be his local CCG who would continue paying for his CHC if he were to be granted it, or whether it would be my local CCG who would have to take over the payments. I ask this because the local nursing homes that I have been viewing over the last couple of weeks have all asked the same question and I'm not able to tell them (the hospital discharge team just brush me off and won't/can't answer this question and won't find out for me).

I'm travelling by car (a several hour trip) to see my dad in hospital today, so any replies to my query will be gratefully received and replied to later on - probably this evening or tomorrow morning.

Many thanks in advance to anyone who can advise.

My dad lived in one town but his GP was registered in another so costs seemed to be covered by the CCG his GP came under, not the one he physically lived within.

 

[Fielder]

My dad lived in one town but his GP was registered in another so costs seemed to be covered by the CCG his GP came under, not the one he physically lived within.

Thanks for telling me that, 56von.