section 2/nhs chc

[Lulu]

Mum is undergoing 28 days of assessment and it will be some time before we know what will happen after that. She was receiving NHS CHC up until she was admitted to the assessment unit, but I am told that this has now ceased. If she is discharged after 28 days and the section 2 doesn't move to section 3 (when I believe the 117 rule, after care is placed, will she still be reassessed for NHS CHC? If they start to medicate and her behaviour ameliorates will there be any chance of funding (am thinking well-managed needs here). It is likeley that her previous emi nursing home won't accept her back and we shall need a challneging behaviour unit. What if there are no beds - highly possible. Could she stay on assessment unit until a bed comes up?
Has anyone been through this process who could advise as to what to expect? Would really appreciate it - it is scary enough without having to worry about finances on top of everything. Having chosen a good Home for her, I now feel that she is like a homeless waif.

 

[Karjo]

Mum is undergoing 28 days of assessment and it will be some time before we know what will happen after that. She was receiving NHS CHC up until she was admitted to the assessment unit, but I am told that this has now ceased. If she is discharged after 28 days and the section 2 doesn't move to section 3 (when I believe the 117 rule, after care is placed, will she still be reassessed for NHS CHC? If they start to medicate and her behaviour ameliorates will there be any chance of funding (am thinking well-managed needs here). It is likeley that her previous emi nursing home won't accept her back and we shall need a challneging behaviour unit. What if there are no beds - highly possible. Could she stay on assessment unit until a bed comes up?
Has anyone been through this process who could advise as to what to expect? Would really appreciate it - it is scary enough without having to worry about finances on top of everything. Having chosen a good Home for her, I now feel that she is like a homeless waif.

Are you able to visit your Mum in the assessment unit and do you have P of A for health and welfare? if so you will be able to assess how your mum is doing and speak to the staff for advice. Her bed may be held but if she is no longer on CHC I think it would be worth investigating who will be paying for the nursing home bed until she is discharged.
If she's improves with medication I think the home would still need to assess her before discharge and there would be a Care Plan Approach meeting to which you would hopefully be invited. As you say a well met need is still a need but of course this is where you need to keep fully up to date with what is happening, as communication is not always great. A lot depends on whether your Mum is happy to be in the unit, ie not trying to escape and whether she will take the medication. She will only go onto a section 3 if they cannot help her "voluntarily" and then meds are given covertly or in other ways.
Sorry I have no experience of this as my mum was sectioned which went onto section 3, but was not in a nursing home at the time.
Its a difficult time and I feel for you, as the not knowing with everything is so hard.

 

[Lulu]

Thanks for your reply karjo - sorry of course that you are on the same jouney.
The Home has told us that they probably won't keep the bed indefinitely (which I understand completely), and I assume that they will be in contact with the assessment unit.
Mum remains much the same in the unit and meds are having to be given covertly at times, maybe all the time I'm not sure. Having cared for her for years with us I know her inside out, but will ensure they miss nothing. She is not happy at all, anywhere, and if she found an open door she waould be off. Falls are frequent requiring a&e - no fractured hips yet, but I hold my breath.
what a nightmare it is ....By the way I hold an EPA and the staff are being good at keeping me informed at the moment.

 

[count2ten]

My understanding from working within hospital discharge teams ( both acute and long stay general and MH wards), is that the checklist should always be completed in line with any other assessments, and if not deemed eligible at that stage a request can be made for a DST to be completed in any event. If we don't ask we don't get.

This may be of interest - point "f" in particular - from the National Framework for NHS Continuing Healthcare...

58. The reasons given for a decision on eligibility should NOT be based on the following:
a. person’s diagnosis;
b. setting of care;
c. ability of the care provider to manage care;
d. use (or not) of NHS-employed staff to provide care;
e. need for/presence of ‘specialist staff ’ in care delivery;
f. the fact that a need is well managed;
g. the existence of other NHS-funded care; or 17
h. any other input-related (rather than needs-related) rationale.

If detained under S.3 then S.117 free aftercare kicks in automatically and checklist will not be needed.

 

[Karjo]

Thanks for your reply karjo - sorry of course that you are on the same jouney.
The Home has told us that they probably won't keep the bed indefinitely (which I understand completely), and I assume that they will be in contact with the assessment unit.
Mum remains much the same in the unit and meds are having to be given covertly at times, maybe all the time I'm not sure. Having cared for her for years with us I know her inside out, but will ensure they miss nothing. She is not happy at all, anywhere, and if she found an open door she waould be off. Falls are frequent requiring a&e - no fractured hips yet, but I hold my breath.
what a nightmare it is ....By the way I hold an EPA and the staff are being good at keeping me informed at the moment.

I would keep a good check on what medication is given to your Mum if she is falling. The idea is to help calm these poor souls not comatose them, but all too often on my Mums journey medication such as lorazepam went from being given PRN or a required basis to routinely twice a day depending on who was on duty, just in case she got agitated! And rhis was on top of anti depressants, sleeping pills and a long list of antipsychotics. The results were horrible to see and resulted in falls, black eyes, fights, bruises etc. I know she is a handful but this medication never seemed to solve anything, just ended days mixed with nights, incontinent and even more confused and determined to escape as she seemed to realise what was happening. So much so she went on strike and refused anything she thinks may be medication, even antibiotics unfortunately.The last time she was in an assessment unit however, they were, other than on one occasion which resulted in a fall and black eye and overnight in hospital, much better at not overmedicating. I think times have maybe moved on or as it was a different unit maybe just a better psychiatrist and staff. She is now under a lovely psychiatrist who really listens and has taken note of the horrendous side effects she has suffered. I think he seems to follow the "first do no harm" principle. Sometimes I wish infact he would medicate a bit more, but Mum does seem to have got over the withdrawal stage when evrything was stopped and agitation was bad, and is adjusting slowly and with good care and a much calmer environment and a good eye kept on her she, fingers crossed, is doing OK. She also sleeps at night which is a bonus, and is pretty alert in the day, and has not fallen for a while. Infact she wears out the carers as she is always on the go!

 

[Lulu]

Thanks once again Karjo.
I was very concerened re meds whilst she was still in the nursing home - I didn't want her over sedated becasue then there were worsening falls, worsening agitation as she fought it, and not taking adequate food/fluids, so was happy for the sectioning rather than playing around with meds. I have asked the Dr in the assess. unit not to over sedate as well becasue all drugs have their side effects, and before you know it you don't know what is causing what. I am pleased to hear things are brighter for your Mum now. Ever onwards ...