NHS continuing care

Bowey123

A friends father is in hospital at the moment.  He has severe cognitive decline which means that he will probably have to go into a home on discharge.  He is unlikely to be safe at home.
Looking at the decision support tool for NHS continuing care it may be possible that he would be entitled to this rather than having to fund his own care.
What is the next step?
Will friend have to ask for an assessment before he gets discharged?  Who does the assessment?  Will it be done when he is there or only from his notes?  Will friend be allowed to be there?
Who chooses the nursing home?  Friend or NHS?
Any help gratefully appreciated.

MalMonroe

Hi, having been through similar with elderly relatives, I know that what usually happens is that the hospital staff arrange an assessment while a patient is still in hospital. In fact, in most cases, assessments are ongoing throughout a patient's stay. And then hospital staff will discuss with the patient (if lucid) and their relatives what they feel the best course of action will be. Your friend won't have to do anything because his father should receive a thorough assessment - usually by a group of professionals - a mental health team, physiotherapist, occupational therapist, etc., before there can be any thought of discharging him. 

If your friend asks if he can be there then he should be allowed, since it's his father and it sounds as if his father isn't able to make his own decisions. I'm sure your friend could have some input as to where his dad goes - if there are suitable vacancies of course - and discussions with the relevant professionals will follow.

Your friend's dad won't just be discharged with no arrangements in place for his further care and his family will be consulted. If your friend isn't consulted about his father's care then he should start asking questions. But from my own and my family's experiences, we've always been kept in the loop. 

Hope that's of some help to your friend, it's a worrying time, I know. 

Albermarle

Bowey123 said:

A friends father is in hospital at the moment.  He has severe cognitive decline which means that he will probably have to go into a home on discharge.  He is unlikely to be safe at home.
Looking at the decision support tool for NHS continuing care it may be possible that he would be entitled to this rather than having to fund his own care.
What is the next step?
Will friend have to ask for an assessment before he gets discharged?  Who does the assessment?  Will it be done when he is there or only from his notes?  Will friend be allowed to be there?
Who chooses the nursing home?  Friend or NHS?
Any help gratefully appreciated.

The basic  issue is does he need social care ( provided by the local council),  or does he also have ongoing health needs that need some kind of medical intervention from NHS/nurses etc. Many fall into a grey area inbetween, which is where the decision support toll is used to determine the outcome. There is a half way house where a  nursing home gets some financial support from the NHS to help pay for the nursing, but not the rest of the costs.
As far as I know, dementia does not normally get NHS funding, and it will be the local council who will be responsible for making sure he is safe. That means if he has enough savings/assets he will have to pay for it himself. 
Still no harm in trying to get some NHS funding, they can only say no.

elsien

In my area there is a slightly different system. Assessments aren’t done in hospital around continuing healthcare because they need the beds. So The basic checklist is done in hospital and if there is a possibility they will need some level of health funding then they are sent to a short-term bed in a nursing home and the CHC assessment is done there. Your friends need to ask the Ward or the discharge coordinator about whether a checklist has been done, and ask for one if it hasn’t been. The timescale once in the care home is intended to be within four weeks. The assessment should involve the CHC nurse assessor, a social worker, professional carers and whoever is representing the person. It can be hit and miss whether a social worker is available or not.

 Then if they don’t get full health funding, (and most people don’t - if they get anything they get the nursing top up which means that the local authority retains responsibility for those who aren’t self funders). Then there needs to be a discussion around whether the person is able to go home or not and how that can be facilitated if they need help to be safe, or whether the person can stay where they are or needs to find a different care home, because the local authority won’t pay for full nursing care for someone who doesn’t need it.

Who makes the decision depends on whether there is a health and welfare power-of-attorney in place or not, and also who is funding the place. It is a best interest decision if he lacks capacity, and without an LPA the decision maker will be whichever which ever professional takes responsibility for his care. In practice with the NHS if there’s a choice this tends to mean asking family to look at them and see what they think but there is only a short timescale for doing this. If he does qualify for the nursing needs assessment and he lacks capacity to be fully involved himself, he has the right to have someone there discussing and asking the questions on his behalf. And if he can’t make his own decision about where he lives long term the mental capacity act says that his family/friends must be consulted on his behalf.

There is a severe bed shortage at the moment and people having to go to care homes which are not their families choice initially, because they don’t need to be in hospital any longer and the hospital want them out. Unless someone makes a fuss on their behalf. 

What you need to be aware of as well is that health funding is not based on the diagnosis but on the intensity and complexity of the needs. So for example the domain around skin integrity, If someone is prone to pressure sores but these are being well managed by good quality care, this will score lower than someone with open sores which are not healing. 

The other thing to be aware of is that full health funding is not granted permanently. It is reviewed annually and if the persons health needs have changed, even if their dementia has progressed, they can lose full health funding and then there has to be a discussion around moving to a different care home if it’s not dual registered as residential/nursing. 

 If you look on the age UK website they have some good fact sheets around residential care/nursing care and how health funding works.

Bowey123

Many thanks for these replies.  They are very helpful.
Friend lives 200 miles away and is worried sick in case they try to send him home.

Savvy_Sue

elsien said:

What you need to be aware of as well is that health funding is not based on the diagnosis but on the intensity and complexity of the needs. So for example the domain around skin integrity, If someone is prone to pressure sores but these are being well managed by good quality care, this will score lower than someone with open sores which are not healing. 

that may be so, but it has been established that "A well-managed need remains a need". So, because good quality care means that the person doesn't currently have pressure sores, it should be recognised that this is because they have received and continue to receive care, and that care is given because it is needed, so at least SOME weight should be given to that need. 

MikeJXE

I went through this with my wife 11 years ago. The hospital did the assessment after I refused for her to come out.

They put forward care homes and I inspected and refused them all then chose my own which was accepted 

Be careful you are not pushed into something the patient wouldn't desire 

diystarter7

Hi OP

Lets keep it simple as there is often a lot of stress around times like this

The family needs to ask ward staff nurse about 'Safe discharge plan.'
This needs to be completed in the hospital and a written plan given

The assessment considers if support is required going back home by ways of equipment/rails/physical/shopping/bathing/toileting - you name it, it trys to ensure the person going back home can manage and then the further assessment may be carried out and this plan may be inc in the safe discharge plan, ie looks at ADL and how the person will manage or not. 

The assessment will also determine everything else as it stands if they can return home and or need a few weeks in care home etc etc.

Som ensure the safe discharge report is completed and family see it or is told what the plans are and they can take it from there.

(Re nursing homes etc etc - they will help and advise as required if the gent qualifies or supply info and request further assessments to determine longer-term needs etc)

So dont be shy, ask and ask as you know the hospitals are very busy and your mates concern is their dad and he comes first.

Re continuing health care - see link - do rad, very detailed and easy to follow

https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/

Thanks

ps - you can ask to be present when assessments are carried out and there is no reason for them to deline this that I know of if you are family/friend/rep and the patient/cleint wants you there if they have the capacity to make this decision

diystarter7

Bowey123 said:

Many thanks for these replies.  They are very helpful.
Friend lives 200 miles away and is worried sick in case they try to send him home.

They may it depends on the assessment, safe discharge report, your friends have to argue against this and see where it takes them

Thanks

elsien

Savvy_Sue said:

elsien said:

What you need to be aware of as well is that health funding is not based on the diagnosis but on the intensity and complexity of the needs. So for example the domain around skin integrity, If someone is prone to pressure sores but these are being well managed by good quality care, this will score lower than someone with open sores which are not healing. 

that may be so, but it has been established that "A well-managed need remains a need". So, because good quality care means that the person doesn't currently have pressure sores, it should be recognised that this is because they have received and continue to receive care, and that care is given because it is needed, so at least SOME weight should be given to that need. 

I agree, but it will be given a lower priority on the scoring system, which was the point I was trying to make. 

Albermarle

Who makes the decision depends on whether there is a health and welfare power-of-attorney in place or not, and also who is funding the place. It is a best interest decision if he lacks capacity, and without an LPA the decision maker will be whichever which ever professional takes responsibility for his care. In practice with the NHS if there’s a choice this tends to mean asking family to look at them and see what they think but there is only a short timescale for doing this. If he does qualify for the nursing needs assessment and he lacks capacity to be fully involved himself, he has the right to have someone there discussing and asking the questions on his behalf. And if he can’t make his own decision about where he lives long term the mental capacity act says that his family/friends must be consulted on his behalf.

Am I right in saying that the ' Best Interest' decision route takes priority, even if their is a Health & Welfare LPA in place?

The idea being that hopefully everybody involved in the persons care, will come to the same conclusion over what is in the persons best interest. Only if an agreement can not be reached, then the person appointed as their LPA, can make the final decision ( or a professional if no LPA in place)? Even then if the issue is particularly contentious, it might go to the Court of Protection and any decision overturned. Is that correct ?