NHS continuing care

MikeJXE

The best decision for the patient is what the NHS and social services tell you

If the patient is in a similar situation as my wife was as I commented earlier and comes out for family to look after Continuing health care will take forever 

The only reason mine was a few weeks was because i refused to be at home and let the ambulance drop her off. 

Brie

Albermarle said:

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 ?

We had to fight to get the best outcome for MiL as everyone agreed she needed to go into care rather except for the LA professional who thought she could come home to live with us as she had prior to her hospital stay. 

At that point she was completely bedridden and needed help to eat and the LA pro suggested that this could be managed at home with 1 care person visiting every day.  First suggestion was twice a day, upped to 4 times, then upped to 2 people 4 times a day.  We continued to argue because we would not equipped nor able to tend to her needs in between visits.  The LA pro looked at us (a couple in their mid 60s) and said that between the 2 of us we could lift MiL in and out of bed etc etc.  I pointed out that I worked full time so was she proposing I quit my job, which apparently she was.  Not very helpful.  Thankfully the nursing staff that had more contact with MiL were happy to argue on our side and helped us get the LA pro to reverse her decision.

They did refuse any NHS funding though so everything had to be self funded to grind down any savings MiL had to the level when LA funding kicked in.  We did check out the proposed care home and were satisfied with it and were grateful for the care they gave MiL in her final weeks.

elsien

Albermarle said:

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 ?

Not quite.
 It is a best interest process but if there is a health and welfare power-of-attorney they are the decision maker within the boundaries of whatever the decision is to be made. So if the person isn’t a self funder the LPA can’t insist on a more expensive home, for example. And quite often people are in agreement so it does feel like a seamless process.

If there is a query as to whether the LPA is or is  not acting in the person’s best interests then the OPG can be approached to consider whether the LPA needs to be removed. 

But it is entirely possible to disagree with the professionals and still be acting in the  person’s best interests. Some professionals can be very risk averse at times, and not fully consider all the available options. And the bottom line is that the person should have chosen the LPA because they are the ones they trust to make the right decision for them, taking their previous wishes into account, and the circumstances at the time.
The ultimate arbiter would be the court of protection if the decision was serious enough and agreement couldn’t be reached any other way. The expectation is that everything will have been tried to resolve any dispute first before a court application. And unless it’s an urgent application the CoP not a quick process and can take months. 

Clowance

Does anyone know if a Continuing Healthcare assessment can be carried out in a nursing home? Relative just moved to one this week (self funding) and didn't think to ask while in hospital as I assumed he wouldn't qualify.

elsien

Clowance said:

Does anyone know if a Continuing Healthcare assessment can be carried out in a nursing home? Relative just moved to one this week (self funding) and didn't think to ask while in hospital as I assumed he wouldn't qualify.

Yes it can. The care home can fill out the initial checklist if they think he may have nursing needs and the results of that checklist determine whether a full assessment is carried out or not. Talk to the care home nurse or manager.

diystarter7

Clowance said:

Does anyone know if a Continuing Healthcare assessment can be carried out in a nursing home? Relative just moved to one this week (self funding) and didn't think to ask while in hospital as I assumed he wouldn't qualify.

Good morning

It can but read this - very clear and helpful

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