Continuing Health Care - Preparing to fight PCT's decision

nololly

Thanks for the advice. Assessment is being done for . However the family have decided to let him be discharged as his care recently has gone down. they feel if he can settle in a nursing home with his own belongings and some stability in the staff this might be better for him. he has also recently been diagnosed with prostrate cancer. Thankfully it is very low grade and non aggressive.

malid

Everyone will have different experiences of care homes; as far as I am concerned, hospitals (not all) have offered the best nursing care.

You will need to be clear about your uncle's needs. The award of CHC is dependent on him having nursing requirements not 'care' in its broader sense.

nololly

The hospital have said that it it a nursing home he needs and then stipulated that it had to be an EMI nursing home.

monkeyspanner

nololly wrote: »

feel as though I am being fobbed off by the nursing staff and social workers.

More than likely you are being fobbed off. Very few social workers and nursing staff are aware of the detail of the CHC assessment and funding system and there are widely held misconceptions about eligability. Moreover most staff do not want to deal with the extra paperwork involved in properly assessing a patient for CHC funding.

The discharge team is obliged to carry out an initial checklist assessment for CHC funding to see if a cases should be refered for a full assessment using the DST (decision support tool) introduced in Oct 2007 prior to discharge. But this is often ignored in their rush to free up a bed. Do not be rushed into a quick discharge by allowing the family to be made to feel guilty about bed blocking. Your relative has a right to the proper care and assessment process. I do, however, understand your desire to get your relative settled and moved on from the hospital environment.

Reading through your relatives medical conditions makes me think that he should get CHC funding. However, you will probably need to prepare yourself for a fight and it can take months to get the system to move. Persistence is perhaps as important as the actual condition of the patient as this funding is never volunteered by the relevant PCT's even though there have been numerous court cases which various PCT's have lost.

If you start by having a look at the DST and the supporting CHC framework document, links for which are in one of my previous posts. If you have a problem finding them post again and I will dig them out for you. I am assuming that you are in England, the system differs in Wales and Scotland thanks to devolution of health care to the Welsh or Scottish Assemblies and neither has implemented the new DST.

margaretclare

Supervision of feeding/difficulty in swallowing - that's a nursing job because there is a danger of choking.

Supervision of medication - again, a nursing job. Not a 'care' job.

Anyone who is incontinent needs assessment using the Waterlow Scale - this is a nursing tool for assessing skin vulnerability.

It's prostate cancer, not prostrate. See: http://www.prostate-cancer.org.uk/

HTH

nololly

thanks, i will definetly look up previous post. there has been further developments though today.

Hospital rang this morning at 11 ish to say that he would be discharged next week so that assessments could be done but warned that he could lose his bed in the nursing home. i rang the nursing home and confirmed that they would keep his bed.

when my mother and her sisters who are all in their seventies, went in to visit at 1.30. they were informed that he was being discharged that afternoon and was at that moment awaiting the ambulance. assessment they said would be done in the home.

unfortunately I did not find out until after 5 with work commitments. the home were still under the impression that he was arriving next week. i am ringing the social worker tomorrow. I am totally disgusted that a defenceless old man can be treated this way.

greenflamingo_2

We have just received a letter from the IRP saying that the meeting in May will review the decision relating to the original assessment in September 08 and will not look at any other paperwork after that. We complained to the PCT in September 08 and didnt agree with the original assessment and then a 3 monthly assessment took place at my FIL's nursing home in November 08. The nurse did not use the DST tool and only looked at diet and psychiatric domains. We were then told later that the original decision stood and we complained to the IRP.

I am getting a bit confused here:

1. Does the PCT have to use the DST tool and reassess my father on all domains once you complain about their original assessment?

2. I'm not sure if they are trying to pull a fast one by simply doing a "3 month assessment" and only looking at the psychiatric and dietary domains instead of going through all of them?

3. I am sure that you had to request a reassessment by the PCT before you could officially complain to the IRP? Its as if the IRP know nothing of the Nov 08 visit to my father.

The crux of this is that we can produce logs from the nursing home for November 08 showing that he is doubly incontinent and on steroids but havent got anything else prior to September 08. If the IRP just looks at the September 08 assessment they will probably rule in the PCT favour.

Can someone advise on this pse?

chcfan24

greenflamingo wrote: »

We have just received a letter from the IRP saying that the meeting in May will review the decision relating to the original assessment in September 08 and will not look at any other paperwork after that. We complained to the PCT in September 08 and didnt agree with the original assessment and then a 3 monthly assessment took place at my FIL's nursing home in November 08. The nurse did not use the DST tool and only looked at diet and psychiatric domains. We were then told later that the original decision stood and we complained to the IRP. QUOTE]


Have the PCT given you an explanation why your claim failed at panel in Sep'08. They should have gone through each domain with you before presenting it to panel.

Why did they reassess your FIL again in Nov'08 if your case had just been to panel 3 months earlier.

I would ask who is chairing the IRP meeting and write to the chair prior to the meeting setting out your complaints, doing it this way will make sure you get all your points over and give them all these points in writing to take away rather than speaking on the day and something being missed.

Good Luck

greenflamingo_2

chcfan24 wrote: »

greenflamingo wrote: »

We have just received a letter from the IRP saying that the meeting in May will review the decision relating to the original assessment in September 08 and will not look at any other paperwork after that. We complained to the PCT in September 08 and didnt agree with the original assessment and then a 3 monthly assessment took place at my FIL's nursing home in November 08. The nurse did not use the DST tool and only looked at diet and psychiatric domains. We were then told later that the original decision stood and we complained to the IRP. QUOTE]


Have the PCT given you an explanation why your claim failed at panel in Sep'08. They should have gone through each domain with you before presenting it to panel.

Why did they reassess your FIL again in Nov'08 if your case had just been to panel 3 months earlier.

I would ask who is chairing the IRP meeting and write to the chair prior to the meeting setting out your complaints, doing it this way will make sure you get all your points over and give them all these points in writing to take away rather than speaking on the day and something being missed.

Good Luck

Thanks CHC
Yes the PCT went through everything with us - overuling all the medical/professional opinions! So we asked for a reassessment as we didnt agree with the findings.

On looking through the mountain (literally) of paperwork I found a letter from the PCT dated 28th November discussing the 3 month reassessment of my FIL and saying that because there were " no significant changes" between the original assessment end August and the latest assessment on 25th November the DST tool was not used. Apparently unless there are "significant changes" they are saying they dont have to use the DST tool and go through the CHC procedure. Can this be correct?

I have however got the logs from the nursing home stating that my FIL was "remains doubly incontinent" on an entry dated 12 November. As the reassessment was on the 25th November this should have been picked up by the assessor as I would have thought that someone who was continent (but wasnt anyway) and then doubly incontinent in the space of 3 months would be a significant change! So I am going to scan the letter and email it to the Chair IRP.

chcfan24

Greenflamingo It would appear that if there are no significant changes then they do not need to use the DST. Of course this is another of their ploys enabling them to deny funding.

I was unsure whether denying a correct assessment is lawful but apparently they could say the criteria had not changed.

Sorry I gave you the link to the forum but I am unable to give you the link as a new user.

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