Continuing Health Care - Preparing to fight PCT's decision

monkeyspanner

claudiac wrote: »

Monkeyspanner - Can you give me some quick advice here please. Situation is FIL is in a locked ward for assessment, and today when I was at work and unreachable, they phoned MIL at home to say he is to go into care home. They said they had sent her a letter inviting her to the meeting, she never got one, they said the consultant and charge nurse on ward attended, but we were not notified, nor invited. What do you think my first step should be to challenge them?

If your FIL is on a locked ward then I assume he has been temporarily sectioned for assessment.
When you say he is to be discharged to a care home is that at the NHS expense or your FIL?
Is it a permanent care home place or for recouperation/recovery/stabilisation?
Have they assessed and detailed his care needs?
Has he had a CHC checklist or full CHC assessment?
If so have you been given the opportunity to comment on their assessment prior to a decision being made?
Have you been given a CHC funding decision in writing setting out their decision and the reasons for it?

Almost certainly they will not have followed proceedure as set out in the National Framework so if you have time wade through that and see what they have and haven't done. Push for a copy of any assessments that have bieen done and object if you disagree. If you are unhappy with the decision then ask for an IRP (independant review panel) and if they have not followed proceedure you could complain to the SHA but they don't normally get involved until the PCT appeal proceedures are exhausted.
Hope this helps.

monkeyspanner

ArchieThe_Fish wrote: »

The CHC system is an act of complicity between the DOH and the PCTs. With regard to Alzheimer's and those suffering at the advanced
stages - cognition is key, and it is this which is undervalued in the present DST - this is the mechanism that allows the PCTs to deny funding. Our challenge has gone via the DOH complaints system and then via the PArliamentary ombudsman - it is now due for Judicial review - this is imminent - fingers crossed it all goes thru - the DOH response digs a hole futher against them, we feel. I wish you alll well with the trauma of taking on this iniquitous and corrupt system of
alleged 'health need' evaluation
archie

I wish you good luck. Are you doing this on your own?

Our experience was that the assessment of cognition was superficial in the extreme, an everyday conversation at best. Only when asked very specific questions regarding close relatives by us did the level of impairment become apparent. It was lucky we were at the assessment.

claudiac_2

monkeyspanner wrote: »

If your FIL is on a locked ward then I assume he has been temporarily sectioned for assessment.
When you say he is to be discharged to a care home is that at the NHS expense or your FIL?
Is it a permanent care home place or for recouperation/recovery/stabilisation?
Have they assessed and detailed his care needs?
Has he had a CHC checklist or full CHC assessment?
If so have you been given the opportunity to comment on their assessment prior to a decision being made?
Have you been given a CHC funding decision in writing setting out their decision and the reasons for it?

Almost certainly they will not have followed proceedure as set out in the National Framework so if you have time wade through that and see what they have and haven't done. Push for a copy of any assessments that have bieen done and object if you disagree. If you are unhappy with the decision then ask for an IRP (independant review panel) and if they have not followed proceedure you could complain to the SHA but they don't normally get involved until the PCT appeal proceedures are exhausted.
Hope this helps.

We were told he was in the locked ward 'voluntarily', my MIL had to sign a form when he went in (she has POA).
All we know is that the ward called MIL, telling her he is to be discharged, but will be unable to be cared for by her any more, so will need to go into a care home. My best bet is they want us to pay as the social worker is coming today, and I am sure she will have been told to do the financial assessment to see how much money they have. We have not been informed in any way by the hospital, the assessment was done without us knowing, ward said they sent MIL a letter informing her, she did not receive one, so nobody in the family was present. We do not yet know what their assessment says as we have not received a copy of it. We do not know if he was assessed for CHC checklist or full assessment.
In short we know very little. I am going to MIL now to be her advocate with the social worker, we will tell her nothing, we will sign nothing. Once we hear what she is saying we will go to the ward and start by asking the above questions. I think now might be a good time to request all records held at the hospital, so that we can at least see what they have written. I have printed out the hospital's discharge procedure, none of which has been followed, and also the complaints procedure, and we will start on that.
Meanwhile, FIL has deteriorated to the extent he is now kept in a wheelchair, looks miserable, is much more confused. It is an awful situation for him to be in, but if we start a complaint and force the issue with them then he would have to stay there until it is resolved, and I am not so sure that this is in his best interests. So, a lot to think about, but thank you for your advice so far, and I am sure I will return for further help.

monkeyspanner

This must be a very difficult time for you. As a personal retrospective reflection I would have wished to focus more on my MIL's welfare and less on understanding and trying to keep up with the administrative process. So your comment regarding your FIL's best interest is important.

It is not unusual for the elderly and infirm to be discharged from hospital dehydrated and malnourished. So your FIL's condition may in part be due to basic care being neglected. So you need to balance the need to get the process properly undertaken vs the very real need to get your FIL into a stable caring environment as soon as possible. You may need to fight the battle for CHC in retrospect.

I think you are on the right track to consider obtaining your FIL's medical records. These can be revealing. Don't be too upset if you find personal comments about patients relatives in the records.

There is a minimum requirement that prior to discharge a CHC checklist should be undertaken. This process should be lenient so that all patients who need a full assessment will get one. This lenient application of the checklist is not always followed as obviously a full assessment and consideration of the DST is costly. There is also often a misconception of the nature of CHC funding. Often you will hear medical staff say something along the lines of "you need to be at deaths door to get that" and "you won't get that in a care home". This is absolutely not the case. CHC funding is available to anyone whose primary need is medical rather than domestic and can be delivered in any environment including the patient's home.

So picking up on the point you made about being told your MIL will be unable to care for your FIL at home. It would be interesting to find out if this is based on a medical need your FIL has and what is the nature of is need. For instance if he has unpredictable or violent behaviour.

You will probably feel the social workers are not particularly helpful. They are bound to follow a laid out proceedure and in the absence of a CHC award will have to carry out a financial assessment. It would be as well for you to understand this process and you will probably have to go down the self-funding route whilst processing the CHC assessment as well. It took us well over 9 months of self-funding to obtain a CHC award and retrospective payment. A bit of detail here, make sure you keep a record of any expenses connected to the CHC as if sucessful you should be able to get out of pocket expenses for the person holding POA. Try to get the social worker on you side, after all success in obtaining CHC funding reduces their expenditure but they are inclined to take the easiest most familiar route which is for your FIL to be self-funding or for the coucil to assist with funding.

I could give you all sorts of detail regarding the financial assessment and will be happy to do that when you need it. In the meantime I wish you luck in finding out what is going on.

nickwoods

HELP!! a brief history. My dad was taken into a secure mental health assessment unit for 12 to 21 days as he has been diagnosed with dementia. 3 months later having been awarded nhs chc funding he was transferred to a secure EMI care home of our choice. We have received one letter since that time saying he was still eligable for chc.
Now we have received letter saying he requires a full MDT meeting on the 28th of June as he now no longer meets their strict criteria for funding.
My father has deteriorated significantly in the last 12 months, physically aggressive, very restless, constantly walks all day, no longer recognises even close family members. Incapable of understanding and doing even the most basic of tasks. He has become withdrawn and socially isolated due to his inability to communicate. He is now spoon fed but still has had a dramatic weight loss and is doubly incontinent.
There is also a question of changing PCT's. At present he is under Trafford PCT, his care home is in Bolton and Bolton social services have advised to make him a Bolton resident.
When we first chose this care home social services asked us to ask if the home would accept Trafford rates.
The Bolton social worker has given us a copy of her assessment and we have noticed several errors, firstly a rating of severe in a category that doesn't carry a severe rating. This doesn't exactly instill confidence although she is recomending that he is eligable for chc.
We don't know whom to trust or what to expect at the MDT.
Can anybody give any advice, there is little information on re-assessments. After reading other peoples experiences with the MDT and PCT we feel very unprepared for what we are about to face. HELP HELP HELP.

taradog

My father was admitted to hospital in 2008 after a fall . He had a stroke in 2000 and regained very little mobility but was cared for by my mother.

In 2008 it was found he had suffered a heart attack and Tia s resulting in him falling. After a long period in the hospital ; the doctor advised my mother that he would not be able to return home as he needed constant nursing care , and would need hoisting as he had no mobility or body strength and could not self care.

No one informed us at any point about chc or assessments and I do not believe he was assessed by the Nhs. My parents had a full social services financial assessment and my mother ended up having to pay a large amount of his fees.

I am looking at whether he should have been given help by the Nhs but do not want to pay a high no win no fee charge as I feel anything received should return to my mum to make her life more comfortable .

I would appreciate any help or advise from those of you with experience of this.

My father had no mobility and paralysis in his left side.

Diabetes type 2

Angina

Depression

Cognitive was ok and he could feed himself



My father has now passed away .

monkeyspanner

It is difficult to judge if your father should have received CHC funding. I will set out a few bits of information below to help you investigate further.

- The first point to mention is that time limits for appealing CHC decisions were applied from April 2012. So if your father was assessed for CHC funding you could be out of time. Here is a link to the guidance notes for time limits http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133055

- In order to judge you will need to find out if an assessment was carried out. This in itself could prove difficult. You could approach the hospital discharge team or the local Social Services and ask.

-If there was no assessment and you wish to follow this up you will need medical records from hospital (a charge will apply) your father's GP and the care home. You should then approach the PCT (if in England) and request a retrospective review. I think it is likely that at least in the first instance their response will be you are out of time. You will probably need to be assertive and persistent to get any reasonable response. If you draw a blank you could then approach the SHA and ask them to review if the PCT followed the proper proceedure in your fathers case.

- Your fathers case predates the introduction of the National Framework and DST (decision support tool) in England so it will have been judged by the PCT rules in force at the time. These vary from PCT to PCT so you will need to assertain what their proceedure was.

- For information support you could try https://www.counselandcare.org.uk they run a free helpline.

I hope this helps and good luck

monday23

Does anyone know about Northen Ireland. My parent is in a nursing home paying all fees themselves (getting the nursing allowance ) and feel sure if they were in England they would be entitled to continuing care or at least be able to go through the procedure. All lines of enquiry have drawn a blank as apparently in N Ireland there are no guidelines, continuing care doesn't appear to exisit and the couglan case doesn't apply. Anyone know anything?

monkeyspanner

Extract from an Alzheimers Society document

"No guidance about continuing healthcare has been issued in Northern Ireland. This means that it is up to the local health and social care boards to decide on their own criteria for who qualifies for continuing care. If a person feels they may qualify for continuing care, they could contact their local health and social care board ask them to confirm their criteria and ask how to get an assessment."


Full text here http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=1321

monkeyspanner

monkeyspanner wrote: »

It is difficult to judge if your father should have received CHC funding. I will set out a few bits of information below to help you investigate further.

- The first point to mention is that time limits for appealing CHC decisions were applied from April 2012. So if your father was assessed for CHC funding you could be out of time. Here is a link to the guidance notes for time limits http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133055

- In order to judge you will need to find out if an assessment was carried out. This in itself could prove difficult. You could approach the hospital discharge team or the local Social Services and ask.

-If there was no assessment and you wish to follow this up you will need medical records from hospital (a charge will apply) your father's GP and the care home. You should then approach the PCT (if in England) and request a retrospective review. I think it is likely that at least in the first instance their response will be you are out of time. You will probably need to be assertive and persistent to get any reasonable response. If you draw a blank you could then approach the SHA and ask them to review if the PCT followed the proper proceedure in your fathers case.

- Your fathers case predates the introduction of the National Framework and DST (decision support tool) in England so it will have been judged by the PCT rules in force at the time. These vary from PCT to PCT so you will need to assertain what their proceedure was.

- For information support you could try www.counselandcare.org.uk they run a free helpline.

I hope this helps and good luck

Sorry this is incorrect in that the new National framework and DST were introduced in October 2007 so when your father had the TIAs he should have been assessed under the new framework.