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Continuing health care funding - Carers UK Forum

Continuing health care funding

For issues specific to caring for someone with dementia.
Hi everyone!

Wondering if there's anyone out there who has experience of this funding.

Mum is going to be discharged from hospital into a residential bed at a local nursing

She is 92, has dementia , severe osteoporosis (back gone at almost every level ). Long standing wound of seven years on leg which prior to admission was being monitored on a daily basis by district nurse.

Admitted to hospital four weeks ago because of severe hallucinations. Seeing insects and red fish. Also saying pipes were leaking abdcthstcthe carpet was wet. In hospital also hallucinating. She was very dehydrated and has kidney damage. On admission she was still able to weight bear and .

She has been assessed using the NHS continuing healthcare check list. She scored one A and two Bs. The remainder being Cs . The A was for cognition. One B was for drug therapy and medication symptoms.
The other B was for skin integrity.

The Rationale for Decision was:-

Mary has a known demrntia and recent delirium. She requires support for personal and physical care needs. For residential care home placement with D.N support regarding skin care and non compliance of medication . Shecdirs not trigger for full health assessment not for FNC funding.

Knew the skin integrity section the assessor just mentioned her heel and sacrum areas and that there 'was a dressing to left leg'. No mention of WHY the dressing was there! !! I spoke to the assessor 're this. The wound on left leg has been there for seven years. Will never heal because at home she continually removed the dressings. District nurses have been going in daily to monitor same. Tissue viability nurse has also been involved in the past and special treatment /dressings have to be applied to the area to ensure sepsis does not occur. On many occasions swans have proved positive for MRSA.

I have spoken to the head District nurse who knows mum well and she says she will liaise with the assessor 're this.

Re drug therapy/meds. Assessor only mentioned that mum is variable in compliance with medication in particular with oral laxatives.

I've told assessor that she is bon compliant with prescribed special dressing on left leg and again the head District nurse will liaise with her on this point.

Hopefully she will be reassessed and awarded further A scored. She needs two As to go down the route for continuing health care funding.

She is now weaker since the assessment and has great difficulty weight bearing. Takes two to transfer and has not walked for the last five or six days.

Any of your experiences or advice will be greatfully received. Xx thank you. Xx
Hi Joan ... seasons greetings.

CHC / NHS Continuing Healthcare ?

You certainly have come to the right place.

Main thread :

https://www.carersuk.org/forum/support- ... inks-32532

If totally new to you , strongly recommend starting with the video from Professor Luke Clements.

Make yourself comfortable , it's fairly long but , if you dislike bland text , well worth it from a social care expert with several admirers on this forum over the years.

Not eligible ... NHS FNC an alternative ?

Section within the main thread with two links explaining the alternatives :
Not eligible for CHC but may be so for NHS funded nursing care ?

Appeal against a decision ?

Again , separate section in the main thread ... two links with guidance :
Appeals against CHC rulings ?

NHS-funded nursing care

NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.

Who is eligible for NHS-funded nursing care ?

You may be eligible for NHS-funded nursing care if:

you're not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse
you live in a nursing home

How will my needs be assessed?

You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care.

Most people don't need a separate assessment for NHS-funded nursing care. However, if you do need an assessment or you haven't already had one, your clinical commissioning group (CCG) can arrange an assessment for you. Find your local CCG.

Outcome of the assessment

If you're eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided by registered nurses employed by the care home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.

If you're not eligible for NHS-funded nursing care and you don't agree with the decision about your eligibility, ask your CCG to review the decision.

The cost of NHS-funded nursing care

NHS-funded nursing care is paid at the same rate across England. In April 2018, the rate was set at £158.16 a week (standard rate).

Before October 1 2007, there were 3 different levels or bands of payment for NHS-funded nursing care – low, medium and high.

If you moved into a care home before October 1 2007, and you were on the low or medium bands, you would have been transferred to the standard rate from that date.

If you moved into a care home before October 1 2007, and you were on the high band, NHS-funded nursing care is paid at a higher rate. In April 2018, the higher rate was set at £217.59 a week. You’re entitled to continue on this rate unless:

you no longer have nursing needs.

you no longer live in a care home that provides nursing.

your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £158.16 a week, or

you become entitled to NHS continuing healthcare instead.

Have a ponder ... then get back to us.
Thanks Chris. Will definitely have a look. Kind regards Joan.

Best wishes to you and yours for 2019
Cheers ... we are all going to need it !!!

Too many storm clouds on the horizon even before that clock ticks overs 12pm tonight !
Definitely appeal. When you say she will be reassessed, have you formally appealed? Many appeals succeed, though it is a postcode lottery. The non-compliance Ithink is important. We did win an appeal and it was on the basis of behaviour. Although my brother's behaviour was pleasant, so on the first application he was not given an A, on the appeal one of the team helping me realised that he was behaving in such a way that his health would suffer - pretending he'd taken his tablets but actually secreting them under his tongue and stuffing them under the mattress, to mention only one thing. His behaviour meant he was incapable of looking after his own health. I think that was the third A.
Post code lottery ... rationing by design ... shades of the PIP appeal debacle ?

Explored in a separate CHC thread :

https://www.carersuk.org/forum/support- ... 20rationed
We had our initial big meeting way back at the start of Sept.....3 chase up telephone calls ( two from me and one from the Parkinson nurse ) plus an email and they still haven’t replied to us either way to say if we have been successful or not.

Part of me doesn’t want to chase it again for fear of them holding it against us as a nuisance and the other part of me says who ever shouts loudest gets what they want......

I’m frustrated as what a waste of my time and everyone else’s....the two care company representatives, the social worker, the Parkinson’s nurse, and the 1/2 day I took as holiday all to be present at the meeting in my mums home and then to hear nothing......
Delays in CHC Assessment decisions ... regretably , nothing new ... 28 days is the stated objective ... the following link will be of assistance :

https://www.continuing-healthcare.co.uk ... e-decision
How Long Should I Wait for a Continuing Healthcare Funding Decision ?

We investigate the length of time it should take to receive a continuing healthcare funding decision.
Oh Chris for some reason the link you sent me didn't work but I managed to find Luke Clements by googling him and watched the video. It was interesting but I feel that I will need to listen to it again for everything to sink in!!! When you're on the wrong side of seventy it takes longer for facts to filter through to the brain!!!

Anyway I am going to wait and see the outcome of the district nurse's assessment on mum. She said she will liaise with the hospital assessor so hopefully, because she has known mum for seven years, she will be able to give a clear picture of Mum's needs. I hope so!!! Will keep you updated.

Mum would be apalled if she knew she was having to sell her bungalow to fund her care. She used to say that when the national health service was formed It was there to support you from the cradle to the grave!!

My parents were not wealthy people. They had ordinary jobs. Dad a paint sprayer and mum as a spinner in the woolen trade. They had a strong work ethic. Dad worked long hours and mum part time when i was a child to ensure that they could buy their own home. They never claimed benefits, never went on fancy holidays etc. Yet they knew of other people who had similar wages to them would "live up" to their income and not own their own home. And then at the end of the day these people are totally funded for care in their old age!! Not fair!!! And don't get me started on imigrants who have never contributed to our health system or fought for our country like my dad did! !!

Rant over....I'll keep you updated.

Joan, make sure you apply for continuing health care - it sounds as if it's what your mother would want. How soon is the nurse going to report back to you? Your mother's needs are one thing, but another is how they are paid for. What the nurse says and what the hospital assessor says will be part of the application for CHC, but there has to be an application.