Continuing Healthcare Assessment

For issues specific to caring for someone with dementia.
Hi Everyone

My Mum (almost 84) is living in an EMU unit in a residential care home and has Vascular Dementia. She has been there for 12 months, having being discharged from hospital as being unfit to return home. A DOLs is also in place.
She had the CHC assessment before being discharged from hospital and did not qualify for NHS funding. She does however qualify for some LA assistance, but my Dad has to pay quite hefty top ups.
Over the past year, her condition has deteriorated substantially, to the point where she is unable to walk or weight bear (a hoist is used on her), she is completely incontinent, she is unable to feed herself, has very fragile skin (regular skin tears)and has lost almost all mental capacity.
My questions are:
Should she have another CHC assessment? Should this be done automatically or does it have to be requested?
If she now qualify for NHS funding, will this mean she has to be moved to a nursing home?

Any advice will be greatly received.

Many thanks
One word ... DEFINATELY !

Main CHC / NHS Continuing Healthcare thread : ... here-35998






( I'll change POINTON to a different colour ... almost clashes ? Now done ... all I now need is Pointon to complain ? )


Enough to answer your immediate question ?

Heavy going but ... said System was designed that way ... on purpose ?
Thanks Chris

However this doesn't answer all of my questions.

If she qualifies for NHS funding, I believe the funding is somewhat less that the cost of the care home. Does this mean that she will need to be moved from the EMI unit into a nursing home? I would like to avoid this if necessary.

Who do I contact to arrange the reassessment as the c are home do not seem to know.

Kind Regards
CHC / NHS Contining Healthcare is FREE ... whole section towards the end on that ... TOP UP FEES ... highlighted earlier.

Are you being requested to pay on top of the funding so generated ?

Or ... a case of the NHS funding a " Silver star " package whereas you're seeking a " Gold star " one ?

If it's on a " Needs " basis , it's the NHS's problem ... not yours.

An ancillary link I occasionly use in addition to whats in the main thread ... under CHC / NHS CONTINUING HEALTHCARE : PROBLEMS ? ( LINKS TO EXTERNAL SITES ) : ... ng-part-1/

You will find the information therein very useful ... including guidance on " Reassessment. "

So many to choose from ... I limited those to actual links to save expanding the thread by a factor 5 / 6.

( Links ... akin to appendices in a book ... for further reference ... some as long as a whole , additional , chapter. )

As a general guide , and targetted for dementia , the Alzheimer's Society is also recommended ... specialists in help and support for dementia sufferers : ... entia-care

Section :

Alzheimer's Society's view on NHS Continuing Healthcare . ... healthcare

In addition , AGE UK ... very good , in isolation , on CHC / NHS Continuing Healthcare : ... ealthcare/

Their fact sheet ... available from the link on that page ... is one of the best there is ... 34 pages in .pdf format :

[ ... re_fcs.pdf

Slightly more fine tuned than " Our " main thread when it comes to dementia ... just one condition that normally triggers
CHC / NHS Continuing Healthcare / NHS Nursing Funded Care.


We , on the forum , are not experts , nor legally qualified ... we just do the best we can to assist fellow carers ...
from our own knowledge and experience as carers ... information is my trait ... where to look , and where to go
... a traffic cop if you like ... or a mere librarian ?
Hi Chris

Just to let you know that I have just been contacted by Social Services to confirm that a CHC assessment has been booked as I requested.

The Social Worker told me that if my mother is assessed as having care needs only (but qualifying for CHC), she will need to be moved from her existing residential care home to a council run home and we will still need to pay top up fees. If she is defined as having nursing needs, she will need to be moved to a nursing home and we will still need to pay top up fees. If she is assessed as needing 'end of life care', then that would be free.

I feel that she social worker was trying to put me off, however I have insisted on the assessment.

What are your thoughts? I doubt whether she will be assessed as having nursing needs, but we would prefer for her to remain in the existing care home if necessary.
Hi Debby.

Very interesting !

My thoughts or advice ?

If the latter , one for those qualified to do so out there.

Given the circumstances , my recommendation would be AGE UK ... meat and drink to them ?

Main web site and contact details :

( Now , even an Online Advisor ! )

My thoughts ... social worker .... in whose interest is she acting ... possible conflict ?

Top up fees ?

Nothing but a try on !

One horrible thought ... CHC application ... social worker taking the lead ?

According to the " Book " , yes ... PRELIMINARY assessment ONLY ... is allowed ... perhaps this part should be rewritten ???

( If I have a toothache , do I see my doctor ... or a dentist ? Given what's on the preliminary assessment menu ,
replace DOCTOR with BOOKMAKER ???????? )

What is the preliminary assessment ?

First, you'll have a preliminary assessment of your needs using a checklist. This might be carried out by a doctor or a nurse when you're being discharged from hospital, or by your GP or by a social worker.

Preliminary assessment checklist

The checklist covers the following categories ( Also known as " Care domains " ) :

cognition (understanding).
psychological/emotional needs.
mobility (ability to move around).
nutrition (food and drink).
skin (including wounds and ulcers).
symptom control through drug therapies and medication.
altered states of consciousness.
other significant needs.

What is the full assessment ?

If the preliminary assessment shows that you may be eligible for CHC, then you'll have a full assessment. This will be carried out by a multi-disciplinary team, consisting of either :

two healthcare professionals from different healthcare professions,
one healthcare professional and one specialist community care assessor.

The multi-disciplinary team will use a checklist similar to the one used in the preliminary assessment checklist and score you on how serious your needs are in each of the categories in the checklist.

Because most of the categories considered in the assessment process don't relate to mental health, and because of the way they are scored, people with only mental health problems are rarely considered eligible for CHC, as opposed to those with physical health problems.

AGE UK ... let them loose on this !

CAB and the Carers UK Advice Team in the wings ???
Hi Chris

The Social Worker called back to say that the District Nurse which serves the care home has agreed to do the preliminary assessment (says that sometimes they refuse??) and that if Mum qualifies for a further assessment they will be in touch.

I am pretty certain that she will qualify as she is no longer mobile at all and needs to be hoisted by 2 staff members, she is doubly incontinent, is unable to feed herself (using any form of cutlery and also needs help holding a cup) and has very fragile skin (many tears, bruising etc). My main concern is that they will move her.

The social worker said that she may need a nursing home (unlikely in my opinion) or may be moved to a different care home (presumably cheaper than the current one). She has only been in residential care for a year and currently lives in a secure unit (EMI) in a residential care home which other than a few minor issues we are very happy with (her clothes and toiletries are constantly going missing). It was very hard to find a home with an EMI unit a year ago and I feel we were left with a choice of 2. The current one is very close to where I live, so very convenient for visiting. If she does qualify for CHC, I wonder if she will be forced to move to cut costs. This would really upset my father who is also 84 and suffers from cancer as he relies on me for transport for visiting and even though her dementia is very advanced, he would think any move would unsettle her.

I will contact AGE UK for their opinion, but in the meantime, thank you for your help.

Kind Regards
Your more than welcome , Debby.

CHC and related ?

No matter what's contained in that main thread , the actual reality for anyone is a ... nightmare.

More than enough evidence in a separate thread to suggest it's rationed by design. ... 20rationed

A deduction which is supported by a House report in that thread,

A mile course ... just two furlongs in ... and the fences get tougher.

Faced with that , no wonder so many give up in sheer frustration ?

2019 ... is this really what it comes down to ?

Keep us appraised , Debby.
Just from my own memories - my brother had CHC for carers at home, so I have no experience of care homes or nursing homes.
I understand you must absolutely not be required to pay top-up fees. I would not think you will necessarily get CHC from what I read here (it's a postcode lottery too). I do not know how many items on the CHC list you would record top marks for. The decisive one in our case was that my brother's behaviour was detrimental to his own health - this made him a medical rather than just a social care case. Immobility and double incontinence were not enough.
The assessment should not, as said above, be wholly in the hands of the social worker - it has to be NHS and social services together.
There is, as you probably know, a halfway house whereby you don't get awarded full CHC but a contribution to nursing home fees. If that is what the social worker means by top-up fees, it would make some kind of sense, but 'top-up fees' is the wrong terminology. And who is paying these fees? It has to be your mother, not you. Only your mother's financial position is relevant.
Yep ... if CHC / NHS Continuing Healthcare is refused first time around , NHS Nursing Funded Care MAY be an alternative.

Spelt out in detail within the MAIN thread.

Whole section , including legal opinions , on top up fees in that thread.