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Does anybody have experience of applying for continuing healthcare funding for an elderly relative?

(8 Posts)
SaulGood Thu 25-Jun-15 13:10:35

I know the threshold is high and it's a long and arduous process but we're probably going to be going through it with my grandmother.

She is 90 and has had all home based support withdrawn as her medical needs are too complex for district nursing. She is currently in short term respite care which is partly funded by her state pension. We are in the process of looking for a full time home for her.

Does anybody have any experience of the CHF and the criteria used to make the decision. I know there's no specific guidance and it depends on how her primary caregivers assess her needs. I've found massive variation in outcomes.

We're assuming we won't be successful as very few people are but given that the fund exists for people whose care is dependent upon a primary health need, I'd argue that she probably should be a prime candidate.

CMOTDibbler Thu 25-Jun-15 13:26:20

I haven't been through it, but I have looked at resources before.

You need to gather as much evidence as possible showing that your GM has severe needs in at least two of the categories, or one Priotity need. You can download the decision support tool from here which shows you how these are scored. Its all about unpredicatability, severity, complexity and the level of skill needed to manage these.

It would be worth going through it with the head of care at her current placement and finding examples of incidents that back up a rating.

SaulGood Thu 25-Jun-15 13:45:51

Thank you for that CMOT. That's extremely useful. On the face of it, she has one priority need, plus severe needs in at least one, possibly two areas, high needs in several others.

I can see how and why they'd argue her needs were lower though. The care home she's in atm isn't adequate. She's already had two emergency hospital admissions because her needs are more complex than they can deal with.

CMOTDibbler Thu 25-Jun-15 13:54:36

In an awful way, that does add to your ammunition though. Perhaps write a log of events so you can track the issue to consequence and where a skilled intervention would have kept her out of hospital. And in the areas you think they will argue on try to get more information to back it up.

SaulGood Thu 25-Jun-15 14:11:06

Thank you. It's such a difficult and sad time. She's in tears because she desperately doesn't want to go into a home. All she ever says is "please take me home". My parents have their own health problems ongoing atm and they are trying to advocate for her. Every little step is taking forever. We're waiting for my parents to have power of attorney but it's going to take 10 weeks and so many things can't happen until we do that. We don't even know where to start with half of it.

CMOTDibbler Thu 25-Jun-15 15:05:31

If she has dementia, then 'take me home' doesn't always mean literally that. It can mean 'I'm scared, I don't understand, I want to be safe'.

SaulGood Thu 25-Jun-15 16:27:32

She doesn't have dementia. She knows exactly what she's saying.

whataboutbob Fri 26-Jun-15 13:29:38

Hello, I have been thorugh the process with my Dad. It was a bit different because he is at home. I told his dementia team I wanted him assessed and they came along and did the initial assessment, which is to screen people and see if they might qualify. It was done by a social worker who had neve rmet him ,the OT from the dementia team, and me. That triggered a full assessment, which is when the CCG (the budget holders) sent 2 nurse assessors , there wa salso one of his carers, the social worker and me. The meeting lasted 4 hours and we went through the Decision Support Tool one domain at a time. The crux of the matter for Dad was that you need 2 severe scores to qualify. Becuas eof his AD he scored severe on cognition, but they refused to score him severe on behaviour (even though he needs 1:1 all day because of challenging behaviour). I politely said I disagreed, the scores were logged and they said they would refer it to their senior. Then 3 weeks later we got a call to say he'd got it. However it took about 2 months for the money to come through and for them to start paying the carers agency.
He does not have a huge number of serious physical issues and it was the behaviour aspect that swung it (as is often the case when people with dementia are awarded CCG).
With you it will of course be different, it will hang on the physical needs. You need to prove that she has severe needs in at least 2 domains. Words like "intensity" "unpredictability" and the epxression "a met need is still a need" are all part of the CHC assessment process. The more you can show they apply, the stronger your case.
As well as the Government documents which CMOT has linked, I found extrmeely useful advice from Care to be Different's website. It was set up by a mumsnetter who fought to get CHC for both her parents.
I did not actually pay anything, I jsut read the relevant pages of the website carefully and also emailed a couple of times and Angela was kind enough to reply with good advice. Good luck. I found it quite a lot of work, but by no means impossible so don t be put off.

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