CHC Questions to ask

[MereDintofPandiculation]

I've just been told Dad has been refused CHC.

CHC assessor is coming round tomorrow to go through her reasoning. What questions should I ask her?

Assessment was done by assessor and by nursing home nurse who, I am told, agreed with the assessment. SW was on sick leave. I wasn't told the date and time of the assessment, so did not have the opportunity to attend.

Am I right in my understanding that, if CHC is refused and we only get FNC, then my father can still get Attendance Allowance?

[wigglypiggly]

If he is self funding, gets fnc only, he should still get AA, it's on the gov.uk site. Ask to see the assessment and the scores for each domain, she may have a copy of his careplan, drug chart, food, fluid, continence, pressure relief, turning, swallowing, behaviour chart which you can match up with their scoring. If you Google chc checklist you can see the different sections and see what care you think he needs to co pare it to hers. Do you know why it was refused.

[hatgirl]

Usually only grounds for appeal against a CHC decision is if you feel the process has not been completed correctly.

A social worker/ local authority representative was not involved in the decision therefore you have grounds to argue you want to repeat the CHC assessment process.

To that end it doesn't really matter what the nurse assessor's 'reasonings' were you will probably be able to repeat the process properly.

I suspect though that the nurse assessor is reasonably confident that even though they haven't followed proper process that their decision will be upheld but they are trying to head you off going down that route to avoid the aggro.

What were your dad's 'scores' out of interest?

[MereDintofPandiculation]

Thanks wiggly for confirming the AA situation.

She claims CHC was refused because she doesn't believe his medical needs are sufficiently complex.

Assessor came round to see me this morning, but implying she was simply going to show me her report, not that she was seeking evidence from me so I hadn't got all my ducks in a row. It's going to CHC panel tomorrow am. I haven't got a copy of the report yet, but the assessments for all areas are "Low" apart from 3 "Moderates" and two "none". I have to agree with most of those assessments, except I think one of the "low" should be a "mod" and one of the "Mods" should be "high". I've got the GP to send across a statement on his paranoid thoughts, which they hadn't any evidence of from the care home. We also had discussion around "a managed needs is still a need" which she claims to have included in her assessment.

I need to find out how they move from those scores to an overall decision - if he's borderline, arguing that two scores should be higher might tip it, if he's a long way below, then an appeal isn't going to be worth it.

Definitions are interesting. Mobility hampering daily living - she's working on the basis of whether he can wash, eat and use the toilet. I regard daily living as everything that is part of his life - can he get out to do some shopping, to go to talks, go to Chapel, visit family? Can he walk a short distance? - apparently that means can he cross the room to a commode, not can he go for a gentle amble around the local park.

[Hellywelly10]

Tbh op if most of his scores are low to moderate and you only think two can be increased then hes unlikely to get chc imo.

[hatgirl]

I need to find out how they move from those scores to an overall decision - if he's borderline, arguing that two scores should be higher might tip it, if he's a long way below, then an appeal isn't going to be worth it.

The final decision is based on the nature of the needs, the complexity of the needs, the unpredictability of the needs and the intensity of the needs described in the 12 information gathering domains.

Essentially CHC is there to fund care needs that are so overwhelmingly medical that they are beyond the scope of social care. So for example someone requiring daily input from qualified staff to dress and manage non healing pressure sores would be beyond the normal remit of social care workers, a nurse would most likely be needed.

Someone displaying dementia behaviours so aggressive that they were requiring very regular input from a registered mental health professional (e.g to adjust medication/ use sedation) would be beyond the remit of social care.

Someone with a complex medication routine e.g requiring titration or covert administration of meds would in most circumstances be beyond the remit of social care workers.

If you have enough needs that are so complex/intense/unpredictable that more often than not they require specialist (for example sometimes family members can be trained to do some stuff careworkers would be allowed to do) or medical input on a regular basis, it would suggest eligibility for CHC.

With mainly lows and moderates it's likely he is nowhere near the tipping point into CHC. It's probably why they proceeded without the social worker because they suspected it wouldn't be a contentious decision.

You can still appeal that the process wasn't completed correctly but all they will do is repeat it with a social worker and presumably come to the same decision?

Also, yes, activities of daily living mean the basics required e.g washing/dressing/preparing a meal. The activities you have described would be 'social activities'.

[MereDintofPandiculation]

Thanks,hatgirl and helly - that's helpful. At least I won't have to spend time gathering evidence for an appeal!

It's really a crap way to deal with older people, isn't it? As long as they're getting fed, washed and toileted, they're perfectly OK? Bored out of their mind, effectively in solitary confinement in one room shared with a commode.

[Hellywelly10]

I know op.The way the assessments are set up it gives false hope to famalies that their loved one may qualify for free care. It creates false hope imo.

[MereDintofPandiculation]

It gives false hope that their loved ones are treated as people with a life as opposed to warm bodies in storage!

[hatgirl]

I can see how it would feel that way if you've had the CHC assessment without the corresponding Social Care assessment being completed,

You have to remember that the CHC is a medical needs assessment to determine eligibility for NHS funding. It's for all age groups not just older people which is why the domains are so broad - e.g I also use it at work for young adults with learning disabilities.

A social care assessment (Care Act assessment) and any subsequent care and support plans should look holistically at the persons whole life and their social needs as well. Now that eligibility for CHC has been determined you can request the social worker does a full Care Act assessment which does cover all of that and won't just be looking at medical eligibility.