Preparation for NHS Continuing Healthcare MDT Assessment?

AGE UK can refer you to a company to help with the appeals process; one hour of their time is funded by the Government. They were able to give me enough information to confirm my opinion that there was no point in an appeal (less severe needs than you seem to have), which I was rather relieved about, as I was in no state to take on yet another load of paperwork.

So despite several 'high' and the rest 'moderate' indicators, DM was not considered to have a 'primary health need'. They seem to be looking for unpredictability and the need for daily nursing decisions. If a "High" need can be met by a routine intervention it doesn't indicate a primary nursing need.

but from what I can gather NH don't even reduce their fees by the FNC payment can't really see point in awarding it. The NH assume at the start that you will get FNC and base their fees on that. Buried in the small print on our contract is a statement that if FNC isn't forthcoming, any nursing requirements will be dealt with by District Nurses not by the nursing home nurses. So the point of getting it is to be able to continue to access the 24hour availability of NH nurses instead of relying on sporadic visits from District Nurses.

Your mum - if already in NH- is likely to already be getting FNC (claimed direct by the NH to CCG). The nursing Home wouldn't have been including that in her care charges to whoever is managing her funds, as it comes direct from local CCG (NHS commissioners). I'd read it as they are reminding you CCG (health) is contributing to her nursing home placement for her nursing needs.

If you feel confused by it all, you can request a full copy of her DST report (as her LPA health and welfare: client reps) from that continuing healthcare (CCG CHC) team. Usually they (CCG) send you a letter of outcome with details of appeal process.

If you look on HMGov website there is plenty of documents on CHC process.

So disappointed for you. Had the nurse at NH been there would it have changed?

That's brilliant news @Sundayscented, well done!

Approved full CHC .

The meeting was over the internet led by a CHC Nurse Practitioner. With Mums' Social Worker, the Care Home Lead Nurse and us answering questions and adding any items.

The NP was good at explaining things and asking questions. She took a brief history of how we got to this point then went through each of the care domains. The Care Home and us left the call and the CHC Nurse and SW discussed Mums case. They rang back within 15 minutes to say we'd got full funding. Mum was scored as 3 highs, 4 moderate and everything else low/ neutral. She said their reasoning was that her prognosis was not very good and in one care domain bordered on severe.

I think the Care Home Nurse's input was the main reason we succeeded. She was wonderful and gave lots of information, she had previously said to us that she thought Mum should get full funding. We only had the information to mid December when Mum went into hospital but the nurse had good records from her January admission to the care home.

Off to celebrate now! If anyone has any questions I'll try to help. Good luck to everyone else going through this.

Don't underestimate how large care needs can be, and remember anything you commit to will be for the long term, without the option of sick leave or days off

Just found this really useful thread - we have our CHC meeting on Friday and I'm grubbing around on the internet trying to get some idea of how best to prepare. Good luck for tomorrow @Sundayscented, and I too would be interested to hear how it goes if you feel you can share. My mum has been in hospital since late December after suffering a huge stroke and we are hoping that the meeting will enable us to make some decisions about mum's future, and whether she can come home or will be better cared for in a nursing home. We have already been told that her care needs are 'heavy'.

Hope it goes well @Sundayscented

We have our CHC meeting tomorrow - wish us luck!

We found this publication from Beacon -
document 2: Guide to Continuing Healthcare Assessments - www.beaconchc.co.uk/xazewat3apruc2u/
and
this from Irwin Mitchell solicitors

Hope they help others

Fingers crossed for a fair meeting and positive outcome. Your DM would be pleased you are giving it your all on her behalf.

Good luck @DorsetCamping really hope it goes well (this is Flygirl-name change!)

Hope it goes well @DorsetCamping

My DSis did this for my DM, she found it as PPs have mentioned, pretty exhausting. All the best.

Remember you and the nurses are working from a different context - she is quite possibly the ill-est person you have had dealings with whereas the nurses will have seen many who are more ill. That will colour both your perspectives.

What you do know is what she was like 6 months ago. So if they present a picture that is more rosy than 6 months ago, you can think whether she has recovered in that respect, or whether they are falling in to the trap of forgetting that behind every need that has been met there is nevertheless a need that has to be taken into account.

Do take it very seriously from now on and don't skimp on the evidence you produce (although you may not have much if you haven't been able to see her for the last year). Passing the first stage doesn't mean she has a strong case, it merely means she hasn't been screened out as being a waste of time to assess.

Here is the decision tool
www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool
It's not a tick box exercise, but they'd expect several "High" ratings, and a demonstration, not that she has nursing needs, but that she has unpredictable nursing needs that need nursing decisions on a daily basis. Go through it carefully, and when you come across needs try and quantify -eg - she's had pressure sores - ok, dig in your notes of your communications with the care home as to when she's had pressure sores, how long they've lasted. And so on with everything

I found it interesting to go through with my father - cognitive impairment, susceptibility to pressure sores so needing turning in bed through the night, serious heart problems limited mobility. deaf, often in a fantasy world so meaningful communication is not possible, incontinent - but still nowhere near the threshold for CHC - because it really brought home to me how bad health could be. MAde me feel how lucky we were.

Hi Dorset. I'm a hospital Social Worker and do DSTs all the time, I always forewarn families that they can be an emotional affair. Do have a look at the DST paperwork beforehand, it's easy to find online but let me know if you can't find it. The most frustrating thing is that the process is about fitting people into boxes, and the issues around 'double scoring' across domains. It can get tricky for example, if someone has challenging behaviour due to their cognitive impairment, and sometimes this can cause disagreements.

As a Social Worker, I'll always fight for what is right for my service users, and most of the time I get the right results. There are some nurse assessors who are arseholes and I roll my eyes when I see it's them conducting the assessment, but on the whole I've found them a good bunch and we work well together. I do get frustrated by the lack of consistency though, I can have two different cases which are similar and the nurse assessors may assess them differently, that's where I certainly do challenge. One nurse assessor will always score no needs in communication if the person can say words, regardless of whether they make any sense or not - that is not communicating, so I always lodge a disagreement. Another thing I'm always careful about is if someone's need in a domain doesn't appear to be that high because the need is being met, so for example, someone has not had any falls for a week because they've had one to one care. It is because of that care that they haven't had falls. A met need is still a need.

Please give me a shout if I can help in anyway, I appreciate how daunting and complex the health and social care landscape is.

I have been in many many CHC mdt's and referred for assessments.

To be honest you can't really prepare for them as it's just about your mum's abilities/needs/communication etc and if she is already in a care home then the care staff will likely be best placed to discuss and put forward evidence of her need for assistance in various different areas of her life. Especially if she has deteriorated and family have only had short visits over the previous month's.

I agree with PP in that it may be a little emotional for you to hear the realities of her day to day needs now which may not match what you yourself feel/think. But if it means she gets the financial support she is entitled to then it's best for everyone to be open and honest.

The nurse clinician will probably chair the MDT and will go through each section of the checklist, the evidence already gathered from care staff, your mum (if able to contribute/sometimes just observations taken) medical notes and yourself and check everyone agrees or has further input to share. Once this is done there is basically a scoring system, it is slightly different for each area (called domains in the CHC paperwork). The domains include communication, nutrition, breathing etc.

My advice is just to share your honest opinion and anything you feel is pertinent so you feel heard and considered. It is an inclusive process and not to be apprehensive about. Good luck