NHS continuing care

[Myusername2015]

Hi; after anyone with advice on NHS continuing care. My 85 year old father has unexplained complete blackouts now sometimes up to 3x a day at any time; in the last month alone these blackouts have caused him to injure himself with a broken nose; cracked head and latest yesterday 3rd degree burns. He is currently at home with Carers 3 X a day but clearly that isn't sufficient. I've approached the district nurse to complete an initial checklist (we've found a lovely nursing home that takes NHS cc) anyone have any idea on what I need to do to fight his corner on this? I'm aware it's incredibly difficult to get hold off such funding. Thank you

Keep reminding the nurse about completing the checklist. Even if they don't recommend that goes for the full assessment on the back of the checklist you can still ask for the full assessment anyway.

Have you had a social worker involved previously?

It's unlikely he will get CHC just because of the blackouts, and to be honest if he is managing at home with careers 3x a day it might be that doesn't need nursing care just yet either, but he might meet the criteria for residential care instead?

Thanks for that; the problem is he isn't managing with the Carers X 3 a day and he has almost killed himself 3 times this month alone as the blackouts are so unpredictable. It's so hard isn't it this funding battle I am positive they will turn him down and he'll have to sell his only asset his house-just seems so unfair. Good to know we can still ask for the full assessment.

From my experience of continuing care funding, there usually has to be some quite serious 'health' needs to be eligible. We're talking double incontinence, non weight bearing (so needing 2 cadets for hoisting), pressure area management, possibly assistance with peg feeding, high amounts of medication. It's not usually awarded for people with more 'social' needs as such.

Have you thought about or been told about assistive technology, possibly available through your local authority? So a lifeline (like a panic button)? Or would sheltered accommodation be the next step of he's not ready for residential care?

Carers not cadets!

You'd likely need evidence of him needing input from a trained nurse several times a day, it's essentially a condition that would require him to be living in a hospital ward if he wasn't in a nursing home placement - is he having much care from the district nurses at the moment? Is he being investigated?

It sounds like a frightening situation for him at the moment, it must be worrying for you

My Aunt was awarded CHC but was in a nursing home, bedridden, doubly incontinent and not feeding well. Hope he gets the support needed

It's difficult to get CHC, but there are lots of resources to help you. The decision support tool is published here. They will look at all your father's health needs over 12 domains. He will need to be assessed as severe or critical in several domains, and his needs will have to be both complex and unpredictable. To give you a hint, my DH did not qualify when he was only quadriplegic (no use of arms or legs at all) and needed 24/7 attendance including waking night care, but did once he developed a secondary condition called ADR, which is random and life threatening and requires skilled HCP interventions. It was about 8 years after he first started needing care support that he got moved onto CHC.

It's, sadly, not about the actual level of his needs. It's about whether his needs can be primarily identified as health needs over social care needs. It's a bit of a strange distinction, IMO! But all you can do is read the law and prepare your case. He can have his family members at the assessment if he wants. If you can get his GP and any HCPs involved in his care to advise you, you can get to grips with how each domain applies in his case. Read the support tool and do your own assessment (look on Age UK for help), then ask their advice beforehand on what they think. You might have to apply a few times.

Good luck.

Thank you so much for the advice all; it's really appreciated. It feels like a complete unknown minefield out there; he does have a panic button on him but as he is unconscious when he blacks out he has no warning or memory of them happening...which makes me feel even residential care wouldn't meet his needs...for example he smashed his head and broke it completely open last time causing massive bleeding but has no memory at all of it thank god I had popped round or I don't think he would be with us now. Will look into age UK. Thanks again all

I'm involved with assessments for this for work, the criteria are really high but some areas are somewhat subjective IME.

I know it seems galling that people have to pay for their ongoing social care needs but the purpose of NHS continuing healthcare funding is to pay for the care of those in a community setting that otherwise would need to be in a hospital because they need an ongoing level of nursing care that is above the cost of the funded nursing contribution of £156.25 a week per nursing client that the NHS pays to nursing homes per to provide their own nurses in lieu of NHS nurses.

NHS care is free at the point of access to all equally regardless of wealth as it should be. That resource simply doesn't stretch to meet the social care needs of all the elderly people in the country too.

I know hatgirl I'm not disputing that there are limited resources with far more needs than can be met; it just seems strange to me how abstract the process is in determining the difference between medical and social need. The hospital have said on their opinion he is likely to meet criteria but it depends who is doing the assessment; that to me is just barmy. I'm amazed there isn't a more straight forward way through what seems an absolute maze; and as my dad has limited capacity it's incredibly difficult to do as his child alongside working full time.

A few points that might help: To be eligible for Continuing Healthcare (CHC) you don't have to be in a nursing home; you don't even have to be in a care home - you can be in your own home. Also, it doesn't matter who is actually delivering your care, i.e. it can be a spouse or family member; their qualifications are irrelevant - what matters are the actual care needs. It's vital (and indeed a requirement under the Care Act) for a person to be assessed for CHC before they are asked to pay anything for their care. In addition, if a person receives CHC at home, the funding may also cover respite care. Be sure to get the Checklist done (ask a social worker, district nurse or other health or social care professional) and don't be fobbed of. They must give you notice of when the Checklist will take place and you should be invited to be there and input. I would strongly recommend looking at the Checklist yourself in advance and looking at what scores should be given - so you can argue for these when it's actually done. Be sure to look at the criteria for getting through the Checklist too (I think it's pages 7-8). Getting through the Checklist gets you to stage two of the process: the full multidisciplinary team (MDT) assessment.

Incredibly useful caretobedifferent I have joted down lots from there. I didn't realise we had a right to be there when the checklist was completed or that there was a duty to do this before being asked to pay for care. Huge thanks

Would renting out your dads home to pay for his care be an option if he went into a care home.
Does he get Attendance Allowance (not sure if that's still what they call).

Good luck with that.
I'll also add to the mix you need challenging, unpredictable and complex needs.

My mum with severe dementia has just been awarded it. She had to move from care home to nursing home.

Best wishes