CHC process help please!

[Croatia2018]

Hi all, does anyone have a little more knowledge on CHC? Following a fall my nan was admitted to hospital with a broken hip, she then went onto a nursing home in an assessment bed. She had her fall in September she has had a couple of hospital admissions since being in an assessment bed for UTI’s which has severely affected her kidney function. She was at home before caring for herself. She is now no longer mobile. She is incontinent, her memory has rapidly declined, she intermittently takes her medication. She has been assessed for CHC where they have said she has a primary health need however this need isn’t as great to qualify for full funding only part £150 odd a week, they have said that she requires 24/7 nursing care. They have said she will need to sell her house to fund the rest of her care and that we need to go through the court of protection to do this. My question is how can she not be eligible for full funding when her needs are that great she requires 24/7 nursing care but no so great that she doesn’t qualify for full funding, I can’t help but think that if my nan wasn’t 89 years old more in the region of 30-40 this wouldn’t be a question the NHS would find her care maybe at home. Has anyone had any success in appealing? From what I can gather you can’t appeal the decision just the process? Thank you all so much for any information

Continuing health care is for nursing needs. There is a difference between needing a carer and a registered nurse.
If she needs the care aspect for help with dressing, meals, meds etc then from a CHC aspect she won't qualify.
If you can give evidence as to why she would need a registered nurse to provide care as apposed to a carer then it would be overturned.
When doing the CHC it's a checklist of needs and requirements and you have to have a certain amount of ticks in order to qualify.
You can appeal though, you can ask for a reassessment.
Good luck.

When I have sat through CHC meetings they look at very specific things to do with nursing such as behavioural needs, continance, pressure care, eating and drinking, medical needs, communication, optional needs etc etc. In my experience which is not that advanced, successful applications are usually when the person is very frail, poor skin integrity, not eating and drinking well, very confused, doubly incontinent, poor mobility with an often unstable medical condition such as diabetes with unstable BM's. Many people are self funding nursing homes,a small proportion of them get full funding, most would just get the payment she has been offered. You can Google the full checklist with different ratings to understand more.

Thank you for your replies, it’s just so confusing! At the CHC meeting they said that she requires 24/7 care in a nursing home or 24/7 care at home with x2 careers. They did say that as she often shouts she would need an EMI/nursing bed, her capacity fluctuates on a daily basis depending on whether she has a UTI or not (she gets them quite regular and usually needs x2 rounds of antibiotics to treat them) I just feel really let down by the NHS they moved her out of hospital to an assessment bed where they said this would meet her needs better but failed to mention she would no longer be recieving daily physio (she was able to walk whilst she was in hospital) I then attended the CHC meeting on Thursday where they basically just said you need to sell her house she’s requires 24/7 care. I have informed the nurse who carried out the CHC assessment that I will be appealing, I’ve started reading up on case law and the CHC framework. TBH I don’t know what I’m hoping to achieve I just feel like the NHS aren’t really taking much responsibility for her deteriorating health and I don’t know if I’ll even get anywhere but I’m going to try and get everything that she is entitled to! Don’t get me wrong i don’t think the NHS should foot all of the bill and my nan should pay towards her care like she has paid into the MHS however I don’t feel like what they are offering is fair or proportionate to the rates of a care home per week. Thank you for your replies

Did you watch the BBC film 'Care' recently. I gather it was based on a true story and may be worth watching as similar themes. Good luck....it does not sound impossible.

It seems to me that chc funding is available for people with complex needs, not for the nursing care that can be given by carers. Self funders pay more for the same bed in a carehome that someone else who may get funding for, I think its seen that the person is just moving into a different home, that if they own their own home they have to sell up to pay, as if they were just moving. It's an unfair system. What she may get will be the f.n.c. payment which is the nursing part. I don't think self funders should pay more for the same bed, they are just propping up the system and subsidising people who don't pay.

CHC funding is for meeting health needs that are over and above what can be met by the funded nursing contribution of £156.26 a week (basically the share of what the NHS is paying towards someone living in a nursing home if they have nursing needs) the rest of the cost is met by the person themselves, and/or their family and/or social services.

CHC is reserved for people whose health care needs are so great that on balance they are greater than their social care needs (washing, dressing, eating etc) or have a significant impact on the ability of the people looking after them to do so safely.

Care for social care needs is means tested so if your nan has a house she will have to fund the remainder that isn't funded by the nursing contribution until her savings/assets drop below £23k . It might not feel fair but that's the system we have.

What I find so unfair is how much self funders have to pay extra, it's the same home, same staff, meals, activities but its 1200pw, why is that? It's not the residents fault that social funding wont or cant pay the same rates, they have contributed to the system, the family often end up paying large amounts of inheritance tax on money that has already been taxed. I know so many people who save in the hope they will find what they think will be a nicer home but the really good ones often have a waiting list and often more expensive doesn't always mean better care.

Can you look at renting her house out to pay towards or for the care? It would need to make about 3000 a month to meet 1200 a week costs. Her pension can be used plus the nursing payment towards the 1200 weekly charge.

Thank you all so much for all of your replies, I’ve asked for another meeting with health and SS I will be making sure I go into this meeting fully prepared with all health notes etc regarding her needs. We thought about renting her house out however it would need a new bathroom, kitchen upstairs toilet plus general maintenance for it to be rentable even after we had done this the rent and her pension would not cover the monthly amount needed. I’ve never had any dealings with CHC funding or funding of elderly services at all and from this experience, I just think the whole system is corrupt and completely unfair, I don’t think my nan should get her care for free at all however I do think it should be proportionate and more evenly split m, the measly £150 odd the NHS is offering is peanuts compared to the actual weekly cost of a nursing home. Hindsight is a wonderful thing! I wish I had asked my nan to sign over her house 10 years ago.

Good luck op. My beloved ma died recently and I thank god that we all avoided having to go through these types of dilemma - they were on the horizon but not yet experienced.
It’s really important for those reading to have sorted out powers of attorney - health and financial.
Good luck with the appeal and hindsight can go do one !

The £150 is the contribution made by the NHS to meet the nursing element of the care because in this country we still have healthcare provided free at the point of access.

If your nan was at home this would be provided by district nurses for 'free' as well.

Social Care is means tested. Everything not covered by the nursing contribution is classed as a social care need and your nan has the means to pay for it at the moment. If she was still at home and had carers coming in she would still be paying for her social care costs.

If you had got her to sign her house over ten years ago you would currently be facing an investigation for deprivation of assets.

@hatgirl I would be more than happy to be investigated for deprivation of assets if the other is selling my nans house and paying extionate rates per week for trained people to look after my nan while the NHS counts their responsibility as £156 a week

The NHS (CHC) are only funding c50k people in England. To put that into context 850k are currently living with dementia.

What does she ACTUALLY need the nurse for? Can she not stay at home with a live in carer? They can give meds, food, personal care etc.

I'm really sorry you're going through this. Unfortunately in the current climate it is extremely difficult to even get the funded nursing component of CHC.

By all means appeal but unless someone has significant mental health needs - wandering, aggressive, or unable to eat and drink or have enteral feeding (likely palliative/end of life) it is almost impossible to gain funding.

CHC full funding is as others have pointed out for people who need trained nursing care above and beyond what can be provided by a carer - unfortunately incontinence, support with feeding, bed bound and pressure care can all be provided in a nursing home environment by regular carers.

The NHS is on its knees and the people to be angry at are the private companies charging the extortionate amounts for care homes - they have a captive audience. That is nothing to do with the NHS or social services unfortunately