CHC and nursing element

[citykat]

A rant and request for bright ideas please, DF in hospital with stage 4 liver cancer, it's spread, is terminal. He has nephrostomy bags from a separate problem ( so plastic bags off wee strapped to him that need emptying every 3 hours). He can't walk. Lives alone. He's been refused CHC and assessed as not needing nursing care either. I am so cross they can just expect him to get on with it. He's dying with months to live. Is it worth appealing or is it right that you need a tracheostomy or similar to get any of this care?
I know we will have to go down the senate social care route but I find it upsetting that he can't have nursing care.
Thanks for any advice.

Sorry to hear about your poor dad. I would ask to speak to the palliative care team if he is so unwell, if his prognosis is very poor he may be able to get fast track funding, this is something you must discuss with his doctor, the ward manager, palliative care and social worker. Its non means tested. Has he had a chc assessment done? Ask to see it and ask how they made their decision. Does he want to go home or into a hospice or carehome. Was he getting any help before he went into hospital.

From what you describe I'd speak to the palliative care team and ask about fast-track CHC.

Generally CHC will try to turn down anyone and anything for CHC. However a well-worded fast-track request is different.

Marie curie and Macmillan have info on funding

He should qualify if he needs personal care (having a diagnosis or the bag isn't sufficient if he can still undertake all his own medical care. There's a form that's completed by the discharge team and you need a certain number of points/very high needs. If care is social (eg help with showering, dressing, meals etc) then it's the council care system and that's means tested. No you don't need a tracheostomy to qualify but you do need healthcare multiple times a day at home (rather than just what the district nurse can do) and once 4 visits a day doesn't suffice nursing care in a residential setting. As he's terminal hospice is an alternative

Have you looked at the CHC checklist and the CHC decision support tool? That will give you an idea of what sort of interventions are graded as high enough to qualify. I don't think just having a bag will necessarily qualify if changing and emptying it is straightforward.

Also think about how he will manager in the weeks ahead, he might not be able to empty his bags anymore, risks of kidney blockages or infection.

Thanks for the replies. I will ask for CHC to be redone in a month or so, assuming he's still here. It is ridiculous. He can't walk ( cancer in bones). Someone coming in 4 times a day is not going to cut it. We will find a nursing home. We are too far away to provide the level of card he needs and the NHS won't, so a private provider will be found. Not what I thought would happen. I thought dying people were entitled to 3 months in a care home at end of life stage. But we will get him somewhere nice where they will look after him. And make the last few months count.

I dont know about the 3 months free care, this may be what you get from fast track funding, they used to base full funding on a 3 month prognosis, have a look at the website. I would ask sooner rather than later, if he has cancer is he already known to the palliative care team or Macmillan nurses, fast track funding doesnt take long to come through and if he qualifies then he could move somewhere nice. The alternative is he can go home under the generalist palliative care team.

OP you've been fobbed off and I'm so sorry.

Has he had a social care assessment in hospital? Based on the information in your posts, as a social worker the minute that passed over my desk I would be sending it straight back to the ward asking them to screen him for fast track pathway CHC. The criteria is different to normal CHC.

I'm angry on your behalf.

I meant to say you absolutely need to get back to the ward and either ask them to make a social care referral or ask them to complete the fast track paperwork.

Good luck!