NHS Continuing Health Care

[Elderlyproblems]

I would be eternally grateful, if someone could explain to me, what this is, and how it works.

My Dad was in a Retirement village (where residents are self sufficient), but for the past 2 months has been bouncing between hospitals and care homes (for rehab). He has lost a lot of muscle mass, and is mostly bedbound. His faculties are mostly ok (normal 80% of the time), but he does have episodes of not knowing what's going on, paranoia about the nurses and where he is (sometimes thinks he is in prison/captured), and hospital delirium. He's currently back in hospital, as his COPD was too much for the nursing home to manage. He is not well enough to go back to his flat, as he has no mobility at the moment.

Would he qualify for CHC? And if so, what does this even mean? Does it mean he could go back to a nursing home, and stay there for free, until he is well enough to go home?

His flat is worth about £150k, but CHC says it's not means tested.

Any insights would be amazing. TIA.

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf this might be a helpful start before some experts come along.

My MIL had as bad a stroke as they come, left doubly incontinent, unable to feed herself or speak, extremely limited movement, needed round the clock care. She didn't qualify for CHC.

That sounds terrible! Did they say why? Who did she live with at the time?

Contact Beacon they are really helpful in explaining the CHC Framework. You get a certain amount of free time to speak to them.

https://www.beaconchc.co.uk/how-we-can-help/

CHC is completely free and should cover the full support your father requires, if eligible. It is based on the foundation that your father has primary care needs. The CHC Framework outlines what those primary care needs are.

As I said speak to Beacon and they will explain everything.

Good luck

My experience with my mother was that NHSCH is extremely hard to get but with the help of the hospice my father received it. Good luck, get some professional input if you can.

Thank you for this. I can't understand how hopealong MIL didn't qualify, given her state. Would that be because she lives with family and it's deemed they can help? I can't help my Dad, as we live 350 miles apart. Even if I could get him shipped up here, he is 22 stone, and I can't move him!

All I remember is that they carry out an assessment and it wasn't even as if we were 1 or 2 points away from qualifying, it was more than that. I remember thinking at the time what state do you need to be in to qualify.

She was in hospital for about 6 weeks and then in a nursing home for about 12 weeks and that stay had to be self funded. Very sadly she then had a pulmonary embolism and died. This was at the worst stage of Covid so we were unable to visit her at all. And yep I'm still very bitter at the whole of the partygate saga but that's a different subject.

I really hope you are more successful than we were. Perhaps mental health issues score differently, sure someone will comment who knows more on this front. Good luck, i didn't want to sound negative but just thought it helpful to understand what a tough process it is.

The background to CHC is that it is paid by the NHS so people with considerable, constant nursing needs can receive that care outside hospital, generally in a nursing home but sometimes at home. The framework is very tight and very demanding: most CHC bodies far outspend their budget so there is no space for generosity in the system. As above, Beacon are great, and the checklist is online for anyone to access, but on the face of it don’t be surprised if your dad does not qualify.

CHC - a very simple explanation is that the person's needs are medical, not just social, and the NHS should be meeting that need. The NHS is free at the point of care, so the person should not be paying and it's not means tested.

Social needs could be carried out by someone trained to wash, dress, feed, lift etc but it doesn't mean the carer requires in-depth specialised training. So if the care is "basic" social care then it wouldn't be covered by the NHS.

What an individual might consider complex care needs can be vastly different to what CHC assessors consider complex care needs. It can vary across the country. At the very least the patient should have a checklist to see if they might qualify for a full assessment.

I applied for it for my stepfather. He has Parkinson’s, Lewy Body dementia, double incontinence, acquired bran injury and is held in a care home under a DOLs. He needs 2 carers to move him, bathe him, toilet him, give him meds. He can be violent as a result of his dementia.
The nurses told me he clearly doesn’t qualify as his needs can be met and theyre not complex health needs. I pointed out that as he is not legally allowed to leave his care home, where hes basically held under lock and key, why should he then be forced to pay for this pleasure! They laughed at my disgust.

We got it for Dad but that was for very high nursing care needs but no need to be in hospital and terminal diagnosis (weeks to live).

We had a Macmillan nurse who helped us fill in the forms.

As described upthread if care needs can be met by carers then it's social care.

If the care needs to be delivered or very closely managed by registered nurses then it's continuing care. Lots of care can be taught to competent carers and then just overseen by community nurses. Tube feeding and administering medicines are obvious examples

I don't think he would. My uncle had severe vascular dementia- could not walk at all, was doubly incontinent, could not speak or communicate in any way, had bladder cancer, heart and kidney problems, did not recognise anyone at all and he was assessed 3 times over 8 years and did not qualify.

We have CHC funding for our adult son. As previously mentioned, it is very hard to get. The checklist seemed easy enough and our social worker applied. The assessment took 12 hours and was harrowing. At the end, he was refused.

He is unable to walk, talk, has multiple daily seizures, fed through a tube etc etc etc.

The assessors decided he just required social care. The Local Authority would not provide social care as his needs were too high for them to legally accept.

We appealed and after 18 months, he was awarded CHC funding.

Be prepared for a fight.

A previous poster said their family member didn’t get it as the nurses said the needs were being met. The nurses are wrong, a well managed need is not an exclusion. See https://caretobedifferent.co.uk/using-the-well-managed-need-principle-to-your-advantage/

It’s definitely worth fighting as any care costs can be claimed back, even if the worst should happen and you lose your loved one.

I wish you luck.

And he required some nursing card - which they paid 140 a week towards but he did not qualify for CHC. He spent more than £300,000 on care home fees, having previously spent £150,000 on care home fees for my aunt.

I am afraid that you are highly unlikely to get CHC. My DM had a stroke, dementia, a broken hip, was doubly incontinent and bed bound and didn’t qualify. The state of support for the elderly is atrocious. I wasted a lot of time and effort educating myself about CHC and it was a stressful waste of time.

Your DF should qualify for attendance allowance (which is a drop in the ocean) and a lower level of support for nursing care (which most nursing homes will apply for on his behalf).

I suggest contacting Help the Aged and Adult Social Services in your Dad’s area.

It’s shit OP but you will eventually come out the other side.

Thanks everyone. It doesn't sound very promising then. The last time he was in hospital, they discharged him and an ambulance took him back to his flat and dumped him there. Thankfully my sister was there and managed to arrange carer visits etc, but what happens if you have no relatives? Would they have just left him there, immobile and buggered off?

Unfortunately, he is refusing to do any physio, his legs have apparently dwindled to twigs, so I have no idea where we go from here.

We could sell the flat to fund his care, but the care homes want £9k up front - what do people do about that? There is a care home near me that would be good, but how do you ship a patient 350 miles in a car?

What a nightmare.

Hi OP, I hired a private ambulance to move my DM a couple of hundred miles to a care home near me. It cost about £800 though.

Do you have power of attorney for your DF? That will simplify things.

It has nothing to do with your MIL being at home with family. CHC is independent of anything and funding can not be awarded based on family help. They must provide the full level of care required by the patient.

It is just notoriously difficult to get because it is NHS funded and they only have a certain budget within each area.

That doesn't mean that your father is not eligible but you may have to get your fighting gloves on.

Speak to Beacon and also read through stories of other's people's experiences and can I recommend you become familiar with the CHC framework? That helped us a lot to fight our corner with my Mum.

https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

Good luck

@Hopealong same with mine - massive stroke, no cognition, couldn't speak, couldn't move and doubly incontinent and we got it for first 2 months to get her out of hospital but was reassessed a few months later and it was removed as she could by then eat normal food, not mush. Appealed and lost 😡

My mother got a CHC contribution to her nursing home fees for the last few months of her life, I think because she had a catheter due to inoperable bladder cancer which needed nursing support, but she was only awarded about £180 a week, for the nursing element of her care, and we had to pay the rest of the nursing home fees (about £900 a week), as we were still responsible for the residential and general care element.

I agree your dad is very unlikely to get CHC, certainly not enough to pay full nursing home fees. His flat will probably need to be sold to pay for care.

Your condition that requires care needs to be medical rather than social, basically not just what you would expect from normal aging.

I did successfully get chc for dgm who had advanced Alzheimer's, doubly incontinent, very violent. I think we were fairly lucky as the assessor understood the situation and that they had very little in the way of assets (below the threshold for council help anyway, house exempt as dgf lived there).

You can get 6 weeks care home funding as respite then the council will fund in lieu of you selling a property (you hand over the money on completion)

Thank you for this. I can't understand how hopealong MIL didn't qualify, given her state. Would that be because she lives with family and it's deemed they can help? To get CHC there need to be constant nursing needs, in other words the medical needs need to be complex and unpredictable, so nursing decisions need to be made. If they can’t wash or feed themselves, that’s care, not a nursing need. If they need help taking their medicine, that’s something anyone can be trained to do, ditto being turned to avoid bedsores and so on.

so it’s not how unwell or frail you are, or that you have no help.

We could sell the flat to fund his care, but the care homes want £9k up front Not necessarily. They’ll want paying in advance not arrears but only a month. I believe there are interim arrangements available while a house is waiting to be sold, but I’ve not had experience of that