Would this behaviour qualify for CHC funding?

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My mother has severe dementia, no awareness of time or place but is physically fit and able bodied. She lives in a nursing home and unlike her fellow residents she is able to move quickly and has very erratic sleeping patterns.

Her nighttime behaviour is really starting to be problematic for the home as she has no attention span and if she’s not asleep she is wandering about and in and out of other residents rooms and sometimes removes all her clothes in the process.

the nursing staff have commented that they think she needs close nighttime monitoring due to her unpredictable behaviour and the nuisance she is being to other residents as she wakes them up throughout the night.

Whilst the home haven’t requested additional fees, I’m expecting them to, however my brother is of the opinion that this higher level of care should be funded by the health authority as it’s outside of what is considered normal and should be covered under continuing health care.

Anyone with any experience of this care to share their thoughts?

CHC is generally for care that is more than an unqualified person could provide, but constant monitoring may qualify under 'behavioural' domain, if in doubt ask for an assessment

https://caretobedifferent.co.uk/spotlight-on-behaviour/

I doubt it. CHC funding is very difficult to secure and has to be for a primary medical need that requires nursing care. Dementia behaviour isn't classified as that. It's deemed to be a social care need, not medical. It's wrong, I know. Dementia is caused by disease of the brain but the system is totally stacked against those with the condition.

Have a look at beacon beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/

They were really helpful with obtaining funding for Dad they have a toolkit with lots of info.

I’d say not - her needs rent ‘complex’ and the care she requires can be provided by a health care assistant rather than nursing care.
As an aside, has she had a medication review? My stepfather was like her and he ended up being prescribed medication to help him sleep at night - it made so much difference.

Is she living in a specialist dementia home, the staff need to ask for a GP review to rule out any infection, medication, sadly if does happen with dementia.

Behaviour is one of the main domains in the CHC decision support tool. The behaviour needs to be caused by a medical needs (dementia, schizophrenia, brain injury for example).

I was a CHC assessor for a decade and I did regularly give CHC to people with dementia whose main needs were from the behaviour domain. It’s all about risk to self, property or others. If carers are getting regularly hurt or she is trashing her room or hurting herself due to her behaviour then I would be thinking that it might be a primary health need. Obviously if there are other health needs then it adds to the weighting.

My parent with dementia was turned down for CHC. They couldn’t be left alone, had multiple health needs, and needed monitoring constantly due to unpredictable and violent behaviour. The threshold is extremely high, to say the least.

My aunt with dementia needed one-to-one care in all her waking hours to prevent her hurting herself. Didn’t get CHC. If she had needed two-to-one care (maybe if she was physically stronger to push past one carer) then she might have got it.

She needs a medication review and possibly an assessment by older people's mental health to see if having a 1 to 1 is the only way or whether medication can help her.

I suspect from what you have said she wouldn't get CHC as she only has issues in one domain - behaviour - and so would not get enough points to be eligible.

I doubt it. We tried with MIL but she was only granted FHC. I think you practically have to be a death's door to get CHC.

Only if you have complex nursing needs or you get the GP to fast track in time for end of life care.

Don’t they put her is a bed with raised sides so she can’t get out ?

Yes. I had a family member who qualified mainly for behavioural problems, CHC then failed review as the dementia progressed and they lost mobility/ability.

Not any more, that is restraint, the staff would need to carry out a bedrail assessment, behaviour and falls assessment. Mobile residents can climb over bedrails, it's safer to have a low,bed plus the poa or residents representative has to consent to using bedrails.

We were told my parent couldn’t have one of those beds because they’d still manage to climb out but would be at greater risk of hurting themselves in the process.

Many individuals with dementia try to climb over the bed rails.
a low bed, crash maths, sensor alarm or sensor mat be useful. The staff would then be alert to her leaving her bed or room and can guide her away from other rooms.
I agree, a review looking at meds would be useful. People need to be cared for in the least restrictive way, which is not always 1:1.

Hi OP, have you found the CHC decision support tool? I would recommend going through it, carefully, and then "marking" your mother against it. We got CHC for my grandfather when he was violent and constantly wandering off and resisting care and didn't know where he was etc. But CHC was later removed because he lost the strength and mobility to be violent, essentially.

Don't request an assessment until you've done some reading, or request an assessment and then urgently do the reading. Make sure you are there on the day of the assessment, you cannot view this as optional. You are likely to need to push the assessors - certainly in the county I was dealing with they were pushing for lower assessment gradings even when it was blatantly nonsense. Make sure you have had thorough discussions with the nursing home and get them to document the problems in detail and in writing before you begin the process. Do this once you've done the reading and discussed each area of the CHC decision support tool with them so they are documenting all areas - and ideally going back and finding where they have already documented.

Unfortunately I don't think you will get it.
My late mum couldn't talk, walk, dress or feed herself. Didn't know what day it was or who anyone was.
She was refused as they couldn't complete the assessment as she was too ill.
More than likely they couldn't be bothered as they knew she was dying.

No harm in trying. MIL with Alzheimer’s and night time wandering didn’t get CHC until she had a terminal leukaemia diagnosis on top.

Definitely worth a try, but I wouldn’t bank on it.

Your mother’s behaviour sounds very similar to mine. She is currently in a very small residential home (only 2 staff on overnight) and her disturbed sleeping has become an issue. Plus she cannot express discomfort and moans, groans and screams instead.

Her care home requested a nursing needs assessment which was finalised today. I had a quick chat with mum’s social worker who I think said that as she needs to move to an Elderly Mentally Ill dementia unit ‘the nursing element would be funded’. I think that she was referring NHS Funded Nursing Care which is £254 a week. I came online to research if I have got that right and saw your post.

Has your mum had a nursing needs assessment done by social services recently?

Hi, you describe your mother as being in a nursing home and the nursing staff which would suggest that she is already getting funded nursing care(FNC). Lots of people say nursing though when it isn't and they are referring to residential care. It sounds like a review of needs from both GP and social services to check everything is being considered would be helpful to you and the care home staff. Does she have input from district nurses or older adults mental health / memory services? They would help if nursing needs assessment was needed.

I was also coming here to mention Funded Nursing Care. Speak to the care home. With my Mum it was the same process as for CHC - essentially we applied for CHC and one possible outcome (the one we all thought most likely) would have been getting the extra funded nursing care money, but not full CHC.

The home initiated it all if I recall.

in the end Mum died before the process was complete.