Full CHC assessment - What to expect?

All about caring
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Hi everyone,

Surprisingly my brother scored high enough on the checklist to get a full assessment from the NHS. During the checklist meeting I got the distinct impression that the social worker was trying to push for more B’s than were actually necessary, but that’s another story.

I’m here to ask anyone who’s been through it what to expect when it comes to the full CHC assessment?

Who actually attends these things?
The letter states someone from the NHS will visit my brother’s home to carry out the assessment, and that people who know of his situation will be involved, like a social worker - but his social worker doesn’t have a clue about him at all, so I can’t see the point in any of them showing up.

His house is small and there’s not enough room or furniture to seat a whole bunch of people, so I hope they don’t come mob handed, but of course, short of phoning round everyone associated with him we’re not sure who to actually expect on the day.

The only ones who actually have a clue about his needs are his carers and family. The social worker, and the specialist nurses etc have never taken the time to understand the full extent of his needs until recently when the council started insisting on “evidencing” needs.

Can anyone tell me if it’s likely to just be the NHS assessor visiting, or if every Tom, Dick and Harry will be tagging along too?


What happens during the assessment?
I assume it’s just a more in depth version of the checklist? But can anyone tell me from their experience what was asked, how much detail they wanted and if you needed to provide any paper work or documentation etc in order to validate what you were saying in any way?


Do they want to look around the house?
My brother has some mental health issues (PTSD/OCD/Anxiety) on top of his primary condition, and he is extremely funny about people he doesn’t know going around his home (had thefts in the past) and so I’m wondering if it’s part of the assessment to go snooping around a person’s home in any way?
He had a home assessment for PIP and they didn’t ask to look anywhere, so I hope it’s the same case for this?

Do they carry out any [physical tests?
Again, with the PIP assessment they wanted to do minor balance and grip type tests and some other things on him, so I’m wondering if the CHC people will come with any physical checks they need to carry out?

Realistically, is this a waste of time? What are his chances of actually getting CHC?
I know no one but them can tell me for sure, but I can’t help feeling like all this is for nothing, because he just scraped through the checklist on B’s, that I (and his carers) personally would have put as C’s.

Short of helping with toileting (bladder and very rarely bowel incontinence) minor to moderate spasms, monitoring to avoid choking, giving him his daily tablets, helping with his physio and handling his depression and lack of motivation (and aggression born of frustration) some days there really isn’t a huge amount of “health care” support that he needs. He doesn’t need anything like manual evacuations or tube feeding or any specialist kind of medical care really…yet at least. He’s nowhere near as bad as some people are that I know who have been refused NHS funding.

Has anyone got funding with mostly B’s and C’s, or do you really need some A’s in there to get accepted?

If anyone has received either full CHC funding or joint funding - what’s it like?
Is it as much a blessing and a curse as some people say? If so, why?

What happens if they refuse to fund?
Will the fact the NHS say his needs aren’t high enough impact on his current care package with the council in any way?

Is CHC still governed by the Care Act like Direct Payments?
I hate to say it and sound ungrateful, but I’m kind of annoyed that he’s being assessed and could potentially move to NHS funding, because I’ve spoken with a community care solicitor this week, who assured me the council are acting unlawfully in how they’ve handled his case, so I was ready for a fight with the council and we’d been feeling confident we’d actually win and maintain his current funding level regardless of their attempts to cut it, but now I feel like I’ve got to go back to the drawing board to understand what the NHS can and can’t do. It’s all new and unfamiliar territory and I know my brother is going to stress out if he doesn’t understand how the CHC differs to Direct Payments and how much this assessment could impact on his current care package.

Any advice and stories of personal experience would be a big help, thanks all!

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Full CHC assessment ?

Main thread :

https://www.carersuk.org/forum/support-and-advice/all-about-caring/chc-coughlan-grogan-judgements-nhs-contuing-healthcare-nhs-fnc-hospital-discharges-all-under-this-one-thread-35998

CHC : WHAT IS IT / QUALIFICATION / ASSESSMENTS / VIDEO ( PROFESSOR LUKE CLEMENTS )

Whole thread colour coded for ease of reference.

( CHC at home ? Pointon : main thread : POINTON CASE : CARE AT HOME )

CareToBeDifferent web site … a whole oasis on CHC matters … and assessments :

NHS Continuing Healthcare Checklist assessment - 11 common mistakes - Care to be Different

( A lot of information in the main thread is extracted from the CareToBeDifferent web site. )

On the mental health angle … MIND :

https://www.mind.org.uk/information-support/legal-rights/health-and-social-care-rights/continuing-healthcare-chc/

Strongly recommended reading.

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Hiya,

There are loads of useful things in the link above and apologies if people are meant to be directed to that thread rather than responding here. However I wanted to respond because you have asked some practical questions which I thought I could help with. My background is in Social Work and although I have branched out into something a bit different (and relate to carers in a different way), I have sat in many DSTs in the reasonably recent past and I thought I may be able to help with some of your questions, although from the “other side of the fence”. Appreciate this is not the viewpoint of family members who have been through it who might have different experiences and I can only talk based on my experiences, but this is what I would say -


Who actually attends these things?

It has to be a multi disciplinary team which normally means a CHC assessor from the NHS (who in my experience has always been a nurse) and a social worker from the council. Even if the Social Worker has no idea, they probably have to come for it to be valid. The social worker is likely to try and push for CHC as this is in the councils financial interest, so if that is the outcome you want it is probably worth them being there. Sometimes someone like a community nurse will come. The CHC assessor will know who has been invited so ring them and they can tell you.

What happens during the assessment?

You go through all the same “domains” as the checklist but in more detail and when it comes to “scoring” there are more options and will probably be more debate. You can easily google the documentation. The nurse advisor will ask questions and then you are meant to agree scoring. Probably the Social Worker will try and push the scores higher because it is in the council’s interest for the NHS to fund. It can be a long meeting and quite tedious as things often overlap. How long it takes depends on how much everyone talks and the skill and the approach of the assessor. You can say if you or your brother needs a break. There is loads of advice in the previous post in the links about how to approach the assessment. But basically you need to say what you think, if you think your brothers needs are downplayed, then say. Any evidence or specifics you have is useful. So for example, don’t just say “occasional incontinence”, try and be able to say confidently how often, dates (e.g. 4 times this month). The focus is also on how unpredictable it is and how much different aspects of someone’s health overlap and make things more tricky. I have experienced families and individuals “play down” their own needs because they don’t want to seem too bad, things like saying “I might be in a lot of pain, but you know, I don’t want to complain, I can manage”. This doesn’t help your chances of getting CHC.

Do they want to look around the house?
Never in my experience. The only possibility would be if your brother had some specialist equipment and the assessor didn’t really know what it was and wanted to see it. But I think your brother would need to agree to this and you could go with them or bring it to them.

Do they carry out any [physical tests?
Again, not in my experience. They normally rely on looking at records where other people have done these tests. Not PiP records but things like if someone has already had a memory test from the dementia team.

Realistically, is this a waste of time? What are his chances of actually getting CHC?

Can’t answer that! If he doesn’t get it, perhaps its worth knowing what the process is?

If anyone has received either full CHC funding or joint funding - what’s it like?

Sorry, I can’t say what it likes to get it as my experience is from the other side of the fence.
What happens if they refuse to fund? Is CHC still governed by the Care Act like Direct Payments?

Easier to answer these two together. Firstly CHC is not governed by the Care Act as this is the law for the Local Authority, and CHC is funding from the NHS. If he gets CHC there are different ways that decisions are made about what care/support he gets and I dont know the detail of this. It should be what meets his needs. I don’t think there is a law that governs this. I think the belief is that CHC is more “generous” but I cannot guarentee that. This means you would be going into a bit of an unknown, but your brother wouldn’t have to pay for anything. You can receive CHC like a direct payment and it’s called a personal health budget. You would get a support or care plan that looks similar to what a council does. You should have a care manager who may be a nurse or a social worker employed by the NHS. They will do a similar job to what the social worker does now.

If they refuse to fund, nothing changes about his eligbility under The Care Act or what he is entitled to from the council. If you are having a fight about this already, then this would likely continue. But basically if he doesn’t meet CHC criteria, then what ‘health’ needs he has on the DST doesnt change what social care needs he has under The Care Act, he still has these and the council has to meet them and the council might continue to try and cut things (if this is what is happening from what you are saying). If he gets full CHC then all care is paid for by the NHS, this includes aspects of care that would be considered social care, because that is just how it works. If he gets joint funding then it can get complicated I’m afraid but may help your situation in that the council may be less concerned about the cost if there is money coming from elsewhere.

hoping this is of some use,

K

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As an ancillary issue , Katherine … the reasons why a non medical person , a social worker , is involved in CHC :

NHS Continuing Healthcare: Should social workers be involved?

In essence , as " Care " in the strictest sense , is both adminstered by the NHS AND LAs , the presence of a LA rep is required to
represent their interests … when it comes to finances and the effect on the LA’s budget … so much for " Care " … based on
the ability to pay … not need ?

Hopefully , at some future date , social care will be reunited with it’s twin sister , the NHS , and the need for LA involvement
will cease.

( Green Paper , Social Care thread : https://www.carersuk.org/forum/support-and-advice/all-about-caring/social-care-funding-green-or-red-herring-paper-various-schemes-and-utter-madness-all-together-in-this-thread-32659?hilit=social%20care%20green%20paper )