Many Continuing Healthcare funding applications are thrown out because care notes and records are not up to scratch.
In retrospective cases there are sometimes no care records at all.
The issue of care notes in NHS Continuing Healthcare assessments is one of the most frustrating obstacles families face.
There are care homes and care providers who keep good, comprehensive notes on a day-to-day basis. Sadly, though, there are many instances elsewhere where the notes and records are simply not fit for purpose.
So what can you do?
Care notes and NHS Continuing Healthcare – here’s what often happens:
A family attends an NHS Continuing Healthcare assessment meeting and the assessors look at the care notes to find evidence of care needs. If the care notes are not comprehensive, or they’re sketchy and fail to paint a full picture of a person’s day-to-day care needs, the assessor will generally say that a funding recommendation can only be made based on what’s in the care notes and if there’s no evidence written down of a specific need, then it doesn’t count.
This is not untypical.
Even if there is a care worker – or even the care manager – in the assessment meeting, they may not want to acknowledge that the care notes are not up to scratch, and so that can be a big problem, too.
Here are some points to help you argue your case:
Local authority legal limit
Every decision about Continuing Healthcare funding comes down to one thing: the local authority legal limit for care.
If a local authority takes responsibility for care (i.e. it means tests a person) when in fact the person’s needs are beyond its remit, it will be acting illegally. If a person’s care needs are beyond the local authority’s legal remit, the NHS must cover the cost of care through NHS Continuing Healthcare funding.
On the other hand, if a person’s care needs are within the local authority’s legal remit, the person can be means tested and the NHS does not have to pay Continuing Healthcare.
Simple as that.
And so, assessors cannot make a decision about funding based on there being no adequate care records; the decision can only be made by looking at actual care needs. If there are no notes, the local authority cannot accept responsibility for care without risking stepping outside the law. Throwing a Continuing Healthcare application out because of a lack of care records is not the same as throwing a case out because the person’s needs were within the local authority’s remit.
If care records have been destroyed or are inadequate, a CCG has no basis on which to decide that a person was ineligible.
Saying there’s ‘no evidence’ because of a lack of paperwork is a very different thing to there being ‘no evidence of a specific care need’.
If the ‘system’ has failed to keep records, it is not the fault of the person who required the care. A decision about the provision of Continuing Healthcare funding must be accompanied by a valid, reasoned and written rationale from the Clinical Commissioning Group (CCG). A lack of care notes is not a valid rationale.
Up-to-date-knowledge by assessors
Let’s look at the Decision Support Tool (DST) – this is the form used to record care needs during a full multidisciplinary team (MDT) assessment.
Glossary, page 53:
“Multidisciplinary Team: A team of at least two professionals, usually from both the health and the social care disciplines… It should include those who have an up-to-date knowledge of the individual’s needs, potential and aspirations.”
DST page 6 ‘Summary’ point (ix):
“The DST asks multidisciplinary teams (MDTs) to set out the individual’s needs in relation to 12 care domains. Each domain is broken down into a number of levels, each of which is carefully described. For each domain MDTs are asked to identify which level description most closely matches the individual’s needs.”
If the care notes are inadequate, the members of the MDT cannot possibly have an up-to-date knowledge of these things – and cannot possibly carry out a reliable assessment of needs in each domain. You could therefore argue that the assessment is flawed.
Care staff often have little time – and may not even be aware of Continuing Healthcare
In a busy day and on a busy shift there is often little time to complete comprehensive daily care notes. In an ideal world it wouldn’t be like this but, sadly, the care system we have at the moment seems often far from ideal. Carers are also often massively undervalued and overworked.
However, there is a wider serious issue here – and not just in relation to Continuing Healthcare. It is a potential safeguarding issue. Care staff need to refer to care notes to help them provide the right care to each individual. If the care notes are inadequate this immediately raises concerns about the safety and wellbeing of the person receiving care. A new member of staff looking at the notes should immediately be able to see exactly what’s needed and why.
Where care notes are clearly inadequate, the care authorities should be raising concerns about such a failing as a matter of urgency, as it puts vulnerable people at risk.
From the point of view of Continuing Healthcare funding, though, it’s vital for families to frequently check the check the care notes and to raise any issues, e.g. omissions, misleading statements, errors, or where there are just a few words like ‘routine care’ repeated across several different days with no substance or accuracy about what actual care is needed.
In addition, care staff may have never heard of Continuing Healthcare, they and may not have any idea what kind of notes are required to support such an assessment.
If you can, show the care staff the 12 domains and the eligibility criteria and explain that the care notes will be used to support care needs throughout the whole assessment process.
If you’re asking a care worker or care manager to support you in an assessment meeting, make sure they understand the Continuing Healthcare eligibility criteria and the 12 domains. It’s worth stressing to them also that a Continuing Healthcare assessment is not an assessment of their competence as a care provider; it is instead an assessment of needs.
Care notes and NHS Continuing Healthcare: training for care providers and care homes?
We have come across a case where a Continuing Healthcare assessor in a full assessment meeting (MDT meeting) proudly announced that the Continuing Healthcare team trained all care homes in the area to keep the correct notes for Continuing Healthcare assessments. Whether this is actually the case or not is another matter. It was ironic in this instance, though, because the notes in the case she was assessing were inadequate.
Ask the assessors what they have done to train care staff in your area to keep the correct notes specifically for Continuing Healthcare assessments.