Discharged from hospital without a Continuing Healthcare assessment?

Discharged from hospital without a Continuing Healthcare assessment?

Discharged from hospital without a Continuing Healthcare assessment?Being discharging from hospital without a Continuing Healthcare assessment is one of the most common ways people risk being wrongly charged for care.

Increasingly, we hear from families who are harassed by hospital discharge teams into removing older relatives from hospital; they are then forced to start paying for care in a care home.

If you’re in this situation, and no NHS Continuing Healthcare assessment has been carried out. the hospital discharge team will almost certainly ask questions about your relative’s money. If your relative has savings or assets over a certain level, they’ll then no doubt be told to pay for their ongoing care. However, this may not be correct.

Having a relative in hospital can be very distressing for the whole family, and in such situations families are often at greater risk of being railroaded into agreeing to such a discharge – and yet without the funding assessment process even having been properly explained.

Being discharged from hospital without a Continuing Healthcare assessment is where many mistakes are made about paying for care.

A very common statement by some hospital discharge teams is that NHS Continuing Healthcare assessments are done at a later date ‘in the community’ – and that the person must leave hospital first. However, when this happens, families report they can then find themselves waiting months for an assessment. This whole process could also lead to people being wrongly charged for care. Here’s why…

  • Remember that an assessment for NHS Continuing Healthcare establishes whether a person is beyond the legal limit for local authority care (social care). If that’s the case, the NHS should pay for full ongoing care. If a person’s care needs are beyond the local authority’s remit, and necessarily the responsibility of the NHS, it is unlawful for that person to be charged for their care.
  • No one can say who should pay for a person’s ongoing care until an assessment for NHS Continuing Healthcare funding has taken place. This assessment is nothing to do with a person’s money or house; it’s about health and nursing care needs only.
  • If the NHS or the local authority remove your relative from hospital and into a rehab/reablement facility, your relative should not be charged for this intermediate care.
  • If your relative has an initial Checklist assessment for NHS Continuing Healthcare while in hospital and this indicates that a full assessment is needed, the NHS is responsible for paying for ongoing care until the assessment process is complete – whether or not your relative remain in hospital during that time. It’s worth looking at the National Framework guidelines, page 25, paragraph 74.
  • If a person is being pressured to leave hospital and start paying for long term care without this assessment process having taken place, it could constitute financial abuse on the part of the care authorities, because the person may be forced to pay for their ongoing care when that is in fact not required.

If you are in this situation with a relative in hospital:

  1. Insist on a Continuing Healthcare assessment being done while your relative is still in hospital. Part of the purpose of a Continuing Healthcare assessment is to ascertain what a person’s ongoing care needs are and what care may need to be put in place. It is, of course, also an essential process to determine who pays for that care. If you are finding that an assessment is being refused, and yet your relative has health needs and requires ongoing full time care, make a complaint in writing to the hospital management.
  2. Make it clear to the ward staff – and the discharge team – that you expect a Continuing Healthcare assessment to take place before your relative is discharged. You may also want to let them know you have made a written complaint.
  3. Get in touch with the Continuing Healthcare team within the local Clinical Commissioning Group (CCG) and insist on an immediate Checklist assessment for NHS Continuing Healthcare funding.

Why are elderly people wrongly charged for care?

Should I sign hospital discharge forms for my relative?

 

8 Comments

  1. Angela 4 years ago

    Thanks for your comment, Iain. Yes, my understanding of this is that once a Checklist has been undertaken in hospital and the person being assessed then has to wait for a full MDT assessment to be arranged, the NHS is responsible for paying for care in the meantime – no matter where that care is delivered.

    • Chris-G 3 years ago

      Look up “Discharge to Assess” …. The new scam to avoid even Checklisting patients in hospital. Our CCG had spent it’s CCG budget for 2013/14 before Sept 2013. They made other plans too, that can only have involved altering the criteria so that patients no longer qualified.

      Below is a verbatim E-mail extract from a CCG Director trying to cover up the lack of a Checklist and subsequent CHC assessment from 4 months ago. My father in law was sent home from hospital with his thigh bone poking out by over an inch from a failed amputation. The wound was also MRSA infected. His doctor stated that he had been sent home to die from the surgical failure and his infection because he would not (could not), agree to surgery.
      Here is what was written:-

      Nov 3rd 2014: ” ‘Discharge to Assess’ has been instigated to expedite the discharge of patients who were medically fit for discharge but who were awaiting CHC assessments in acute hospital beds.
      There are significant implications attached to patients remaining in hospital beds unnecessarily; for example acquired infections and a loss of independence, as well as impacting on bed capacity for those individuals who require acute hospital care.
      Each patient is discussed whilst in hospital to determine the most appropriate care provision to enable discharge, with the expectation that the CHC assessment takes place shortly after discharge where the needs suggest there may be healthcare needs.
      If an individual is then found to be CHC eligible the CCG pays for the care received from the point of discharge. In this sense patients are not at all disadvantaged and many patients are relieved at the opportunity to go home – wherever ‘home’ may be.”

      This is total nonsense. It puts the entire onus on the very sick or mentally incapacitated patient to apply for a Checklist once they have been discharged from hospital.
      Nor is a patient sent home to die, Fast Tracked because there is no actual need to assess them until they get home. Most families would be more concerned with the prognosis of death to even contemplate contacting the CCG for assessments.

      The National Framework does not appear to allow this behaviour. It is the case for example that only a Checklist document can be used in discharge circumstances….. in fact, many hospitals seem to have a link via computer to the Local Authority so that it can all be fixed and agreed in private and without using the mandatory Checklist. Any record of the discussion is in fact a de-facto Checklist. It is used to replace it and that is unlawful.
      The CCG’s carry full responsibility for the discharge of patients that require continuing healthcare but they are not particularly involved in the process now.

      The said CCG director also stated in Aug 2013 that the CHC assessment was under way in hospital for my father in law. On Nov 3rd 2014 the director wrote “I also advised you to request a Checklist submission if you feel Mr XXXX’s needs have changed, as per my e-mails.” [Never sent to me. I did however get an out of office notification.] It can be seen that cheating and lying are all the rage.

      Wordy but cathartic.

  2. Iain 4 years ago

    Reading the National Framework Guidelines Paragraph 74 states the following…..

    74. Where the Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.

    my reading of this is that until a CHC Assessment finds against ineligibility funding should be provided by the CCG. So if there is a massive delay between discharge and assessment there is no way the individual should have had to pay for their own care.

    Is that your understanding of the meaning of this paragraph?

    • Chris-G 3 years ago

      Hi Iain,
      The trouble in our area is that they simply do not do the checklist at the hospital. Obviously they would not want to do a more expensive CHC assessment either. Four months after discharge it was suggested that the home do a checklist if I still had concerns. Since when was the home responsible for completing NHS hospital discharge procedures for the CCG?

      What is outrageous, is that they don’t seem to do fast track assessments for those expected to die. Yet their hospital gets double bubble…….. One. The Patient does not die on their premises…. Two. The patient pays for their healthcare whilst dying in an often unsuitable environment. A Nursing Home is not after all a Palliative care facility on the whole.
      Apologies for anyone that is recently bereaved, but there is no simple way to talk about such matters.

    • Matt G 3 years ago

      The purpose of the Continuing Healthcare assessment is to assess the continuing; that is ‘on-going’ health needs of the person, to determine whether their needs are complex, intense, unstable or unpredictable to be solely the responsibility for the NHS, on the grounds that the delivery of care required to manage the person is greater than one could expect a local authority to provide.
      Consequently, in most cases, it would be inappropriate to undertake a CHC assessment on someone who is clearly at the tail-end of being acutely unwell, as there ongoing needs have yet to be established.
      The purpose of a checklist is only to filter out people who clearly are nowhere near the eligibility criteria threshold, everyone else would indicate a need for greater clarity. i.e a DST.
      Discharge to assess is a process which should not be chargeable to the person receiving the care untill such time as the person has stabilised, in which case one can assess the on-going need properly. If at that point the needs are intense, complex, unstable or unpredictable and the care required is greater than one would expect a Local Authority to provide, then NHS funded care would continue.
      As a foot note, Nursing homes should be, and mostly are, perfectly able to support dying people. Where palliation needs are more complex, they would, and do, access specialist palliation services via macmillan or specialist palliative care nurses as well as hospice provision.
      Fast Track assessments is not about someone dying, but is about someone having a rapidly changing and/or deteriorating condition, which may be entering a terminal phase.

  3. Angela 4 years ago

    Previous comments:

    September 29, 2014
    Edwina Smart wrote…

    As soon as we were told by the Consultant that my mother needed 24 hour nursing care we were immediately visited by a social worker. At my mother’s bedside we were asked all about her finances and at no time were we told of a CHC assessment. It was just assumed that we would pay for care (despite my mother having had 2 strokes, nearly dying of aspiration/pneumonia and being immobile since 1997). In fact, this was in 2011 and I had not heard of CHC. We did attend a ‘planning meeting’ regarding future treatment which I now understand was a MDT meeting. I wonder if it was a bogus CHC assessment?

    We were threatened to move my mother from hospital and were given a date whereby if we had not found her a home the hospital would evict her presumably to a home anywhere. We begged for a place in a (private) respite bed at the local rehab hospital and then she eventually moved to a permanent nursing home. At no time were we offered a CHC assessment, not even by the social worker that was assigned to us when my mother moved. So far, we have spent in the region of £150,000 in care fees. I first put in for an assessment in 2012 and we are still fighting it!

    October 01, 2104
    Chris G wrote…

    Just had this happen to my father-in-law. Three times in the space of about six weeks. Every time we tried to get a discharge date from hospital they would not even estimate. Then twice we arrived to find him returned to his Nursing Home for recovery at his own cost and not the NHS’s.

    On the first occasion he almost died from two separate seizures: He had refused his medication because he believed that he had already had it. He was adamant in his angry refusal and so the hospital staff took him at his word and simply left him to collapse, with the risk of death as a result. Simple covert medication would have solved the problem if the CSU that assessed his needs had actually properly reported that his judgement is faulty and not to be relied upon in an unalterable situation. E.g.. He can refuse a meal but he should not be able to randomly take or refuse medication that is not simple analgesia. It is also the case that he refuses meals because he believes that he has just had it. We have watched him refuse a meal and then eat it seconds later. So much for him having full cognition!

    One the second occasion they sent him home with inches of his amputated thigh bone poking through the destroyed and diseased end of his stump. They did not understand that he continually refused corrective surgery because he believed every time he awoke that he had had surgery all over again and it had again failed. Then he got angry and petulant and the refusal began all over again.

    I asked a Surgeon if he would be allowed to operate if he was suffering infections and taking large doses of morphine. He said of course not! He still did not get it that a patient with a brain injury in the same circumstances cannot be relied upon to refuse or accept the need for medication or surgery.
    A CCG Director told me that their CSU would liaise with the hospital from the outset. It never once happened. So a proper discharge process was never undertaken.

    Of course he has had two CHC assessments this year, before the operations mentioned above, by that same CSU; one to remove his CHC funding and another for intractable pain, neither of which took the slightest note of his two year old amputation failure and the MRSA treatment along with opiate pain relief. Instead, the local appeal insisted that they could not accept photographs of his wound dated on the days of the assessments because they could not verify the dates, locations or even if they were of my father-in-law. The decisions were made safe in the false knowledge that “His amputation wounds had healed fully”. Just a pity that neither CHC assessor actually looked at them.

    To be called a liar by way of ducking the appeal is reprehensible. Especially as I cannot verify if any of the evidence they did present was in fact true or the within the dates it alleges to include etc.

    There has been action to artificially lower the local CHC funding budget. It is the case that nationally mandated needs assessments that match the eligibility criteria are no longer being used to establish Primary Health Needs.

    So even preparing for the discharge process with some knowledge of it, was thwarted by a Hospital that well knew the consequences of allowing a family to intervene and delay the discharge.

    • Angela 4 years ago

      Edwina – thanks for your comment. That sounds all too typical, sadly, and questions about money being asked at that point are entirely wrong. The social worker in such a situation also risks breaking the law by not taking into account the legal limit for local authority care: http://caretobedifferent.co.uk/nhs-continuing-healthcare-assessments-2/

    • Angela 4 years ago

      That’s so dreadful, Chris. There just aren’t the words to really describe the deep impact all this has on so many famililes and individuals. Thank for your comment.

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