Do Care Homes Play A Part In Preventing Successful Outcomes For CHC Funding?

Care Records form an essential part of the NHS Continuing Healthcare assessment process, whether as part of a current NHS assessment for a living patient in care, or retrospectively, when looking at eligibility for past periods of care (whether the patient is alive or deceased).

An individual is eligible for NHS Continuing Healthcare (CHC) if they have a “primary health need”. This is when it can be said that the main aspects of the care they require are focussed on addressing and/or preventing health needs. It is not about the reason why an individual requires care or support, and it is not based on their diagnosis. It is about the  quantity and quality of their overall actual day-to-day care interventions taken in their totality. If found eligible for CHC, all their assessed health and social care needs, and the cost of accommodation will be paid in full by the NHS (ie free of charge at the point of need).

A full assessment of a living patient’s eligibility for CHC funding is carried out by an NHS Clinical Commissioning Group (CCG) and County Council (Social Services) at a Multi-Disciplinary Team meeting (MDT). The MDT’s assessors should not only meet with the patient in person to assess their healthcare needs, but also review their available care/nursing home records as well. These care records, combined with their personal assessment of the patient, plus input from patient’s family representatives and care team, should enable the MDT assessors to get a true picture of the patient’s daily care needs. The MDT panel will then summarise the level of need in each domain of the Decision Support Tool (DST) and will include a recommendation as to whether the patient’s needs are intense, complex and/or unpredictable and whether they are  eligible for CHC Funding, therefore.

If eligible, that could save the patient many thousands of pounds a month in care fees and even prevent them from having to sell their home to fund their own care. That’s why the outcome of the MDT assessment is so important.

In order to carry out a fair and robust assessment of a living patient, the MDT’s assessors should take all reasonable steps to obtain all relevant and available care and medical records.

If reviewing eligibility of past periods of care, i.e. undertaking a retrospective claim – whether the patient is alive or deceased – it is expected that the MDT’s assessors will also need to obtain and review all relevant clinical records (e.g. hospital, GP and physiotherapy records etc.) and include them in their case file. Otherwise, they are likely to end up with a distorted and inaccurate picture of past healthcare needs.

Owing to the Covid-19 pandemic, more and more CHC assessments are being conducted “virtually” – i.e., without any in-person assessment of the individual – meaning that the keeping of accurate records by care providers is ever more essential.

Inevitably, incomplete sets of care home notes and records are more likely to lead to the MDT reaching a negative outcome for CHC Funding. Quite simply, if it’s not written down, the CCG can argue that the need doesn’t exist – leaving families to face an uphill battle to argue to the contrary. Those very familiar with their relative’s needs may fare better and fill in the gaps, but this is no easy task, given CCGs’ emphasis on “verifiable evidence”. Good record keeping is therefore essential, and the evidence is there for all to see. That, of course, presumes the records are accurate, which sadly, is very often not the case!

If the care provider’s records fail to demonstrate a factually accurate picture of the quality and quantity of interventions delivered each day, how can the assessment realistically portray the full picture of the individual’s needs? That could lead to a drastically unfair outcome for patients who are financially reliant on the MDT undertaking a properly considered assessment of their eligibility for CHC Funding.

The same is true of a retrospective review, and a CCG will be heavily criticized if they do not provide and consider a comprehensive set of detailed records, where available. Sadly, in many cases, even when these records are requested and properly considered by the CCG, they do not accurately reflect the care being provided. Proving a need retrospectively is even more difficult, as many unfortunate families discover, often all too late.

For current assessments of a living patient, CCGs have recently been criticized for only obtaining one month’s care records.  This short window is unlikely to be representative or sufficient evidence of challenging or changing needs. We recommend that it would be far more prudent if an MDT looked at least three months’ care records to get a more accurate perspective of the patient’s current care needs when completing their DST – which has, until recently, always been accepted as best practice.

For retrospective claims looking back over the past periods of care for reimbursement, the CCG should ideally obtain all clinical and care records available for the enquiry period.

That said, many families will often testify, the care home records are factually inaccurate, misleading or grossly inadequate, and don’t reflect the full picture of their relative’s daily care needs.

Whilst some records may be beautifully presented with fancy graphics and colour icons denoting areas of care provided throughout the day, eg mealtimes and sleeping patterns etc, it is the substance that you need to look at, not the pictures. Much really depends on the care home’s attitude and ethos towards record keeping, staff training, and, of course, the time available to complete entries accurately and fully. For some care homes, the records may be secondary to providing care – more of an afterthought; sometimes completed long after the event or at the end of a tiring shift when timings and recollections may be hazy or rushed in an effort to get home. To others, top quality care and good record-keeping are essential and go hand-in-hand.

Others may ‘blue sky’ the records and paint a glossy picture, perhaps for their own ease or so as not to distress families. For example, if a patient has dementia and other challenging needs, has experienced hallucinations or incidents of aggression during the day – perhaps lashing out and biting/punching carers, presenting a risk to themselves, other residents and staff members – to read comments such as, “Barbara had a small breakfast”, “Tom has had a better day today” or “Geoffrey is much the same today” are meaningless. Such paucity of content tells you nothing about the incidents, frequency or  how the need was managed by the staff. This type of inaccurate and misleading record keeping offers CCGs a perfect loophole to avoid necessary funding decisions.

Good record-keeping is therefore essential to have the best chance of success of securing CHC funding. Unfortunately, care homes do play a vital part in successful CHC applications, and we recommend that you review your relative’s records frequently to ensure that they are an accurate reflection of their daily care needs. If you know there are missing entries, speak to the care home manager and get the matter rectified immediately.

Records completed to a high standard are more indicative that care has been planned and delivered in an organised and consistent way for the patient’s safety and well-being, and demonstrates a desire to enhance the patient’s quality of life.

It is easy to understand why some care/nursing homes have come under criticism by NHS England and the Care Quality Commission for poor record keeping. It also makes you wonder how a care home can properly manage a patient’s complex or challenging healthcare needs if their records are inaccurate, strewn with meaningless and irrelevant entries. Surely, that must be reflection of either a pressurised and/or under-resourced care home.

Remember: It is a legal requirement for nursing homes to keep adequate records as set out in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) 2010. The first part of the Regulation explains why records are needed — providers who do not have relevant information will jeopardise the health, well-being and safety of their service users, who then will not benefit from the services provided.

The requirements to keep certain kinds of records are broken down into two sections.

• In Regulation 20(1a), care providers must keep accurate records and relevant documentation about the person needing the service (ie care records).
• In Regulation 20(1b), care providers must keep corresponding records about the people employed to provide the service (i.e. staffing records) and the management of the service … Regulation 20 turns attention to how the records must be kept.

In 20(2), it requires any record, paper or electronic, to be kept securely, but in a place where it can be accessed promptly when needed. A record should then be kept for an “appropriate” period of time, after which it should be securely destroyed.

So, there should be no delays when making a request to a care facility to provide you or the CCG with a full set of care records which according to GDPR, should ordinarily be sent within one month of your Subject Access Request.

Our Tips:

1. Ask to see your relative’s care records frequently. Check they are complete, in good order and detailed, and that any major incidents you know about are fully recorded. If the bigger incidents aren’t recorded accurately or at all, there’s a good chance that the smaller daily events won’t be mentioned either.
2. Lots of smaller entries on the healthcare issue eg appetite, weight loss, pressure care, incontinence, mobility, breathing, etc. all build up an evidential picture of daily care needs. That could be important evidence to support your application for CHC Funding.

Summary:

Whilst better record keeping doesn’t guarantee a successful outcome for CHC Funding, you stand a far better chance if the MDT and any appeal panel have a more comprehensive and detailed picture of the patient’s particular needs when formulating their decision as to eligibility for CHC.

Here’s a selection of helpful related articles from our Care To Be Different website. Use the search bar on the Home page to find hundreds more.

June’s feature on flawed CHC assessments and the importance of good record keeping
Need help getting copies of your relative’s care home records?
Preparing for the Multi-Disciplinary Team Assessment
What to expect when you attend a Continuing Care assessment
Can The MDT Panel Refuse To Proceed If I Have An Advocate?”
Retrospective claims – 3 New Tricks To Watch Out For!
My Dad Has Dementia – So Will He Automatically Qualify For CHC Funding?

If you need help assessing your relative’s level of need in any domain on the DST, or advocacy representation at an MDT or appeal, don’t hesitate to contact us or get help from one of our specialist Advice Lines to discuss your case today.

If there is a particular topic you would like us to cover, we’d love to hear from you! Just send an email via our “Contact Us” page with the subject “blog request” and we’ll do our best to cover your suggested topic.

 

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