How long have you been waiting for a Continuing Care assessment?

How long have you been waiting for a Continuing Care assessment?

Many people needing an assessment for NHS Continuing Healthcare – or who are waiting for a Continuing Care appeal – are experiencing long delays in getting this done. It can be exasperating for families. And, in the meantime, their elderly relatives in care may be (wrongly) means tested and told to start paying care fees.

How long have you been waiting?

The health and social care authorities tend to put the onus on families to find out about care fees funding in the first place and many families are left in the dark about NHS Continuing Care funding. Then the authorities leave it up to families to chase proper assessments, pick up on maladministration in the assessment process and raise objections when care fees are imposed illegally. It causes a huge amount of anger and distress for families.

Retrospective claims

If you’ve lodged a retrospective claim for NHS Continuing Care  with the NHS to reclaim care fees already paid, the chances are you’re still waiting to receive even an acknowledgement of that application. You may not have had any replies to your phone calls or letters. This lack of communication is unacceptable behaviour for any organisation, let alone one with responsibility for vulnerable people.

Keep chasing your claim with the relevant NHS Continuing Care Dept. Let them know you’re not going to go away and that you need to be kept informed of timescales for reviewing your claim. In our experience of the whole Continuing Care process, you often have to make a nuisance of yourself to get a response.

The Continuing Care Dept may say that they have a backlog of claims to deal with, but this is no excuse for not providing you with any information at all about when they’re likely to look at yours.

Current Continuing Care assessments

If you’re waiting for a Checklist assessment  and you’re told by the Continuing Care Dept that it will take weeks or even months to get this done, this could well be an attempt to get you to start paying care fees.

The NHS may be short staffed, but a Checklist assessment can be carried out by any health or social care professional who understands the process, e.g. an informed care home manager, a social worker, a community psychiatric nurse, a district nurse, a GP (although many GPs are unaware of the process), or another health or social care practitioner who knows your relative’s health and care needs. It is a relatively short assessment and should certainly not take months to get done.

If you’re getting no response from the NHS itself, ask a health or social care professional directly to carry out the Checklist and send it to the NHS Continuing Care Dept local to your relative. Talk to the GP as well, and raise your concerns.

If you’re waiting for a full Continuing Care assessment (Decision Support Tool),  and you’re getting no response, keep sending letters to the NHS Continuing Care Dept.

Many people also find it helpful to get the local MP involved too, and to copy in the MP on all correspondence. Find your local MP here.

The full assessment should take place – and a decision made about funding – within 28 days of the Checklist assessment.

Continuing Care assessments in hospital

If your relative is in hospital and you’re being told they’ll be assessed once they’ve left hospital, be cautious. Read these 5 things to check before your relative is discharged from hospital.

If your relative is likely to show significant improvement in the short-term, the NHS may provide short-term rehab or reablement care, and so may wait until your relative’s actual care needs are clearer before it does an assessment. However, if your relative’s condition is unlikely to improve in the short term, a Continuing Care assessment should be carried out before they are discharged.

Continuing Care appeals and review

If you’re challenging or appealing a decision about Continuing Care funding and you’d like a review – or if you’re waiting for an Independent Review at the Strategic Health Authority – there are specific timescales in which this should take place. Read more about Continuing Care review timescales.

Always remember, it is not correct for the NHS to expect people to pay for care while waiting for an assessment. If this were the case, it would give the NHS carte blanche to delay assessments indefinitely. For that reason, at Care To Be Different we often recommend that families dig their heels in and refuse to start paying care fees until the proper assessment process has been followed – to allow a proper decision to be reached about who is actually responsible for paying for care.

Any health or social care professional who tells you otherwise – or who simply says there’s “no point” doing an assessment because “you won’t qualify” – may be trying to get you to pay for care under false pretences.

How long have you been waiting for a Continuing Care assessment or review? Leave a comment below.

7 Comments

  1. Mrs Lucinda Butler 1 year ago

    Do not give up. After a ‘not fit for purpose’ NHS Continuing Healthcare (CHC) assessment of my husband with MS (he is blind, completely paralised, peg fed, has supra pubic catheter, moderate cognitive impairment he was then 39, was refused CHC funding in early January), I went to panel where nothing was changed. I stated that our local CCG were unlawful in their findings so It was recommended that an 8 week re assessment took place with a new Panel ( as it turns out a lovely Nurse Assessor from another county did it with an out of county Social Worker). She in fact along with the Social Worker stated my husband was to be awarded CHC funding and had a primary health need! It took 8 months after the initial Checklist had taken place before the first assessment! I have one piece of Advice BEFORE your loved one gets assessed, obtain written evidence by Drs, Specialists, Dieticians, Physios, OTs, Phyc. The more evidence you have the better – even if your family is in a nursing home you can still arrange this, it may take time and effort but it is worth it in the long run. My husband is looked after by me at home. We are now still waiting for the CHC to get their act together and organise payment/transfer from Social Services, now 8 weeks from agreeing my husband should get funding and I am still having to argue and push it along. You need to question everything, have evidence, use examples about your loved ones. I have a health background so I have some knowledge. Just because a need is being managed well and seems not to be complex it is still a need. Good Luck and keep fighting.

  2. Linda Witchell 3 years ago

    Thank you very much. The people who came to do the assessment contacted the GP who has agreed on fast track. I am now waiting to hear further. Presuming she gets the funding how would I argue the case for not paying top up? Should I try to get advice from somewhere? Thanks again

  3. Linda Witchell 3 years ago

    My mother was discharged from hospital into a nursing home “for an interim period of 6 weeks to enable assessment for Continuing Healthcare (CHC)/Funded Nursing Care (FNC) in March 2015. She had been assessed in hospital but narrowly missed the scores needed. CHC was paid for this ‘interim period’ but we had to agree to a top up because I insisted on a specific home that was more expensive. 19 months (and much distress and confusion about the funding situation) later, she finally had an appointment to do the Decision Support Tool. This comes 2 weeks after her GP gave her ‘weeks or months to live’. Apparently they had received the Checklist in February this year. They are not going to ask for any repayment (thank goodness as she has been through some serious health scares, including being treated for TB for the last 8 months). My question is, do we have any case for not paying the top up now she is so frail (presuming she is awardedicated the CHC) and would there be any hope to reclaim any of the you up fees back?

  4. J W SERGINSON 6 years ago

    NHS now trying to carry out a now assessment using down rated tools to find a way to avoid a retrospective assessment. They are also stalling by queiring the authority by saying they have to check the relevance of a best interests decision. it is now 5 months since a claim was lodged for my mother in law who is still heavily sedated using quetiapine, which is not licensed for dementia. The manoevering about procedure seems the order of the day.

    • Angela 6 years ago

      Many thanks for your comment. What you’re experiencing seems all too common at the moment, sadly, and it causes no end of stress and distress to the families involved. It can sometimes become a battle of wills, and so it’s worth standing your ground and holding out for what you know to be right.

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