Our previous blogs have looked at the importance of having up to date detailed and accurate care home records. These form the core evidence of any assessment for NHS Continuing Healthcare Funding and for any retrospective claim when seeking reimbursement of care fees that may have been wrongly paid. You can read these blogs again below.
However, you’ll now know from reading our blogs, that it is not just a question of having good records to support your relative’s claim for NHS Continuing Healthcare Funding. You also need to check regularly that they accurately reflect your relative’s actual care needs.
As part of the Operating Framework 2012/13, the NHS ‘Safety Thermometer’ was introduced – “Developed for the NHS by the NHS as a point of care survey instrument, the NHS Safety Thermometer provides a ‘temperature check’ on harm that can be used alongside other measures of harm to measure local and system progress in providing a care environment free of harm for our patients. The NHS Safety Thermometer allows teams to measure harm and the proportion of patients that are ‘harm free’ during their working day.”
The information that the Safety Thermometer collated was used to formulate a report designed to highlight and confirm the main focus of concerns for the NHS which were leading to high numbers of avoidable hospital admissions. The main focus was on ‘pressure ulcers’ (also known as pressure sores or bed sores) and ‘falls’ sustained at care homes and hospitals. The intention was to highlight services which were doing well and those which were underperforming. The overall expected outcome was that ‘Good’ performers would be rewarded financially; the numbers attending hospitals as a result of falls and pressure sores would reduce; lengthier stays in hospital would reduce, and so thereby reduce the cost incurred by the NHS.
The Safety Thermometer’s reported results found that, from April 2014 to the end of March 2015, just under 25,000 patients had developed a new pressure ulcer and on average 2,000 pressure ulcers were being newly acquired each month within the NHS in England. This is an alarming statistic, especially when you consider that nearly all pressure sores are caused by neglect, and are therefore entirely avoidable with basic preventative measures, proper risk assessments, monitoring and supervision. If skin integrity is not monitored carefully, then elderly or vulnerable patients who may be immobile and wheelchair/bedbound, may be at a higher risk of developing complications from pressure sores which can be difficult to treat and cure, and on occasion can prove fatal. The NHS recognised that they were sadly failing too many patients and needed to address the problem.
According to Deely, Posnett, Walker 2012, the cost of treating a pressure ulcer varied at that time from £1,214 to £14,108. The more severe the pressure sore, the longer it can take to heal, and consequently, the greater likelihood of complications in severe cases – all adding to cost and at the expense of the NHS.
Due to the deluge of pressure sores being reported within the NHS network, we suspect that some pressure sores became reclassified and downgraded as ‘blemishes’, ‘moisture lesions’ or even ‘friction burns’ instead.
TIP: When reviewing your relative’s care home records, check whether there are any references to blemishes, moisture lesions, friction burns and the like. Is it actually a pressure sore by another name?
Important: For practical purposes too, you need to know whether any discoloration is simply a blemish, or is potentially something far more serious, such as a pressure sore. Either way, it needs to be recorded accurately, and if it is a pressure sore, it should be called exactly what it is, and not be downgraded to a blemish!
Skin Integrity: If the care home records do not accurately record a pressure sore (or describe it a moisture lesion instead), it may affect the scoring in this particular Care Domain, and therefore directly impact on your relative’s chances of obtaining NHS Continuing Healthcare Funding.
Falls at hospital or care home
Mobility: Falls in hospitals and care homes can be prevented by providing 1:1 care and supervision. However, that can prove to be very expensive, and so, the NHS will not, or cannot, provide funding for 1:1 support for everyone; so rarely gives it to anyone.
We hear anecdotally from an experienced nurse (now retired), that as a result of the Safety Thermometer reporting, hospitals decided that they would introduce ‘bay tagging’ to prevent further falls from hospital beds. Essentially, this meant that those at risk of falls could be well-managed in one bay, containing, for example, 4 to 8 beds. Someone would supervise that bay, telling people to ‘sit down’ or not to stand up, etc. Those patients who were confused or agitated were then nursed in bed to prevent them from falling.
Alternatively, those at high risk of falling, who wandered and were restless or agitated, were given 1:1 support in hospitals to prevent any falls and negligence claims. However, upon discharge from hospital, care homes were declining to accept these patients without 1:1 support funding in place, as they were naturally concerned that they could be held liable if a vulnerable patient, known to be at risk, fell whilst in their charge.
When seeking CHC Funding, it could be argued that your relative’s healthcare needs are more likely to satisfy the 4 Key Indicators, particularly ‘Intensity’, and therefore trigger eligibility for NHS fully-funded care if they’re receiving 1:1 care. Such expensive funding would come out of the NHS budget.
For some care homes, particularly if understaffed, it is perhaps more convenient (ie easier) to ‘make’ patients immobile and nurse them in bed instead. Once rendered immobile, they can quickly lose the ability to stand or confidence or will to walk again. If nursed in bed, their behaviours can be controlled, with less risk of them wandering and falling. Plus, if the patient’s needs are ‘well-managed’ and the patient is fully compliant with routine pre-planned care interventions, then their care needs will arguably become less Intense, Complex and Unpredictable. As such, it might make it more difficult to justify your relative’s eligibility for CHC Funding.
If the patient is ineligible for CHC Funding, or it is withdrawn, then they will have to pay for their care (and accommodation) out of private funds or else seek Local Authority Funding.
Check your relative’s care home records frequently, not only to ensure their well-being, but also to ensure that their care needs are accurately recorded.
Remember: Inaccurate or misleading entries in the care records could severely affect your relative’s scores at a Full Assessment (using the Decision Support Tool), and their chances of getting NHS Continuing Healthcare Funding or retaining their existing package of fully-funded care.
Look out for mention of blemishes, moisture lesions and friction burns. Are these entries really pressure sores by another name? You know your relative best. Do the care home records accurately reflect their symptoms?
Most pressure sores are entirely avoidable with proper care. If your relative has sustained a pressure sore or serious injury from a fall in a care setting that could have been prevented, consider getting legal advice, as they may be entitled to compensation. Visit our one-to-one page for further information.
For further information, we recommend that you also read these blogs: