June’s feature on flawed CHC assessments and the importance of good record keeping

June’s feature on flawed CHC assessments and the importance of good record keeping

Given some of the strange decisions where individuals have been rejected for NHS Continuing Healthcare Funding (CHC), you have to wonder how ill your relative has to be before they qualify for this free funded package of NHS healthcare.

A previous enquirer wrote, “After a big fight we got funding fast tracked for my Dad who had terminal pancreatic cancer, but only after he had died!!  At the MDT eighteen days before, he was obviously not dead enough because he got turned down….”

These comments are a sad reflection of the failing NHS CHC assessment process.

It seems quite unreasonable that someone who could be so ill, is refused for CHC funding at a Multi-Disciplinary Panel, and yet within a matter of days qualifies for Fast Track CHC funding. What could have changed in that short period of time to make someone considered by the MDT assessors to be ineligible for CHC Funding, suddenly become eligible under a different process? Bizarre! But, it does demonstrate how MDT assessments can go wrong, forcing families into paying many thousands of pounds a month for their relative’s care, just because of a flawed assessment.

For more information on fast track assessment process, read our blog, “How to Fast Track the Continuing Healthcare process”.

If you have been told your relative has to be at ‘death’s door’ to qualify for CHC funding, then that is simply untrue!  Read our blog: How ill do you have to be to get NHS Continuing Healthcare funding?

An individual has a right to request an NHS Continuing Healthcare assessment at any stage of their life, and not just at an end of life stage.  If your relative has a ‘primary healthcare need’, then regardless of the setting where that care is being provided, they may be entitled to CHC Funding.  Read selected blogs below for further guidance:

‘Primary health need’ made simple – what does it really mean?

Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…

The Importance of Good Care Home Records

We strongly recommend that you keep a note of your own attendances when visiting your relative in their care home.  The better the records, the more chance you may have of successfully claiming NHS Continuing Healthcare Funding (CHC) for your relative.

Sometimes care home records may be incomplete.

There can be missing records or pages, which have either been misfiled or just lost.

Sometimes medical or daily entries can be incomplete, too.

It is a good idea to check the care home records from time to time to see that they are up to date and accurately reflect your relative’s healthcare needs.

A claim for CHC Funding is often only as good as the records available.

Somewhat cynically, some care homes may intentionally not make comprehensive or complete records.  The reason being, is that good note keeping could mean that an individual triggers for NHS Continuing Healthcare Funding and result in the care home losing out financially. Care homes generally receive a lower ‘bed rate’ from the NHS Clinical Commissioning Group than they could charge an individual who is self-funding instead. That shortfall could cost the care home thousands of pounds a month per resident.

Note: If CHC is awarded, that free package of NHS funded care should cover all your relative’s healthcare needs, including accommodation. Your CCG’s standard contractual rate with a local care home is often a lot lower than the actual cost of providing care. Some care homes try and make up this shortfall (however disguised) by charging additional fees – known as ‘top-up’ fees – to meet this cost. Most families don’t often realise that being charged a top-up fee is unlawful, and must be challenged. Otherwise, your relative could be paying thousands of pounds to the care home unnecessarily! Top-up fees is a complicated subject all on its own. But, if you think you have been charged a top-up fee then visit our on-to-one page for legal assistance. For further reading on top-up fees, read our helpful blogs:

Should you be paying care fees?

Care home top-up fees: Do you really have to pay?

Are You Paying Top-Up Fees Unnecessarily?

TOP-UP FEES – Unfair Care Home Practices Now Face Government Sanctions

Therefore, it is not unknown for care home staff to make deliberate omissions in their records for ‘financial gatekeeping’ reasons.  The less people that qualify for CHC, the more the care home can get away with charging their private paying residents.

Records can, of course, be incomplete for other genuine reasons.  Care home staff often just don’t have the time to write up a resident’s notes on every single separate occasion they have contact with them (even though preferable).  That would be painstakingly time consuming, and could place other needy patients at risk.  Poor record keeping, abbreviated notes and meaningless entries are, therefore, quite common, and will certainly not help your claim for NHS Continuing Healthcare.  If the records accurately and contemporaneously report events as they happen, then you will stand a better chance of obtaining CHC Funding.

Problems can also occur when staff members write up their notes at the end of the day, towards the end of a long shift. Staff memories may not be as reliable after a long day’s work, rushing around, attending to many residents with differing needs. Staff may be tired, confused, mistaken, or more likely to partially record an entry, perhaps leaving out critical material, which could significantly increase your relative’s overall scoring and chances of obtaining CHC Funding.

For example, if ‘Doris’ is doubly incontinent and has had several accidents during the day with multiple changes of clothing, but only one entry is recorded regarding the need to change her soiled clothing, then clearly it won’t form an accurate picture of Doris’s daily activities and could undermine the intensity of her healthcare needs. Incontinence could, of course, directly impact on her other healthcare needs, lead to urinary tract infections, catheterisation, pressure sores and other complications.  But, if there is little information recorded, then one could easily get a false impression of Doris’s actual needs and render her Care Plan ineffective.

Nursing staff may have a lots of records to write up for different residents, and if they save them all to the end of the day, that is when things can go wrong – entries can be missed, misstated or understated. For example, when comparing a sample of residents’ records for pressure sore management, it may be not be surprising to read that the same staff member has ‘miraculously’ repositioned multiple immobile residents all at exactly the same time. Physically impossible!

It might be quite easy to write “Doris had a good day today” when in fact she was hallucinating – talking to imaginary people and objects, had fallen, needed assistance with eating to prevent aspiration and choking, and wandered around half undressed due to cognitive impairment.  To write down each single entry properly does take up a lot of time, and if staff are keen to go home, or simply do not have the patience to write up all the records in detail, then you can understand why, often, some notes are not an accurate enough presentation of true healthcare needs. Yet, care home records form an integral key part of the CHC assessment process. Most frustrating!

Our tip: Keep whatever records you can, with the times and dates of attendances, and a detailed description of events. This supplementary evidence could improve your relative’s chances of getting CHC funding.

For further information around the subject, read our blogs:

The dangers of pressure sores, pressure ulcers and bed sores

Applying for Healthcare Records. Dealing with delays

This month’s key questions about Continuing Healthcare Funding

Share your experiences and help others by leaving a comment below if you have encountered similar issues…..

2 Comments

  1. Elaine Wilson 16 hours ago

    Yes sadly my dad , nearly dead , skeleton like, immobile, doubly incontinent, several strokes, skin diseases, didn’t have health needs, sadly died. Worked his entire life without a day off paying his Tax and National Insurance in this country. Whilst others who choose not to work and claim benefits are funded without question. Sad country the UK is becoming when decent people don’t get the support they need at the end of their lives. I am ashamed to live in England. Professional’s too scared to be honest in fear of losing their jobs have no common sense and guts. The message given to people seems to be if you have any income pass it on to our children now or spend it because with or without money you will be looked after, bit of a lottery , you are not going to get better care paying for it yourself .The same flannel that’s wiped your **** on a Monday is going to wipe your face on Tuesday.

  2. Sue H 2 days ago

    We had a retrospective MDT (Multi Disciplinary Team) appeal yesterday after putting in a (NOD) Notice of Dissatisfaction. This was face to face with two experts in nursing, a social worker and a ‘minutes’ taker, all from the same CHC Team. They stressed that having the family there ‘may’ provide them with additional evidence that is not in the notes, and that could increase the chances of being found eligible. I am left downhearted with the discussions regarding the ratings in certain Domains. Interestingly, a few of points I think claimants should be aware of … 1/ BEHAVIOUR – the difference between Medium/moderate and High – a person with Dementia in a wheelchair, compared to being mobile, is at a disadvantage regarding the ‘intensity’ of danger to self and others. As they are no longer mobile they cannot escape, hurt themselves or other guests and staff. It doesn’t matter if they physically abuse staff who approach them in the chair, as the member of staff can manage the need by ‘getting out of harms way’. The nurse admitted that now she sometimes has to refuse existing funding to people with dangerous dementia issues if they becomes wheelchair bound. 2/ MOBILITY – the difference between Medium/Moderate and High – if a person is immobile, but can slightly lift their arms whilst being hoisted, they are again downgraded from ‘high’ to ‘moderate’ as they can ‘assist’ in the transfers. Although there is no actual assisting, they are not completely immobile so the staff find it easier to handle the patient. It truly beggars belief, my father-in-law was wheelchair bound and could not walk. 3/ CONTINENCE – he was double incontinent but with frequent UTIs which the social worker said could have been managed by a team in a LA placement, or hospital, and therefore not a CHC priority healthcare need. He had suffered from Alzheimer’s for 5 years and thought his wife was still alive and that he was still in his own home. However, they pushed and pushed for my husband to say that his father recognised him (even if it was fleeting), again an excuse to down-score. We will not know the outcome for over 6 weeks and are not holding our breathe. They kept on and on about these specific points until we were exhausted. 3 hours, 5 o’clock, over and done with – they’ll finish their discussions without us regarding the intensity/complexity etc. as we had run out of time.

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