Check carefully what Continuing Healthcare assessors write down about your relative’s care needs
There are many hundreds of comments on the Care To Be Different website highlighting how some Continuing Healthcare assessors describe care needs falsely.
Indeed, families frequently pinpoint how care needs have been incorrectly detailed in NHS Continuing Healthcare funding assessments.
It’s a major problem – because the way that needs are described can make the difference between a person receiving the funding or not.
So what can you do if a Continuing Healthcare assessor is trying to play down your relative’ needs?
Read on for 3 helpful examples – plus some tips…
Families often have to argue hard to get some assessors to properly record the severity of need in each care domain. (The care domains are the categories of need assessed during the Continuing Healthcare assessment process.)
Let’s think about the physical and/or cognitive ability a person may or may not have to dress and wash themselves.
Let’s call this person Mrs X and assume she matches one of these two descriptions:
- She has a degree of dementia that makes her incapable of making any practical decisions for herself or indeed doing anything for herself.
- She’s had a major stroke that has left her severely physically disabled and unable to do anything for herself.
In Continuing Healthcare assessment notes for Mrs X’s needs, it would not be unusual to see the phrase: “Washes and dresses herself with assistance”.
Of course, the family knows that’s not quite right, but it just seems to be how things are described in Continuing Healthcare – and so it can go unchallenged.
Then of course, a CCG decision making panel reads those words and concludes that Mrs X’s needs really aren’t that great – and the decision is: no funding.
That’s a very simplistic way of looking at it, but it highlights the point.
The phrases “Needs supervision with washing and dressing” and “Needs assistance to wash and dress herself” are also very common – and again they do nothing to paint an accurate picture of the nature and extent of Mrs X’s actual needs.
“Cannot wash or dress herself without assistance” is slightly better, but it still implies Mrs X can help in the process in some way – which is unlikely.
More accurate is something like this:
“Mrs X needs constant care, day and night, for even the most basic things such as getting clothes on, maintaining vital oral health and protecting her skin from the impact of poor hygiene. She is unable to carry out even the most basic tasks for herself – in any way. Without such care and intervention, Mrx X would suffer painful injury, distress and potentially fatal skin breakdown.”
For someone with Mrs X’s needs this is an absolute minimum in the care that is required.
2) “A delight”
Another phrase we’ve seen in assessment notes is “Mrs X is a delight to look after.”
Not only is this wholly subjective on the part of whoever may find Mrs X a delight to look after, but it says absolutely nothing about Mrs X’s care needs.
Instead it implies that Mrs X’s needs are really not that great and everyone’s just having a pretty easy time.
This of course is rarely the case. And so the same thing can happen – the language used in the assessment notes contributes to the overall playing down of care needs.
And the result? No funding.
A further example of misleading language in care notes can be seen in phrases like: “Mrs X is very independent.”
We’ve seen this written about someone whose behaviour is extremely challenging, on account of the severity of their dementia. The person would rarely let care staff even touch them or provide the vital care they needed. This was not because the person needing care could actually perform the tasks themselves; it was, of course, because of their cognitive impairment.
And so describing them as ‘independent’ completely negates the degree of need here – and is likely to stop them receiving a ‘Severe’ or ‘Priority’ score in the Behaviour domain.
It is also hugely disrespectful towards a person needing care when assessors try to brush the person’s serious needs under a carpet of positive language.
Part of the purpose of the NHS Continuing Healthcare assessment process is also to flag up actual care requirements, and any attempt to play these down puts the person needing care at increased risk of neglect.
What can you do if Continuing Healthcare assessors describe care needs wrongly?
All of the above issues are of course often further compounded by the following:
- many care staff don’t have time to record proper care notes; in addition, many are not trained in any way to understand why the care notes are critical to the Continuing Healthcare process;
- families report that, in may cases, the actual assessors don’t have appropriate qualifications in the actual health issues they’re assessing.
Always ask to see the care notes in advance of an assessment, and make sure any errors, omissions or misleading statements are corrected prior the assessment.
In addition, always ask an assessor what makes them personally qualified to assess your relative’s care needs. Do they have specific medical, nursing and/or care knowledge and experience to do so? What is their specific expertise?
The National Framework on page 74 paragraph 30.2 states:
“Whilst as a minimum requirement a Multidisciplinary Team (MDT) can comprise two professionals from different healthcare professions, the Framework makes it clear that the MDT should usually include both health and social care professionals, who are knowledgeable about the individual’s health and social care needs.”
Note the word ‘individual’ too. It’s not acceptable for an assessor to have just a bit of knowledge about a broad health issue; instead, they must have appropriate knowledge about your relative’s specific needs.
Always check closely how Continuing Healthcare assessors describe care needs in a Continuing Healthcare assessment.
Challenge them about anything and everything that doesn’t seem right in the way they’re recording needs.
Insist that they include in the notes your own objections to what they’re writing.
There is a section on page 18 of the Decision Support Tool (the form used in the full assessment for NHS Continuing Healthcare) that allows the family to add comments about the assessment. It’s headed:
“Individual’s view of their care needs and whether they consider that the multidisciplinary assessment accurately reflects these:”
If you feel that the notes made by the assessor(s) do not accurately reflect your relative’s needs, be sure to write that on that page – and use additional paper if needed. This is particularly important if an assessor refuses to note your own comments in the individual domains.
Read more about the language used in NHS Continuing Healthcare assessments: