If you are caring for a spouse, parent or other close relative whilst they are resident in a care or nursing home, then you will generally be familiar with their day-to-day care needs.
Unfortunately, we know that often the care records are not updated sufficiently regularly, or else are inadequately completed, so as to contain inaccurate or misleading entries. Often, it is simply due to lack of resources and insufficient staffing looking after too many residents. Staff don’t often have the luxury of time to be able to record each and every time an incident occurs or care is administered, nor to consult the Care Plans as frequently as they should. All of which can lead to poor record keeping!
As your relative’s carer, you will be familiar with their daily needs and be best placed to spot any inaccuracies or omissions in their care records. For their safety and well-being, you will also know whether or not their Care Plans are being followed.
It’s vital to ensure that their care records are accurate, up to date, and contain full, detailed entries as to their daily activities, care needs, incidents and any accidents (whether a fall, or soiling, due to incontinence). All monitoring and supervision should be fully recorded.
If your relative has entered into a care home and is awaiting an initial Checklist screening assessment, or else has already obtained NHS Continuing Healthcare Funding (CHC) and is due to be reassessed to check whether or not their funded care package is still adequate to meet their healthcare needs – then the CCG’s (Clinical Commissioning Group) appointed assessors should review your relative’s care home notes and records when carrying out their assessment.
However, if the records are not up to date, are incomplete, inaccurate, or else contain fundamental errors, then the CCG’s assessors will not gain a true picture of your relative’s daily care needs. Good records are of paramount importance and can be critical to succeeding in getting them CHC Funding.
Whilst we anticipate that many CCGs’ assessors would generally acknowledge that most care notes are incomplete and can never be a perfect record, these contemporaneous, objective, written records do form an essential part of the assessment process. Hence, it’s essential that you attend the Full Assessment as you are best placed to supplement the assessors’ knowledge of your relative’s care needs, fill in any gaps, and to correct any misunderstandings they may have. Otherwise, inevitably, what is written in ‘black and white’ is likely to carry significantly more weight – whether it is correct or not – when making their recommendations for CHC Funding. Any omissions in the care records may count against your relative – even if they seem obvious to you (and the assessors). From an assessor’s point of view, it’s easy to justify downgrading a scoring by referring to the records. They may take the view that if it’s not recorded, then it didn’t happen.
Often, if there has been mismanagement or neglect, then the care home records may be ‘silent’ as to the incident for fear of blame. For example, it is quite common for elderly, frail or vulnerable residents to fall. Most falls tend to go ‘unwitnessed’, and so it is not beyond the realms of possibility that a fall will not even be recorded, or else ‘played’ down as being a very minor incident. If your relative cannot communicate their needs reliably (or at all), then the care home might get away with it – unless you happen to notice bruising or that they are in pain! But the frequency and number of falls may be a key factor for arguing for ‘high’ needs under the ‘Mobility’ Care Domain at a Full Assessment.
If your relative is incontinent, then without adequate care, they may be left for hours in soiled or wet clothes, which is degrading. They then become at risk of developing urinary tract infections (UTI’s) or pressure sores, which, if ignored and not treated quickly, can lead to more serious health complications.
Similarly, if your relative is immobile, wheelchair or bedbound, then they may be at high risk of developing pressure sores. Pressure sores are primarily caused by neglect and are totally avoidable with proper supervision and management. There should be a Risk Assessment in place to monitor skin integrity and to prevent pressure sores from occurring.
However, practically speaking, you cannot be on hand all day long and have to trust the care staff to do their job as your surrogate professional carer. But you will not necessarily know whether your relative was actually repositioned as frequently as set out in their Care Plan (say every 2/4 hours), or indeed, at the exact time recorded in their notes.
Commonly, due to shortage of staffing, some care home records are written up at the end of a long day. Therefore, it is quite possible for staff to mix up entries and put them in the wrong resident’s record, or perhaps just guess an estimated time that a resident was repositioned, if remembered at all.
If you are not there to monitor your relative on a regular basis, then they may sustain injuries, have incontinence accidents, develop pressure sores, suffer malnutrition, lose weight, not be given their medication on time or at all, develop behavioural problems etc., which you would not necessarily know about, unless the care homes have notified you of these incidents.
Therefore, it is vital that you regularly review your relative’s care home records to check that they are up to date and contain an accurate record of all your relative’s daily care needs.
Poor care home records are likely to result in a poor outcome at any assessment for NHS Continuing Healthcare Funding or any reassessment or appeal. If the healthcare needs aren’t recorded, then you may face an uphill struggle to convince the Clinical Commissioning Group, or any later Appeal Panel that your relative’s needs are indeed far more intense, complex and unpredictable than what is stated in the records in black and white.
You will need to monitor and review your relative’s records to check for any changes in their daily healthcare needs. If they have a long term condition, then unfortunately, their health is likely to deteriorate rather than improve, as time goes by. Those changes need to be recorded, as it may be the trigger point that entitles your relative to CHC Funding.
You are entitled to see all your relative’s care home records at any stage, and we suggest that you do so regularly. The care home cannot object, and if they do, it should raise alarm bells and give you even more determination to go and inspect them regularly.
If you visit your relative frequently at the care home, then due to familiarity, there may not be any issue in allowing you to view your relative’s records. If you meet with resistance, quote Paragraph 79 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (October 2018) which states that you can have access to these confidential records if a ‘best interests’ decision needs to be made.
“79. Where a ‘best interests’ decision needs to be made, the ‘decision-maker’ must take into account the views of any relevant third party who has a genuine interest in the individual’s welfare (if it is reasonable and practicable to consult them). This will normally include family and friends. The decision-maker should be mindful of the need to respect confidentiality and should not share personal information with third parties unless it is considered in the best interests of the individual for the purposes of the NHS Continuing Healthcare assessment of eligibility. Where the individual has made an ‘advanced statement’ to the effect that they do not want personal information shared with specific individuals, this should be taken into account in assessing the individual’s best interests.”
However, for compliance with Data Protection legislation, most care homes will now insist on seeing prior legal authority before allowing you to review this personal data. A Lasting Power of Attorney will suffice as appropriate legal authority for the care home to release your relative’s records to you.
If, however, your relative has mental capacity but has not yet made a Lasting Power of Attorney for their Health and Welfare or Property and Finances, then they should attend to this immediately. We recommend they do not delay in putting the wheels in motion, otherwise you may lose control over crucial decisions and will need to apply to the Court of Protection for a Deputyship Order, which can be time consuming and expensive. In the meantime, any decisions about your relative’s health care needs or their finances may have to be put on hold, or worse, put in the hands of a third party to make important decisions acting in their ‘best interests’.
Here’s a selection of other helpful blogs for further reading around the subject:
- June’s feature on flawed CHC assessments and the importance of good record keeping
- Why you should consider making Lasting Power of Attorney or a Will
- Focus: Falling at the care home
- Understanding the four key indicators
- BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare
- New to NHS Continuing Healthcare Funding? Here’s a guide to the basics you need to know…
- Preparing for the Multi-Disciplinary Team Assessment
- The dangers of pressure sores, pressure ulcers and bed sores
- Do you need legal capacity to assist your relative’s claim for NHS funding? Arguing “BEST INTERESTS”
If you’ve experienced problems in getting hold of your relative’s care home records leave a comment below and tell others how you overcame the problem.