Here’s a comment posted by Emma regarding CHC Funding in reply to one of our previous blogs, which is typical of the frustration felt by many families going through the assessment process.
“Today I came out of an NHS Continuing Healthcare (CHC) Checklist meeting for my mother, with the next stage being the Decision Support Tool meeting. The assessor states she believes my mum’s care needs are social care…. which I find so hard to accept. In summary, my mum has been in a nursing home since she had a stroke back in 2014, losing her ability to use or move her right side. Unable to stand or weight bear, all aspects of personal care need to be completed for her. Severely cognitively impaired (says yes to everything!) she can’t even point to a picture if she wants a drink. EVERYTHING has to be anticipated for her. Double incontinent, changed 5 times a day. She has to be washed and changed twice a night. She’s unable to communicate her wants or needs or if she’s feeling poorly. Epilepsy (last seizure over a year ago) diabetic (insulin required). Starting to show signs of pressure sores. Recently diagnosed with dysphasia and now at risk of aspiration. The staff and the level of care she receives is fantastic. I’m basically looking for a bit of guidance or pointers, does this sound like social care??? Am I wasting my time trying to get funding? Thanks in advance.”
Thank you Emma for sharing your experience with us.
In answer to your situation – no, you are not wasting your time!
Our advice: firstly, don’t get disheartened and do not give up if faced with such comments!
But why is this scenario so common amongst our readers and those seeking NHS Continuing Healthcare Funding (CHC) for their relative?
Yes, it is very hard to accept such disparaging comments when your relative presents with multiple healthcare needs across various Care Domains – as in Emma’s situation above. Particularly so, as you are going to be emotionally invested in trying to secure CHC Funding. As in Emma’s case, it can be hugely frustrating to hear a CCG assessor say that your relative won’t qualify for CHC because her needs are ‘social’ needs, not ‘healthcare’ needs.
Understanding the difference is critical to success: Social needs are provided by the Local Authority and are subject to means-testing. So, if you have capital or assets in excess of £23,250, you may have to pay for all your relative’s care needs.
NHS Continuing Healthcare Funding is free funded care provided by the NHS irrespective of your financial position.
For more in-depth reading, look at our blog: Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…
You know your relative better than anyone, may see them daily and are best placed to see their challenging behaviours and limitations. Yet an NHS assessor comes along at an appointed day and time to make an ‘on the spot’ assessment of their healthcare needs. The outcome of such a relatively brief assessment is invariably likely to be negative, leaving you feel down and disheartened – often left trying to fathom out how ill your relative has to be, to be eligible for CHC Funding. There is a common misconception that an individual has to be ‘at death’s door’ to get CHC. That’s simply incorrect! For more information, read our blog: This month’s top 5 questions are answered…
You are then left in disbelief, having to understand the CCG’s refusal to grant CHC Funding, and justify why your relative’s needs are more than just social needs and qualify as healthcare needs.
Such a negative outcome may cause some families to give up. Perhaps, because they just accept the CCG’s decision to refuse CHC as being correct, sacrosanct and beyond reproach. After all, you have tried, given it your best shot, but the NHS have said, “No” – so, you may decide that is the end of the line and there is nothing more you can achieve.
Others may want to challenge the decision, thinking it perverse, and totally contrary to their relative’s healthcare needs – but may lack the physical and mental stamina to continue the fight, or else lack the wherewithal to even know where to start an appeal!
Others, who do appeal, face an uphill lengthy battle against the CCG to get the outcome overturned.
If you are told that your relative’s needs are social needs and you genuinely disagree on good grounds, you must argue your case and appeal. An award of CHC could save your relative paying a fortune in care home fees – hence why the CCG may try and put you off claiming, by perhaps suggesting that their needs are social needs.
Read our blog: What to say when denied NHS Continuing Healthcare where you will find more tips relating to the appeals process. You can, of course, make it clear you’re going to appeal – and then you’ll need to challenge (in writing) all the mistakes made during the assessment process. You’ll find several articles on the appeal process here.
Of course, every case depends on its own particular facts, but some of the health needs mentioned in Emma’s scenario above will seem all too familiar. Yet some individuals may get CHC Funding, and others may be declined on the same facts. The chance of funding varies according to the area you live in.
Share your experiences below if a CCG have made comments similar to those made to Emma, and let others know how you responded.