Nursing and care home fees can be extremely expensive. Some of our nurses have practised in nursing homes charging as much as £1500 per week! CHC funding is arranged by the NHS and provided to those who are assessed as having a primary health need. CHC funding can pay for care in people’s own homes as well as care homes or hospices. CHC funding is not means tested and covers 100% of the care costs.
In a Nutshell
There are lots of people and firms that offer assistance with CHC claims. But the process is not a legal process – it is a clinical process.
Decisions are made about CHC based on the opinion of multi-disciplinary (nursing and others) team members. Accordingly, we recommend any support provided to those seeking assistance is clinician lead or heavily supported by nurses such as ourselves. As nurses we understand the specific medical issues that lawyers can't and when discussing with fellow clinicians (such as decision panels) we know what we are talking about - first hand.
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The process is set out in a document called the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. A copy of this document can be found here.
Identification Stage: this step is the identification that a patient or an individual should be considered and assessed for CHC funding. This is obviously a crucial stage and patients are missed. If there is any doubt then a checklist (stage 2) should be completed – it does not take long!
Checklist Stage: following identification a ‘NHS Continuing Healthcare Checklist’ should be completed by a competent member of staff (usually a nurse or social worker) who is both skilled and trained in its completion. There are 12 domains or areas of need that are looked at and assessed – each need being given a scoring. The scores within the checklist are totted up and if the required scores are achieved then a full assessment should be carried out.
The checklist should be completed prior to discharge (from hospital/secondary care) into a nursing home or social care. The local CCG (Clintical Commissioning Group) is responsible for conducting the assessment if the individual is within their own home or a nursing home.
Fast Track Assessment: A process is available for those patients who are approaching the end of their life. This process allows for the full assessment to be circumvented and funding awarded. The process is set out within the Framework and we are often asked to assist and/or advise.
MDT Assessment: Decision Support Tool ‘DST’ Stage: if, during the checklist stage, sufficient scores are awarded then a DST document should be carried out by a multi-disciplinary team of clinicans.
The team will assess the individual against the criteria in the National Framework. The DST form guides the clinicians through a series of domains and the assessed needs of the individual are documented.
Then, once this assessment is done the team will then consider whether the identified needs as a whole result in sufficient nature, intensity, complexity and unpredictability.
A conclusion will be drawn and a decision made as to whether funding should be allocated or not.
Decision Panel Stage: The MDT assessment (the DST process) will be presented to ‘Panel’ who will decide funding having taken into account the MST assessment.
We help and assist with the initial application for CHC funding. We attend and clinically assess an individual patient. We present our clinical opinions and contribute to assessment meetings.
If the panels do not find in the favour of the patient, and, following assessment we feel that the decision is wrong, we assist and lead an appeal.
Head of Practice