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! If the patient is assessed as having a primary health need then the NHS should fund their continuing healthcare. Both care homes and in-home care can use the funds. CHC funding is not means tested and covers 100% of the care costs.
Contact us to start the process or read below to find out more first.
There are lots of people and firms that offer assistance with CHC claims but the process is not a legal process – it is clinical. Decisions about CHC are based on the opinion of a multi-disciplinary (nursing and others) team. Therefore, the assistance should be clinician led or heavily supported. As nurses, we understand the nursing issues and when discussing with fellow clinicians (such as decision panels) we therefore have creditability and share an understanding.
Scott Lister is a practising registered nurse and a (currently non-practising) solicitor. Scott is the lead clinician at Apex Health Associates – a niche practice of nursing (and CHC) experts.
The Process
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care outlines the full process. For ease here is a breakdown of the process:
Identification Stage: where a patient or an individual is considered and assessed for CHC funding. This is obviously a crucial stage and patients are missed. If you think either you or someone you care for are eligible then get in contact with us. If there is any doubt of eligibility, a checklist (stage 2) will be completed – it does not take long!
Checklist Stage: a ‘NHS Continuing Healthcare Checklist’ is completed by a trained member of staff (usually a nurse or social worker). There are 12 sections that need to be scored. The scores are then totted up and if the required scores are achieved then a full assessment will 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 (Clinical 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. Allowing the full assessment to be circumvented and funding awarded. That 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 clinicians. The team will assess the individual against the criteria in the National Framework. The DST form will allow the clinicians to document the needs of the individual. Then, once this assessment is done, the team will consider whether the identified needs 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, clinically assess an individual patient and 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.
If you wish to start the process, email us today at info@apexhealth.net or call us on 0203 633 2213.
Scott Lister
Head of Practice
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