Recent success stories

 

Complex needs

Mr S’s late mother had previously been found eligible for CHC. However, the evidence clearly indicated this should have been for a much earlier period. Unfortunately it’s quite common for local health authorities to make a ‘compromise’ offer in the hope the applicant will accept it, thus enabling considerable saving against their CHC budgets. A retrospective application was made together with comprehensive written and verbal submissions that his mother’s needs were complex and intense, as she had been suffering not only from dementia but chronic pain from a degenerative spine and sadly developed a grade 4 pressure ulcer to her sacrum which in itself was indicative of poor care from her provider. Even though the DST scores did not illustrate a primary healthcare need, it was still possible to demonstrate eligibility in any one or more of the four key questions and in this case, it was clear that his mother did have complex and intense needs around pain management, nutrition and skin. The local health authority therefore agreed to backdate eligibility for an additional 12 months of nursing home fees.

Full reimbursement of 12 months nursing home fees.

Limited care records

Mrs F’s mother moved into a nursing home due to cognitive decline associated with likely undiagnosed dementia. Sadly, this affected her psychological and emotional state of health, resulting in her refusal to eat or drink very much which led to more than 10kg of weight loss over two months and social isolation. The care provider did not consider making an application for CHC. Based on review of limited care records, I completed a draft ‘Checklist’ and advised Mrs F that an application can and should be made in light of potential eligibility and helped prepare for the DST assessment. The multi-disciplinary team agreed that Mrs F’s mother not only qualified for CHC but she would be fast tracked for it as well.

Qualified on the first application and fast tracked for CHC.

Dementia behavioural challenges

Mrs C’s father was sectioned under the Mental Health Act due to his unpredictable aggressive behaviour and then, after a short period of care at his daughter’s purpose-built annex, had to go into a nursing home where he required 24-hour care and supervision until he passed away eight months later. However, he continued to display challenging behaviour and was assessed for CHC but found ineligible. His daughter made a local appeal which was unsuccessful and then asked for my help to prepare an appeal to the Independent Review Panel (IRP). On review of the care records and CCG paperwork, I submitted the CHC assessment had been flawed from the outset. The IRP remitted the case back to the CCG for another review and I made further written representation on behalf of his daughter. The CCG admitted that Mrs C’s father should have been eligible for CHC for the entire duration of his nursing home placement and further agreed to review his needs for an earlier period.

​CCG procedural errors. On review, eligible for CHC.

Dementia 1:1 care

Mr J complained to his mother’s CCG about their decision to deny eligibility. He received a letter from a director of the CCG advising him their decision stood because the “law was the law.”  Mr J noted with some irony the director had listed her qualifications which included a degree in law. On appeal I was able to demonstrate the directors learned opinion was wrong because his mother required extensive periods of 1:1 care to manage extreme anxiety and that sedation (via Lorazepam) was not always successful because she would often refuse to take it.  Medication had to be given covertly, adding complexity to an already intensive level of care. 

​CCG applied the law incorrectly. On review, eligible for CHC.