The process of applying for Continuing Healthcare can be a confusing one, so we have outlined the various stations of the process below.
NHS Continuing Care funding is a form of funding provided to meet the personal care costs for an individual, regardless of their setting, be it in a nursing home, residential home or still living at home. It should be noted that NHS Continuing Healthcare is not in any way, shape or form means tested.
How Do I Apply for NHS Continuing Care Funding?
The process for applying for NHS Continuing Healthcare Funding will largely depend upon the location in which the individual requiring the assessment is living. This can often be in the hospital awaiting discharge, living at home with full-time care, or in a nursing or residential home. We shall attempt to address each aspect in turn in this article:
Where the Patient is Still in Hospital
Section 2 (2) of the Community Care (delayed discharges etc.) Act 2003 states that when a patient is in a hospital setting, the hospital is responsible for ensuring all reasonable steps are taken for a full assessment for NHS Continuing Healthcare Funding is carried out prior to discharge where it is the case that it appears the patient has a need for such care. Unfortunately, in our experience, this is often something that does not occur. Assumptions may be made that where a patient has been in a nursing home, suffers an episode that requires hospital admission, and is then due to be discharged back to the nursing home that these obligations by health services to undertake an assessment for Continuing Healthcare are not required.
This is obviously incorrect as it may well have been the case that the patient did not require or meet the criteria for NHS Continuing Healthcare Funding prior to their hospital admission but their health needs have increased such that they have a primary health need at the point of discharge. This would then make them eligible for NHS continuing healthcare funding. We would, therefore, suggest that the family involved in the discharge of the patient from hospital take steps to inform the discharge team that an assessment for Continuing Healthcare funding has taken place, or shall take place, prior to discharge from the hospital.
When Residing in a Nursing Home
In order to be classified as a nursing home, the home must be registered as such and will be required to have registered nursing staff and social care professionals on hand who are employed by the home. It is often the case that when an individual is living in a nursing home, possibly long term, that the local Clinical Commissioning Group will request that the initial assessment for Continuing Healthcare Funding is completed by the registered nurse employed by the home. Please be aware that this, however, is not always the case and many the Department of Health’s Clinical Commissioning Groups employ Nurse Assessors specifically for the task of undertaking assessments of patients for continuing healthcare funding.
As a first point of contact we would always suggest that individuals approach the Clinical Commissioning Group directly, whatever the setting of the patient as the National Framework for Continuing Healthcare Funding makes it clear that the responsibility for coordinating and arranging the assessment for Continuing Healthcare Funding falls to the responsible commissioner and local authority, namely the Clinical Commissioning Group in which the patient resides.
The factual position set out within the National Framework and the practical application is the same, however, unfortunately often differ and despite the fact that the rules are set out in black and white within the Framework for NHS continuing healthcare, many Clinical Commissioning Groups do not follow the same and seek to avoid their responsibility for completing the assessment process.
When Residing in a Residential Home
As set out above, the first port of call should be to contact the local Clinical Commissioning Group directly. When in a residential home it is unlikely that the home will employ registered nurses and as such the ability for a nurse to undertake the assessment is not the same as it would be if the patient were living in a nursing home. If the patient has a social worker involved in their care planning and package of care, then this would be a secondary point of contact that could be made to request a checklist assessment is undertaken for continuing healthcare funding. As a fall-back position, if the patient is under the treatment plan of the local District Nursing Team then they would be in a position to undertake a Continuing Healthcare Funding checklist assessment to be used as an initial screening too. Finally, it may be the case that the individual’s General Practitioner would be willing to complete an assessment of the initial phases of Continuing Healthcare Funding.
When the Patient Lives at Home
The assessment process will follow largely the same pattern as would be the case if the patient was in a residential home. It is unlikely that they will have full-time nursing care and support from a Registered General Nurse and therefore such an individual would not be available to complete the initial screening assessment.
We would advise as before and, in all health and social care instances, that patients initially contact the local Clinical Commissioning Group and insist that they undertake the assessment. However, if this is met with resistance then the options as set out for securing an assessment when an individual resides in a residential home should be pursued. Once again, this would be to contact the individual’s General Practitioner, and/or Social Worker or a member of the District Nursing Team if they are being treated or involved with any of the above.
The Assessment Process Itself
The initial assessment for any individual wishing to be considered for eligibility for NHS Continuing Healthcare Funding is first to be assessed via a Continuing Healthcare Funding checklist assessment. This is intended as a screening tool with a low bar of eligibility to satisfy. The full process for entitlement to Continuing Healthcare Funding is a two-stage assessment process. The first step is for a Continuing Healthcare Funding checklist to be undertaken. This article has set out the basics to go about requesting a checklist assessment dependant on the setting of the patient.
Only if an individual passes a checklist assessment will they be referred for a full multi-disciplinary assessment undertaken on a Decision Support Tool document. This is the second stage of the assessment process.
In order to pass a checklist, an individual must have either two or more A’s, 1 A and 4 B’s, or 5 B’s within the 11 areas of consideration. In addition, an individual who has an A in the domain of Behaviour, Breathing or Altered States of Consciousness will automatically require a full assessment for Continuing Healthcare Funding irrespective of what the other scores within the checklist assessment are. By way of a working example an individual could have 1 A for Behaviour and score C in all other areas, and they will still require a full Decision Support Tool assessment undertaken by a multi-disciplinary team.
If you have any questions regarding Continuing Healthcare Funding and the entitlement to the assessment process, or indeed any queries relating to Continuing Healthcare Funding you should not hesitate to contact a member of the Compass CHC team for a free, no obligation discussion.
Author: Tim Davies LLB