Continuing Care Assessment
Posted: 05 Jul 2014, 15:30For those carers who are not familiar with the above, I think a brief introduction is necessary.
However, I must point out before I start that, what follows, is only my interpretation of the rules and guidelines surrounding the assessment and not the interpretation that you may put on it or, indeed, the interpretation that the assessors will allocate to it.
I shall finish this piece with an observation on the assessment of my wife Jean who is now approaching the 14th year of Alzheimers disease and is totally cared for by myself.
The assessment uses lots of invented jargon which can be confusing and upsetting for those not prepared. So let’s have a look at some of the jargon:-
Continuing Care Assessment (CCA).
An assessment of an individuals health and social care needs and their desired outcomes.
Decision Support Tool (hereafter known as DST).
The purpose of the DST is to support the application of a National Framework. National Framework of what I have no idea and seem unable to find any further reference in the documentation supplied to me as to what it is and where to find it.
A little further on in the guidelines for the assessment it does mention that it is the National Framework for NHS Continuing Healthcare.
Multidisciplinary Team (hereafter known as the MDT)
These are the people who ask the questions and tick the boxes in each of the 11 or 12:-
Care Domains.
These are the 11 or 12 different areas relating to the patient which are to be assessed. Each of the domains is broken down into levels which are carefully described. However these levels are mainly, if not always, subjective, open to interpretation by the carer and amongst the MDT’s carrying out the assessment.
The carer has his or her work cut out to ensure that the level selected by the
MDT’s at least matches the actual facts.
Primary Care Trusts (PCT’s).
The Authorities which oversee and allocate resources on behalf of the NHS.
Local Authorities (LA).
[/u
]Need no real explanation in that they are supposed to send your allocated Social Worker to attend the Assessment.
[u]Other jargon too complicated to explain:-
Single Assessement Process (Sap), Common Assessment Framework (CAF) and Care Programme Approach (CPA), End of Life Care Strategy (ELCS).
I found the jargon above in the first 11 pages of the DST guidelines supplied to me. There are 35 paragraphs describing the details of the CCA and how it should be carried out by the MDT.
There are some significant paragraphs within the guidelines which are worth a mention:-
Summary (Page 3, paragraph vi, line 1)
“ MDT’s are then asked to make a recommendation as to whether the individual should be entitled to NHS continuing care.”
I take this as a sharp reminder that they are in charge!!!
Process (Page 9, Paragraph 22, Line 7)
[/u
]“If, after considering all the relevant evidence, it proves difficult to decide or agree on the level, the MDT should choose the higher of the levels under consideration and record the evidence in relation to both the decision and any significant differences of opinion.”
I see this as a chance both to argue the allocated level at the time of that assessment and to use this, if necessary, for any appeals process I may wish to take up at a later stage.
[u]Process (Page 9, Paragraph 25, Line 4)
“……. the domain levels selected should be based on current needs but the likely change in needs should be recorded in the evidence box for that domain and taken into account in the recommendation made.”
I believe it is up to the carer to gather evidence before the assessment to be able to highlight the likely future deterioration of the patient but don’t forget there may be changes for the better.
Process (Page 10, Paragraph 29, Line 1)
[/u
]“ Needs should not be marginalised because they are successfully managed. Well-managed needs are still needs”.
e.g. My wife’s consumption of medication is well managed. Without a carers intervention the medication would not be taken.
[u]Observation.
CCA -Supposed to be carried out yearly. The one prior to this one was January 2012. Indicative of the parlous state of the Social Services framework in my area.
All previous CCA’s have been carried out by MDT’s that know Jean and have known her since the onset of the disease. The MDT usually comprised of the Early Onset Alzheimers Community Team Leader and our Local Authority designated Social Worker.
The latest assessment was carried by 2 practising nurses and a social worker. None of these have ever met Jean or myself and have had no contact with Early Onset Team or our designated Social Worker.
Following conversations and phoning I had enough evidence to more than suggest that the MDT’s allocated on this occasion formed part of a ‘hit squad’ with the sole purpose of reducing Jean’s Independent Living Allowance Budget!!!
I advised my original MDT’s of the case and the Team Leader for Alzheimers agreed to attend to put her viewpoints forwards. On the day before the assessment I rang to ensure that she would attend and to discuss some points so that we were singing from the same hymn sheet, only to find that she was hospitalised due to a significant accident and that no one was available to take her place.
Effectively, you are on your own lad. This sent me running for the assessment guidelines, a look at the Mental Health Capacity Act and any other thing I could get hold off to help.
On the day of the assessment I was subjected to an interrogation which lasted for 3 hours and 10 minutes. Every minute detail of the 12 Care Domains was picked over and all, save one, was upgraded.
At the end of the assessment I was totally worn out and told the MDT in no uncertain terms that, after they had gone, I would decline into a depression for a short while.
The problem being that all the Assessment was about what Jean cannot do and nothing about what she can do.
I am not in denial about what Jean’s condition is nor what the prognosis is but to have to discuss it for over 3 hours brings it home like a kick up the bum.
On top of that, there were times when I felt vibes from the MDT that made me wonder if I was doing the right things for Jean.
Finally, the fact that they do not know or have contact with Jean was made very clear by some of the downright stupid questions they asked at times and by some of the care suggestions that they proposed.
I sincerely hope that you will find this post informative and maybe even helpful.
However, I must point out before I start that, what follows, is only my interpretation of the rules and guidelines surrounding the assessment and not the interpretation that you may put on it or, indeed, the interpretation that the assessors will allocate to it.
I shall finish this piece with an observation on the assessment of my wife Jean who is now approaching the 14th year of Alzheimers disease and is totally cared for by myself.
The assessment uses lots of invented jargon which can be confusing and upsetting for those not prepared. So let’s have a look at some of the jargon:-
Continuing Care Assessment (CCA).
An assessment of an individuals health and social care needs and their desired outcomes.
Decision Support Tool (hereafter known as DST).
The purpose of the DST is to support the application of a National Framework. National Framework of what I have no idea and seem unable to find any further reference in the documentation supplied to me as to what it is and where to find it.
A little further on in the guidelines for the assessment it does mention that it is the National Framework for NHS Continuing Healthcare.
Multidisciplinary Team (hereafter known as the MDT)
These are the people who ask the questions and tick the boxes in each of the 11 or 12:-
Care Domains.
These are the 11 or 12 different areas relating to the patient which are to be assessed. Each of the domains is broken down into levels which are carefully described. However these levels are mainly, if not always, subjective, open to interpretation by the carer and amongst the MDT’s carrying out the assessment.
The carer has his or her work cut out to ensure that the level selected by the
MDT’s at least matches the actual facts.
Primary Care Trusts (PCT’s).
The Authorities which oversee and allocate resources on behalf of the NHS.
Local Authorities (LA).
[/u
]Need no real explanation in that they are supposed to send your allocated Social Worker to attend the Assessment.
[u]Other jargon too complicated to explain:-
Single Assessement Process (Sap), Common Assessment Framework (CAF) and Care Programme Approach (CPA), End of Life Care Strategy (ELCS).
I found the jargon above in the first 11 pages of the DST guidelines supplied to me. There are 35 paragraphs describing the details of the CCA and how it should be carried out by the MDT.
There are some significant paragraphs within the guidelines which are worth a mention:-
Summary (Page 3, paragraph vi, line 1)
“ MDT’s are then asked to make a recommendation as to whether the individual should be entitled to NHS continuing care.”
I take this as a sharp reminder that they are in charge!!!
Process (Page 9, Paragraph 22, Line 7)
[/u
]“If, after considering all the relevant evidence, it proves difficult to decide or agree on the level, the MDT should choose the higher of the levels under consideration and record the evidence in relation to both the decision and any significant differences of opinion.”
I see this as a chance both to argue the allocated level at the time of that assessment and to use this, if necessary, for any appeals process I may wish to take up at a later stage.
[u]Process (Page 9, Paragraph 25, Line 4)
“……. the domain levels selected should be based on current needs but the likely change in needs should be recorded in the evidence box for that domain and taken into account in the recommendation made.”
I believe it is up to the carer to gather evidence before the assessment to be able to highlight the likely future deterioration of the patient but don’t forget there may be changes for the better.
Process (Page 10, Paragraph 29, Line 1)
[/u
]“ Needs should not be marginalised because they are successfully managed. Well-managed needs are still needs”.
e.g. My wife’s consumption of medication is well managed. Without a carers intervention the medication would not be taken.
[u]Observation.
CCA -Supposed to be carried out yearly. The one prior to this one was January 2012. Indicative of the parlous state of the Social Services framework in my area.
All previous CCA’s have been carried out by MDT’s that know Jean and have known her since the onset of the disease. The MDT usually comprised of the Early Onset Alzheimers Community Team Leader and our Local Authority designated Social Worker.
The latest assessment was carried by 2 practising nurses and a social worker. None of these have ever met Jean or myself and have had no contact with Early Onset Team or our designated Social Worker.
Following conversations and phoning I had enough evidence to more than suggest that the MDT’s allocated on this occasion formed part of a ‘hit squad’ with the sole purpose of reducing Jean’s Independent Living Allowance Budget!!!
I advised my original MDT’s of the case and the Team Leader for Alzheimers agreed to attend to put her viewpoints forwards. On the day before the assessment I rang to ensure that she would attend and to discuss some points so that we were singing from the same hymn sheet, only to find that she was hospitalised due to a significant accident and that no one was available to take her place.
Effectively, you are on your own lad. This sent me running for the assessment guidelines, a look at the Mental Health Capacity Act and any other thing I could get hold off to help.
On the day of the assessment I was subjected to an interrogation which lasted for 3 hours and 10 minutes. Every minute detail of the 12 Care Domains was picked over and all, save one, was upgraded.
At the end of the assessment I was totally worn out and told the MDT in no uncertain terms that, after they had gone, I would decline into a depression for a short while.
The problem being that all the Assessment was about what Jean cannot do and nothing about what she can do.
I am not in denial about what Jean’s condition is nor what the prognosis is but to have to discuss it for over 3 hours brings it home like a kick up the bum.
On top of that, there were times when I felt vibes from the MDT that made me wonder if I was doing the right things for Jean.
Finally, the fact that they do not know or have contact with Jean was made very clear by some of the downright stupid questions they asked at times and by some of the care suggestions that they proposed.
I sincerely hope that you will find this post informative and maybe even helpful.