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Continuing Health Care Appeals
If you are currently going through a CHC appeal or a Continuing Health Care appeal, Nellie is here to help. Our team of registered and qualified social workers are experts in navigating the appeals process and can provide you with comprehensive support every step of the way. Trust Nellie to provide you with the highest quality care for your continuing health care appeal.
How can we help with continuing health care funding?
Nellie Supports can help you every step of the way
Your Questions Answered
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What do we charge?
Our continuing health care appeal service works on a no-win no-fee basis, so you only pay if you win ensuring an affordable, risk free continuing health care appeal service, if you are just lookign for support with the continuing health care process, such as support at a DST meeting, we can still help with our set fee services.
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What is Continuing Health Care (CHC)
NHS Continuing Healthcare funding is available to adults living in England who have particularly intense, complex or unpredictable care needs. Unlike local authority funding, it is not means tested. NHS Continuing Healthcare is a fully-funded package of care that some people are entitled to receive as a result of disability, accident or illness. It covers the full cost of the person’s care and residential accommodation.
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Continuing Health Care Checklist
The NHS continuing healthcare checklist is a practical guide that assists professionals to accurately identify individuals who may be eligible for NHS continuing healthcare funding. This assessment tool can provide valuable insights in multiple scenarios and can be used to determine if an individual should progress to further assessment of eligibility.
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Decision Support Tool Meeeting (DST)
After a positive CHC Checklist, a comprehensive continuing healthcare assessment will take place in the form of a DST meeting. This doesn't guarantee that the individual will receive funding, but it is the next necessary step in the process of identifying whether a person is eligible for NHS funding. Normally a decision will be reached at the end of the DST meeting.
The Local Integrated care Board (previously CCG) will assign a nurse to organise the assessment and solicit contributions from other health and social care professionals. The nurse and their teammates (the multidisciplinary team) will analyse all of the evidence regarding the patient's wellness needs by utilising a Decision Support Tool (DST).
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CHC Appeals
The Local Integrated care Board (previously CCG) decision can be appealed within six months of receiving the notification letter. After that, the Local Integrated care Board has three months to appraise and finalise the local review phase. This process can sometimes take up to a year, but the exact duration depends on geographical location. After that, you have another six months from the time of being notified to request a review via an Independent Review Panel (IRP). Once your request is received, NHS England must convene this IRP within three months. Three decision makers will work together to decide on the outcome - an independent Chair along with one health and social care professional not associated with the original Local Integrated care Board who made the decision.
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Why Choose Nellie?
Nellie Supports are different to other providers; as Registered Qualified Social Workers, our team can not only support you through the entire process, they can complete their own independent assessments to feed in as evidence to DST meetings and CHC Appeals.
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Whats included?
It depends on each individual; if you are querying whether someone could meet the thresholds for Continuing Health Care funding, then our team can complete a care assessment and checklist to ascertain the viability of a funding application. If you have been rejected, we can collate information and complete new assessments to support you in an appeal. Everyone is an individual, and every approach we take is unique.
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Why a Social Worker?
Whether in a hospital setting, the community or a care home, as part of a continuing health care application is a DST Meeting (decision support tool); this meeting is attended by a Nurse assessor and a Social Worker. As such, we utilise the experiential knowledge of our Social Workers to ensure that whether it is support at a DST or with completing a Continuing Health Care Appeal, this knowledge and experience is invaluable. Additionally, as registered Social Workers, our team are able to collate not only evidence from social and health providers but also complete independent assessments themselves to use as additional evidence.
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Can we complete video-link or face to face assessments?
We can visit you in your own home or any other suitable space you feel most comfortable and at a time of your choosing. In those instances where face-to-face assessments aren't viable, we offer a fully secure video-link assessment service.
Accreditations
Social Work England is a specialist body taking a new approach to regulating social workers in their vital roles. All of our Social Workers are registered with Social Work England for your peace of mind.
Our assessors are accredited Montreal Cognitive Assessment (MoCA) assessors with specific experience in completing capacity assessments and specialist reports.
All of our assessors have undergone extra training to become accredited financial vulnerability experts according to Lichtenberg standards, so they can provide even more detailed reports on mental capacity.
CASE STUDY
Anne's mother, Dianne, had been living in a care home for the past five years after being diagnosed with Alzheimer's dementia. Anne's condition had become progressively worse over the past several years, and for the past three years, she had been aggressive towards care staff, suffered from double incontinence and had severe bouts of depression.
Anne's local authority social worker completed a continuing healthcare checklist and identified that Dianne met the criteria for a decision support tool (DST) meeting, howver this never happened. When Anne contacted the social work team to chase this up, she was advised they were waiting for an appointment date to come through.
Two years later and Dianne was still self-funding her care, and no DST had taken place.
Dianne contacted our team, who completed their own full adult social care needs assessment and a speculative CHC Checklist. With this evidence, contact was made with Dianne's local authority and local Integrated Care Board, and a DST date was organised along with representation from the local authority.
Dianne and Anne were represented at the DST by our Social Worker, and a successful agreement that Dianne's care would be funded was reached; however, that wasn't quite the end of the story.
Our Social Work team was able to make an appeal on behalf of Anne and Dianne to apply for the funding to be back-dated, resulting in nearly two years of care fees being repaid to Dianne.
Frequently Asked Questions
What is the success rate of CHC appeals?
The success rate of CHC appeals can vary depending on the specific case and circumstances. However, it is important to note that appealing a CHC decision can be a complex and lengthy process. It is recommended to seek the advice of a legal professional or a CHC specialist to assist with the appeals process. Additionally, providing thorough and compelling evidence to support the appeal can increase the likelihood of a successful outcome.
How long does a capacity assessment take?
Obtaining NHS Continuing Healthcare can be a challenging process as it requires an individual to meet certain criteria and be assessed accordingly. The intensity, frequency, and unpredictability of each care domain are evaluated, and the individual is graded based on these factors. The ratings range from no needs to priority for each criterion. Therefore, it is essential to understand the criteria and requirements thoroughly and prepare accordingly to increase the chances of being eligible for NHS Continuing Healthcare.
What is the maximum CHC funding?
The maximum amount of funding available through CHC (Continuing Healthcare) varies depending on the individual's needs and circumstances. There is no set limit on the amount of funding that can be provided, as each case is assessed on a case-by-case basis. However, it is important to note that CHC funding is only available to those individuals who have been assessed as having a primary health need. It is recommended to seek the advice of a healthcare professional or a CHC specialist to determine the funding options available for your specific situation.
Is NHC continuing health care funding means tested?
Unlike local authority funding, NHS Continuing Healthcare (NHS CHC) funding isn't means tested. This means that an individual's financial circumstances won't affect their eligibility for NHS CHC. Instead, eligibility is based solely on meeting the criteria and requirements for the program. Understanding these criteria and preparing accordingly can increase the chances of being eligible for this valuable program.
What is the scoring for CHC?
The CHC (Continuing Healthcare) is scored by evaluating the individual against a range of criteria and grading them accordingly based on the intensity, frequency, and unpredictability of each of the criteria or 'care domains.' The possible ratings are no needs, low, moderate, high, severe, or priority for each criterion.
What is a primary health care need?
A primary health need for NHS Continuing Healthcare (NHS CHC) refers to an individual's significant and ongoing healthcare needs. It includes care that can only be provided by a registered nurse or doctor, as well as care that is required throughout the day and night. To be eligible for NHS CHC funding, an individual must have a primary health need and meet other criteria and requirements of the program.