Understanding Care Services: NHS Continuing Health Care

What Is NHS Continuing Health Care?

In England, NHS Continuing Health Care (NHSCHC) is care funded by the NHS. It is available for people aged 18 and above and is provided to meet physical or mental health care needs that have arisen through disability, accident or illness. NHSCHC is care that takes place away from a hospital. Care can be provided in your home or in residential accommodation.

Who Qualifies for NHS Continuing Health Care?

You will qualify for NHSCHC if you are assessed as having a primary health need. The NHS Choices website provides a very unhelpful circular definition of this. A primary health need, it is explained, is one that is on-going and substantial and is related to your health. An assessment will take into account the nature and complexity of your needs; the intensity and severity of your needs, and the unpredictability of your needs.

How Do You Get NHS Continuing Health Care?

In short, you need to be assessed. The assessment is carried out by a multidisciplinary NHS team. There is no right to an assessment, but if it seems that you might need NHSCHC then the Clinical Commissioning Group (CCG) for your area must carry out an assessment.

The fact that you have a long term medical condition is not, of itself, a qualification for NHSCHC. However, the following circumstances are likely to suggest that an assessment is appropriate. 1. Where  you are due to be discharged from hospital and you have long term needs, 2 Where a period of intermediate care has come to an end, 3. Where your health declines significantly, 4. Where you are approaching the end of your life, 5. Where you reside in a nursing home and your health care needs are under review and 6. Where your health and social care needs are being assessed as part of a community care assessment.

In most circumstances, there is a two stage assessment process. The first stage is an initial assessment. The purpose of this is to decide if you need a full assessment. The initial assessment may be completed by a doctor, social worker or other health care professional.

The full assessment is carried out by two or more health and/or care professionals. The assessment looks at the following criteria: behaviour, cognition (understanding), communication, psychological/emotional needs, mobility, nutrition (food and drink), continence, skin (including wounds and ulcers), breathing, symptom control through drug therapies and medication, altered states of consciousness, other significant needs.

Each of those criteria (or domains) is assessed on the following scale: no needs, low needs, moderate needs, high needs, severe needs or priority needs. The criteria in bold are assessed, on the full scale, from low through to priority. The criteria in italics are assessed from low to severe. The remainder are assessed from low through to high.

You will be eligible for NHSCHC if one or more criteria are assessed at the priority level or two or more criteria are assessed as severe. You may also be eligible if one criteria is assessed as severe and you have needs assessed in a number or other criteria or a number of criteria are assessed as high and/or moderate.

A two stage assessment is obviously a little time consuming. It can take 28 days from the initial assessment to determine you eligibility by way of a full assessment. Clearly in some cases this is far too slow. There is, therefore, a fast track procedure that can be used where your condition is worsening and/or you are terminally ill.

What Is the Cost of NHS Continuing Health Care?

There is no cost to you if you qualify for NHSCHC.

Who Provides NHS Continuing Health Care Services?

NHSCHC services can be provided by any number of health professionals including physiotherapists, occupational therapists, speech therapists and domiciliary carers. When you are assessed as being eligible for NHSCHC, you will be allocated a personal health budget. This is an amount of money that is used to support the needs that you have. It is similar to the personal budgets allocated by social services to support social care needs.

Just as with a social care personal budget, you can ask for your personal health budget to be paid to you in the form of a direct payment. A direct payment puts you in control of choosing who supplies your services. You don’t have to do this. You may, however, enjoy the freedom and choice that direct payments give you. You can find out more about personal health budgets and direct payments on this page.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Understanding Care Services: Intermediate Care

What Is Intermediate Care?

Intermediate care covers a range of short term care services including reablement. You can find out more about reablement by going to my article here. Intermediate care is short term support. It can last for a period of up to six weeks. It may, in certain circumstances, be extended beyond that six weeks’ period. Intermediate care is one part of an overall care package provided to you.

What Is the Purpose of Intermediate Care?

Intermediate care aims to keep you living in your home independently for as long as possible. By providing you with the right support you may be able to:

avoid having to go into residential accommodation

avoid having to be admitted to hospital,

be supported on discharge from hospital

recover more quickly from illness

Who Qualifies for Intermediate Care?

Intermediate care is an option for any adult who may benefit from it. An adult is anyone aged 18 or over. The aim of intermediate care is to help you to maintain, or regain, your independence to continue, or return to, living in your home. Therefore, you are likely to be offered intermediate care in the following circumstances.

To help you avoid admission to hospital. For example, you have a fall at home, with the right, timely support, it may be possible for you to avoid the need to be admitted into hospital

To support your discharge from hospital. If you have had a stay on an acute hospital ward you may need a little help to regain your confidence and skills to continue living independently at home. Intermediate care can allow this support to be provided in your home upon your discharge from hospital or in a rehabilitation home (sometimes known as bed-based accommodation) prior to your moving back into your home.

Before you move into long term residential care. Typically, intermediate care is offered as a stepping stone between hospital discharge and admission to long term residential care.

To support people who you have dementia or other mental health needs. In these circumstances, avoiding hospital admission in the first place is the ideal. If this is not possible, timely discharge should be the aim. Intermediate care may be available to support either of these goals.

End of life care. People who are being cared for at home during their last days may have the quality of their lives enhanced by some simple adaptations. This could involve, for example, helping carers learn different ways of doing things. In such circumstances, intermediate care may be available.

How Do You Get Intermediate Care?

In the ideal world, you would be automatically referred for intermediate care if ever you found yourself in one of circumstances outlined in the previous section. However, the world is not ideal and it may well be the case that you will need to prompt a health care professional to refer you to the intermediate care team. Suitable health care professionals to prompt might be your GP, a district nurse, the discharge team in a hospital, staff attending to you on an A&E ward, paramedics attending at your home or an out of hours GP. Alternatively you may refer yourself.

Once a referral has been made you will require an assessment from the intermediate care team. The contact details of Thanet’s intermediate care team are:

Westbrook Integrated Care Centre 
150 Canterbury Road 
Margate 
Kent
CT9 5DD

Telephone: 01843 254134

The East Kent Intermediate Care Team’s website address is: http://www.kentcht.nhs.uk/home/our-services/intermediate-care-east-kent/?entryid109=228837

What Is the Cost of Intermediate Care?

Intermediate care is free for up to six weeks. It may in certain circumstances be extended beyond this period.

What Does Intermediate Care Involve?

There are four types of intermediate care.

The first type is referred to as crisis response intermediate care. This is very short term care – usually for a period of up to 48 hours. A health care professional will make a referral to a crisis response team who can rapidly ensure that you receive an assessment and receive the support you need. The support can be provided in your home or in residential accommodation.

The second type of support available is called home-based intermediate care. So called for the simple reason that the support is provided in your home.

The third type is known as bed-based intermediate care. This involves support provided in a setting away from your home – for example in a residential home.

The final type is reablement. The approach underpinning reablement is aimed at helping you to live your life independently. Reablement workers are not charged with the responsibility of doing things for you; they are responsible for helping you become confident and competent in doing things for yourself. You can find out more about reablement by going to my article here.

Who Provides Intermediate Care Services?

There are many health and social work professionals who may be involved in supporting your intermediate care needs. These professionals include: doctors, nurses, occupational therapists, social workers and care and support workers.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Understanding Care Services: Reablement

What Is Reablement?

Reablement is a service offered to you to help you regain or maintain your independence and thus continue living safely in your home. Typically, it is offered to you after you have spent a period of time in hospital or where you are recovering from injury or illness.

The approach underpinning reablement is aimed at helping you to live your life independently. Reablement workers are not charged with the responsibility of doing things for you; they are responsible for helping you become confident and competent in doing things for yourself. Therefore, reablement workers should not be coming into your home to cook a meal for you; they should come in to help you learn or relearn the skills to do this for yourself.

What Is the Purpose of Reablement?

If things go well everyone benefits from reablement. You gain the skills and confidence to continue living in your home independently. You may still need home care from a home care provider; however, there is evidence to suggest that this is at a much lower level than it might otherwise have been.

Who Qualifies for Reablement?

This varies from area to area. The aim is to provide reablement services to people who will benefit from it. It is Local Authorities who oversee reablement and, as with all types of health and social care, there are limited resources available to provide the service. Some hard decisions will have to be made, therefore.

If you live in Kent, reablement is called enablement. You can find out more about what is available from Kent Social Services here and here.

How Do You Get Reablement?

The first step is to get yourself referred to the Local Authority. In Kent you can make a referral yourself; for more information go to this page. You will then need to have an assessment. The purpose of the assessment is to determine what help you need to be able to continue living your life in your home as safely and independently as possible for as long as possible.

What Is the Cost of Reablement?

Reablement is free for a period of up to six weeks. This is the case even if you normally have to pay wholly or partly for care that you are receiving. In certain circumstances, reablement may continue beyond the period of six weeks.

What Does Reablement Involve?

Everyone who has reablement is different; therefore, the detail of the service you receive will be tailored to your needs. There are, however, some common features of enablement.

The aim is always to help you regain your confidence by learning or relearning important skills to help you live independently for as long as possible. There should be a reablement plan in place that both you and your reablement workers are working to. This plan will include goals for you to aim for. These goals could include such things as walking up and down stairs and/or preparing a meal.

Who Provides Reablement Services?

It is local authorities that run the service. They may sometimes be run in conjunction with NHS Continuing Care. Local Authorities may have their own reablement workers. Alternatively, Local Authorities may use private suppliers to provide the services. It is probably that other health professionals, like occupational therapists and physiotherapists, may be involved with your reablement service. You are entitled to sort out your own enablement provider.

Whilst you are receiving reablement support, social services should be working with you to determine the care you will need when reablement finishes. Such other people as your carers and family should be involved in this planning also.

If you would like any further advice about reablement or any aspects of domiciliary care, please contact me on the telephone number or at the email address below.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.