Case studies & success stories
Independent Assessment Success Story
We helped with
Independent Assessment
This week’s success story is one of perseverance and, ultimately, negligence by a very well-known provider.
The family came to us after an application for CHC funding had been rejected by the Integrated Care Board ICB). The patient was in receipt of 24-hour 1:1 care, which the home had insisted was required due to the risks posed by his challenging behaviours. When the patient was found not eligible for CHC funding, the family was faced with a monthly bill of over £10,000. When they refused to pay, the home tried to evict the patient, but no alternative placement could be found, even with the assistance of a specialist agency. The family was stuck between a rock and a hard place.
We conducted an independent assessment for CHC funding and recommended the decision be appealed. Our review of the care home’s records revealed shocking omissions and a clear failing to evidence the need for 1:1 care, which is why the application for CHC funding had been turned down. Whenever this highly restrictive level of care is required, the care provider must demonstrate why it is needed – through 10-minute observation charts – and must demonstrate its attempts to find an alternative solution – through detailed behaviour monitoring charts or “ABCs” (Antecedent, Behaviour, Consequence). In this case, the home had not even bothered to document incidents of assault so serious the police had been called.
Despite these failings on the part of the care provider, we were able to pull together sufficient evidence from its inadequate records, the Mental Health Team and the family to demonstrate clearly the severity of the risks posed by the behaviour, and the need for 24-hour 1:1 care. At Local Resolution appeal, the ICB overturned the decision of ineligibility and agreed to reimburse almost two years’ care fees, and to fund the placement going forward.
A genuine need for 24-hour 1:1 care should ALWAYS lead to a finding of eligibility for CHC funding on the grounds of nature and intensity, as it far exceeds the lawful remit of the Local Authority. However, in our experience, many families find themselves being asked to foot the extortionate bill for these fees, usually because the care provider has failed to demonstrate why this level of care is needed.
Is your relative being charged for 1:1 care unnecessarily? Contact us today for advice on 0161 272 5222 or 0800 011 4136 or get in touch via at farleydwek.com if you need help with your CHC case.