Nurse Judy's introduction to care records and NHS continuing healthcare

Nurse Judy’s introduction to care records and NHS continuing healthcare

Before joining Moore & Tibbits two years ago, I was a Nurse Assessor, dealing with NHS continuing healthcare assessments and appeals.

The move from assessing patients, to supporting and advising clients about the continuing healthcare process has been an eye opening experience.  Whilst I knew that this assessment is often stressful for families, I was surprised at just how confusing the whole process seems when you are (often unexpectedly) launched into the health and social care maze.

Whilst the law governing eligibility for continuing healthcare funding hasn’t changed, actually getting the funding, in these cash strapped times, seems harder than ever.  This isn’t helped by the many ‘myths’ surrounding the funding…"I was told Dad wouldn’t get it because he doesn’t use a hoist"……."We were told by the care home that Mum would not be eligible because she doesn’t have challenging behaviour"……"My Aunt cannot get CHC because she still lives at home"…It’s not surprising that many people get put off before they start.

During my initial meetings with clients, I always advise, whether they decide to instruct us or not, that they familiarise themselves with the process and ‘jargon’ of NHS continuing healthcare.  A key part of this is acknowledging the importance of care records as central to understanding someone’s care needs; and that is often the nub of the issue – the quality of those records can affect whether someone is found eligible or not for CHC and mean the difference of thousands of pounds per week in care fees.

It is vital that family members attending the CHC assessment familiarise themselves with their relative’s care needs.  This can be done by attending regular care plan review meetings and reading through the care records.  Do not be afraid to ask questions and be an active participant in the process.  I advise many clients to keep their own diary of visits with their loved one, and to compare notes with the care provider to ensure that all the individual’s needs are being met.

There are three main elements to the care records:

Care plan

The care plan is a picture of an individual’s care needs at a particular time. 

It sets these needs out under specific health and social care areas that are broadly similar to the domains used in the continuing healthcare process

It is usually reviewed and updated by care staff on a monthly basis, and includes a range of risk assessments such as:

  • Falls risk assessment
  • MUST (malnutrition / nutrition)
  • Waterlow (skin monitoring)

Other professionals such as speech and language therapists and mental health teams can provide support and advice that is then incorporated into the care plan, and their involvement will be recorded in correspondence and a record of professional visits.

Daily Records

These provide a record of how the care plan is implemented on a day to day basis.  One of the biggest areas of concern is that these notes often do not provide sufficient details about an individual’s level of care.  It is not uncommon to see entries such as “has been fine today” or “had their usual day” – if your loved one’s daily records are full of comments similar to these it is highly unlikely they will be found eligible for continuing healthcare funding.

If someone has very specific needs, for example in relation to challenging behaviours or continence, it is vital that comprehensive information is recorded by care staff about the level of support they need to provide.  Remember, someone is only eligible for continuing healthcare funding if they have a ‘primary health need’ which is above and beyond what the local authority can be reasonably expected to provide.

MARS sheet

This is a record of the medication someone needs, when it was given and whether or not they accepted it.  Some medications are prescribed to be used at the discretion of care staff (commonly referred to as PRN) and when they should be given will be addressed in the care plan.  Where an individual refuses medication, and they lack mental capacity around that refusal, there may be a covert medication policy in place, allowing staff to give the medication without that person being aware – for example in a yoghurt.

Evidence used at the continuing healthcare assessment does not need to be the equivalent of ‘War and Peace’, but it should be pertinent and include the length of time taken to manage needs and the outcomes of the strategies employed by care staff.

If you are not sure what to look for, need further information or would like to book a consultation, please do get in touch so that I can support you to achieve the best result for you and your family.

01926 491181 or email:

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