Round Table
We had the three month review. I think it went OK. I don't think there is any problem with the funding of continuing care, but we are still waiting to hear the decision on additional one to one care.
I had done as much advance preparation as I could.
Because Rosemarie had moved from one borough to another, responsibility was transferred to a new Community Mental Health Team. I met the new Psychiatric Nurse a few weeks ago when she took over, and she proved to be an enthusiastic, committed young woman who clearly had Rosemarie's interests at heart. We got on really well, and she insisted on coming to the review (I was about to ask her anyway). She managed to get the date changed to one she could make, and arranged to meet Rosemarie beforehand. She sat there reading all the notes and the care plan and announced at the end that it was clear Rosemarie needed more one to one care and she would push very hard for it.
I had a meeting with the Care Home Manager and the Care Manager to discuss how they were approaching it. They had a fine line to tread: they could not appear too well able to cope or they would not have demonstrated the need for another person, but at the same time they could not state that they are leaving Rosemarie at risk. They had to say (and show) that they are just about coping but it puts a great strain on the staff and adversely affects the general level of care they can give to other residents.
Rosemarie's recent enthusiasm for standing up, and the fact that she has had a few falls (not serious) when staff could not reach her in time is a timely justification.
I spoke with the representative of the CCG on the phone a few days beforehand and she seemed very pleasant and professional. I asked her what the appeals procedure was if we were dissatisfied with the decision. She said she didn't know and didn't think anybody had ever appealed. I let this hang for a few seconds and asked her if she could find out.
The meeting consisted of the representative from the CCG plus a trainee, the psychiatrist from the Community Mental Health Team, the Care Home Manager, the Care Manager, the duty nurse, my daughter and myself. We took over one of the lounges, and clustered like bees around a small round table.
The first part of the meeting consisted of reviewing the criteria listed in the Decision Support Tool Dr Evans had filled out all that time ago. Nothing had got better, some things had got worse: this was all pretty straightforward.
Then we came to the discussion about the one to one care and it was a bit like pushing at an open door. Everybody made their case clearly and the CCG representative noted it all down. I pointed out that for the last three months I had been effectively a part time care worker because I was there for several hours every day and that freed up a member of staff for other duties. I would be going back to work soon and that would put additional strain on the existing staff.
It appears that 24 hour one to one care is only funded in cases where there is the real threat of violence, and this obviously does not yet apply to Rosemarie. One to one care comes in 6, 12 or 24 hour blocks so the only option on offer was 12 hours. I made the point that the alternatives were providing the 12 hour one to one care or consigning her to her bed for an additional 6 hours a day - which was unacceptable for several reasons.
The CCG representative seemed to be swayed by the arguments but said the decision was not hers, but that she would put the recommendation forward. The meeting ended on a pleasantly positive note.
Of course it couldn't be that easy.
A couple of days later the Care Centre received an email saying the CCG needed evidence of the requirement. Why this wasn't brought up at the meeting I couldn't imagine. I checked that the Care Home were clear what 'evidence' the CCG was looking for and what form it would take. I was assured that everything was under control and the necessary documentation would be provided in the next couple of days.
I so much wanted to take charge of this but with a heroic effort of will I kept my mouth shut.
We are still waiting.
I had done as much advance preparation as I could.
Because Rosemarie had moved from one borough to another, responsibility was transferred to a new Community Mental Health Team. I met the new Psychiatric Nurse a few weeks ago when she took over, and she proved to be an enthusiastic, committed young woman who clearly had Rosemarie's interests at heart. We got on really well, and she insisted on coming to the review (I was about to ask her anyway). She managed to get the date changed to one she could make, and arranged to meet Rosemarie beforehand. She sat there reading all the notes and the care plan and announced at the end that it was clear Rosemarie needed more one to one care and she would push very hard for it.
I had a meeting with the Care Home Manager and the Care Manager to discuss how they were approaching it. They had a fine line to tread: they could not appear too well able to cope or they would not have demonstrated the need for another person, but at the same time they could not state that they are leaving Rosemarie at risk. They had to say (and show) that they are just about coping but it puts a great strain on the staff and adversely affects the general level of care they can give to other residents.
Rosemarie's recent enthusiasm for standing up, and the fact that she has had a few falls (not serious) when staff could not reach her in time is a timely justification.
I spoke with the representative of the CCG on the phone a few days beforehand and she seemed very pleasant and professional. I asked her what the appeals procedure was if we were dissatisfied with the decision. She said she didn't know and didn't think anybody had ever appealed. I let this hang for a few seconds and asked her if she could find out.
The meeting consisted of the representative from the CCG plus a trainee, the psychiatrist from the Community Mental Health Team, the Care Home Manager, the Care Manager, the duty nurse, my daughter and myself. We took over one of the lounges, and clustered like bees around a small round table.
The first part of the meeting consisted of reviewing the criteria listed in the Decision Support Tool Dr Evans had filled out all that time ago. Nothing had got better, some things had got worse: this was all pretty straightforward.
Then we came to the discussion about the one to one care and it was a bit like pushing at an open door. Everybody made their case clearly and the CCG representative noted it all down. I pointed out that for the last three months I had been effectively a part time care worker because I was there for several hours every day and that freed up a member of staff for other duties. I would be going back to work soon and that would put additional strain on the existing staff.
It appears that 24 hour one to one care is only funded in cases where there is the real threat of violence, and this obviously does not yet apply to Rosemarie. One to one care comes in 6, 12 or 24 hour blocks so the only option on offer was 12 hours. I made the point that the alternatives were providing the 12 hour one to one care or consigning her to her bed for an additional 6 hours a day - which was unacceptable for several reasons.
The CCG representative seemed to be swayed by the arguments but said the decision was not hers, but that she would put the recommendation forward. The meeting ended on a pleasantly positive note.
Of course it couldn't be that easy.
A couple of days later the Care Centre received an email saying the CCG needed evidence of the requirement. Why this wasn't brought up at the meeting I couldn't imagine. I checked that the Care Home were clear what 'evidence' the CCG was looking for and what form it would take. I was assured that everything was under control and the necessary documentation would be provided in the next couple of days.
I so much wanted to take charge of this but with a heroic effort of will I kept my mouth shut.
We are still waiting.
posted by Other Kosh at 8:06 pm
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