Continuing Care – The Recommendation
Having gone through the 11 named domains and the mop up clause of domain 12, the next part to consider is the recommendation. As individuals or advocates, we are not involved in this part, it is for the Multi Disciplinary Team (MDT) to decide on the recommendation. Their recommendation should be supported by the Panel unless there are clear and articulated reasons for doing so. Those reasons must of course be fair and reasonable.
So how is the recommendation done? The MDT must then, metaphorically speaking, piece the person back together, having taken them apart with the 12 domains. The MDT then looks at the “Nature, Complexity, Intensity and Unpredictability” of the individual.
The advocate can discuss the recommendation with the MDT, but often the MDT won’t give a recommendation at the assessment meeting, often because they are not recommending funding and don’t want to risk a confrontation in front of the family. If they are recommending, then they might say it in front of family, but lack of discussion about their decision should not be taken as not recommending.
The nature of the needs is often about one or two conditions and the range of needs as a consequence. So for example, dementia might be the condition and from that comes confusion, poor communication, poor risk assessment, poor continence etc. Nature, unless it is an unusual condition is not usually the element that will be most important.
Complexity is often about how different elements of someone’s condition interact with each other. So for example, if someone has poor mobility and therefore struggles to get up to go to the loo, they can end up with a UTI due to reluctance to drink. The UTI, like chest infections, can set up a kind of toxicity in the body, which then leads to that person being overall physically and mentally very unwell during the period of the UTI (or chest infection).
Intensity is about a high level of need, this is often because that particular need has scored high or severe in the various domains. It is about a lot of need, so someone underweight would need constant encouragement to eat. Encouraging someone to eat is not necessarily a high skill task, but needs to be done many times during the day. It could however require a high skill level such as specialised wound dressing of the skin, which needs regular changing. It can take quite a while to do a complex dressing, which might need changing every few days, but not multiple times per day.
Unpredictability is what it means in normal language. So if someone has a fluctuating health condition, then it would be unpredictable. It could also be something that reoccurs regularly, like having lots of UTIs or chest infections.
It is hard to explain in simple terms why someone should be funded for Continuing Care and others aren’t, but it is about the persons needs being difficult to look after. That doesn’t mean that the person is difficult (although they might be), it is that their healthcare conditions are difficult to look after. Someone with regular, but fluctuating aggressive behaviour might be difficult, but someone with a complex skin care regime would not be seen as difficult, just difficult to look after, they need a lot of time and skill.
I’ve found that the most important one of these is unpredictability and the least important is nature, with complexity and intensity someone in the middle. But if the person is challenging to look after, then hopefully that is sufficient to get a recommendation.
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