The Needs Assessment will count as the assessment for Continuing Health Care

The Decision Support Tool is about counting up 'levels of disability which will add up to eligibility for assessment - not for implementation that's a long way next.

Levels of assessment go from :- no need , through to low, medium, high, severe.

For example ....

Section 2. Care Domains ... there are twelve of these.
... behaviour,cognition,psychologicl/emotion,communication,mobility,nutrition,continence,skin integrity,breathing,drug/med/symptom control, altered consciousness, other significant care needs.

about the last ... twelth Domain - releavnt to schizophrenia.
76. In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here.
In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need
and to take that need into account (and record it in the 12th care domain) when deciding whether a person has a primary health need.

A full assessment for NHS continuing healthcare is required if there are: • two or more domains selected in column A; • five or more domains selected in column B, or one selected in A and four in B; or • one domain selected in column A in one of the boxes marked with an asterisk (i.e. those domains that carry a priority level in the Decision Support Tool), with any number of selections in the other two columns.
go to Check List tables

2. Behaviour ( mostly level of challenging behaviour )

3. Cognition

No evidence of impairment, confusion or disorientation.

..... no needs

Cognitive impairment (for example difficulties in retrieving short-term memory)
which requires some supervision, prompting or assistance with more complex activities of daily living,
such as finance and medication, but awareness of basic risks that affect their safety is evident.
OR
Occasional difficulty with memory and decisions/choices requiring support, prompting or assistance.
However, the individual has insight into their impairment.

...... low needs

Cognitive impairment (which may include some memory issues)
that requires some supervision, prompting and/or assistance with basic care needs and daily living activities.
Some awareness of needs and basic risks is evident.
The individual is usually able to make choices appropriate to needs with assistance.
However, the individual has limited ability even with supervision, prompting or assistance to make decisions about some aspects of their lives,
which consequently puts them at some risk of harm, neglect or health deterioration.

moderate needs

Cognitive impairment that could include marked short-term memory issues and maybe disorientation in time and place.
The individual has awareness of only a limited range of needs and basic risks.
Although they may be able to make choices appropriate to need on a limited range of issues
they are unable to do so on most issues, even with supervision, prompting or assistance.
The individual finds it difficult even with supervision, prompting or assistance to make decisions about key aspects of their lives,
which consequently puts them at high risk of harm, neglect or health deterioration.

High needs

Cognitive impairment that may include, in addition to any short-term memory issues, problems with long-term memory or severe disorientation.
The individual is unable to assess basic risks even with supervision, prompting or assistance,
and is dependent on others to anticipate even basic needs and to protect them from harm, neglect or health deterioration.

Severe needs

3. Psychological and Emotional Needs:
There should be evidence of considering psychological needs and their impact on the individual’s health and well-being.
Use this domain to record the individual’s psychological and emotional needs
and how they contribute to the overall care needs, noting the underlying causes.
Where the individual is unable to express their psychological/emotional needs (even with appropriate support)
due to the nature of their overall needs, this should be recorded
and a professional judgement made based on the overall evidence and knowledge of the individual.

1. Describe the actual needs of the individual, providing the evidence that informs the decision overleaf on which level is appropriate, including the frequency and intensity of need, unpredictability, deterioration and any instability. 2. Circle the assessed level overleaf.

Psychological and emotional needs are not having an impact on their health and well-being.

no needs

Mood disturbance, hallucinations or anxiety symptoms, or periods of distress,
which are having an impact on their health and/or well-being but respond to prompts and reassurance.
OR
Requires prompts to motivate self towards activity and to engage them in care planning, support, and/or daily activities.

low needs

Mood disturbance, hallucinations or anxiety symptoms, or periods of distress,
which do not readily respond to prompts and reassurance
and have an increasing impact on the individual’s health and/or well-being.
OR
Withdrawn from most attempts to engage them in care planning, support and/or daily activities.

Moderate needs

Mood disturbance, hallucinations or anxiety symptoms, or periods of distress,
that have a severe impact on the individual’s health and/or well-being.
OR
Withdrawn from any attempts to engage them in care planning, support and/or daily activities.

High Needs [ no ctegory of ... severe ... ]

Reaching a recommendation on whether the individual’s primary needs are health needs should include consideration of:

· Nature: This describes the particular characteristics of an individual’s needs (which can include physical, mental health, or psychological needs), and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.

· Intensity: This relates to both the extent (‘quantity’) and severity (degree) of the needs and the support required to meet them, including the need for sustained/ongoing care (‘continuity’).

· Complexity: This is concerned with how the needs present and interact to increase the skill needed to monitor the symptoms, treat the condition(s) and/or manage the care. This can arise with a single condition or can also include the presence of multiple conditions or the interactions between two or more conditions.

· Unpredictability: This describes the degree to which needs fluctuate, creating challenges in managing them. It also relates to the level of risk to the person’s health if adequate and timely care is not provided. Someone with an unpredictable healthcare need is likely to have either a fluctuating, or unstable or rapidly deteriorating condition.

Each of these characteristics may, in combination or alone,
demonstrate a primary health need, because of the quality and/or quantity of care required to meet the individual’s needs.

Also please indicate whether needs are expected to change (in terms of deterioration or improvement) before the case is next reviewed.
If so, please state why and what needs you think will be different and therefore
? whether you are recommending that eligibility should be agreed now or that an early review date should be set. Where there is no eligibility for NHS continuing healthcare and the assessment and care plan,
as agreed with the individual,
indicates the need for support in a care home setting, the team should indicate whether there is the need for registered nursing care
in the care home, giving a clear rationale based on the evidence above.