Case Studies

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Continuing Care Case Studies
To be used for training
These four case studies are designed to assist
practitioners to understand better the
application of the National Framework for NHS
Continuing Healthcare. The case studies are
fictitious and images are taken from the NHS
Image Library.
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Case study 1 Richard
Richard is a 75 year old gentleman with a
diagnosis of advanced Parkinsons disease. He
lives at home with his wife who has been his main
carer. He has recently had a deterioration in
his condition, which has significantly affected
his ability to verbally communicate. He is
currently in-patient in an acute hospital and has
just been assessed for NHS Funded Continuing
Healthcare.
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Richard discussion
The care domains of psychological/emotional
needs, mobility, nutrition, continence, breathing
and drug therapies evidence unpredictable and
intense care needs requiring skilled nursing
intervention. The type of needs (nature)
described effect every aspect of care required
throughout a twenty four hour period and requires
regular daily monitoring and review by a skilled
carer to manage the identified risks. This is
demonstrated with one severe weighting on the
drug therapy domain and with the other five
domains having a high weighting.
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Discussion (2)
The Parkinson disease process also gives rise to
unpredictable and variable needs depending on the
relative rigidity of his limbs and whether he is
the frozen state or not. The patients disease
process is now advanced and his needs are now
unpredictable and unstable throughout the twenty
four hour period. His carer needs to interpret
his fluctuating needs, manage and readjust
medication and positioning throughout the day to
reduce further risks to his health. Richard is
judged to have met the criteria for NHS Funded
Continuing Healthcare at this time.
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Case study 2 Stephen
Stephen was diagnosed with Aspergers syndrome in
childhood. He was admitted to a mental health
inpatient unit 18 months ago following a serious
assault on his mother, with whom he shared the
family home. He had become known to adult
psychiatric services the previous year, following
episodes of aggressive behaviour towards his
mother, precipitated by auditory
hallucinations. He is being assessed to see
whether he is eligible for NHS Continuing
Healthcare.
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Stephen findings
Three care domains - behaviour,
psychological/emotional needs and drug therapies
and medication - show evidence of unpredictable
and intense care needs requiring skilled
intervention. The type of needs (nature)
described affect some aspects of the care
required throughout a 24-hour period. Stephen
requires close supervision by skilled carers to
manage the identified risks. This is demonstrated
with a severe weighting in the behaviour
domain, and a high weighting in the
psychological/emotional needs and drug therapies
and medication domains.
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Further considerations
In making their recommendation decision about
eligibility, assessors should be mindful of the
guidance that the decision-making rationale
should not marginalise a need because it is
successfully managed well-managed needs are
still needs. Only where the successful management
of a healthcare need has permanently reduced or
removed an ongoing need will this have a bearing
on NHS Continuing Healthcare eligibility. In
Stephens case, there are significant risks
associated with the transition from inpatient
care to a community setting. Stephen has met the
criteria for NHS Continuing Healthcare. Like all
cases, this will need to be carefully considered
at the first review (within three months).
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Case study 3 Rebecca
Rebecca is a 24-year-old woman with autistic
spectrum disorder, epilepsy with occasional
seizures, and tuberous sclerosis. She has
profound communication delay and displays some
challenging behaviour. She is being assessed for
eligibility for NHS Continuing Healthcare.
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Rebeccafindings
The care domains of behaviour, cognition,
communication and drug therapies and medication
reveal evidence a degree of unpredictability
requiring skilled intervention. The
interventions required to meet Rebeccas needs
are undoubtedly necessary and crucial to her
wellbeing. However, they are not sufficiently
complex (in terms of the skill needed to manage
the totality of care needs), nor sufficiently
intense in their character, to lead to a
judgement that Rebecca has a primary need for
healthcare.
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Case Study 4
Mary Smith
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Mary - discussion

• The care domains of psychological/emotional
  needs, mobility, nutrition, communication, skin
  and drug therapies evidence unpredictable and
  intense care needs requiring skilled nursing
  intervention.
• The type of needs (nature) described affect every
  aspect of care required throughout a 24-hour
  period, and require regular daily monitoring and
  review by a skilled carer to manage the
  identified risks. This is demonstrated with the
  six domains having a high weighting.
• The Parkinson disease process also gives rise to
  unpredictable and variable needs. Her disease
  process is now advanced and her needs are
  unpredictable and unstable throughout the 24-hour
  period.
• Marys leg ulcers, incontinence, nutritional
  status and poor mobility mean she is at risk of
  further deterioration if these problems are not
  managed. To reduce further risks, her carer needs
  to interpret her fluctuating needs, and manage
  and readjust her medication and positioning
  throughout the day.
• Mary is judged to be eligible for NHS Continuing
  Healthcare at this time.