The Decision Support Tool (DST) is used extensively by multi-disciplinary teams to assess if there is a ‘primary health need’ for CHC funding.
The DST is an extended document with some level of complexity, so users of the DST will need guidance in how best to complete it effectively.
In this article we look at completion of the DST in relation to specialist seating needs, and how best to document this.
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What is a DST checklist?
The DST is a document template used nationwide by clinical teams to assess if applicants qualify for Continuing Healthcare funding. The purpose of this template is to provide consistency in the eligibility process for CHC funding.
It should be completed by a multidisciplinary team of healthcare workers, which consists of at least two different healthcare professionals.
The DST checklist, as referred to this in this article, is a list of 12 health domains in the DST tool that are assessed in detail, to establish whether the individual has a primary health need. Each of these criteria are assessed in relation to their nature/intensity/complexity/unpredictability.
The 12 care domains are:
- Breathing
- Nutrition
- Continence
- Skin and Tissue Viability
- Mobility
- Communication
- Psychological
- Cognition
- Behaviour
- Drug therapies
- Altered states of consciousness
- Other significant care needs.
Detailed descriptions for each section are important to show whether they meet any of the four characteristics (nature/intensity/complexity/unpredictability). Each section is subdivided into no needs (N), low (L), moderate (M), high (H), severe (S) or priority (P) levels of need, depending on the domain.
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Why specialist seating needs must be properly documented
Some of the 12 care domains are clearly impacted by specialist seating. Because of the nature of specialist seating and its ability to meet complex needs, particularly with care chairs, this provision can highlight the intensity and complexity of someone’s health needs.
Seating can impact on several clinical areas, whether this is posture, pressure care, mobility, or cognition.
Posture and pressure care are closely linked, and are key facets to get right with specialist seating. People with postural deformities or higher pressure needs will have more intense and complex needs under the “Skin and Tissue Viability” section.
It may be assumed that specialist seating is a one-off fix and therefore removes the ‘ongoing need’ required to qualify for CHC funding. However, even if the person’s needs are well-managed with specialist seating, they are still ongoing needs and still count towards funding in this way. In the case of specialist seating, specific knowledge and training is needed to operate the seating in accordance with their care plan.
Key considerations when writing seating evidence for the DST checklist
When filling out the CHC DST, here are some useful tips to help make your application as compelling as possible.
Use of clinical language aligned to the DST
Using clinical language aligned to the DST will strengthen your application and demonstrate your knowledge of the funding criteria.
Take care with the use of terminology, for instance a condition that could be described as ‘severe’ may not necessarily be classified in the severe level of a care domain. Check the domain level descriptors to see which level fits most closely with their needs.
Specificity is essential
It is easy to include generic statements like ‘the client needs constant support’ and ‘the client has many long-term care needs’. However, being as specific as possible (i.e. what type of support/what long-term conditions) will make your application more convincing and more likely to be successful.
Aligning specialist seating with the DST checklist
As mentioned already, different sub-sections of the checklist align closely with specialist seating needs. Here are some of the key sections of the checklist to highlight the client’s seating considerations and features needed:
Mobility
The right seating should enable activities, rather than becoming the therapeutic activity itself. Minimal physical effort should be needed to stand from the chair and transfer safely, and reduce the risk of falls while doing so. This is where the use of standaids or hoists may be needed in conjunction with the chair.
Skin integrity
Pressure relief is a prime consideration with seating, and attention should be paid to the pressure relief, cushioning and tilt-in-space function in the chair.
Behaviour
Poor seating can cause agitation and distress in an individual, particularly if they have cognitive difficulties. Minimising stress and pain with therapeutic seating can improve how individuals react to their condition and improve participation with others.
Nutrition
Supportive seating aligns the body posture, and with the help of supportive backrest and head supports, makes it easier to swallow and digest food.
To research these areas in more depth, download our 88-page seating assessments ebook, packed with clinical guidance about the importance of specialist seating.
Download Our Seating Assessment Ebook
Common documentation pitfalls
When completing the DST documentation, be aware of these common pitfalls and ways to avoid them.
Underestimating well-managed needs
Just because a need is already well-managed, it doesn’t mean it is not an ongoing and significant need.
Poorly recorded daily evidence
Accurately recording times and details of care provided by all carers and staff throughout the day presents a more watertight case.
Lack of cross-referencing
Showing how care domains interact and impact each other can strengthen the application.
How we can help support the DST checklist
We have lots of seating assessment resources to help with completing the DST tool, such as justification templates and assessment reports.
We are here as a partner to support your family or client in this complex process. Reach out for a no-obligation assessment or joint visit for free, independent seating advice in your DST meeting.
For more guidance on filling in the DST tool, follow this guidance from NHS Continuing Healthcare.
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Ralph has many years' experience in the healthcare sector. In a previous life he worked in finance, and his spreadsheet skills come in handy for all the analysis and research he does as he investigates topics and solutions for some of the world's most complex healthcare conditions and challenges. Aside from writing in-depth articles and organising webinars and interviews with top healthcare professionals, Ralph also administrates Vivid's "Healthcare Pioneers Board", a large group of healthcare specialists with multiple disciplines, who are working together to improve care for years to come.
