Will a care home apply for Continuing Healthcare on our behalf?

Published 22/03/2017

Please note: This article was published prior to July 2022, and some information may be outdated.

NHS Continuing Healthcare funding assessment process – should you leave it to a care home to start this?

Many people ask this, and here are some tips to help you:

Let’s suppose your relative needs to go into a care home. They may currently be in hospital or perhaps still at home.

You know about NHS Continuing Healthcare funding, and the care home has also mentioned it.

But will the care home be proactive in securing that funding for your relative?

The first thing to find out is whether the home has already had people who’ve been funded through NHS Continuing Healthcare. If they have, the Continuing Healthcare team at the CCG can’t argue that the home is too expensive for such funding.

However, it’s vital that you as the family are proactive in pushing for NHS Continuing Healthcare – don’t leave it to the care home.

There are several reasons for this:

No one knows your relative like you do – and you are (generally) best placed to make sure all their care needs are taken into account and that the NHS Continuing Healthcare understand the full picture of needs and risks.

If your relative is new to the care home, the staff may not have had a chance to really understand the ins and outs of your relative’s needs.

Never assume that a care home will have solely your interests at heart. A care home is (more often than not) a commercial business. They get paid through care fees, and they will – naturally – want to secure good revenue from each resident/room. The care home will be paid less through NHS Continuing Healthcare funding than they will if your relative pays as a ‘self-funder’.

There are many conflicts of interest when it comes to NHS Continuing Healthcare.

If the care home does offer to help, make sure you are fully involved and that you, as your relative’s representative, are the main point of contact for the Continuing Healthcare team.

Staff in care homes may not understand much about NHS Continuing Healthcare, and we hear many stories where contributions from staff have been damaging to a person’s funding case.

If your relative is not yet in the care home, the care home won’t yet have any daily care notes. So make sure you get to see the hospital notes and/or any other care needs reports and assessments that will be used for the NHS Continuing Healthcare assessment – and highlight anything that’s not right or that plays down your relative’s needs.

It’s also very typical for a care home to want to show that they’re providing good care, and that there are no problems with a person’s care, and that there are no risks – because, of course, risks could (potentially) reflect badly on the home. BUT it’s always the underlying needs that should be assessed – so a care home has no reason to feel ‘on trial’ in an NHS Continuing Healthcare assessment, and yet many seem to feel it’s an assessment of their ability to provide care – which of course it isn’t!

It’s not unusual for a member of care home staff sitting in an NHS Continuing Healthcare assessment meeting to say things about your relative such as: “He’s fine. There’s no problem. We don’t have to do anything outside the usual routine.” etc. – and yet the assessment isn’t about whether or not care is ‘routine’ – instead it’s about your relative’s individual day-to-day needs, as if no care were in place. An example that can help illustrate this is an Intensive Care Unit (ICU): The care that is delivered in an ICU is probably ‘routine’ for an ICU, and yet the day-to-day care needs of the patients in an ICU are huge.

It’s important to add that there are some exemplary care homes, who will support you throughout the Continuing Healthcare assessment process. It always good to hear reports like that. A good care home that is on your side can be invaluable.

Unfortunately, we also receive reports from families that indicate some care homes may actually try to sabotage the process.

So if your relative is going into a care home or starting to receive care from a care provider, make sure you (as the family) are proactive in pursuing NHS Continuing Healthcare funding on their behalf.

Tagged Categories: Care fees, Care homes and hospitals, CHC funding, NHS Continuing Healthcare

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10 Comments

mike January 15, 2018 at 6:47 am

Hi – I’m not sure if this is the right place to ask a question but if someone could point me in right direction please. My father has been in a care home for over a year self-funding. He has Parkinson’s and behaviour issues mainly relating to dementia. Still being properly diagnosed and he’s having a mental assessment. The care home has served him with notice as he was found late at night naked in another residents room. Lots of confusion ensued and the police were called. They said its common and nothing further would happen, however the home have said he now needs one to one care 24 hours which is going to cost a whopping £3360 a week and we must move him. They supposedly now can’t cope with his behaviour. The home have applied for an NHS Continuing Healthcare (CHC) assesment which we are awaiting and they think he needs a scan. His front loba area is deteriorating. However if we move him will to obvoiusly more affordable and suitable home will this impede the CHC process and how can the home justify such a large amount of money? It will just mean the pots empty very rapid and then council will have to pick up tab. He has a Deprivation Of Liberty Safeguard and it seems they have a nurse outside his room but there’s a pressure pad to alert them also. Any info would be appreciated as i’m not sure where to turn.

Chris-G May 25, 2017 at 4:04 pm

After a brain injury and both legs amputated, two amputations of an already amputated left leg, the development of liver cancer and skin problems as a result, and epilepsy, and several hospital and intensive care stays in addition, the local CCG did not once ensure that a Checklist was done at the hospital. The hospital did not do such things either, they just assumed that 'he would be more comfortable' in his nursing home bed. This of course, took no account of who would be paying for the bed. Having been banned from any and all communications with the Commissioning Support Unit (CSU), I was forced to utilise the 'skills' of a senior manager at the CCG. They variously told us that the hospital was liaising with the CSU to arrange assessments or that they had ensured that the CSU was acting. It was all lies. Then after almost a year........ They blamed the care home for not carrying out Checklists after each and every discharge from hospital...... So yes apparently, a nursing/care home can and indeed should carry out Checklists after every hospital discharge or upon first arrival at their home. Otherwise, Continuing Healthcare funding attempts will not even be resumed, let alone started.

Penny Golledge May 26, 2017 at 6:31 am

This situation doesn't just effect the elderly, it also affects the young, disabled. After 6 years of struggling to fund my daughter's care because the Council have systematically discriminated, it has become increasingly clear there is a deliberate manipulation of the referral process into the community going on, within the hospitals. This is being perpetrated by certain individuals, to appease the CCG's and they are making their decisions based on Cost, not Patient Need. My daughter had a Stroke in 2011, she was just 26. She was never given an appropriate Care Plan, she didn't meet the criteria of some service providers, and she didn't fit into any category they wanted to fund. So the failure to provide her with appropriate Care, directly transferred all the 'costs' onto me as her Mother who was 'expected' to look after her. I had Breast Cancer in 2009/10, my daughter then had her Stroke in 2011, then my husband died of Oesophageal Cancer in 2013. The Councils and CCG seemed to have already decided my daughter was 'living with me' so I should foot the bills, and the Local Authority refused to apply for Continuing Healthcare (CHC) funding, saying my daughter did NOT have a Primary Health Need. I later discovered the commissioning of services laid heavily with the G.P. practice, I also learned the referral team had used my home Post Code to determine which 'CCG' would pay, when they should actually have used the G.P.'s Post Code. I am currently seeking legal advice. Despite my daughter's prognosis, acquired brain injury due to her stroke, medical history as a child and shortened life expectancy as a result, plus she had paralysis due to the stroke so was reliant on extensive Care Provision, CHC funding has not been offered, and in fact she has been systematically discriminated against instead. I discovered, thanks to this site, the Council and CCG have broken the Law on many counts, their assumptions and lack of medical knowledge have jeopardised my daughter's recovery. In fact many times they have blamed my daughter for NOT complying when their assessments make sure she 'doesn't' fit the remit.

Laurel Santos April 19, 2017 at 9:03 am

This is indeed helpful. Looking forward to more great posts from you.

Mavis Schindler April 17, 2017 at 11:14 am

My husband has been in a nursing home since February this year after a period in hospital over Christmas and New Year.
He has been paying full costs (less the 'nursing element'). He is a long-term diabetic requiring insulin daily. His blood sugars are very erratic and need regular monitoring throughout the day. He has dementia so is no longer able to manage his condition himself. As a result of the diabetes he has no vision in his right eye and 'tunnel' vision in his left. He also has deep wounds on his toes that require regular dressing and checking by a specialist podiatrist. His mobility is poor and he needs assistance to wash, dress and stand. and needs a wheelchair. He is now incontinent and can get very agitated. A Continuing Healthcare (CHC) Multi-Disciplinary Team (MDT) meeting was held recently in which I was fully involved. Despite having 4 high scores and 4 moderate it was decided that his health care needs were being adequately met under the current arrangement, and he would have to continue paying the 'social care' element of the costs of his care. I queried the result in view of the number of High scores and his health needs, but was told that it was probably a disappointing result for me, but I could appeal if I wished. I have now had written confirmation of the decision. I understood that the fact that health care needs are being met should not affect the assessment decision, which should be made on 'needs'. I am left wondering if I have sufficient grounds for an appeal? Has anyone else had a similar experience?

Linda Nelson March 23, 2017 at 10:17 pm

My mother was in a care home, which was registered for dementia/residential. She had a fall and was admitted to hospital, whereupon the care home said they would not have her back as she needed dementia/nursing care. Understandable, but the timing of me being told was cynical as it was the day payment for the next months fees had been paid by standing order and they said they would not reimburse us. Mum had already had an assessment for NHS continuing care with the manager present, who underplayed mum's needs. The social worker at the hospital was very supportive and we got an assessment for mum before she left hospital. The ward manager attended and told it as it was. She was awarded NHS Continuing Healthcare (CHC) funding. The new home that she went to told me what the NHS funding was - £700, although the fees were actually £900, but the home was not legally able to charge the family for the shortfall. Mum was in that home for three years and seven months. I feel that Care Homes do not want their clients to have NHS funding as they can get higher payments from people who are self funding.

David P. March 22, 2017 at 3:25 pm

We have just got fast track for our 92 year old mother with dementia, but after hours trying to find out who what where and when does this happen to no avail. We have just been told that the care home our mother is in will do whats required. Howeve,r we are already not happy with several issues with the care the home provides. Our impression was the NHS was to provide this care under the fast track award. Has any one else had this problem or can shed light on this issue?

SG March 22, 2017 at 3:25 pm

We [the family] applied for Continuing Healthcare for my father who was diagnosed with Parkinsons whilst in an NHS hospital. We failed in our attempt. We moved my father into a Care Home where his health deteriorated. One of the staff [an ex NHS nurse] took it on to apply for Continuing Healthcare on our behalf as soon as she felt he would qualify. The time came and she was successful and we benefited from the decision for 9 months before my father passed away. maybe we were lucky, but we were extremely grateful that this staff member took on the whole process on our behalf.

Christine Forrest March 22, 2017 at 3:24 pm

We are currently awaiting a decision from our CCG, on an appeal for CHC funding for our 92 year old mother. I received a note from this CCG when the appeal process began to say that should the appeals assessor need to request further health notes, then the appeal could take up to 40 days to resolve. Is this an acceptable time period? As we feel this CCG has used every delaying tactic possible to either slow up the process or hope we lose interest. Our original DST took place on 15th November last year and the CCG finally started the appeal on February 15th.