Am I eligible for NHS Continuing Healthcare? 5 questions...
One of the most frequent questions families ask on our blog is whether their relatives will be eligible for NHS Continuing Healthcare funding.
And yet it’s a question no one can answer – at least, not until the person needing care has actually been assessed for NHS Continuing Healthcare.
It is possible to hazard a guess about whether they should be eligible, but the only way to actually know is to be assessed.
What’s more, a Continuing Healthcare assessment is the first thing that should happen when a person needs care; means testing and being told to pay for care is strictly secondary to this.
If you’re asking yourself whether your relative is eligible for NHS Continuing Healthcare, answer these 5 questions first:
1. Does your relative have some health needs AND do they need care?
If the answer to this is yes, don’t pay a penny in care fees until they’ve been assessed for NHS Continuing Healthcare funding. This process starts with a ‘Checklist’ assessment. Here’s how to get the assessment process started.
2. Has anyone told you your relative ‘won’t qualify’ – before the Continuing Healthcare assessment process has even begun?
If so, ignore them. As we mention above, no one can tell you this until after your relative has actually been assessed. The person telling you that your relative won’t qualify may have a vested interest in trying to put you off.
3. Do people keep talking to you about ‘doing an assessment’, and yet you’re not sure what they actually mean?
They may be talking about a social care assessment – or perhaps a straight forward health assessment or some other kind of assessment. Not all ‘assessments’ relate directly to Continuing Healthcare. Read more here about different assessments and which one is relevant when.
4. Have you read the eligibility criteria for NHS Continuing Healthcare?
This is really important. You can find the links to the criteria in the main assessment forms here. You’ll see that there are two main stages to the Continuing Healthcare assessment process: an initial Checklist assessment and then a full multidisciplinary team (MDT) assessment.
You’ll also notice that there is a scoring system in both cases, i.e. a person will be given a score for the severity of their needs in relation to different aspects of their health and care.
However, the scores are not the only things that should guide an NHS Continuing Healthcare assessor in making a funding recommendation. Assessors must also:
- look at the whole picture of need and use competent professional judgement too, taking into account the nature of the care needs and how complex, intense and unpredictable they might be. (Note: A person does NOT have to have highly complex care needs to qualify for NHS Continuing Healthcare funding.)
- abide by the law and the principles established in the Coughlan case. The courts and the statutes made by Parliament about care funding and care fees always override any ‘guidance’ published about Continuing Healthcare. Examples include the ‘Standing Rules’ and the Care Act – and you’ll find links to those here.
Most importantly, however, the local authority has a vital role to play in the Continuing Healthcare process. The local authority must decide whether or not a person’s care needs falls within the local authority’s own legal remit for providing care.
If the person’s care needs fall within the local authority’s legal remit, the person will be means tested (this is actually voluntary), and if the person has sufficient means they will have to pay.
If the person’s care needs are beyond the local authority’s legal remit, the person should receive NHS Continuing Healthcare funding to cover ALL their assessed care needs.
Make sure you also read the national guidelines for Continuing Healthcare funding. These are called the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
5. Are you finding the divide between health care and social care needs confusing?
Although there is no definitive list of which care needs are social care and which are healthcare needs, the National Framework goes some way to defining each in broad terms. Read more here about the difference between a social care need and a healthcare need. Each person’s case should be looked at individually, and all care needs should be taken into account to determine whether a person is or isn’t eligible for NHS Continuing Healthcare funding.
28 further links to help you with care fees and NHS Continuing Healthcare funding
Thank you for all this information, I find it is so valuable as I’m still defending the case about my mother. When mother had her stroke, 24 September 2009, she went to a local hospital A&E dept. and then into the Stroke ward. On December 14 , she was moved to a local Community Hospital as my mother had settled but need medical care. On 30 March 2010, the financial department for the local county council came and asked about my mother’s bank accounts; and was she a home owner.
Then, on 09 April, I went to visit my mother on my way home, as I did every night. This day – WOW! The bed was empty – I panicked and found a nurse. I was then told that a social worker had arrived, my mother signed a release form and she was taken to a residential nursing home 12 miles away.
Mum had to start paying for her care now. I was told that she had to pay more money than she had in the bank, so I was forced to sell mum’s house. Cutting out other things, my mother was seen by an assessor on 22 July 2013 about CHC. That’s when it all went down hill. I was greatly upset by the manner of the assessor and how she graded my mother so that she still had to pay. Total rubbish! Thats when I first found this website as I wanted more information to see if I was right in making my assessment. The assessor broke every rule in the book, my mother was paralysed down her left side, Had Charles Bonnet Syndrome, registered blind, had dementia, double incontinent, fell out of bed and broke her right leg, kept choking on solid food, could not feed herself, could not locate the emergency bell or even press it, leg ulcers, heavy bruising as she was on warfarin, swore rudely at staff (I never heard my mother swear as she was a deputy-headteacher); I could go on but no-one really cares, there is no real help other than this website. Anyway, I’ve gone on too much, but now I have the confidence to take on the local CHC, I’ve complained and have acquired a referral meeting on 09 February. I deliver my case and will use this site and Pamela Coughlan. Thank you
I just wonder if anyone else has had a similar situation, in the early part of 2016 (Jan/Feb) I applied for Continuing Healthcare (CHC) for my mother in Law, after a period of no communication, I contacted the department, who informed me that they were waiting to get the checklist completed, eventually in mid September 2016, after I made numerous telephone calls she underwent the checklist, which indicated that she should go to the next stage (Decision Support Tool – DST). This seemed to get delayed with various excuses – no social worker had been appointed, backlog of cases etc. – unfortunately she passed away on the 18 November, and still hadn’t had the DST, I have since complained to the Local Health department, and this complaint is under investigation. I am of the strong opinion that she should have qualified for CHC from the beginning of 2016, and it is my intention to make a claim for back payments that we made for her care (she was self funding) for part of that year. I would be interested to know if anyone else has had a similar situation, and if so what the outcome was. Or if there is any other avenue of furthering this issue, I have no intention of closing this chapter!
Jeff, sad news. But to the matter. My FiL was funded for several years and then ironically when he developed liver cancer and required re-amputation of one of his legs, he suddenly did not qualify anymore. We too have been awaiting action since 31 Jan 2016 when he died and indeed have been fighting for re-instatement of funding since Oct 2013 when it was removed and again in April 2014 it was refused (when he got even sicker). I would advise anyone in this or similar situation to refuse to pay anything until a CHC assessment is completed. Make the council and/or the NHS prove matters before paying for something that is likely not the patient’s expense. As for your resolve Jeff, we are all with you. Good luck.
Does this apply in Wales?
My Mum has mid-late stage Alzheimer’s/Vascular Dementia and has been in a Residential Care Home since Nov 2013. Her condition has recently deteriorated to the point that an NHS District Nurse and Nursing Assessment Team completed a CHC Checklist last week, at my request and the Checklist showed that Mum is “scoring positive” with A’s for Cognition, Behaviour and Mobility and 5 x B’s and 3 x C’s. Although I wasn’t present when the Checklist was completed I wasn’t too concerned as the results were good (in as much as they probably do reflect the situation as it is). I have requested a copy of the Checklist results but I haven’t seen it as yet! The DN also advised that this indicates Mum now needs to be moved into a Nursing Home. This is where I’ve hit a bit of a wall!
Although the DN said that her score shows that she is eligible for a full CHC MDT Assessment, she has recommended that “it would be wise to wait until she is in the Nursing Home and settled so a true picture of her health and wellbeing an be ascertained”and that she had been advised a period of 3 mths is recommended.
I responded by referring to the National Framework para 60 and the flow diagram (Figure 1) on page 23 (para 61) and requested that the DST be completed BEFORE she moves, particularly as her needs are unlikely to improve over the next three months.
This is the reply I’ve received today:
” I have perused the Framework myself and feel that the principle of “wait and see” at 64 and 65 applies, whilst it mentions transfer from an acute setting, and Mrs S would be moving from residential to a nursing home, this would still apply as it is a change of care setting which could improve her issues with better nursing management. However I was still unsure so have contacted CHC directly.
They have advised that my rationale is correct, also the principle of completing a DST in Practice Guidance 28.1 – Assessment … is … the gathering of relevant, accurate, and up-to-date information on an individual’s health and social care needs. If there is a change in environment then this would not reflect an accurate picture of their needs within the first few days. Only when a care plan has been initiated to manage their needs effectively, and to give the person time to settle into that environment, can it be assessed as to its effectiveness whilst highlighting the individuals true needs. the principle of “wait and see” at paras 64 and 65 applies.”
Would I be right in going back to her, quoting paras 55, 56, 58 on page 21 and PG 11 11.1 , 11.2 and 11.3 on pages 61 and 62? These all relate to the fundamental principles of a CHC Assessment in that the underlying health and care needs are assessed, not the needs as they appear once they are managed. Para 11.2 could be particularly relevant in my Mum’s case – “if they move to a different environment and their needs reduce this does not necessarily mean that the need is now well managed”.
I would be grateful for any advice anyone has as I can see that I’m at the start of what could be a long and drawn out process!
My father was awarded CHC in march 2016, via the fast path. Having been in hospital for 6 weeks. He was moved to a nursing home and his condition remains the same although he is slowly losing weight and getting weaker. He is 85, has alzheimzers, is non weightbearing, blind, cannot do anything for himself , on thickened fluids, spends all his time in bed dependent on nursing staff. We have been warned by the manager that they are worried that he may fail the review as he is not demanding enough due to him not wanting to get uut of bed and is not at risk of pressure sores as he moves when asked! He would not if they did not ask he would just stay in one position. How do we address these points any one got any suggestions? His review is imminent.
I am in the process of supporting my cousin, as my Aunt is in hospital and has now passed the checklist and a meeting has been arranged for Tues Jan 31st to complete the DST. Anticipating a decline please could you tell us if that is the case, what is the situation with funding while we appeal any decision. Will my Aunt remain the responsibility of the NHS?
The hospital has already tried to discharge her into the care of social services without completing a checklist and social services accepted responsibility until I pointed out the LA would be breaking the law.
Many Thanks.
My 87yr old mother had a major stroke just before Christmas which has taken her left side, leaving her unable to walk,stand without the assistance of 2 nurses/carers, needing toileting with a hoist and diminished /restricted sight in her left eye. She has a urinary catheter and needs regular bladder flush outs and is doubly incontinent. Her existing medication for other health issues is crushed for her to take as her fluids have to be ingested with thickener and her food is pureed. She has skin breakdown that requires daily care and has mild altered mental state which Dr’s put down to fatigue (common after strokes). She has been in hospital since the stroke and has spent the last 4 weeks in a Rehabilitation unit. A Continuing Healthcare (CHC) assessment has been completed by a Snr Staff Nurse, although not completed fully and without asking my mother’s permission and without advising my brother and I (who have POA) to be present, stating at a ‘Family Meeting’ that they were going to do a ‘Needs Test’??. We have a copy of the CHC but have yet to agree its contents. The CHC was 8 ‘C’s and 3 ‘B’s and therefore a recommendation for Social care only. We are going to challenge the assessment scoring, but would Mum’s paralysis and obvious disability mean that she would be eligible for Continuing Healthcare Funding ?
Thank you both for the encouragement. We are expecting a battle, and Yes, the so called ‘health Professional’- in our particular case, a Senior Staff Nurse- has lied to our faces, saying that Mum needs ‘Healthcare’.But SHE completed the Continuing Healthcare (CHC) with scores and the last page recommendation, of ‘Social care’. We have compiled our Appeal , but not yet submitted, to the Checklist findings. Although we have been given a copy of the ‘uncompleted’ CHC we have not been asked to sign that we agree to its findings and have been told to wait until Social Services get in touch and they will explain everything. Our stance at the moment is to ‘give them enough rope to hang themselves’, make notes of all their errors and then to come back with all the accumulated knowledge from the recommended reading (Nat Framework, DST tool, etc). Would you agree with this strategy so far or suggest a different approach ? It is my intention to regularly update this forum at each stage so that others can learn from our experience and hopefully not have to jump through the hoops that many seem to had to in the past
Hi Jim,
I personally would challenge the completed Checklist now. You need to be careful that the hospital doesn’t try to discharge your mum rapidly without giving you the opportunity to challenge it. Look up hospital discharge procedures on this site, it really helped me recently.
I am helping my cousin as my Aunt is now facing similar challenges. Initially when my cousin asked for a Checklist to be completed she was told that she hadn’t made the criteria, she wasn’t included in the process or given a copy, that is against the guidelines. My Aunt was discharged into social services care at 8.30pm and transferred to a care home for a 3 week stay. She is now back in hospital. I believe that was breaking the law, when asked for the completed Checklist, surprise, surprise it can’t be found!
I would advise you to be prepared to challenge any social worker as to the legitimacy of taking responsibility of your mum’s care.
In the Checklist guidance it gives the scoring to recommend a full assessment. I would suggest your mum is at a high risk of falls under mobility and that is an A.
I have been reviewing guidance. Here is what at:- https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/211256/NHS-funded_Nursing_Care_Best_Practice_Guidance.pdf
The NHS-Funded Nursing Care 2013 revised Guidance states:-
21. In order to address this issue and ensure that unnecessary stays on acute wards are avoided, there should be consideration of whether the provision of further NHS-funded services is appropriate. This might include
• therapy and/or rehabilitation; • rapid response support; • hospital at home; • supported discharge; • intermediate care/health reablement; or • an interim package of support in an individual’s own home or in a care home.
22. In such situations, assessment of eligibility for NHS continuing healthcare and for NHS funded nursing care should usually be deferred until an accurate assessment of future needs can be made. The interim services should continue in place until the determination of eligibility has taken place. There must be no gap in the provision of appropriate support to meet the individual’s needs. Where the NHS receives a positive checklist completed as part of hospital discharge planning, but defers or delays the completion of a full NHS Continuing Healthcare (CHC) or Funded Nursing Care (FNC) assessment any interim services should be provided or commissioned by the NHS (see paras 62 – 67 of Framework)’
So that means that anyone (and there seem to be many these days), that receives one of those delayed CHC assessments ‘so that the needs can stabilise’, should be receiving paid care until such time as they are found to not require it, usually during an actual MDT led assessment.
What is hilarious within this guidance is that Para 9 states that a CHC assessment must be undertaken before Funded Nursing Care can be offered. Then Para 16 states:- ’16. Whether the decision about NHS-funded nursing care is made subsequent to a full assessment of eligibility for NHS continuing healthcare (using the Decision Support Tool6 (DST)) or following use of the NHS continuing healthcare Checklist, a registered nurse should be involved in identifying and documenting the registered nursing needs.’ ……. So contradicting Para 9 above.
Then Para 18 states:- ’18. CCGs are reminded that a decision about the need for NHS-funded nursing care should only be made after a decision that the individual is not eligible for NHS continuing healthcare. ‘ With guidance like this it is no wonder that NHS staff make so may mistakes.
The Game moves on. I have just had a conversation with a lady who introduced herself as Mum’s appointed Social Worker. She stated that she had been to see my mother in the hospital today and it was her recommendation that Mum should go into a ‘Nursing Care Home’ So I then inquired as to A) Why she had spoken to Mum without our presence or notice and B) How she came to that decision ? She stated that it was just a brief conversation to introduce herself to Mum and ask her about her ‘wishes for her care’ and, that the her decision was based on the Continuing Healthcare (CHC) and the findings of the Multidisciplinary Team (MDT) report. What MDT report ? I replied. Something else we were not told was going to happen or invited to attend. I pointed out that my brother and I held POA and make decisions to help Mum, but apparently POA (which the Hospital hold on file) only stops her from talking to Mum if she has cognition issues (???). We have been Invited to a meeting next week to discuss progress and ‘funding’. I stated that we believe Mum qualifies for CHC funding but she stated that she did not believe this too be the case (due to the CHC & MDT findings) and that “very few people, if any, qualify for CHC funding” in her experience, and that a financial assessment needs to take place. This I refused to discuss Mum’s finances at any time. Our Appeal against the CHC goes in tomorrow and we will see what happens. A little agitated and annoyed at the moment so any comments would be gratefully recieved. Thanks
First, apologies for not updating as promised and, second, thanks again for all the encouragement. The day after my last post, whilst visiting Mum, I asked the Ward Manager if she could confirm that the Multidisciplinary Team (MDT) had met and that the Decision Support Tool (DST) had been completed. She stated that neither had happened and didn’t need to. (Still haven’t found out what the Social Worker was talking about – conveniently ‘gone sick’ !!) and that the Checklist stood and that was the document that would decide Mum’s ‘future’. I stated that we had reservations about completion of the Checklist and its findings and that we would be appealing. She then, quite persistently and vehemently, pushed me to raise the points with her, which I politely declined several times (I hadn’t got me notes there in any case). At this point, she became quite agitated and said that “it didn’t matter whether we submitted a formal appeal or not”, because the appeal paperwork would come to her ” and she would “not be changing any of the decisions” !! And anyway, we were only doing this to get funding and “in her experience, she had never known it to be given”.
That evening our 6 page appeal AND COMPLAINT was submitted, highlighting all the procedural errors and our reasons for disputing the domain decisions. Three days later, we were contacted by a very contrite and helpful member of the Stroke Coordination team and a meeting arranged for a later date in order that a new Continuing Healthcare (CHC) assessment could be completed. We have attended that meeting, chaired by the Stroke Coordinator , a Doctor, Snr Staff Nurse, O/T & Physio. Apologies were made for our lack of involvement, the way that the CHC had been completed, and the ignoring of our views. We then had a 2 1/2 hour discussion of the Checklist where we put our views and our concerns and had detailed explanations from their side. The Checklist now looks very different, with a ‘negotiated’ score of 3 ‘A’s, 5 ‘B’s & 3 ‘C’s !!
We are now awaiting the meeting with the MDT and completion of the DST. I will keep you posted.
At this point a big thank you to Care to be Different and all that have commented and encouraged.
My advice at this juncture is to read as many of the articles posted here and take your leads from them, but I strongly recommend that you download and print ‘NHS Continuing Healthcare Checklist’ document and fill it in with your own conclusions/evaluations, the ‘National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care’ document and study and highlight areas where mistakes have been made and points that are applicable to your particular circumstances and lastly the ‘NHS-funded Nursing Care Practice Guide July 2013 (Revised)’, doing the same with that.
From our experiences, NHS staff seem
a. either poorly trained or apathetic to NHS Healthcare
b. dont want to pay for care if they can get away with it
c. to jump through hoops to help if you do your homework and challenge them !!
DON’T GIVE UP, DON’T GET FOBBED OFF, DO YOUR HOMEWORK !! . . . and ‘Good luck’ !!
My father has mixed dementia and since Christmas and has deteriorated considerably to the point that he has become violent towards my mother; his gp has prescribed him a Benzodiazepine to try and calm him down. He doesn’t recognise her when he is being violent and refers to her as ‘that woman’ and has told me she needs killing. We have arranged a social worker for him and have had a visit from a member of our local mental health team who has suggested respite care and a means test to assess who pays for his care. When asked about what would happen when he returns home she advised that he would probably stay at the home as a return to the house would possibly create more problems. She talked about some local homes that would be suitable due to their mental health care, based on this my question is two-fold: if the lady from the mental health team suggests only certain homes are suitable due to his mental health needs would this point towards him needing Continuing Healthcare? And would the violence he has shown mean that he should be fast tracked?
“Unfortunately the mental health nurse from my team that needs to be involved in the DST is not available that day. As you know we will need to convene a multidisciplinary team to complete the DST and so we would also need to determine the availability of the social worker and ward staff that need to contribute.” (CCG nurse assessor)
Is it possible/legal for the CCG to “stack” the mdt in its favour ? Can we object to or ask for staff to be appointed?
Hi, my father is 57 and has suffered a massive and severe brain injury 4 months ago and very possibly will need 24 hr care for the rest of his life. my mum cant provide this herself as she has cancer herself , they own there own home but have little savings my mum is worried she will have to sell the home they both own and which she lives in to pay for his care ??? as he would need to go into a nursing home ? my mum is worried to death she will lose the home they have shared together there whole lives even though sadly my father remembers very little of his family and nothing of his life. this is a very sad time made worse by these unknown factors thank you for any advice x
Wow lots of interesting info. My dad has had Lewy bodies for about 10 years . Sadly at nearly 90 he has deteriorated. He’s now in an excellent assessment centre attached to a hsp . A meeting to decide a way forward is being called next week with a view to residential care which I agree is necessary . This will include me POA and only daughter . Mum is 88 and living in their assisted living apartment and I’m worried about her finances as she lives of dads money . How do I see if he’s entitled to this NHS Continuing Healthcare. It’s been said he’s medically fit! He insulin dependent diabetic with Lewy bodies and so now frail . He can now walk or shuffle a little but couldn’t when he went to the assessment center . What should I be saying preparing for this meeting . They seem very keen on mentioning personal care but I think dad would need nursing care as well. They have got savings but these won’t last long especially with mums at home care.
Thank you Richard for your reply . I will purchase the book .
Any help appreciated . The process seems very complicated I worry for those who don’t have family.
Where does the Continuing Care Assessment take place? My dad lives at home. How can an assessor judge his care needs if just meeting him? Only I know how he his 100%!!
I wonder if you could advise me please?
My 87 year old father has had a stroke and has ended up needing a permanent catheter for retention. He is at home with 4 carers a day because he cannot even drain the catheter himself.
should he qualify for continuing healthcare funding please?
mom was admitted to hospital with cardiac failure and fluid build up. She had a series of falls. 4 in the last six weeks. Lives on her own and not eating or drinking. Hospital admitted her into CCU and stabilized symptoms. We applied for CHC funding. Checklist completed with a family member present as professionals hounding mom to be discharged although we have told them she cannot go home. She does not own property she lives in. Checklist completed by nurse on hand held device so no hard copy. Assessment stated mom qualified for full assessment. Contacted later in the day another nurse saying she had downgraded original checklist as moms scores were too high and she now did not qualify for CHC funding. She had not seen mom at this time. Is this process now flawed and can the checklist be downgraded. Can we request a new checklist assessment and who do we complain to
Hi,
If a person is taking medication and it does not have any effect on them. Am I right that they are entitled to a assessment automatically. I am sure I read somewhere that you automatically qualify if the medication does not work.
Hello
Could anyone give e a quick answer on this please? _ I have been trying to get CHC for my late Mother in Law, a checklist was done before she passed away and that triggered a DST, but that was never done. It has now been agreed that a retrospective review be carried out, and that is to be heard tomorrow. but i have just received correspondence that a DST was done last week, and she did not meet the criteria – I did not receive any notification that the DST was to take place – under the National Framework, should I have been informed and invited to the DST meeting?
Thanks
Jeff