Can you get NHS Continuing Healthcare Funding if you are already paying care home fees?

Can you get CHC funding if you are already self-funding care?

Yes. You can still qualify for CHC funding even if you have been paying the full cost of your care privately.

NHS Continuing Healthcare is a package of ongoing care arranged and funded by the NHS for adults who are assessed as having a Primary Health Need.

Where someone qualifies for CHC funding in a care home, the NHS is responsible for funding their assessed care package, including accommodation and associated care costs.

Unlike local authority funding, CHC is not means-tested. Your relative’s savings, income, property ownership and other assets do not determine their eligibility.

Nor does it matter whether they have been paying care home fees for several months or years.

The deciding factor is whether their assessed needs establish a Primary Health Need under the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

Equally, paying substantial nursing home fees does not automatically establish eligibility. The nature and extent of the person’s actual care needs must be examined.

How is eligibility for CHC funding assessed?

CHC eligibility is not determined by a particular diagnosis, the number of medical conditions someone has or whether they live in a residential or nursing home.

Instead, the assessment considers the totality of their health and care needs, including four key characteristics:

• Nature: The type of needs the person has and the interventions required to manage them.
• Intensity: The extent and severity of those needs, including the level and continuity of care required.
• Complexity: How different needs interact, making care more difficult to manage.
• Unpredictability: How needs fluctuate and the risks that may arise if care is not provided promptly.

These characteristics must be considered together when determining whether someone has a Primary Health Need.

For example, your relative may require significant support with cognitive impairment, challenging behaviour, swallowing difficulties, immobility, pressure damage or other serious health concerns.

However, no individual diagnosis or care requirement automatically qualifies someone for CHC.

The assessment should establish what care is actually required, how frequently interventions are needed and what risks would arise without appropriate support.

Importantly, a well-managed need is still a need.

If your relative appears stable because nursing interventions, medication, supervision or other care arrangements are successfully managing their condition, their underlying needs should not be disregarded.

What if your relative has never had a CHC assessment?

If your loved one has been paying care home fees without ever being considered for CHC funding, you should establish whether an assessment is appropriate.

The usual starting point is an NHS Continuing Healthcare Checklist.

This is a screening tool used to identify people who may require a full assessment. A positive Checklist does not establish eligibility, but triggers a full assessment by a multidisciplinary team (MDT).

The MDT uses a Decision Support Tool (DST) to record and evaluate needs across 12 care domains, including cognition, behaviour, mobility, nutrition, continence and skin integrity.

The assessment should be supported by relevant clinical and care records, together with appropriate input from the individual, their representative and those responsible for providing the care.

The MDT makes an eligibility recommendation to the responsible Integrated Care Board (ICB), which makes the final decision.

What if your relative was previously refused CHC funding?

A previous refusal does not necessarily mean that your relative will never qualify.

Their needs may have deteriorated since the assessment, making a fresh assessment appropriate.

Alternatively, the earlier decision may have been based on incomplete evidence, understated care needs or an incorrect application of the National Framework.

In those circumstances, there may be grounds to challenge the decision.

It is important to distinguish between the two situations:

• A fresh assessment considers your relative’s current care needs.
• An appeal challenges an earlier eligibility decision.

Depending on the circumstances, both may require attention.

You should obtain the previous Checklist, DST, written decision and supporting records before deciding how to proceed.

Can you reclaim care home fees you have already paid?

Potentially, yes. If your relative should have been eligible for CHC funding during an earlier period of care, it may be possible to recover fees paid privately.

However, reimbursement is not automatic simply because someone later qualifies for CHC.

The appropriate process depends on whether their eligibility was previously considered and what the historical evidence demonstrates.

Previously Unassessed Periods of Care

Where your relative should have been considered for CHC funding but was not assessed at the time, you may be able to request a retrospective assessment.

These cases are known as Previously Unassessed Periods of Care (PUPoC).

National guidance generally provides for the consideration of previously unassessed periods from 1 April 2012 onwards, although exceptional circumstances may justify considering earlier periods.

A retrospective assessment examines the person’s needs during the historical period, rather than relying on their current condition.

Evidence may include:

• Care home and nursing records.
• GP and hospital records.
• Social care assessments.
• Records of incidents, deterioration and clinical interventions.
• Other relevant evidence from family members and professionals.

If retrospective eligibility is established, reimbursement of relevant care costs, together with applicable interest, may be payable.

What if an earlier CHC assessment was incorrect?

Where your relative was previously assessed and refused funding, the position is different.

A period during which CHC eligibility has already been considered, via a Checklist and/or DST, cannot ordinarily be reopened through the PUPoC process simply because the family disagrees with the outcome.

Instead, the appropriate route may involve challenging the original decision through the applicable NHS review or appeal procedures.

For example, there may be concerns that the DST understated the frequency of nursing interventions, overlooked significant behavioural incidents or failed to consider how different health needs interacted.

Previous decisions are subject to the NHS appeal process for which strict time limits apply, so it is important to establish what happened and when.

If you believe care fees were paid following an incorrect eligibility decision, specialist advice can help determine whether there remains a viable route to challenge it.

Does receiving NHS-Funded Nursing Care mean your relative cannot get CHC?

No. Receiving NHS-Funded Nursing Care (FNC) does not prevent someone from qualifying for full CHC funding.

FNC is a contribution paid by the NHS directly to nursing homes towards registered nursing care for eligible residents who do not qualify for CHC.

From 1 April 2026, the standard FNC rate in England is £267.68 per week.

Unlike full CHC funding, FNC does not cover the entire assessed care package. Recipients remain responsible for substantial accommodation and other care costs.

Crucially, CHC eligibility should be considered before a decision is made about entitlement to FNC.

If your relative receives FNC but you cannot establish whether CHC eligibility was properly considered, ask the ICB for the relevant assessment records.

An FNC award should not be treated as proof that your relative could never qualify for full CHC funding.

What should you do if you are already paying care home fees?

If your relative has significant health needs and is paying privately for care, there are several practical steps you should consider.

1. Establish whether CHC eligibility has been considered

Ask the care home or relevant ICB whether your relative has undergone a CHC Checklist or full assessment.

If so, request copies of the assessment documents and written eligibility decision.

Do not assume that a proper assessment has taken place simply because you have been told your relative does not qualify.

2. Examine the care your relative actually receives

Review the available care and nursing records.

Look for evidence of significant needs, including:

• Frequent nursing interventions or monitoring.
• Behaviour that poses risks to the individual or others.
• Falls, immobility or difficulties with transfers.
• Swallowing difficulties, nutritional problems or weight loss.
• Pressure damage, wounds or deteriorating skin integrity.
• Breathing difficulties.
• Seizures.
• A complex medication regime to treat mental or physical health needs.
• Changes in condition requiring urgent intervention.

Consider whether the records accurately reflect your relative’s day-to-day needs.

Someone may be described as comfortable or settled because substantial care and supervision are being provided. The assessment should consider the interventions necessary to maintain that position.

3. Consider whether their needs have changed

If your relative was previously refused CHC funding, establish whether their condition has deteriorated or their care requirements have increased.

Significant changes may justify requesting a fresh assessment.

Where the concern relates to an earlier decision rather than changed needs, the appropriate review or appeal route should be considered.

4. Keep evidence of care fees paid

If there may be grounds to pursue retrospective funding, retain care home contracts, invoices, statements of account, bank statements and relevant correspondence.

These documents can help establish the period and amount of care fees paid if reimbursement becomes appropriate.

Who pays the fees while a CHC assessment is taking place?

Requesting a CHC assessment does not automatically mean that the NHS will immediately take responsibility for your relative’s care home fees.

Existing funding arrangements may continue while eligibility is being determined.

However, the ICB should normally reach an eligibility decision within 28 calendar days of receiving a positive Checklist or other notification that a full assessment is required, unless there are circumstances beyond its control.

Where there has been an unjustifiable delay and the individual is subsequently found eligible, reimbursement of relevant care costs may be due for the period of unreasonable delay, normally beginning from day 29.

This is separate from a retrospective claim relating to an earlier period when CHC eligibility was not properly considered.

If you are continuing to pay privately while awaiting a decision, keep records of assessment dates, correspondence and payments. You should not simply stop paying fees without considering existing contractual obligations.

When might a CHC decision be open to challenge?

Not every refusal of CHC funding is incorrect.

However, a decision may warrant closer examination where the recorded needs appear inconsistent with the care actually being provided.

Potential concerns include:

• The assessment relies on incomplete or outdated evidence.
• Significant needs have been overlooked or understated.
• The frequency and/or severity of incidents has not been properly recorded.
• The interaction between different care needs has not been adequately considered.
• The family has not been appropriately involved or relevant evidence – including verbal testimony – has been disregarded.
• The decision does not adequately explain how the National Framework was applied.

The correct approach is to examine the assessment alongside the underlying clinical and care records.

Where the evidence supports a challenge, overturning an incorrect decision may have important implications for both ongoing care fees and potentially recoverable historical payments.

How Farley Dwek can help if you are paying care home fees

If your relative is paying care home or nursing home fees but has significant health needs, it is important to establish whether NHS Continuing Healthcare funding has been properly considered.

At Farley Dwek Solicitors, our specialist solicitors and experienced nurses can review your relative’s circumstances, examine the relevant clinical and care records, and advise whether there are grounds to pursue NHS funding.

Depending on the circumstances, we can help you:

• Establish whether a CHC assessment should take place and prepare for the assessment process.
• Review an existing Decision Support Tool and identify whether significant needs have been overlooked or understated.
• Challenge an eligibility decision where the clinical evidence and National Framework support an appeal.
• Investigate whether care fees paid during an earlier period may be recoverable through a retrospective funding claim.

Our approach combines detailed clinical scrutiny with specialist knowledge of the National Framework, helping families understand whether an NHS funding decision properly reflects their relative’s assessed needs.

If you are concerned that your relative should not be paying the full cost of their care, or that an earlier funding decision may have been incorrect, contact Farley Dwek Solicitors for an initial discussion about your circumstances.

Frequently asked questions

Can you get CHC funding if you have savings or own a house?

Yes. NHS Continuing Healthcare is not means-tested. Your income, savings and property ownership do not determine eligibility. The decision is based on your assessed health and care needs.

Can you apply for CHC funding after moving into a care home?

Yes. You do not need to apply before entering residential or nursing care. Where there is an indication of a potential Primary Health Need, CHC eligibility can be considered after admission.

Can someone with dementia qualify for CHC funding?

Potentially, yes. However, a dementia diagnosis alone does not establish eligibility. The assessment must consider the person’s overall needs, including cognition, behaviour, communication, mobility and any other relevant health concerns.

Can you reclaim care home fees after someone has died?

Potentially, yes. A retrospective claim may be pursued on behalf of a deceased person’s estate where the circumstances and historical evidence support it. The appropriate process depends on whether eligibility was previously considered and the period of care involved.

Will CHC funding cover the full cost of nursing home fees?

Where an individual qualifies for CHC and their assessed needs are met in a nursing home, the NHS is responsible for the agreed care package, including accommodation and associated care costs. Separate arrangements for genuinely additional private services require individual consideration.

Should you stop paying care home fees while waiting for a CHC decision?

You should not simply stop paying because an assessment has been requested. Existing payment obligations need to be considered while eligibility is determined. If funding is subsequently awarded, reimbursement may be appropriate in certain circumstances.