Who qualifies for NHS Continuing Healthcare?
Caring for a loved one can feel isolating. You’re looking after their affairs, watching their health decline and often paying thousands in care fees. You take on this role out of love, but often without clear guidance. Whether you’re in the early stages of the process or deep into assessments or appeals, the question remains: could your loved one be eligible for NHS Continuing Healthcare (CHC)?
Here’s the truth: if your relative has a primary healthcare need, they are entitled to fully funded NHS Continuing Healthcare. And when health is at stake, every day matters.
In this article, we discuss:
- What conditions might meet the criteria for Continuing Healthcare funding
- What does having a primary health need mean
- How to know if your loved one is eligible
- Who can help you through the process
What conditions meet the criteria for Continuing Healthcare funding?
While no specific diagnosis guarantees eligibility for NHS Continuing Healthcare (CHC), certain conditions often involve complex health needs that may meet the criteria.
Common conditions associated with CHC eligibility include:
- Frontotemporal dementia
- Parkinson’s disease
- Spinal injuries
- Epilepsy
- Brittle diabetes
It’s important to note that eligibility isn’t determined by diagnosis. Instead, it’s based on whether the individual’s care needs are primarily health-related, which we will discuss in the next section.
The CHC assessment criteria and process are notoriously complex, so consulting with experts can provide clarity and support throughout your application.
How do you qualify for CHC funding?
Understanding whether your loved one qualifies for CHC funding can feel like yet another overwhelming task in an already emotional journey. But it doesn’t have to be. With the correct information and support, you can navigate this process more confidently and avoid unnecessary disappointment.
CHC funding doesn’t rely on a diagnosis or a specific condition, but on the quality and degree of the person’s ongoing care needs. To determine eligibility, focus on two key factors:
- Does your loved one have a primary health need?
- How does the NHS assess this? (That’s where the Decision Support Tool comes in.)
If you’re already familiar with the concept of a primary health need, feel free to skip to the next section. But if you’ve ever been told, “your relative doesn’t qualify because it’s social care”, read on, because that’s not the whole story.
What is a primary healthcare need?
One of the most common sources of confusion is the difference between health needs and social care needs. We often explain it like this:
If your relative’s care is mainly focused around assistance with everyday tasks such as washing, dressing, toileting, eating and drinking (“activities of daily living”), they likely fall under social care, which is means-tested and provided by the local authority.
On the other hand, if the majority of care interventions are aimed at addressing or preventing health needs, that may indicate a primary health need and eligibility for CHC funding.
However, most people will have a combination of health and social care needs, meaning the line is often not clear-cut. That’s why professional help can be so valuable.
What is the Decision Support Tool?
The Decision Support Tool (DST) is a formal document used by the NHS to assess whether a person qualifies for CHC funding. It breaks down care needs into 12 domains of care:
- Breathing
- Nutrition (food and drink)
- Continence
- Skin (including wounds and ulcers)
- Mobility
- Communication
- Psychological and emotional needs
- Cognition
- Behaviour
- Medication and symptom control
- Altered states of consciousness
- Other significant care needs
How are needs assessed on the DST?
Each care domain is assigned a “level of need”, depending on the quality and quantity of assistance required. These levels of need range from “no needs” (no help needed) to “priority” (critical need). Not every domain carries a “priority” or “severe” level of need. The eligibility criteria are complicated but, generally speaking, the higher the levels of need, the greater the likelihood of qualifying.
Eligibility for CHC funding is usually expected when the individual has:
- At least one priority level of need,
- Two or more severe levels of need.
However, this is not the only way you can qualify: a combination of high and moderate levels of need can also result in eligibility, depending on the quality and degree of the care interventions.
We know this can sound confusing, and many families find the language hard to follow. That’s why it helps to have someone experienced on your side, making sure nothing is overlooked.
Am I eligible for CHC funding on paid care home fees?
It’s completely natural to wonder whether you or a relative might have been eligible for CHC funding during a period for which care fees have already been paid, especially if you feel you were never made aware of the option.
If you’re thinking, “Could I have applied? Was I misguided? Did I sell the family home unnecessarily?”, we understand how upsetting it can be to discover that other options were available.
But, here’s the good new: not all is lost. At Farley Dwek, we also specialise in retrospective claims, meaning we can review your situation and build a case to recover care fees wrongly paid.
We know it’s frustrating, but the system isn’t perfect. And while we believe the NHS and local authorities try their best to help as many people as possible, the process is so complex that mistakes do happen.
We know how challenging and stressful this can be for families. That’s why we’re here to help guide you through the process, address any concerns, and help you reclaim what is rightfully yours.
Apply for CHC Funding with Farley Dwek
Caring for a loved one with Farley Dwek by your side will no longer feel isolating. We will match you with a specialist who will guide your case with compassion and determination.
Get in touch with our team today; we’re here to help you fight for what’s right.
