Continuing Healthcare Funding
Some people with long-term mental or physical health needs can qualify for free Continuing Healthcare (CHC) funding from the NHS. The package will cover the full cost of the person’s care and residential accommodation. However, certain factors can mean that many people, often wrongly, have been deemed ineligible for continuing healthcare. Our team are here to help advise you on the process and to challenge previous decisions that have been made.
For further information, please contact us today.
NHS Continuing
Healthcare Funding
If you or your loved one have assets, savings and income, it can be very expensive to arrange health and social care. One of the biggest problems with Continuing Healthcare funding is that the eligibility criteria is open to interpretation.
The decision is based on your assessed needs, not on your particular diagnosis or condition. Furthermore, you may be told that you will not receive free care if you do not meet the strict criteria for CHC funding.
The four key indicators requiring a Primary Health need being apparent are: Nature, Intensity, Complexity and Unpredictability.
These are achieved from a Decision Support Tool (DST) Assessment of the individual, based on measuring the severity of 12 Care Domains, which are:
Does the individual suffer from any breathing-related issues?
Description | Level of need |
Normal breathing, no issues with shortness of breath. | No needs |
Shortness of breath which may require the use of inhalers or a nebuliser and has no impact on daily living activities. OR Episodes of breathlessness that readily respond to management and have no impact on daily living activities. | Low |
Shortness of breath which may require the use of inhalers or a nebuliser and limit some daily living activities. OR Episodes of breathlessness that do not respond to management and limit some daily living activities. OR Requires any of the following: • low level oxygen therapy (24%). • room air ventilators via a facial or nasal mask. • other therapeutic appliances to maintain airflow where individual can still spontaneously breathe e.g. CPAP (Continuous Positive Airways Pressure) to manage obstructive apnoea during sleep. | Moderate |
Is able to breathe independently through a tracheotomy that they can manage themselves, or with the support of carers or care workers. OR Breathlessness due to a condition which is not responding to treatment and limits all daily living activities. | High |
Difficulty in breathing, even through a tracheotomy, which requires suction to maintain airway. OR Demonstrates severe breathing difficulties at rest, in spite of maximum medical therapy. OR A condition that requires management by a non-invasive device to both stimulate and maintain breathing (bi-level positive airway pressure, or non-invasive ventilation) | Severe |
Unable to breathe independently, requires invasive mechanical ventilation. | Priority |
Are there risks of malnutrition or dehydration?
Description | Level of need |
Able to take adequate food and drink by mouth to meet all nutritional requirements. | No needs |
Needs supervision, prompting with meals, or may need feeding and/or a special diet. OR Able to take food and drink by mouth but additional risk assessment indicates. additional/supplementary feeding is required. |
Low |
Needs feeding to ensure adequate intake of food and takes a long time (half an hour or more), including liquidised feed. OR Unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a non-problematic PEG. |
Moderate |
Requires skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway. OR Subcutaneous fluids that are managed by the individual or specifically trained carers or care workers. OR Nutritional status “at risk” and may be associated with unintended, significant weight loss. OR Problems relating to a feeding device (for example PEG) that require skilled assessment and review. |
High |
Unable to take food and drink by mouth. All nutritional requirements taken by artificial means requiring ongoing skilled competent intervention and clinical decision making over a 24 hour period to ensure nutrition/hydration, for example I.V. fluids. OR Unable to take food and drink by mouth, intervention inappropriate or impossible. |
Severe |
There are risk elements to varying issues and how complex these become to the other domains is also considered.
Description | Level of need |
Continent of urine and faeces. | No needs |
Continence care is routine on a day-to-day basis; Incontinence of urine managed through, for example, medication, regular toileting, use of penile sheaths, etc. AND Is able to maintain full control over bowel movements or has a stable stoma, or may have occasional faecal incontinence/constipation. | Low |
Continence care is routine but requires monitoring to minimise risks, for example those associated with urinary catheters, double incontinence, chronic urinary tract infections and/or the management of constipation. | Moderate |
Continence care is problematic and requires timely and skilled intervention, beyond routine care (for example frequent bladder wash outs, manual evacuations, frequent re-catheterisation). | High |
All aspects of problems surrounding an individual’s skin.
Description | Level of need |
No risk of pressure damage or skin condition. | No needs |
Risk of skin breakdown which requires preventative intervention once a day or less than daily without which skin integrity would break down. OR Evidence of pressure damage and/or pressure ulcer(s) either with ‘discolouration of intact skin’ or a minor wound(s). OR A skin condition that requires monitoring or reassessment less than daily and that is responding to treatment or does not currently require treatment. |
Low |
Risk of skin breakdown which requires preventative intervention several times each day, without which skin integrity would break down. OR Pressure damage or open wound(s), pressure ulcer(s) with ’partial thickness skin loss involving epidermis and/or dermis’, which is responding to treatment. OR An identified skin condition that requires a minimum of daily treatment, or daily monitoring/reassessment to ensure that it is responding to treatment. |
Moderate |
Pressure damage or open wound(s), pressure ulcer(s) with ‘partial thickness skin loss involving epidermis and/or dermis’, which is not responding to treatment OR Pressure damage or open wound(s), pressure ulcer(s) with ‘full thickness skin loss involving damage or necrosis to subcutaneous tissue, but not extending to underlying bone, tendon or joint capsule’, which is/are responding to treatment. OR Specialist dressing regime in place; responding to treatment. |
High |
Open wound(s), pressure ulcer(s) with ‘full thickness skin loss involving damage or necrosis to subcutaneous tissue, but not extending to underlying bone, tendon or joint capsule’ which are not responding to treatment and require regular monitoring/reassessment. OR Open wound(s), pressure ulcer(s) with ‘full thickness skin loss with extensive destruction and tissue necrosis extending to underlying bone, tendon or joint capsule. OR Multiple wounds which are not responding to treatment. |
Severe |
The risk of harm to the individual is the main purpose, but also how this affects the complexity of care and other domains.
Description | Level of need |
Independently mobile | No needs |
Able to weight bear but needs some assistance and/or requires mobility equipment for daily living. | Low |
Not able to consistently weight bear. OR Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning. OR In one position (bed or chair) for the majority of time but is able to cooperate and assist carers or care workers. OR At moderate risk of falls (as evidenced in a falls history or risk assessment). |
Moderate |
Completely unable to bear weight and is unable to assist or cooperate with transfers and/or repositioning. OR Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate. OR At a high risk of falls (as evidenced in a recent falls history and risk assessment). OR Involuntary spasms or contractures placing the individual or others at risk. |
High |
Has a clinical condition such that, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical. | Severe |
Can the individual reliably communicate their needs?
Description | Level of need |
Able to communicate clearly, verbally or non-verbally. Has a good understanding of their primary language. May require translation if English is not their first language. | No needs |
Needs assistance to communicate their needs. Special effort may be needed to ensure accurate interpretation of needs or additional support may be needed either visually, through touch or with hearing. |
Low |
Communication about needs is difficult to understand or interpret or the individual is sometimes unable to reliably communicate, even when assisted. Carers or care workers may be able to anticipate needs through non-verbal signs due to familiarity with the individual. |
Moderate |
Unable to reliably communicate their needs at any time and in any way, even when all practicable steps to assist them have been taken. The individual has to have most of their needs anticipated because of their inability to communicate them. |
High |
What are the psychological and emotional needs an individual may have and how do they affect their overall care needs?
Description | Level of need |
Psychological and emotional needs are not having an impact on their health and well-being. | No needs |
Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, which are having an impact on their health and/or well-being but respond to prompts, distraction and/or reassurance. OR Requires prompts to motivate self towards activity and to engage them in care planning, support, and/or daily activities. | Low |
Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, which do not readily respond to prompts and reassurance and have an increasing impact on the individual’s health and/or well-being. OR Due to their psychological or emotional state the individual has withdrawn from most attempts to engage them in care planning, support and/or daily activities. | Moderate |
Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, that have a severe impact on the individual’s health and/or well-being. OR Due to their psychological or emotional state the individual has withdrawn from any attempts to engage them in care planning, support and/or daily activities. | High |
Does the individual have any cognitive impairment and scores it accordingly, following a guideline of examples?
Description | Level of need |
No evidence of impairment, confusion or disorientation. | No needs |
Cognitive impairment which requires some supervision, prompting or assistance with more complex activities of daily living, such as finance and medication, but awareness of basic risks that affect their safety is evident. OR Occasional difficulty with memory and decisions/choices requiring support, prompting or assistance. However, the individual has insight into their impairment. |
Low |
Cognitive impairment (which may include some memory issues) that requires some supervision, prompting and/or assistance with basic care needs and daily living activities. Some awareness of needs and basic risks is evident. The individual is usually able to make choices appropriate to needs with assistance. However, the individual has limited ability even with supervision, prompting or assistance to make decisions about some aspects of their lives, which consequently puts them at some risk of harm, neglect or health deterioration. |
Moderate |
Cognitive impairment that could include frequent short-term memory issues and maybe disorientation to time and place. The individual has awareness of only a limited range of needs and basic risks. Although they may be able to make some choices appropriate to need on a limited range of issues they are unable to consistently do so on most issues, even with supervision, prompting or assistance. The individual finds it difficult even with supervision, prompting or assistance to make decisions about key aspects of their lives, which consequently puts them at high risk of harm, neglect or health deterioration. |
High |
Cognitive impairment that may, for example, include, marked short-term memory issues, problems with long-term memory or severe disorientation to time, place or individual. The individual is unable to assess basic risks even with supervision, prompting or assistance, and s dependent on others to anticipate their basic needs and to protect them from harm, neglect or health deterioration. |
Severe |
Consideration as to whether somebody has ‘challenging behaviour’.
Description | Level of need |
No evidence of ‘challenging’ behaviour. | No needs |
Some incidents of ‘challenging’ behaviour. A risk assessment indicates that the behaviour does not pose a risk to self, others or property or a barrier to intervention. The individual is compliant with all aspects of their care. |
Low |
‘Challenging’ behaviour that follows a predictable pattern. The risk assessment indicates a pattern of behaviour that can be managed by skilled carers or care workers who are able to maintain a level of behaviour that does not pose a risk to self, others or property. The individual is nearly always compliant with care. |
Moderate |
Challenging’ behaviour that poses a predictable risk to self, others or property. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions. |
High |
‘Challenging’ behaviour of severity and/or frequency that poses a significant risk to self, others or property. The risk assessment identifies that the behaviour(s) require(s) a prompt and skilled response that might be outside the range of planned interventions. |
Severe |
‘Challenging’ behaviour of a severity and/or frequency and/or unpredictability that presents an immediate and serious risk to self, others or property. The risks are so serious that they require access to an immediate and skilled response at all times for safe care. |
Priority |
This domain considers both the drug regime an individual has and the complexity that is associated with the same, as well as, separately looking at any pain issues that the patient may suffer from.
Description | Level of need |
Symptoms are managed effectively and without any problems, and medication is not resulting in any unmanageable side-effects. | No needs |
Requires supervision/administration of and/or prompting with medication but shows compliance with medication regime. OR Mild pain that is predictable and/or is associated with certain activities of daily living. Pain and other symptoms do not have an impact on the provision of care. |
Low |
Requires the administration of medication (by a registered nurse, carer or care worker) due to: Non-concordance or non-compliance of medication, or type of medication (for example insulin), or route of medication (for example PEG). OR Moderate pain which follows a predictable pattern; or other symptoms which are having a moderate effect on other domains or on the provision of care. |
Moderate |
Requires administration and monitoring of medication regime by a registered nurse, carer or care worker specifically trained for the task because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects. However, with such monitoring the condition is usually non- problematic to manage. OR Moderate pain or other symptoms which is/are having a significant effect on other domains or on the provision of care. |
High |
Requires administration and monitoring of medication regime by a registered nurse, carer or care worker specifically trained for this task because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects. Even with such monitoring the condition is usually problematic to manage. OR Severe recurrent or constant pain which is not responding to treatment. DR Risk of non-concordance with medication, placing them at risk of relapse |
Severe |
Has a drug regime that requires daily monitoring by a registered nurse to ensure effective symptom and pain management associated with a rapidly changing and/or deteriorating condition OR Unremitting and overwhelming pain despite all efforts to control pain effectively. |
Priority |
Altered states of consciousness are noted to include a range of conditions that can affect consciousness, including transient ischaemic attacks (TIAs), epilepsy and vasovagal syncope.
Description | Level of need |
No evidence of altered states of consciousness (ASC). | No needs |
History of ASC but it is effectively managed and there is a low risk of harm. | Low |
Occasional (monthly or less frequently) episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm. | Moderate |
Frequent episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm. OR Occasional ASCs that require skilled intervention to reduce the risk of harm. |
High |
Coma. OR ASC that occur on most days, do not respond to preventative treatment, and result in a severe risk of harm. |
Priority |
There is a twelfth domain that is very broad in its potential scope but can be disregarded when tallying up the chart if not applicable.
Get In Touch
For Legal Advice
We can check and find out whether you or your relative meets the relevant criteria for Continuing Healthcare funding. If you have been turned down before, we can also determine whether we believe this was the wrong decision and should be legally challenged. There are many instances where social services get it wrong. You may not need to sell the family home or use up a lifetime of savings to pay for important care.
FAQs
Continuing Healthcare funding is a fully funded package of care which is provided by the NHS. If you’re eligible for NHS Continuing Healthcare and receive care in your own home or in a care home, the care services are funded by the NHS at no cost to you.
NHS Continuing Healthcare differentiates from funding from the Local Authority, which is means tested based on your financial situation.
For a discussion with no obligation to discuss eligibility for CHC funding, recovering Care Home fees already paid, or any aspect of the NHS Continuing Healthcare process, get in touch with our Care Home Fee experts.
In order to qualify for Continuing Healthcare funding, you must be able to establish that you have a Primary Health Need. In simple terms, an individual has a Primary Health Need if, having taken account of all their needs, it can be said that most of the care that they require is based on addressing and/or preventing health needs. However, in reality it is far more complex than this.
Our national team of Care Home experts have specialist knowledge of the care system and can provide you with expert legal advice about the options for funding your care.
Our clients approach us for a variety of reasons, whether for help to recover past care fees paid, or to appeal against a recent CHC funding decision, or for legal advice about any aspect of the process and for representation at meetings or panels.
If your relative has been granted CHC, they will not have to pay ANY fees for their care. All costs will be paid for in full, including the ‘social’ elements of their care. This applies irrespective of whether they receive care in their own home or in a nursing home.
CHC is not means tested so any savings or property your relative may have, will not be used to pay for care.
Let’s be honest – it is not in the interests of either the NHS or your Local Authority for anyone to be awarded Continuing Healthcare funding. It’s costly and their budgets are consistently under pressure.
Dependent on where you live, your Local Authority may try to make it exceptionally difficult for your relative to qualify for CHC.
If you think your relative might qualify for CHC, it’s important to get help from an expert who will fight your corner and ensure that the application is dealt with fairly. It is best to seek our advice as soon as possible – ideally before the social worker conducts a health assessment. We can provide you with straightforward advice and expert support to give you the best chance of succeeding in your application for Continuing Healthcare funding.
We are not surprised.
If your relative has already been turned down for CHC or they have been told that they no longer qualify, speak to us. We will look at the facts and tell you straight away whether we think the decision is wrong and should be appealed.
Contact Us For Advice With Continuing Healthcare Funding
Get in touch with De Rossi Griffiths today for further information on CHC funding and Care Home fees. We can help you navigate through this process and help you or your loved ones get the care required.