Check the language used in Continuing Healthcare assessments

Check the language used in Continuing Healthcare assessments

Applying for NHS Continuing Healthcare funding can be a tortuous process, and families report that this is often compounded by assessors painting an unduly rosy picture of their elderly relative’s health and care needs.

Many people feel that needs are either overlooked or played down in an attempt (one would assume) to render the elderly person ineligible for NHS funding.
If your relative has had an assessment for Continuing Healthcare and you’ve been sent the assessment notes for comment, pay particular attention to the language used in the notes.

Here are some real examples we’ve encountered, written by NHS assessors, of language distorting the gravity of the health needs of the person being assessed:

  • “…pleasantly confused…” – this was used to describe someone with significant cognitive impairment on account of dementia
  • “…eats well and finishes her meals…” – this elderly lady would eat just a few spoonfuls of food at mealtimes and was rapidly losing weight
  • “…enjoys watching his favourite TV programmes…” – this gentleman could not engage in any way with people or with his environment; the TV was simply switched on and he was placed in front of it
  • “…responds well to reassurance in due course…” – this lady had continual suicidal thoughts on account of her severe paralysis and she was deeply distressed by her situation
  • “…speaks clearly and can communicate her needs…” – this person’s speech was impaired and further complicated by mental confusion; assessors attributed her ‘clear speech’ to the fact that her carers were used to her. This is in no way a valid argument in an assessment.
  • “…inconsistency in bowel action…” – this lady had serious problems on account of her double incontinence combined with other major health problems, which together were causing immense distress. The word ‘inconsistency’ here doesn’t come close to describing the real situation.
  • “…uses a wheelchair for distance…” – this lady was completely immobile and the only way she could be moved from one place to another was by someone pushing her in a wheelchair.

These are just a few examples of things you need to watch out for. They may help you identify additional examples in your own relative’s assessment notes.
It can be easy to get sucked in by the jargon used in Continuing Healthcare – so make sure you pick all notes apart and challenge anything that seems designed to diminish your relative’s health needs.

Read more about how to get assessed for NHS Continuing Healthcare.



  1. Meggie 3 years ago

    This brief article rings so true. When Dad was delusional, hallucinating and terrified and was demanding hospital call the police because he believed it was about to be blown up in a terrorist bomb plot – what did the doctors write after speaking to him for 5 minutes the following day – “bright engaging, somewhat confused”
    He has a urostomy – his cognition and memory are so poor he frequently forgets he has one and is entirely dependent on others for its care, hygiene, changes, morning and evening drainage routine etc – what does a Community Psychiatric Nurse (CPN) write – “self managing with his urostomy” just because some days he remembers it and can empty it himself.
    He takes large numbers of medications, many at high and maximum doses, without which his mental state would be even worse – he no longer knows what he needs, or when, and often tells people he’s better now and doesn’t take tablets. At other times he obsesses about tablets and searches for them – before we knew he had Alzheimer’s and took over his medication management he did once take an overdose by mistake and there are many times he talks about taking an overdose deliberately when he is deeply depressed. What does CPN write – “needs prompting with medications” as if it’s no more than someone saying casually ‘don’t forget to take your tablets later’. In hospital when he refused point blank to go to bed – as he does at home sometimes – and stayed up all night refusing to be persuaded and walking around all night at risk of falls – his notes describe him as “very independent, knows his own mind”. Is the down playing of symptoms, care needs, state of health etc done deliberately?

  2. C Smith 8 years ago

    I couldn’t agree more. Also, if your relative is in a care home you need to go through all their notes, care plans and risk assessments very carefully too, looking for inconsistencies between what you know about your relative and what is recorded. Also look out for inconsistencies between the different types of record held.

    • Angela 8 years ago

      Thanks for your comment. Yes, it’s vital to go through everything in fine detail – and look for contradictions in the assessment notes too: One page might imply that there are no particular health needs, while another will use words that shows there are clear needs. The things that go on are unbelievable. Today we heard of someone in hospital who was on a special diet on account of the risk of choking. The day before the assessment they were taken off that diet – so the assessment notes showed ‘no needs’ – and the day after they were put back on it.

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