What’s the trigger point for getting your relative assessed for NHS Continuing Healthcare?
This is a question many people ask, and there are various ways to answer it. So how do you know if a Continuing Healthcare assessment should be done?
The following are all broad indications that your relative should be assessed for NHS Continuing Healthcare:
- your relative is in hospital and needs ongoing care after discharge; they must be assessed for NHS Continuing Healthcare before being discharged. This is made clear in the Care Act.
- your relative has health needs and is at home and needs care
- your relative has been receiving care for some time – and paying for it themselves – but no one has assessed them for NHS Continuing Healthcare.
- your relative is going into a care home or receiving full time care at home
- your relative was previously assessed but denied NHS Continuing Healthcare – but their needs have now increased
In these situations it’s vital that a proper decision is taken about who is legally responsible for paying care fees.
There is a very important distinction between local authority care and NHS care – the former is means tested, the latter isn’t. And that distinction does NOT depend on how much money your relative has.
It’s vital that families understand this before they pay a penny in care fees.
But how can you gauge whether your relative is likely to be eligible for NHS Continuing Healthcare – and whether it’s worth pursuing?
Keep these two points in mind:
1. You have nothing to lose by asking for an NHS Continuing Healthcare assessment. There are different stages to the assessment process. Don’t be put off by people within health and social care who may tell you it’s ‘not worth it’ or that your relative ‘won’t qualify’ or that a person has to be at ‘end of life’ or some such other nonsense. No one can say whether or not your relative should receive the funding until care needs have been properly measured against the NHS Continuing Healthcare eligibility criteria. Those care needs must also be viewed in the light of the legal limit beyond which a local authority cannot provide care – and beyond which any means test or financial assessment would be illegal.
2. You can look at the assessment criteria yourself (see below) and gauge how you think your relative will fare.
The fundamental point in all of this and the deciding factor in ALL NHS Continuing Healthcare assessments is whether a person’s care needs are primarily social care needs or primarily healthcare/nursing care needs. If the latter, the person should be fully funded via NHS Continuing Healthcare. This means no means testing, no financial assessment, no top up fees.
NHS Continuing Healthcare funding is assessed by and provided by the NHS, through local Clinical Commissioning Groups (CCGs).
NHS Continuing Healthcare eligibility does not depend on any specific diagnosis that your relative may – or may not – have. Nor does it depend on whether they are in a care home or in their own home.
How can you know in advance what the likely outcome of a Continuing Healthcare assessment will be?
You can look at the assessment forms/criteria yourself and ‘score’ your relative yourself, based on their care needs – to get an idea of how they would get on in an assessment.
- Take a look at the Checklist assessment form (or ‘tool’). (Click the link and you’ll find all the Continuing Healthcare forms/assessment documents, including the Checklist. There are 11 sections or ‘domains’ in the Checklist. Look at the example descriptions of needs in each one and score your relative A, B or C for each domain.
- Once you’ve done that, look at the scores required to get through the Checklist (see pages 7-8 of the Checklist form).
- If you believe your relative would ‘pass’ the Checklist, get the NHS Continuing Healthcare assessment process started as soon as possible.
Note: You can’t actually submit your own Checklist to the NHS; instead, it has to be done by a health or social care professional. However, by doing it yourself in advance – just for your own purposes – you’ll get an idea of what scores the assessor should write down and what the outcome should be. It means you can better argue your relative’s case.
The Checklist is stage 1 of the Continuing Healthcare assessment process; it does not determine whether or not your relative will receive the funding – it simply gets you through to stage 2, which is a full multidisciplinary team (MDT) assessment. Stage 2 uses a form called the Decision Support Tool. You’ll find the Decision Support Tool here – it includes the assessment criteria and scoring system (which is different to the Checklist).
You could go through the same process yourself for stage 2 of the assessment process – using the Decision Support Tool – and see how you think your relative would get on at that stage.