What are the assessments needed for long term care?

What are the assessments needed for long term care?

The different care and care funding assessments can be confusing

Frail elderly lady: assessments needed for long term careSo what are the assessments needed for long term care? There are a number of different ones that may need to be carried out – and not all of them will be funding assessments.

It can be confusing when someone from health or social care tells you they’re about to ‘do an assessment’. So, if this happens, be sure to ask them two things:

  1. What is the assessment called?
  2. What is it for?

This may sound obvious, but in a time of crisis, and especially if the health and social care authorities are not keeping you properly in the loop, you can lose track of what’s going on.

Here’s our mini guide to some of the assessments needed for long term care that you might come across. (It’s not a comprehensive list – just some of the most likely ones. We’ve assumed here that your relative has health needs and that you are acting on their behalf.)

Assessments needed for long term care…

Home hazard assessment / safety assessment / rehab-to-home assessment

This isn’t always directly linked to long term care, but it can be part and parcel of the decision making process about where care should best be provided.

Who does it? Often it’s an Occupational Therapist.

When should it be done? It’s often done after someone has had a fall and/or a spell in hospital, and it determines whether a person’s home is safe for their return – and what adaptations may be needed.

Why is it important? It allows the person to be safely discharged back home. However, if you believe the assessor and/or the local authority has a vested interest (for whatever reason) in your relative going back home instead of into a care home – and that your relative’s safety could be compromised as a result, or if you feel that the hospital just wants to discharge your relative as quickly as possible, you can object to your relative going back home.

The assessor may ask you for a key to your relative’s house. If you’re not comfortable with this, say no.

Mental Capacity Assessment

Who does it? Someone who is well-versed in the Mental Capacity Act and is competent to follow the correct procedure for such an assessment. Read more about Mental Capacity Assessments here.

When should it be done? When a decision needs to be made about your relative’s care (or other matters). It looks at your relative’s capacity to make that specific decision; it’s not about their overall mental/cognitive state.

For example, if your relative is in hospital they may be asked whether they want to go back home; they may say yes, and yet they may not actually understand the implications of their answer – or the reasons they’re being asked.

Why is it important? Because if someone lacks mental capacity to make a specific decision, someone else will need to make that decision for them – and in their best interests. On the other hand, if someone does have mental capacity to make a specific decision at a certain point in time, that right should not be taken away from them.

However, if you believe the assessor does not properly understand your relative’s mental capacity (or lack of), or you suspect the assessor is not competent to carry out a Mental Capacity Assessment, and/or that the result of the assessment is wrong, be sure to object. Otherwise your relative’s safety and/or their rights could be seriously compromised. Ask the assessor what qualifies them to carry out a Mental Capacity Assessment.

NHS Continuing Healthcare assessment

Who does it?

Stage 1, The Checklist, can be done by any health or social care professional who understands the assessment process and the eligibility criteria, and is familiar with your relative’s health needs.

Stage 2, the Decision Support Tool, should be completed by a multidisciplinary team (MDT) involving both health and social care professionals – plus you. This MDT is led by a Continuing Healthcare nurse assessor.

If your relative is in a period of rapid decline (whether or not they are at the end of their life), a Fast Track assessment for NHS Continuing Healthcare may be done so that a quick funding decision can be made.

When should it be done? A Continuing Care assessment should be done before your relative starts receiving full time care – and certainly before your relative starts paying. No one should ask about your relative’s money or house before this has been done. It can also be done if your relative is already receiving full time care and nobody told you about it before or your relative’s health has deteriorated.

Why is it important? An NHS Continuing Healthcare assessment determines who is responsible for paying for your relative’s care; it may not be your relative who needs to pay – regardless of how much they have in savings or other assets. It’s vital that you are involved in these assessments and that your input is recorded in the assessment notes.

Financial assessment

Who does it? The local authority/local council.

When should it be done? Only after it has been clearly shown, through a Continuing Healthcare assessment, that your relative does not qualify for full NHS funding.

Why is it important? It looks at your relative’s savings and assets. If the value of these is over the current upper means test threshold, they will have to pay for their care. If they fall below the means test threshold, the local authority will need to pick up the bill. Your relative may still need to contribute something.

You will be asked to submit financial information. You do not have to do this – you can choose to just start paying the care fees, and the local authority will consider your relative to be ‘self-funding’.

Social care report

Who does it? Someone from the local authority or local council or social services.

When should it be done? When anyone’s care needs are being looked at.

Why is it important? To ensure that all needs are properly recorded and that suitable care is put in place. A record of social care needs is also important in NHS Continuing Healthcare assessments, because Continuing Healthcare funding covers nursing care plus social care needs.

Risk assessments

Who does them? Various people – health and social care people, the care provider, hospital teams, mental health teams, etc – depending on the type of assessment.

When do they happen? The relevant ones should be carried out at the start of long term care and updated regularly. Different or additional risk assessments may be needed as your relative’s health needs change.

Why are they important? The may include things like a falls risk assessment, a Waterlow chart (risk of skin breakdown), behaviour chart, tests for cognition, MUST scores (malnutrition risk), SALT assessments (speech/swallowing), etc. They are used to build a picture of care needs and risks (as well as indicating what care is required), and they play an important role in the evidence required for a Continuing Healthcare funding assessment.

Care assessment

Who does it? It is often carried out by a care manager (or similar person) from a care home or care provider.

When should it be done? Before you start receiving care from that organisation.

Why is it important? It looks at whether that care organisation can actually look after your relative – whether they have the skills and the facilities for your relative’s safety, health and wellbeing. It is not an NHS funding assessment, nor is it a local authority financial assessment of your relative’s means.

It can be useful to attend so that you can raise all the various health needs and risks that the care provider should be aware of.


With the possible exception of a Mental Capacity Assessment, it’s a good idea to attend each of the above assessments yourself, so you can input valuable information and be sure that things seem in order. Ask for a copy of the assessment notes afterwards, too, these will show what has and hasn’t been taken into account.

With some risk assessments, there isn’t an actual meeting to attend; instead notes should be kept by the care provider and updated regularly. It’s a good idea to check these from time to time.


  1. Clare Sharma 3 months ago

    My mother is in hospital at the moment, the hospital want her out . She doesn’t feed or wash herself nurses are doing this shes also double incontinence. Does she come under the CHC threshold

  2. Vik 2 years ago

    My Nan went into a home last year after having a stroke, she can no longer make big decisions such as paying bills etc. She also can’t speak.
    Everything, her house, bills, car is in her name and no one else has authority to speak on her behalf.
    The council are now pressuring us to sell her house, what can we as a family do? Because surely it’s against the law for us to do anything without her consent?

    • Care to be Different 2 years ago

      Hi Vik – You cannot sell the house unless you have the requisite authority such as Lasting Power of Attorney. They can apply for a charge to be placed against the property however. Kind regards

  3. christopher goodwin 2 years ago

    My father is currently funded by NHS Continuing Healthcare (CHC) (he is a double amputee, is diabetic and has various other health issues). He has recently had an extended stay in hospital of 1 month and the previous care company have said they are no longer able to meet his needs. He is recently diagnosed with mild dementia and I fear they want to put dad in a home. Most of the time he is very with it and has clearly stated his wish to stay at home. Is there anyone I can speak to please? CHC are trying to find a care package for him but the most recent care company said he requires 2 live in carers and 3 during the day. He clearly doesn’t need more than 2 people as the home is already set up with hoists, electric beds and a wet room.
    Many thanks in advance.

  4. Neil Duncan-Jordan 4 years ago

    My 80-year-old mother is about to go into hospital for an operation in a few weeks, and when she returns she is anxious that someone sleeps in her flat to help my father during the night, who suffers from dementia. Can you advise what assessments she might need to have, when they should take place and who should undertake them? Many thanks

  5. Kim 5 years ago

    Do you have any experience of DST assessment when the primary concern is the mental health of the patient – e.g. severe depression/anxiety that is impacting on their patient’s health and welfare?

    • Angela Sherman 5 years ago

      Each of the 12 care domains should be taken into account in the Decision Support Tool (DST), including Psychological and Emotional Needs – plus the impact such needs have on the other domains. Many people feel that the Behaviour, Cognition and Psychological/Emotional needs get diluted by the other domains, so be sure to build a full picture of need.

  6. Wendy 5 years ago

    My 89 year old mam lives at home and has dementia. She has been self funding for private home care and day centre and now her savings have dwindled to £8000. We had first assessment for CHC and managed to get through to the next stage. However this week I have been under a great deal of stress and felt quite ill. I am mam’s main carer and sleep over every night. I get two days every other week respite to go home and spend time with my daughter and grandson. We again pay for a home carer to stay overnight at a charge of around £150 per night. Mam was diagnosed with dementia in 2011. I have health problems too. As mam’s condition worsens her care needs have increased and I am feeling the strain. She is entitled to two weeks residential care paid for by social services, but my sisters have booked her into a care home nearby, known for its neglect and mistreatment. I am totally devastated and stressed even more. Mam went into a care home before for one week and was in a terrible state, she cried constantly became doubly incontinent and when we got her back home she was so much more confused and nervous and scared. My question is if she is entitled to two weeks residential, why can the same amount of money not be used to fund home care. All of this rubbish stating we need and want to keep our loved ones at home as long as possible is just hogwash because it seems they’ll take any opportunity to whip her away from her home and put her into residential care. Why is there not more support for us that try so hard to look after our loved ones at home? My two sisters have power of attorney (LPA) and I am just her main carer. I know I will have no say, as this happened the last time. No other family member will stay overnight with mam. Is there some safeguard for me and mam to stop this happening and instead of punishing me for being tired or poorly?

    • Angela Sherman 5 years ago

      Those are good questions, Wendy. If you feel your mother is at risk, you could raise a safeguarding issue with the local authority. Write to the Adult Care Team about this. If you feel your sisters are abusing their power of attorney, you may be able to take action via the Court of Protection. https://www.gov.uk/report-concern-about-attorney-deputy

  7. Helen hancock 6 years ago

    We have a private carer ready to look after mum when she comes out of hospital. She needs the same carer or very few carers because of her complex mental health needs. Funding guy is putting obstacles in our way with CHF as he states a private carer cannot be used because not under QCC and needs police check. Surely this can be achieved?

    • Angela Sherman 5 years ago

      The NHS usually has a list of care providers they ‘approve’. However, there’s no reason why an additional provider can’t be put on that list if they pass the checks.

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