If your relative is deteriorating, does this affect eligibility in NHS Continuing Healthcare?
No. 18 in our series of 27 top tips on NHS Continuing Healthcare…
If you’ve sat through an NHS Continuing Healthcare assessment for your relative and you know they’re deteriorating, and yet they’re found not eligible for NHS Continuing Healthcare funding, what should you do?
Let’s look at the issue of deteriorating health needs and NHS Continuing Healthcare…
The first thing to consider is an appeal, and you’ll find lots of information on the Care To Be Different website to help you.
Another thing you can do, however, is to look at what the National Framework guidelines (the main assessment guidelines) say about deteriorating health needs and NHS Continuing Healthcare – in relation to assessments and eligibility:
National Framework page 16 paragraph 38:
“Where it is considered that deterioration can reasonably be anticipated to occur before the next planned review, this should be documented and taken into account. This could result in immediate eligibility for NHS continuing healthcare (i.e. before the deterioration has actually occurred). The anticipated deterioration could be indicative of complex or unpredictable needs.”
“Where eligibility is not established at the present time, the likely deterioration could be reflected in a recommendation for an early review, in order to establish whether the individual then satisfies the eligibility criteria.”
In other words, if it’s pretty obvious that your relative will have deteriorated before the next NHS Continuing Healthcare review (which should be annually or less), the assessors can recommend funding immediately.
Alternatively, your relative should be assessed again in the near future.
The likely deterioration should also be included in the assessment notes.
So this is a useful reference to point out to assessors in NHS Continuing Healthcare assessments, and something that should not be overlooked.
Remember also that if your relative is already rapidly deteriorating, they should be Fast Tracked.
You don’t have to fight this battle alone
Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.