What Is Continuing Healthcare And Is My Parent Eligible?
Someone I know recently applied for Continuing Healthcare. His GP was the person pushing this forward for him, as he hadn’t been aware that this fully funded package of care was even an option. So I thought it would be helpful to look at what Continuing Healthcare is, let you determine if you think your loved one could be eligible and what the application and appeal process consists of.
Continuing Healthcare (also known as CHC) is a complex process, so I’m delighted to have spoken with solicitor Lisa Morgan for this article to understand it fully. A member of Solicitors For The Elderly, Lisa and her team have helped over 10,000 families navigate NHS Continuing Healthcare since 2006, saving them millions in future care costs and retrospectively recovering over £180m.
What Is Continuing Healthcare?
Usually in the UK, healthcare is free (thank you NHS) and we need to pay for social care (that’s help with day-to-day living such as getting washed and dressed).
But with Continuing Healthcare, all your care costs are arranged and paid for by the NHS. So if your elderly parent is in a nursing home, the total costs there would be covered, and likewise if they have a carer at home.
As you can imagine, this fully-funded package of ongoing care is only given to people who are assessed to need support with long-term health needs. It’s not condition specific (so having dementia or recovering from a stroke for example would not make someone eligible).
Instead, it’s based on whether someone has a ‘primary health need’ – essentially, one or more long-term health conditions (such as help needed with breathing or swallowing) as opposed to having care needs as a direct result of getting older.
If you can show throughout the application process that their primary need is for health and nursing support rather than social care, then your parent should be eligible for fully funded NHS care. That means all health and social care costs are covered.
Lisa also helps a number of families apply for Continuing Healthcare retrospectively, acting for an estate to potentially recoup care costs after a parent has died. In England you can go back as far as 2012, but in Wales it’s just the one year (there isn’t Continuing Healthcare in Scotland or NI).
Who Qualifies For NHS Continuing Healthcare?
There’s no formula for success here unfortunately – decisions are very much made on a case-by-case basis by the local Clinical Commissioning Group (CCG) in England or Health Board in Wales.
And if you don’t succeed the first time, don’t be put off. The decision is subjective, based on the opinions of the people assessing your case. If you don’t get the answer you’re looking for, you can always appeal (in fact, 90% of Lisa’s cases are appeals).
There’s also Fast Track Continuing Healthcare. You can apply for this if your parent’s condition is deteriorating rapidly and they may be approaching the end of their life. If they pass the assessment, then a support package can be put in place within 48 hours.
How Much Is Continuing Healthcare Funding?
There’s no threshold on CHC funding – once an individual is approved, it depends on what they need. And it’s not means’ tested, so anyone who fits the criteria is eligible.
There does seem to be a bit of a postcode lottery however – looking at the data from the Department of Health, Continuing Healthcare is more likely to be awarded in the north compared to the home counties for example.
Getting Continuing Healthcare funding isn’t a short process but don’t let that put you off – if you believe your parent is eligible, then you should try. You need to go via the local CCG, who will have their own Continuing Healthcare Co-ordinator.
There’s a two-step application process, and it helps to have either your parent’s GP, ward consultant (if they are currently in hospital) or care home manager (if in a nursing home) on board to help you gather all the necessary information and support you during the process.
You might also want the support of a professional solicitor to help you navigate through the complexity.
All CHC assessments should involve the patient and their families where appropriate.
How To Apply For NHS Continuing Healthcare
Continuing Healthcare Checklist
The CHC checklist is the first step of the process. Carried out by a health care professional, this initial screening assessment is there to check whether someone’s care needs are sufficient enough to move on to the full assessment.
Taking the example of the elderly gentleman I mentioned at the start of this article, his GP was pushing for him to get Continuing Healthcare and filled in the CHC checklist for him (with his consent).
The Continuing Healthcare checklist threshold is set intentionally low to screen people in rather than out. There are 11 areas of need, scored on A (high moderate), B (moderate) or C (low). Depending on the results, your parent may be offered a full assessment.
If your parent is being fast tracked, then it’s likely the checklist will be skipped and they will start at the next stage.
In estate claims, they collate the care and medical records and prepare a Needs Portrayal Document (highlighting the patient’s care needs) and then apply the Decision Support Tool retrospectively.
Full Assessment Using The CHC Decision Support Tool
This stage of the Continuing Healthcare assessment is carried out by a multi-disciplinary team (that could be a doctor, physiotherapist, occupational therapist for example) as they strive to understand if your parent has a primary health need.
They use a Decision Support Tool which looks at your parent’s needs within 12 areas (or what they call ‘care domains’). These include continence, cognition, behavior, mobility, skin and breathing and they’re all scored on a scale from none to priority. The decision support tool takes into account the nature, complexity, intensity and unpredictability of each area too.
Every case is different, so the DST helps them to understand if there is a primary health need. The MDT then passes their decision onto the CCG who make the final call.
Fast Track Pathway Tool
Health needs can sometimes dramatically change when it’s getting towards the end of someone’s life (such as pain control, swallowing concerns etc). If this is the case for your mum or dad and they have significant nursing needs as a result then they could be eligible for CHC.
As time is of the essence, the fast track pathway tool will be used by the CCG which could lead to fully-funded NHS care at home, in a care home or hospice.
Tips For The Best Chance Of Success
- Keep good records that show your loved one’s health and care levels. It’s even more important to do this if your parent lives at home (vs in a care home) as care agencies don’t keep comprehensive records that you can refer back to. These diary entries should demonstrate the amount of care needed, downturns in health, any behavioural episodes etc. Anything you think could be worth recording is.
- Keep all the invoices that show evidence of the type of care that has been paid for, and when. As the Continuing Healthcare retrospective review process lets you go back to 2012, your parent can potentially claim these funds back.
- Make sure that there’s always family input at the assessments – you’re able to and should attend to speak on your loved one’s behalf. Remember, you’re in a unique position as you know your relative better than anyone else, and can fight their corner for them.
- Before going to the full assessment, go through the decision support tool and record where you think your parent sits on it. This stands you in good stead to dispute the MDT if needed.
- Organisation is key here. Keep track of every document that is submitted, and the names of people you have spoken with. Start a folder and put everything in there so nothing get’s misplaced.
- Speak with people who can help you. Applying for CHC can be highly emotional for the family, and outside support can really benefit you. Lisa’s practice offers a free initial consultation (with no time limit) and then different funding options depending on what’s required.
Getting Continuing Healthcare
You should hear from the CCG within 28 days if the application has been successful (but please chase it up if you haven’t as there are often delays). If it’s successful then well done! If not, remember you can always appeal.
Now, it’s important to consider the type of care your parent wants and needs moving forwards.
If your parent is in hospital and it’s best for them to move to a care home, then before discharge make sure you work with the local CCG to identify local homes that are best suited to their nursing needs.
If your parent is already in a care home when they’re awarded CHC, it’s extremely unlikely they will be moved to a cheaper home as this could have a detrimental impact on their health.
You can’t top up the CHC funding. Say for example your parent is living at home and needs live-in care to stay there, which is more costly than moving to the nursing floor at a care home.
The NHS is within its right to provide full funding for the nursing home, but not the live-in carer. That’s not to say that live-in care is never provided under Continuing Healthcare, but it’s important to understand the differentiation here.
Depending on backlog, it may take the CCG time to contact your parent’s chosen care provider to inform them of the decision, and ensure they take over payments. You will be reimbursed for any care costs accrued following the successful decision.
Continuing Healthcare Timeframes
After all that, you may think that CHC lasts for the rest of your parent’s life, but it’s reviewed periodically to check if the primary health needs still stand.
There’s a review after three months, and then annually – all of which is organised by the CCG. This isn’t as in-depth a process, these annual reviews are mainly to ensure the care package is still appropriate.
Continuing Healthcare Appeal
Please don’t be disheartened if you don’t get it – you’re able to appeal. Like I said above, the decision is subjective based on the people doing the assessment, so there’s always a chance it will be granted when it hasn’t been previously.
You can access all records from the previous application and then ask the CCG to undertake a full retrospective review.
Continuing Healthcare On Behalf Of An Estate
Not everyone finds out about CHC funding when they need it. If your parent has passed away and you think there’s grounds to apply for Continuing Healthcare retrospectively, then do.
You’ll need to go through the same approval process as above, but it potentially could be easier to get (if the primary health need is demonstrated) because there is an end date to the care and funding.
If successful, the funds would be released back to the estate and you would have to then go through probate. A retrospective CHC funding process can take some time so don’t delay probate. When the money is released, it is distributed as per the will or rules of intestate.
NHS Continuing Healthcare can make all the difference to someone’s quality of life as they get older, but it’s complicated to understand and navigate. We hope this article has answered lots of questions you might have had. Speaking with a solicitor specialising in Continuing Healthcare could prove really beneficial, especially if you’re going through the appeal process and need some more support. If you think your parent is eligible for CHC funding, then good luck.
NHS Continuing Healthcare FAQs
Continuing Healthcare awards a fully funded package of care to people assessed to have a primary health need. This is classed as one or more long-term health conditions (such as help needed with breathing or swallowing). CHC does not pay for care for people who need help as a direct result of getting older.
Continuing Healthcare (also known as CHC) is when someone’s total care costs are arranged and paid for by the NHS. Normally, the NHS would only pay for healthcare, and individuals have to pay social care costs (for day-to-day living). If you think a loved one is eligible, look at the CHC funding criteria and speak with their GP, ward manager or care home manager.
There’s a two-step application process for CHC.
1. Continuing Healthcare checklist: The initial screening assessment is carried out by a healthcare professional to check whether someone’s care needs are sufficient enough to move on to the full assessment. They use the CHC checklist to see where your loved one sits against certain criteria.
2. Decision support tool: This full assessment is applied by a multi-disciplinary team. They look at 12 areas of care to determine if your parent has a primary health need.