Continuing Healthcare: How can I make sure my relative is receiving the funding they are entitled to?

NHS funded Continuing Healthcare is available for people who receive care for a primary health need. This is regardless of whether the care is being provided in a nursing home, residential care home or at home.

Continuing Healthcare is only available for the cost of health needs and not social care needs. The differences are;

• Healthcare – in general terms it can be said that such a need is one related to the treatment, control or prevention of a disease, illness, injury or disability, and the care or aftercare of a person with these needs
• Social Care – in general terms (not a legal definition) it can be said that a social care need is one that is focused on assisting with activities of daily living, maintaining independence, social interaction, enabling the individual to play a fuller part in society, protecting them in vulnerable situations, helping them to manage complex relationships and (in some circumstances) accessing a care home or other supported accommodation.The assessment process should begin when it appears that an individual may have a care need. For example, when home care is put in place or an individual is moved to a care home. At this stage, the Local Authority will carry out a means test to establish what contribution that individual should be making towards the cost of their care. Continuing Healthcare should also be considered at this point. Sometimes, the Local Authority may decide that the care being provided falls under social care and therefore will not carry out the initial nursing care assessment. If this decision is incorrect, the Local Authority could be acting unlawfully by providing this care. This is because the individual’s needs may go beyond the remit of Local Authority care.

Problems with Continuing Healthcare assessments can arise when there has been a delay in arranging the assessment, there is lack of evidence to support the assessment, or when an assessment has been refused or is unsuccessful. There are options available to individuals facing such circumstances including requesting an appeal of a Continuing Healthcare decision and applying for retrospective Continuing Healthcare, even if the person the assessment relates to has since passed away. If you need any assistance or further information and guidance on the Continuing Healthcare process, please contact our deputyship team.

The Continuing Healthcare assessment is split into two parts. The first is a nursing care checklist which can be carried out by a social worker or healthcare provider. The nursing care checklist is used to establish whether there may be a primary health need. If it appears that there may be a primary health need, the case will be passed to the CCG to conduct a full Continuing Healthcare assessment using the Decision Support Tool. The domains used in both assessments are designed to measure the health care need. Family members and key care providers should be involved in both the nursing care checklist stage and the Decision Support Tool. The views of relatives and care workers with day-to-day contact with the person can be crucial in deciding the outcome of the assessment.

Continuing Healthcare is assessed by the local Clinical Commissioning Group (CCG) and which CCG assesses your relative will depend on which Local Authority they fall under.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*