NHS Continuing Healthcare (CHC) is the most valuable funding in adult social care: if your relative qualifies, the NHS pays for all of their care, including the full cost of a care home or nursing home, with no means test and no contribution from the family. It is also one of the hardest to obtain, because eligibility depends on a nuanced assessment that families are often unprepared for. Understanding how that assessment works — the Checklist, the Decision Support Tool, and the twelve care domains — is the difference between a fair outcome and a wrongful refusal.
What CHC actually is
CHC is NHS funding for people whose need for care is primarily driven by health needs rather than social care needs. The legal test is whether the person has a “primary health need”. Crucially, it is not about a specific diagnosis or a particular condition — someone with advanced dementia might qualify while someone else with the same diagnosis does not. It is about the nature, intensity, complexity and unpredictability of their overall needs.
Because it is not means-tested, CHC protects the family home and savings entirely. That is why it matters so much and why assessments are scrutinised so closely — the sums involved are large.
Step one: the Checklist
The process usually begins with a Checklist — a screening tool that a nurse, social worker or other professional completes to decide whether to refer the person for a full assessment. The Checklist is deliberately set at a low threshold: it is only a screen, so a family should push for one whenever there is any reasonable prospect of eligibility. Passing the Checklist does not mean the person will get CHC; it means they are entitled to a full assessment.
Step two: the full assessment and the Decision Support Tool
The full assessment is carried out by a multidisciplinary team (MDT) — typically at least two professionals from different disciplines who know the person’s needs. They complete the Decision Support Tool (DST), which is the heart of the process. The DST assesses needs across twelve “care domains”:
- Behaviour
- Cognition
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition (food and drink)
- Continence
- Skin (including tissue viability)
- Breathing
- Drug therapies and medication (symptom control)
- Altered states of consciousness
- Other significant needs
Each domain is scored on a scale — typically from “no needs” up through low, moderate, high, severe and (for some domains) priority. The scores are not simply added up. Instead, the MDT looks at the overall picture across all twelve domains, weighing the four key characteristics of a primary health need: nature, intensity, complexity and unpredictability.
How eligibility is actually decided
There are indicative rules of thumb: a single “priority” score in one of the domains that can carry it, or two or more “severe” scores, would usually indicate eligibility. But eligibility can also arise from a combination of lower scores that together paint a picture of intense, complex or unpredictable needs. This is why families should never assume that the absence of a “severe” score means refusal — the interplay across domains, and the unpredictability of needs, can tip the balance.
How to prepare — the part families control
Gather the evidence in advance. The assessment is only as good as the information in front of the MDT. Before the meeting, assemble a diary of your relative’s needs: how often they need help, what happens overnight, incidents of falls or agitation, choking or swallowing problems, skin breakdown, medication changes, and anything unpredictable. Concrete, dated examples are far more persuasive than general descriptions.
Insist on being involved. The person being assessed, and their representative, have the right to take part in the DST meeting and to have their views recorded. Attend it. Speak to each domain. If the professionals’ description understates a need you witness daily, say so and ask for your account to be documented.
Watch for the common unfair moves. Assessments sometimes wrongly downplay needs that are “well managed” — but a need that is only under control because of skilled, intensive care is still a need, and should be scored as such, not marked down because the care is working. Similarly, needs should not be dismissed as “just” social care when they are genuinely health-driven.
Get the outcome and reasons in writing. If CHC is refused, you are entitled to the completed DST and the reasoning. Read it against what you know. Many refusals rest on domain scores that do not match the documented reality.
If you disagree
You have the right to ask for a review of an eligibility decision, and ultimately to take the matter to NHS England’s independent review process. Appeals succeed regularly, precisely because first-time assessments so often understate needs. A refusal is a decision to be tested, not a verdict to be accepted — especially given how much money turns on it.
The bottom line
CHC is worth pursuing whenever health needs are significant, because it pays for everything and protects the family’s assets completely. The families who succeed are those who understand that the DST and its twelve domains are the battleground, who arrive with dated, concrete evidence, who take part in the meeting and challenge understatements on the spot, and who appeal a refusal rather than accepting it. Preparation is the single biggest lever you control.
How to use this guide in practice
Don’t read this as general information — use it as a worksheet. Write down the details of the person who needs care, the current limits of the situation at home, the weekly budget, the documents you already have, whether the local authority or NHS may fund some of it, and who you’ve already spoken with. Then turn every unclear point into a specific question. A family that arrives with a clear picture usually gets more useful answers than one calling under stress with scattered information.
Keep one simple rule: anything about admission, weekly fees, funding and whether a home fits must be confirmed directly with the care home or the competent body (your local authority, the NHS, or the CQC). This guide prepares the search — it does not replace official decisions.
Want a clear shortlist before you start ringing round?
If you don’t know which care homes to contact first, Curalune Care Help can prepare an ordered shortlist of 3–5 suitable options — with CQC ratings, contacts, useful links and a ready-to-send enquiry.
The service helps you organise the search. It does not replace the home’s own assessment and does not guarantee a place, a price or bed availability.
Important limit
Curalune offers practical help with the search and orientation. This article is general information, not legal, financial, or medical advice. Admission, fees, bed availability, eligibility, and the final assessment always rest with the care homes and the competent bodies (your local authority, the NHS, the CQC) — and complex financial or legal questions warrant a regulated financial adviser or a solicitor specialising in later-life care.
The starting point, already done
Finding suitable homes, checking they can meet the level of care and gathering the contacts takes days of phone calls. Curalune Care Help gives you that starting point: 3 to 5 suitable care homes within 24 business hours, with contacts, links and a ready-to-send message you can put to all of them at once. £69, one-off: if you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here
