Who is eligible for Continuing Healthcare?
To be eligible for NHS Continuing Healthcare, your main or primary need for care must relate to your health. For example, people who are eligible are likely to:
- Have a complex medical condition that requires a lot of care and support
- Need highly specialised nursing support.
Someone nearing the end of their life is also likely to be eligible if they have a condition that is rapidly getting worse and may be terminal.
Eligibility and Criteria
The eligibility criteria for Continuing Healthcare have 12 domains that are described in the Decision Support Tool.
Eligibility for Continuing Healthcare is the demonstration of a primary health need. This means that a person’s health needs are deemed to be more than what would reasonably be expected to be part of Social Care support. A ‘yes’ decision ratified by the team or panel means the package of care will be fully funded by Continuing Healthcare.
If an individual is not eligible, in some cases, joint funding can be agreed. This is where Continuing Healthcare agrees to pay for a proportion of the package of care, and the other proportion may be paid for by Adult Social Care.
In some cases, a person may have potential for rehabilitation; this must be fully explored by professionals before NHS-funded Continuing Healthcare can be considered.
Self-funding your care in the community, residential care or nursing care
The care system can be very confusing, especially if you are trying to source your own care, and are not certain how you should do this for yourself or your family. If you think that you or another person you know may be eligible for Continuing Healthcare and the Local Authority is not currently working with you, please contact us.
What is the place of Adult Social Care with Continuing Healthcare?
Some people will have specific needs which are met by both the Local Authority and the CCG. In these cases the CCG works closely with Local Authority colleagues to agree a joint package of care. Where a person qualifies for NHS-funded Continuing Healthcare, the package provided will be appropriate to meet all of the individual’s assessed health and social care needs.
What if I’m eligible?
Find out more in the services we provide page.
Eligibility will be reviewed after three months and then annually thereafter.