Author: Fiona Gilbert BSc (Hons), MA
A Guide to Eligibility for NHS Continuing Healthcare
NHS continuing healthcare can be a difficult process to understand, especially as there are varying circumstances and requirements necessary to be classed as eligible.
There are thousands of people across the United Kingdom who need to receive ongoing care due to an accident, illness or disability. However, not many people know that they may qualify for NHS continuing healthcare, so it is important to find out if you or a family member are eligible.
Unfortunately, there is no straightforward list of health conditions or illnesses that qualify for funding. Most people who require long-term care may not qualify for NHS continuing healthcare because of the strict assessment processes. For example, fragility alone may not be enough to be accepted. However, applicants should not be put off as free healthcare could potentially save you thousands of pounds each year, so it is wise to find out where you and your family stand; therefore, we have put together this guide to help you understand the eligibility for NHS continuing healthcare:
What is Classed as Eligible Health Needs?
To be entitled to NHS continuing healthcare, you must be assessed by a team of healthcare professionals, and they will determine whether or not you have a ‘primary health need’. Qualifying conditions include mobility problems, a terminal illness, rapidly deteriorating health, a long-term medical condition, a physical or mental disability, a behavioural or cognitive disorder or any complex medical condition which needs additional care and support. However, the list is not limited, which means having a condition that is not aforementioned may mean that you, or your loved one, still qualify.
Eligibility is not judged on a person’s diagnosis, so even if you or a family member have already been diagnosed with a health condition, assessments may not conclude it is a primary health need requiring healthcare assistance. Instead, entitlement is determined by the assessment of the person’s day-to-day care needs and how those needs will need to be met.
False promises made to people about their chances of eligibility by health and social care professionals can offer hope and reassurance at the time but can be disappointing when continuing healthcare is refused. Eligibility is centred upon the existence of a primary health need which is recognised through an in-depth assessment process by a multidisciplinary team. Until this process has been carried out, nobody can independently decide that an individual will or will not be eligible, not even a medical professional.
If you or a family member get accepted for continuing healthcare, then the NHS is required, by law, to pay the full costs of your health and social care. The NHS and assessors should not have to take any financial considerations into mind when completing your application, so should they ask any questions regarding your financial situation, it is strongly advised that you reject this request.
Not Just for Those in a Nursing Home
NHS continuing healthcare is not just restricted because of your accommodation or location; individuals are still eligible if they live in a care home without nursing or their own homes. The assessments must be based on the individual’s care needs regardless of where that care will be delivered. However, it has often been shown that some assessment teams struggle to apply these very important principles. That is why it is essential to seek advice, so if you think that you have missed out due to the setting in which you or your family member is cared for, do not hesitate to get in touch.
It is also noted that if you receive NHS continuing healthcare in your own home, this will not cover your mortgage or rent, food and utility bills. However, in certain situations, it may be appropriate for the NHS to contribute to your utility bills if, for example, your bills are impacted by the need for specialised equipment to meet your care needs.
Not for Life
NHS continuing healthcare is based on an assessment of the care needs and how those needs should be met, but it is common for these needs to change over time. If you are accepted, your care needs will be reviewed three months from when the decision was made and then each year after that.
Unfortunately, this means that individuals may lose their right to funding at a later stage, even if they still have similar needs. For example, an individual with dementia who is mobile and presents with challenging behaviour is then immobilised by a fall. Though the diagnosis of dementia has not changed, and the individual’s health has actually worsened, their needs have become less severe because they are no longer mobile, and the person is evaluated as no longer having a primary health need.
This type of situation can be incredibly distressing and upsetting for everyone involved, and there is a campaign amongst charities trying to stop eligibility status reviews for those with degenerative conditions. However, since eligibility has to be based solely on assessed care needs, and not a diagnosis, it is extremely doubtful that this principle will be changed.
Here at Compass Continuing Healthcare, we have an experienced team on hand to assist you in securing funding for yourself or a loved one. If you need any help regarding this matter, get in touch with us today.
Author: Fiona Gilbert BSc (Hons), MA
Do not delay, contact us today. We specialise in securing funding from day 1 and assisting families with the process from the outset. Don’t wait until a negative decision has been made and it is then necessary to have to appeal the outcome. This can take many months and all the while the patient will be having to pay the cost of their care.
Did you know?
If an individual is approaching the end of their life then a “fast track” Continuing healthcare funding assessment may be appropriate. This enables the individual to receive prompt NHS funding to meet the cost of care at the end of life stage.