NHS Continuing Healthcare: Continuing Care And Who Qualifies For It

Continuing care is an NHS care package that meets and pays for a patient’s nursing, social and personal care needs, and covers their accommodation costs if they live in a care home. Most patients receiving continuing care live in a care home with nursing, although you can receive it in other settings.

To qualify for continuing care, you must have a Primary Health Need that overrides any other care needs such as help with washing or dressing. The NHS is legally obliged to provide a full care and funding package for anyone over the age of 18 who has a Primary Health Need resulting from disability, accident or illness.

Continuing care is not means tested, so your income, property and assets are not considered during the assessment process. The eligibility criteria only relate to your health needs and their nature, complexity, intensity and unpredictability.

The National Framework And The ‘Postcode Lottery’

Since 2007, patients have been assessed for their eligibility for continuing care using the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. This contains a single set of criteria which are used to assess whether or not a patient has a Primary Health Need.

Despite the National Framework, many patients are still being wrongly turned down for continuing care funding because some PCTs are applying the rules incorrectly or inconsistently, or because of confusion around defining a Primary Health Need. This means patients in some parts of England are more likely to quality for NHS funding than people living in other areas.

On top of this, many people are also realising that the NHS should have paid their own or a relative’s care home fees in the past – sometimes after the patient in question has died.

What Happens When Continuing Care Is Wrongly Denied?

Paying for care either at home or in a care home can be very expensive. And people with progressive conditions such as Alzheimer’s disease, dementia or multiple sclerosis (MS) often face the prospect of needing long term care over many months or years, with costs spiralling to tens and even hundreds of thousands of pounds over time.

If these people have Primary Health Needs but are wrongly turned down for continuing care, they may not receive any financial help at all because local authority funding is means-tested and the thresholds are very low. And all too often, seriously ill people are having their savings eroded and are being forced to sell their homes to pay for care that should be funded by NHS Continuing Healthcare.

Cheselden’s Role

Cheselden is here to help people either reclaim care costs that should not have been paid, or avoid paying nursing home fees in the first place, because they have or had a Primary Health Need. We are committed to dealing with all continuing care cases fairly and correctly, so that eligible patients get the refunds and/or ongoing funding they deserve.

Find Out More

Please visit the other pages in this section of the website and read our Factsheets 1 and 4 to find out more about continuing care and Primary Health Needs. Our other Factsheets and the Glossary also provide useful information.