NHS Continuing Healthcare for dementia: A step-by-step guide

Many families supporting someone living with dementia don’t realise the NHS may fund their care in full. NHS Continuing Healthcare (CHC) is a non-means-tested funding package that can cover the entire cost of care (including live-in care at home) for people whose needs are primarily driven by health rather than social factors.

This guide, written with input from Hometouch’s clinical team, walks you through every stage of the CHC process for dementia, from the initial checklist to appeals and Personal Health Budgets. This guide covers England. Wales has its own national framework for Continuing NHS Healthcare, delivered by local health boards, and Scotland operates a different system.

Key insights

• If someone is eligible, NHS Continuing Healthcare is fully funded by the NHS. It is not means-tested, so finances are not part of the eligibility decision. It can fund care at home, including live-in care for dementia
• A dementia diagnosis alone does not guarantee eligibility. Assessors focus on the nature, complexity, intensity and unpredictability of care needs, not the diagnosis itself
• The CHC process follows a clear, staged pathway. Families who document care needs thoroughly and attend assessments prepared are better placed to achieve a fair outcome.
• If an application is refused, you have the right to ask for a review, and then an independent review if the decision still stands.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of care that the NHS arranges and fully funds for adults in England whose main need is a health need. There is no means test, so the person’s finances do not count. It can fund care in any setting outside hospital, including the person’s own home as well as nursing and residential care homes.

For those who want their family member to remain in familiar surroundings, a successful CHC application can make specialist live-in dementia care financially viable. It is important to understand how CHC differs from two related funding streams that families often encounter:

• NHS-Funded Nursing Care (FNC) covers only the registered nursing element of care for people in nursing homes. It is not available for home-based care and does not cover personal or social care costs
• Local authority funding is means-tested and administered by the council. It is separate from CHC entirely. The council’s role is covered in whether the council will pay for live-in care

Does dementia qualify for NHS Continuing Healthcare?

This is the question most families ask first, and the answer needs some nuance.

A diagnosis of dementia, Alzheimer’s, vascular dementia, or Lewy body dementia does not automatically qualify someone for CHC. Eligibility is determined by the nature, complexity, intensity and unpredictability of an individual’s care needs at the time of assessment. Two people with the same diagnosis may have entirely different CHC outcomes depending on how their condition currently affects their daily life.

That said, the assessment looks closely at needs that often become more significant as dementia progresses. These include:

• Severe or unpredictable behavioural changes, including distress, aggression or unsafe wandering
• Complex medication routine requiring clinical oversight
• Swallowing difficulties (dysphagia) that create a risk of aspiration
• Rapidly changing or unpredictable episodes that require immediate, skilled intervention
• Significant cognitive decline combined with multiple complex comorbidities
• Substantial risk to safety that cannot be managed through standard care

One practical point that families often overlook: the assessment should reflect the full range of the person’s needs, not just how they are on their best day. Documenting the full range of presentations, including difficult evenings, episodes of distress or periods of acute confusion, is essential.

How do I apply for NHS Continuing Healthcare?

Start with a CHC Checklist, which a GP, district nurse, social worker or hospital discharge team can trigger. Families can also ask their local Integrated Care Board for the checklist. A full multidisciplinary assessment follows if the checklist shows possible eligibility. A decision should follow within 28 days of the ICB receiving the completed checklist or referral.

Step 1: Request a CHC Checklist assessment

The process begins with a referral for a CHC Checklist, the initial screening stage. A GP, district nurse, social worker, hospital discharge team, or other health or social care professional can trigger this. Families can also request it directly from their local Integrated Care Board (ICB) or from the professional managing their family member’s care.

One important caveat: the assessment should not take place while someone is acutely unwell in hospital. The NHS guidance is clear that needs should be assessed in a stable setting, either after discharge or in a community environment, so that the assessment gives an accurate picture of ongoing requirements.

Step 2: The CHC Checklist

A health or social care professional completes a screening checklist to determine whether a full assessment is warranted. The family should receive a copy of the completed checklist and be informed of the outcome.

If the checklist indicates potential CHC eligibility, the process moves to a full multidisciplinary assessment. If not, families can request reconsideration of that decision before proceeding further.

Step 3: The Multidisciplinary Team (MDT) assessment

The full CHC assessment is conducted by a multidisciplinary team, typically at least two health and social care professionals, including those involved in the person’s ongoing care. The assessment uses the CHC Decision Support Tool (DST), which examines needs across 12 clinical domains, including cognition, behaviour, medication, communication, and nutrition.

The person living with dementia and their family are entitled to be present throughout this assessment. An independent advocate can also attend. Families should bring written evidence of needs, such as care records, GP letters, notes from difficult episodes, and should not assume professionals will automatically understand the full picture from clinical notes alone.

Step 4: The eligibility decision

The MDT makes a recommendation to the local ICB, which reviews the evidence and makes the final decision. The National Framework says a decision should be reached within 28 days of the ICB receiving the completed Checklist or a referral for a full assessment. The outcome must be communicated in writing, with a clear explanation of the reasoning.

If the decision is delayed and the person is subsequently found eligible, the NHS should cover care costs incurred during the waiting period. Keep records of any care arranged during this time.

Step 5: Arranging care and the Personal Health Budget option

If eligible, the ICB arranges a care package. Families can request a Personal Health Budget (PHB), which is a mechanism that gives them direct control over how the funding is used and which provider delivers care. A PHB is the route that allows families to choose a specialist provider like Hometouch for live-in dementia care at home, rather than a package arranged for them by the ICB.

It is worth noting that a PHB cannot be used to fund care home fees. For families who want their family member to remain in familiar surroundings with one-to-one support, this option is worth requesting explicitly.

Step 6: Reviews

CHC packages are reviewed after the first three months and then at least annually. Needs, and therefore eligibility, can change as dementia progresses. Families should keep detailed records of changing needs between reviews, including new symptoms, medication changes, and any significant episodes. If needs increase substantially before a scheduled review, you can request a reassessment.

What is the CHC Fast Track pathway?

Fast Track is for people with rapidly deteriorating conditions who may be approaching the end of life. A single clinician, such as a GP or consultant, completes the Fast Track tool, and the checklist and full assessment are skipped. Care should be arranged within 48 hours where reasonably possible.

This pathway is relevant for families supporting someone with advanced dementia who has also received a terminal diagnosis, or where there has been a sudden and significant deterioration in health. If you believe the person may be approaching the end of life, ask their GP or specialist whether the Fast Track pathway is appropriate.

What if the CHC application is refused?

Families can challenge a decision at each stage. A checklist decision can be reconsidered before it is finalised. After a full assessment, you can ask the ICB to review the decision within six months of the decision letter. If the matter is still unresolved, you can request an independent review through NHS England.

After the Checklist: If the checklist outcome is that a full assessment is not warranted, families can ask for this decision to be reconsidered before it is finalised. New evidence can be submitted at this stage.

After the full MDT assessment, families can ask the ICB to review the decision through its local resolution process, within six months of the decision letter. If the matter is still unresolved, families can request an independent review through NHS England. The review is carried out by an independent panel that has not been involved in the original assessment.

Further support: The Alzheimer’s Society has guidance on NHS continuing healthcare

Retrospective claims: A review of past care can sometimes be requested where an assessment was not carried out, including in some cases after the person has died. Time limits apply. If you believe the person may have been eligible for CHC but was never assessed, seek specialist legal or advocacy advice about a retrospective claim.

How does NHS Continuing Healthcare compare with other funding options?

CHC is NHS-funded and not means-tested. NHS-Funded Nursing Care covers only the nursing element in nursing homes and is not available for home care. Council funding is means-tested and sits separately. A successful CHC application typically takes over from other NHS or council funding for the same needs.

These funding streams are not mutually exclusive at every stage. Families may be receiving local authority support or Attendance Allowance while pursuing a CHC assessment. A successful CHC application typically supersedes other NHS or council funding for the same care needs.

Council funding is covered in our guide: Will the council pay for live-in care? For a broader overview of what live-in care costs and how it is funded, see our live-in care cost guide.

How does Hometouch support families through the CHC process?

Hometouch‘s clinical team can help families understand what assessors look for, what to document and how to present evidence. If CHC is awarded and a family chooses a Personal Health Budget, Hometouch can provide one-to-one live-in care with clinical oversight from our team.

Our clinical team understands what assessors look for and can help families understand what to document, when to request a review, and how to present evidence effectively at a CHC assessment. Where a family asks, we can share care records and care plan documentation to support their evidence at a CHC review.

If the person is awarded CHC funding and opts for a Personal Health Budget, package, providing one-to-one support from a carer the family chooses, with clinical oversight from our team, in the familiar surroundings of home.

Talk to one of our care experts today. No pressure, just guidance when you need it most.

Frequently Asked Questions About The NHS Continuing Healthcare

Who can start an NHS Continuing Healthcare assessment?

A GP, district nurse, social worker, hospital discharge team or another health or social care professional can start the process. Families can also ask their local Integrated Care Board for a CHC Checklist.

What evidence should families bring to a CHC assessment?

Bring written evidence, such as care records and GP letters, along with notes on difficult episodes. Professionals may not understand the full picture from clinical notes alone, so record difficult evenings and periods of distress as well as typical days.

Can a CHC assessment take place in hospital?

No. The assessment should not take place while someone is acutely unwell in hospital. It is carried out after discharge or in a community setting, so it reflects ongoing needs.