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.
Families who understand how the CHC process works – what assessors are looking for, what evidence carries weight, and how decisions are made – are significantly better placed to secure the funding their loved one may be entitled to.
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.
Key insights
- NHS Continuing Healthcare is fully funded by the NHS and is not means-tested – your finances are irrelevant to eligibility. It can fund care at home, including live-in dementia care.
- 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 request a review and pursue an independent appeal. Many successful cases are won at this stage.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of care arranged and fully funded by the NHS for adults in England and Wales whose primary need is a health need. When someone qualifies, the NHS covers all associated care costs – there is no means test, and savings, income or property are not considered.
CHC can fund care in any setting outside of hospital. This includes nursing homes, residential care homes, and (crucially) a person’s own home. For families who want their loved one 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. You can read more in our guide to whether the council will pay for live-in care.
CHC is available in England and Wales. Scotland operates a different system (free personal care), which is not covered in this guide.
Does dementia qualify for NHS Continuing Healthcare?
This is the question most families ask first – and the answer requires 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, as dementia progresses, certain needs become significantly more likely to meet the eligibility threshold. 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: CHC assessors should consider the person’s needs on a bad day, not on a typical or average day. Documenting the full range of presentations -including difficult evenings, episodes of distress, or periods of acute confusion – is essential.
Step-by-step guide to applying for NHS Continuing Healthcare
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 loved one’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 – to ensure an accurate picture of ongoing requirements.
Step 2: The CHC Checklist
A health or social care professional completes a 12-domain 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 – 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. A decision should be reached within 28 days of the initial assessment or referral. The outcome must be communicated in writing, with a clear explanation of the reasoning.
If the decision is delayed and your loved one 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) – 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 accepting a council-arranged placement.
It is worth noting that a PHB cannot be used to fund care home fees. For families who want their loved one to remain in familiar surroundings with one-to-one clinical 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?
The Fast Track pathway exists for people with rapidly deteriorating conditions who may be entering a terminal phase of illness. It does not require a checklist, a DST assessment, or a multidisciplinary panel.
A single clinician (typically a GP, consultant, or specialist nurse) completes the Fast Track tool and submits it to the ICB. Care should be arranged within 48 hours of the completed form being received.
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 your loved one 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?
Refusal is common, but it is not the end of the road. Families have clear rights to challenge decisions at every stage of the process.
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 request an independent review through NHS England. This must be submitted within six months of receiving the written decision letter. The review is carried out by an independent panel that has not been involved in the original assessment.
Free advocacy support: The Beacon CHC helpline (0345 548 0300) provides free, independent advice on challenging CHC decisions. Their advisers are experienced in the process and can help families understand whether an appeal is likely to succeed and how to prepare evidence effectively.
Retrospective claims: CHC can be claimed for periods of past care where an assessment was not carried out – including, in some cases, after the person has died. If you believe your loved one was eligible for CHC but was never assessed, seek specialist legal or advocacy advice about a retrospective claim.
NHS Continuing Healthcare vs other funding options
Understanding how CHC sits alongside other funding sources helps families plan effectively and avoid gaps in care provision.
| Funding type | Means-tested? | Funded by | Available for home care? |
|---|---|---|---|
| NHS Continuing Healthcare | No | NHS | Yes |
| NHS-Funded Nursing Care | No | NHS | No — nursing homes only |
| Local authority funding | Yes | Council | Yes |
| Attendance Allowance | No | DWP | Contributes towards costs |
| Personal Health Budget | No | NHS (if CHC eligible) | Yes |
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.
For a detailed guide to council funding, see 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 Hometouch supports families through the CHC process
Hometouch is a doctor-founded live-in care service with a clinical team experienced in supporting families at every stage of the care journey – including CHC assessments and funding decisions.
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. As a clinically led service, we can provide detailed care records and care plan documentation that carries weight in CHC reviews.
If your loved one is awarded CHC funding and opts for a Personal Health Budget, Hometouch can deliver the live-in dementia care package – providing one-to-one clinical support from a carer who clicks with your loved one’s personality and understands their unique care needs, in the familiar surroundings of home.
Talk to one of our care experts – no pressure, just guidance when you need it most.
Frequently Asked Questions About The NHS Continuing Healthcare
Does dementia automatically qualify for NHS Continuing Healthcare?
No. A dementia diagnosis alone is not sufficient for CHC eligibility. Assessors evaluate the nature, complexity, intensity and unpredictability of the individual’s care needs — not the diagnosis itself. People living with advanced dementia who require frequent, skilled intervention are more likely to qualify, but each case is assessed on its own merits.
Can NHS Continuing Healthcare fund live-in care at home?
Yes. CHC can fund care in any setting outside hospital, including the person’s own home. If eligible, families can request a Personal Health Budget, which gives them choice over their care provider — including specialist live-in dementia care. This means your loved one can remain in familiar surroundings with dedicated, one-to-one support.
How long does an NHS CHC assessment take?
A decision should be reached within 28 days of the initial checklist assessment or referral for a full assessment. If the process takes longer and the person is subsequently found eligible, the NHS should cover care costs incurred during the delay. Keep records of any care arranged while waiting for a decision.
What is the CHC Decision Support Tool?
The Decision Support Tool (DST) is the framework used by the multidisciplinary team during a full CHC assessment. It evaluates needs across 12 care domains – including behaviour, cognition, communication, and medication – to determine whether the individual has a primary health need. Understanding how it works helps families prepare and contribute meaningfully to the assessment.
What is the NHS CHC Fast Track pathway?
The Fast Track pathway is for people with rapidly deteriorating conditions who may be approaching end of life. A single clinician can complete the Fast Track tool without a checklist or MDT assessment, and care should be arranged within 48 hours of the ICB receiving the completed form. Speak to your loved one’s GP or specialist if you believe this pathway may be appropriate.
What happens if a CHC application is refused?
Families can request reconsideration of the Checklist decision, or request an independent review following a full MDT assessment. Independent reviews must be submitted within six months of the written decision letter. The free Beacon CHC helpline (0345 548 0300) provides independent advice on challenging decisions.
What is the difference between NHS Continuing Healthcare and NHS-Funded Nursing Care?
NHS Continuing Healthcare covers all care costs – personal, social, and nursing – for people with a primary health need. It is available in any care setting, including at home. NHS-Funded Nursing Care covers only the registered nursing element of care for people in nursing homes who do not qualify for full CHC. It is not available for home-based care.
Can I claim NHS CHC retrospectively?
Yes. Retrospective CHC claims can be made for periods of past care where an assessment was not carried out – including in some cases after the person has died. Seek specialist legal or advocacy advice if you believe your loved one was eligible but was never assessed.
