Does Dementia Qualify for NHS Continuing Healthcare Funding?

Author:
Hannah Morris
Care Home Fees Associate Lawyer
Date:
18/09/2019

This article was updated on 18 May 2022.

The answer to this question is rarely a straightforward one.

Put simply, the diagnosis of any medical condition, including dementia, is not enough for NHS Continuing Healthcare Funding (also called CHC Funding) to be awarded. This is because eligibility is not assessed on a medical condition alone, but also the level and type of care required to meet a person’s health care needs.

Dementia can come in various forms, such as Alzheimer’s, Lewy Body Dementia and Vascular Dementia. There are varying forms of severity and it can affect people in vastly different ways, so individuals’ care needs will also differ.

As a result, some people who are suffering from dementia may be assessed as having a Primary Health Need – meaning they are eligible for CHC Funding - whereas others may not.

For a no obligation discussion, get in touch with our Care Home Fees Solicitors.

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Who is Eligible for NHS CHC Funding?

The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care sets out the guidelines for whether a person is eligible for CHC Funding to be awarded.

You will only qualify for CHC Funding if you are deemed to have a Primary Health Need. Although the National Framework offers a description of what this entails, there is no legal definition so it can be interpreted in different ways. For example, in some cases it might be decided that an individual’s needs will be better suited to care provided by social services.

Paragraph 55 of the National Framework states:

“Having a Primary Health Need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall day-to-day care needs to be taken in their totality.”

To determine whether an individual has a Primary Health Need, there is an assessment process, which is also detailed in the National Framework.

What Does the CHC Funding Assessment Process Involve?

Not all claims for CHC Funding will be successful, and the Department for Health sets out guidelines in terms of how a person’s care needs are assessed. These are the main stages of the assessment process:

      1. Applying for CHC Funding – any medical professional involved in your care who understands NHS CHC Funding should refer you for an eligibility assessment. But if this doesn’t happen, you can start your own claim by contacting your local Clinical Commissioning Group (CCG).
      2. Initial Assessment – an NHS checklist will be completed, which is effectively a screening tool to outline your specific needs and determine whether they meet the threshold for a full eligibility assessment.
      3. Full assessment – this will usually take place with a Nurse and a Social Worker who will complete the Decision Support Tool and recommend whether you are eligible.

 

Although the assessment process and any appeals of a negative assessment decision are pursued through the NHS rather than in the Courts, having a specialist Care Home Fees Lawyer to advise you can be the best course of action when dealing with this complex and time-consuming process.

How Does Dementia Affect a Patient's Needs?

Cognition and Communication

People suffering from dementia often become forgetful during conversations or start to repeat their words. It can be damaging to a person’s confidence if they are aware in the early stages that this is happening to them, and they may rely on carers to anticipate their needs. This can lead to loneliness and social isolation.

Behaviour

One key aspect of CHC Funding assessment focuses on how challenging an individual’s behaviour is. They may not fully understand the nature of their needs and could cause harm to others while in care.

An individual may also refuse medication, not recognising the need for it and could even challenge their carers over things like food intake.

Hygiene

In some cases, people with dementia will lose the ability to make “good” decisions, this doesn’t exclude personal hygiene. Some people with dementia refuse to shower or bathe regularly, either because they struggle with the practicalities of it or because they have lost the motivation.  

If a carer is prevented from providing personal hygiene care, it could result in a whole host of skin-related issues as well as general discomfort.

If you would like to know whether your needs or those of a loved one may be sufficient to qualify for CHC Funding, get in touch with one of our Care Home Fees Solicitors for a free initial assessment.

We will carry out the time-consuming work involved in the CHC Funding assessment procedure and where possible, we can work on a No Win, No Fee basis. Speak to one of our expert team for further advice.

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