Continuing Healthcare Checklist (CHC)
If you are living with a disability or have been diagnosed with a long-term illness you may be entitled to continuing healthcare funding. The continuing healthcare checklist is a screening tool to determine whether you are eligible for healthcare funding. Here we explore what the NHS continuing healthcare checklist is, how much continuing healthcare funding is, what types of care it can be used for and how you can access continuing healthcare funding by completing the CHC checklist.
Healthcare in the UK is free at the point of delivery. Therefore, if you have an identified healthcare need and are receiving live-in care in your own home, you may be eligible for NHS Continuing Healthcare funding, which is arranged and funded by your local Clinical Commissioning Group (CCG). A healthcare need relates to the treatment, control or prevention of a disease, illness, injury or disability and the after care of a person living with these conditions.
Having a disability or having been diagnosed with a long-term illness may not, on its own qualify you or your loved one for NHS continuing healthcare funding. The assessment undertaken by the CCG must conclude that there is a ‘primary health need’ – that means that the overall need is health related and not considered a social care need.
NHS continuing healthcare is non-means tested and funding can be used to receive care in your own home. The level of healthcare funding available will be determined by not just your health needs, but the location of your CCG in the country, as this impacts availability of funding.
What is the NHS Continuing Healthcare Checklist (CHC)?
An assessment for eligibility for continuing healthcare funding is conducted in two stages; firstly a checklist assessment, known as the CHC checklist, will be completed as a screening tool to determine whether a person is likely to move to the second stage, which is a full assessment.
Anyone can request a continuing healthcare checklist, and this can be completed by a GP, social worker, care provider or any other healthcare professional involved in your care.
The NHS National Framework, which was established in 2018 and sets out guiding principles and a framework for NHS continuing healthcare and funded nursing care, it states that eligibility for healthcare funding should be determined post discharge from hospital, so a person’s longer term needs can be better understood in their own non-acute environment. If a person is moving into a residential care home for the first time, a period of time should be given for them to settle into their new environment. A continuing healthcare checklist can easily be completed in the comfort of your own home on return from hospital if you are receiving care at home from a live-in care provider. Once you have requested a continuing healthcare checklist it should ideally be completed within 14 days.
During the interim period before completing the continuing healthcare checklist and establishing whether you are eligible for continuing healthcare funding, a short-term care package can be put in place, to enable you to return home. This can be arranged by the discharge team at the hospital or you can arrange your own care at home with your chosen provider.
Should you or your loved one require end-of-life care at home following hospital discharge there is a fast-track assessment process that negates the need to complete the continuing healthcare checklist.
At The Good Care Group we work closely with many Clinical Commissioning Group’s (CCGs) across the country who provide the continuing healthcare funding to our clients to enable them to receive our high-quality live-in care service. Our Care Managers are also trained and experienced in supporting our clients and their families to complete the continuing healthcare checklist, providing much-needed guidance and advice.
How much is continuing healthcare funding?
There is no cap on continuing healthcare funding. The level of funding will be determined by your assessed healthcare needs using the NHS continuing healthcare checklist assessment. Continuing healthcare funding is different to social care funding, which is allocated by your local authority and ‘means tested’. Means testing means that your personal financial circumstances are considered alongside your care and support needs. With continuing healthcare funding your financial circumstances do not determine the level of funding you can access. It is purely determined by your healthcare needs.
What type of care can continuing healthcare funding be used for?
If you have been approved to receive NHS continuing health care funding following your CHC screening, funding can be used for different types of care packages:
- Live-in care – one-to-one care from a dedicated professional carer can be provided around the clock giving you much peace of mind. This may be suitable for those who are already living with other complex or specialist conditions. There are many far reaching benefits of live-in care for those who are receiving continuing healthcare funding.
- Respite care – flexible respite services from as little as two weeks can provide the care you need for shorter periods of time and enables a family carer to take a much-needed break from caring for their loved one.
- Nurse-led care – if you require clinical interventions usually performed by a district nurse, nurse-led care can be provided by a competent and trained carer, overseen by a team of clinical experts.
- Hourly care – a visiting carer can come to your home from as little as 30 minutes a day to as many hours or visits as you need to support you at the times you need it most.
- Overnight care – if you need the reassurance that your care needs can be met overnight, a professional carer can provide sleeping night care. The carer is on hand to support you up to twice during the night, providing you with comfort and reassurance that someone is there should you need them. Sleeping night care then enables the same carer to undertake their role supporting you during the day.
- Short-term care – a professional carer will support you in own home following hospital discharge and provide interim care whilst you wait to complete your CHC checklist and CHC screening.
- Care home – you can choose to receive your continuing healthcare funding to fund the care you need in either a residential care home or nursing home.
Who is eligible for healthcare funding?
Eligibility for healthcare funding is determined by whether or not a person has a primary health need and the severity and nature of this health need. If a person has a primary health need and their overall health and social care needs cannot be lawfully met by the local authority, then the NHS has a responsibility to meet these needs, whether that is in primary care/acute setting or through a private care provider, either as home care or in a care home.
If you are living with a condition that impacts your health, for example a physical disability or a life-limiting condition or need nurse-led care following an illness or accident, then it is likely that once you have completed the continuing healthcare checklist that you will be eligible for NHS continuing healthcare funding.
It is not surprising that many people find the concept of a ‘primary healthcare need’ confusing. You may assume that a person who is living with dementia and unable to live independently, is unable to mobilise, is incontinent, requires medications administration and cannot wash or dress, would be entitled to healthcare funding. This is not necessarily the case as needs are considered to be social care or personal care needs, which can be met through social care funding. Clearly, the nature and intensity of the dementia can present other primary health care needs, which may result in being eligible for healthcare funding following CHC screening.
There are four characteristics of need defined in the CHC checklist: nature, intensity, complexity and unpredictability. Any one or a combination of these characteristics presenting will determine whether or not a person has a primary healthcare need.
Some examples of the type of support a person with a primary health care need would require include:
- Respiratory and airway management and support
- Feeding and supplementary support, e.g.: PEG feeding
- Extensive moving and handling/mobilisation
- Elimination and toileting (catheter/stoma support)
It is important that the person who requires care feels part of the process in securing their continuing healthcare funding. They of course will need to give their consent to going through CHC scanning and completing the continuing healthcare checklist. If they are unable to give consent Power of Attorney will need to be in place, allowing a family member or trusted advisor to act on their behalf.
What does the continuing healthcare checklist include?
The continuing healthcare checklist looks at 11 areas, called care domains relating to your physical health and overall well-being, and its impact on your daily life:
- Breathing
- Nutrition
- Continence
- Skin integrity
- Mobility
- Communication
- Psychological/emotional needs
- Cognition
- Behaviour
- Drugs/mediation/symptom control
- Altered states of consciousness
The healthcare professional who completes the NHS continuing healthcare checklist assessment with you will assess your level for each care domain and will determine which category your situation best matches, an A, B or C category.
The outcome of the continuing healthcare checklist depends on the aggregate number of A’s, B’s and C’s scored. You will need to have a minimum ‘score’ in the checklist for the Clinical Commissioning Group (CCG) to consider conducting a full assessment of your needs. To move forward to a full assessment the CCG will be looking for you to have scored two or more A’s, five or more B’s (or 1 A and 4 B’s), or at least one A in the following domains:
- Breathing
- Behaviour
- Drugs/mediation/symptom control
- Altered states of consciousness
Once you have completed the CHC checklist and the CCG have determined your score, this will then either lead to a full assessment, or you will be deemed ineligible to go to this stage. Being successful in securing a full assessment of your needs does not confirm funding , this will only be advised once you have been through the full assessment process.
How is funding determined?
Eligibility for continuing healthcare funding is only conclusively confirmed once you have completed a full assessment. The full assessment is usually carried out by a group of health and social care professionals who have been involved in your care, referred to as the multi-disciplinary team (MDT).
The MDT will then make a recommendation to the CCG whether the person is eligible, and the CCG will make the final decision.
However, CCGs will also work with local authorities to make sure that they are able to contribute to the assessment process should the individual wish.
In most cases, the CCG carries out the assessment, but if demand is particularly high and cases are waiting to be assessed it can pay for another qualified organisation to carry this out so assessments can be completed in a timely manner.
What happens next?
If the CCG confirm your eligibility for continuing healthcare funding, care and support can be arranged to meet your individual needs and wishes. This can either be in your own home, or in a care home or other specialist care setting. Many families will arrange the care they need themselves, whilst others will let the CCG team find the right care package and manage the funding budget. If you opt to manage the arrangement yourself, you will receive a personal budget with direct payment of funds to yourself for you to pay for it directly.
If you are advised by the CCG that you are not eligible for continuing healthcare funding, you have the right to appeal against this decision. At The Good Care Group we work with ‘Care to be Different’ an organisation who supports families through the sometimes-lengthy process of securing NHS Continuing Healthcare funding. Born from her own frustrating attempts to secure funding for her parents, founder Angela Sherman provides practical advice and support for those seeking funding.
There are other types of funding you could access should you not be eligible for continuing healthcare funding:
Funding nursing care
If you have an identified nursing need, the NHS may pay a weekly rate for nursing care delivered by a home care provider or a registered nurse to visit you either in a residential home or when receiving care at home. The assessment process is the same as NHS continuing healthcare checklist assessment and it is likely you will be offered this funding if you have failed to qualify for full continuing healthcare funding. At The Good Care Group we provide a high-quality nurse-led care service for which this funding can be used to contribute to the overall weekly cost of care at home.
Social care funding
If you have been unable to secure NHS Continuing Healthcare funding, you may be entitled to some level of funding towards the cost of care from your local authority. The level of funding available is means tested based on your personal financial circumstances – your savings, investments and property. If your capital is assessed at over £23,250 you will not be entitled to local authority funding and will be faced with having to self-fund the care you need.
Talk to us about your live-in care needs
Call our friendly and approachable care advisors today. We are here to give you a better understanding of the cost of care and what continuing healthcare funding might be available to you and your family.