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NHS Continuing Healthcare (CHC) is a crucial funding stream for care home residents with complex health needs, and 2025 has brought significant updates to how assessments are conducted and funding is allocated. These changes affect both care providers and families, particularly those caring for residents with conditions like advanced dementia.
What Is NHS Continuing Healthcare?
NHS Continuing Healthcare is fully funded care arranged and funded by the NHS for individuals who have ongoing healthcare needs that cannot be met by social care alone. Unlike means-tested local authority funding, CHC is free at the point of use and based entirely on health needs rather than financial circumstances.
Key Characteristics of CHC
- Fully funded by the NHS with no contribution from residents or families
- Based on health needs rather than financial means
- Covers all care costs including accommodation, personal care, and nursing
- Available in any setting including care homes, hospices, or at home
- Reviewed regularly to ensure ongoing eligibility
Who Is Eligible for NHS Continuing Healthcare?
Primary Health Need Test
To qualify for CHC, residents must have a "primary health need" – meaning their needs are primarily for healthcare rather than social care. This is assessed across several domains:
- Behaviour – challenging or unpredictable behaviour requiring specialist intervention
- Cognition – problems with memory, understanding, or decision-making
- Psychological and emotional needs – severe mental health issues or emotional distress
- Communication – difficulties with speech, language, or understanding
- Mobility – physical limitations affecting movement and positioning
- Nutrition – complex dietary needs or eating difficulties
- Continence – bladder or bowel problems requiring specialist management
- Skin integrity – pressure sores or wounds requiring ongoing treatment
- Breathing – respiratory conditions needing regular monitoring
- Drug therapies and medication – complex medication regimes
- Altered states of consciousness – conditions affecting consciousness levels
- Other significant care needs – any additional health requirements
Dementia and CHC Eligibility
Residents with dementia may qualify for CHC if they have:
- Severe cognitive impairment affecting daily functioning
- Challenging behaviour that requires specialist intervention
- Complex medication needs for multiple conditions
- Nutritional difficulties such as dysphagia (swallowing problems)
- Continence issues requiring regular nursing intervention
- Mobility problems with risk of falls or pressure sores
2025 Updates to CHC Assessments
Streamlined Assessment Process
The 2025 updates have introduced a more streamlined approach to CHC assessments:
New Assessment Timeline
- Initial screening must be completed within 2 weeks of referral
- Full assessment to be completed within 28 days of screening
- Decision notification within 14 days of assessment completion
- Appeals process streamlined with faster resolution times
Digital Assessment Tools
- Electronic Decision Support Tool (DST) for more consistent decision-making
- Digital evidence gathering reducing paperwork and delays
- Remote assessment capabilities where appropriate
- Integrated care record access for comprehensive health history
Enhanced Multi-Disciplinary Team Approach
The updated process emphasises better collaboration between:
- Care home staff providing day-to-day care insights
- GPs and specialists contributing medical expertise
- Social workers assessing social care needs
- Nurses evaluating nursing requirements
- Families and advocates representing resident interests
Changes to Funding Arrangements
Improved Funding Rates
The 2025 updates include:
- Increased funding rates to reflect true costs of complex care
- Regional variations acknowledging different local costs
- Specialist supplements for conditions requiring additional resources
- Equipment and adaptations funding included in care packages
Faster Payment Processing
- Direct payments to care homes within 30 days of approval
- Interim funding available during assessment periods
- Backdated payments from the date of eligibility
- Transparent invoicing systems for better financial management
Impact on Care Home Providers
Enhanced Support for Complex Residents
The 2025 updates provide care homes with:
Better Resource Allocation
- Adequate funding for specialist staff and equipment
- Training support for staff caring for CHC residents
- Access to specialist services including physiotherapy and occupational therapy
- Medication management support for complex regimes
Clearer Eligibility Criteria
- Detailed guidance on what constitutes a primary health need
- Case study examples showing successful CHC applications
- Assessment tools to help identify potential CHC candidates
- Training resources for care home staff on the CHC process
Administrative Improvements
- Simplified application process with digital submission
- Dedicated CHC coordinators for each region
- Regular review meetings to discuss resident progress
- Clear appeals procedure for disputed decisions
Supporting Families Through the Process
Improved Communication
The 2025 updates include:
- Plain English guidance for families
- Regular updates during the assessment process
- Clear explanations of decisions and next steps
- Support for appeals including independent advocacy
Family Involvement
- Meaningful participation in assessments
- Respect for family knowledge about the resident's needs
- Flexible meeting arrangements to accommodate family schedules
- Written summaries of all discussions and decisions
Practical Steps for Care Home Staff
Identifying Potential CHC Candidates
Care home staff should look for residents with:
- Multiple complex conditions requiring ongoing healthcare
- Unpredictable health needs that change rapidly
- Specialist interventions needed regularly
- Intensive nursing care requirements
- Behavioural challenges needing expert management
Gathering Evidence
To support CHC applications:
- Maintain detailed care records showing complexity of needs
- Document all interventions and their frequency
- Record family concerns and observations
- Collect specialist reports from healthcare professionals
- Note changes in condition and care requirements
Working with Assessors
- Prepare thoroughly for assessment meetings
- Provide honest, detailed information about resident needs
- Advocate for residents who may not be able to self-advocate
- Ask questions if any aspect of the process is unclear
- Follow up on decisions and next steps
Frequently Asked Questions
Can Someone Have Both CHC and Other Benefits?
CHC replaces local authority funding but residents may still receive:
- Personal Independence Payment (PIP)
- Attendance Allowance (in some circumstances)
- Other disability benefits
What Happens If CHC Is Withdrawn?
- Gradual transition to alternative funding
- Appeal rights if withdrawal is disputed
- Alternative funding sources explored
- Continuity of care maintained during transition
How Often Are CHC Decisions Reviewed?
- Regular reviews typically every 12 months
- Triggered reviews if condition changes significantly
- Fast-track reviews for rapidly deteriorating conditions
- Appeal reviews if decision is disputed
Expert Care for Complex Needs
Ashberry Care Homes specialises in providing high-quality care for residents with complex health conditions, including advanced dementia, and works closely with NHS teams to ensure residents receive the comprehensive care they need.
For more information about any funding questions or to discuss how we support residents' with benefits, please contact us to arrange a visit to your nearest Ashberry Care Home. If you're exploring care options, our guide on care home funding provides helpful information about what to look for in quality activities provision.
This article reflects NHS Continuing Healthcare changes as of 2025. Care providers should always refer to the latest NHS guidance and consult with CHC coordinators for specific cases.
