How Can I Qualify for NHS Continuing Healthcare?

NHS Continuing Healthcare is a service for those consumers who have ongoing healthcare needs. This is a treatment plan and package that is completely arranged and funded by the NHS for those individuals who are not in hospital but yet still have some kind of major or ongoing need for healthcare services. If you, or someone close to you, seems to fit this description, it may be worth your while to look into your eligibility for NHS Continuing healthcare. While the eligibility process may be intensive, the benefits can be quite substantial.

The ongoing care provided by the NHS Continuing Healthcare can be provided in several different settings, including your home or a care home. This means that you can receive services from a nurse with which you might already be familiar. It also means that the care provided by the NHS Continuing Healthcare can be performed wherever you are most comfortable. Your nurse or healthcare provider could potential help you with everyday activities such as dressing, bathing, and laundry. If care is received in some kind of healthcare home, NHS pays for the care home fees, including all amenities and board in the home. NHS Continuing Healthcare costs nothing to you, the consumer.

How is Eligibility Determined?

There are some eligibility guidelines for qualifying for NHS Continuing Healthcare. You must be over the age of 18 and you must demonstrate some kind of medical condition that warrants ongoing healthcare. Your main need for ongoing care must relate back to your health or health concern. You do not need to have any specific health or medical condition to qualify for NHS Continuing Healthcare and there is no stipulation as to who provides your care or where your care is provided.  In order to be officially deemed eligible for NHS Continuing Healthcare, you must have your needs assessed.

How can I be found eligible for NHS Continuing Healthcare?

The first stop for most consumers looking to qualify for NHS Continuing Healthcare is to arrange an assessment with a healthcare professional. This professional will use the NHS Continuing Healthcare screening tool, the checklist tool. The checklist tool is used to decide if you should be referred on for a full assessment of your needs. This is the first step in determining eligibility and really only serves to help healthcare professionals decide if your level of need might qualify you for NHS Continuing Healthcare. Once the initial screening is performed, you will receive notice in the mail as to whether or not you will be referred to have a  full assessment completed.

If a full assessment is called for, a more intensive tool will be used to deem eligibility for NHS Continuing Healthcare. This tool is known as the Decision Support Tool. This full assessment will be performed by a multidisciplinary team, all of which have different duties related to your care. This full assessment can also include some information from the healthcare professionals already involved in your ongoing care. This can help to determine need and thus, eligibility. These professionals may even be asked to do independent assessments of your needs.

The information used during this process will be inputted into the Decision Support Tool and will cover certain primary needs of care such as your ability move around on your own, your nutrition and nutritional needs, and your behaviour. For those individuals who feel that they need immediate attention and cannot wait out the assessment procedure, the Fast Track Tool made be used in lieu of the Checklist Tool and Decision Support Tool. If deemed eligible, healthcare may start quickly.

All eligibility decisions are made through the clinical commissioning group. During the entire assessment process, you as the consumer have the opportunity to explain your healthcare needs and concerns. They will be taken in to account when determining your level of need. Eligibility for NHS Continuing Healthcare is something that is reviewed on a regular basis. That means that if needs change once deemed eligible, you may find that you no longer qualify for services.

What happens if I am NOT deemed eligible?

If you are not deemed eligible for NHS Continuing Healthcare, you do still have some options. Your local authority will speak with you about ways you may still be able to gain some support from them. You may also still be found eligible for some payments toward some of your healthcare needs.

You can also formally appeal a decision of ineligibility. This should be done in writing after you have received the official eligibility decision. You have 6 months from the date of the decision to appeal. Once this has been done, you should complete an appeal application form and return it with any evidence that may prove your eligibility for NHS Continuing Healthcare.