NHS Continuing Care - Caron Cares

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Who is eligible?

NHS Continuing Care is awarded to people in care homes who have complex or unpredictable medical care needs. This may be due to disability, accident or illness. It pays for the full care home costs, including room and board. In some instances, it can also be awarded for care in the person’s own home.

If this is the case, companies that offer these services will also use rostering software to know who they are visiting. They will have notes about the person from their family and previous carers.

Decision Support Tool

The team will then use this information to complete a Decision Support Tool.

This looks at 12 different types of needs, including mobility, nutrition and behaviour. The 12th need is ‘Other’, helping decide on the nature, complexity, intensity and unpredictability of needs.

For a detailed breakdown of the 12 areas of need, and to understand how the “Decision Support Tool” is applied. The Department of Health has a document explaining how the tool works. A document to explain a tool! (Says it all!)

Using the assessment and Decision Support Tool information, the team will decide if your relative has a primary health need. They will make a recommendation to their Clinical Commissioning Group. This is led by GPs and other health professionals, responsible for buying and arranging patient care packages. Eventually, they decide whether your relative is eligible for care or not. The rules refer to England only, it’s slightly different in Wales.

Attend this meeting.

You can attend this meeting. You can be with your relative during the assessment. It’s very helpful to have someone there to help them to communicate their needs and to take notes.

The decision

The NHS has 28 days to decide if someone is eligible. Retrospective payments will be made if they do qualify.

Challenging a “No” decision

It is possible to challenge a “No” decision, and many successfully do.

Also, if your relative’s needs are urgent, because their condition is deteriorating rapidly due to a terminal illness, a Fast Track Tool is used instead of the Decision Support Tool to confirm eligibility. Subsequently, if your relative is found to be eligible, their funding from the NHS should be provided as quickly as possible.

What Does it Pay For?

At home: healthcare, such as services from a community nurse or specialist therapist, and associated social care needs, such as personal care and domestic tasks, help with washing, dressing, preparing meals and shopping.
In a care home: care home fees, including board and accommodation.