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There is no list of qualifying conditions, no income threshold and no points total. Eligibility turns on one question: whether the main reason a person needs care is a health reason. Here is how that is actually decided.
Anyone aged 18 or over whose needs amount to a primary health need, in any setting outside hospital — a nursing home, a residential home, a hospice or their own home.
It is not means-tested. Savings, income and property make no difference. And no diagnosis qualifies automatically — two people with the same condition can reach opposite outcomes.
Assessors weigh a person's needs against four characteristics. These are analytical tools rather than four separate hurdles, and they must be considered together, in the round.
The type and quality of the needs, and the kind of interventions required to manage them. Not just what is wrong, but what has to be done about it.
Quantity, severity, continuity and frequency — including how many carers are needed at one time, and how often through day and night.
How needs interact with one another, and the skill and knowledge that interaction demands. This is where most strong cases are actually made.
How far needs fluctuate, how hard they are to anticipate, and what happens if a response is delayed or wrong.
A person who cannot transfer safely has a mobility need. A person who cannot transfer safely and does not recognise that she cannot, and therefore keeps trying to stand, is a different order of risk entirely — one demanding constant supervision, two-person assistance and equipment kept ready.
Read as separate boxes, that is moderate need in each. Read properly, it is Complexity and Unpredictability. Assessments that score twelve domains independently miss this, and it is the most common ground on which refusals are overturned.
A screening tool, completed by a nurse, doctor, social worker or other qualified professional. It decides only whether someone proceeds to a full assessment.
The threshold is deliberately low — it is designed to let cases through, not filter them out. A negative Checklist that ended the process is always worth scrutinising.
A multidisciplinary team of at least two professionals from different backgrounds completes the Decision Support Tool, scoring needs across twelve care domains.
The person and their representative should be invited to take part. Families see what a visiting professional does not, and that evidence belongs in the record.
The team makes a recommendation. National guidance indicates that one Priority rating, or two or more Severe ratings across different domains, would usually point towards eligibility — and a combination of High ratings can also qualify.
It remains a professional judgement on the totality of needs, not an arithmetic total.
The Integrated Care Board makes the decision and must confirm it in writing. Where it departs from the team's recommendation it should give clear reasons — and where it hasn't, that is often a strong ground of challenge.
Where someone has a rapidly deteriorating condition and may be entering a terminal phase, an appropriate clinician can complete a Fast Track Pathway Tool. This should put funding in place urgently, without waiting for the full process.
If a Fast Track was refused or delayed and fees were paid in the meantime, that period is worth reviewing.
Around 60,000 people in England receive Continuing Healthcare at any one time. Of those formally assessed, roughly 17% are found eligible — down from about 31% in 2017/18.
The law did not change over that period. Neither did the National Framework. Which is precisely why a refusal is worth examining rather than accepting.
Tell us the situation and we will give you an honest view, free of charge — including if the answer is no.
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