How to get CHC funding for Dementia

Caring for a loved one with dementia can be emotionally and financially overwhelming. However, if their health needs outweigh their social care needs, they may be eligible for NHS Continuing Healthcare (CHC) funding, which covers the full cost of their care.

This guide will walk you through how to apply for CHC funding, whether dementia always qualifies for funding, and what to expect from the often complex assessment process. In our guide, we cover:

• What is CHC Funding
• Does dementia qualify for CHC Funding?
• Do dementia suffers have to pay care home fees?
• When should someone with dementia go into a care home?
• How can dementia patients apply for CHC Funding?
• What happens if you are eligible for CHC Funding?

What is CHC Funding?

CHC funding is a package of care arranged and funded by the NHS for people with ongoing healthcare needs. Unlike social care, which is means-tested, CHC funding is based solely on health needs and covers 100% of care costs, whether in a care home or at home. This funding is intended to provide care for those whose primary need for care is due to health rather than social needs.

Learn more about NHS Continuing Healthcare funding.

Does dementia qualify for CHC funding?

Not all dementia patients will automatically qualify for CHC funding, but many may, depending on the severity of their symptoms and overall health.

The decision to provide funding for a patient is determined by assessing their needs across 11 different care areas or domains. Dementia typically affects the “communication”, “cognition,” and “behaviour” domains, but the overall assessment considers how severe the disease is in other areas as well. For example, problems with motility, continence, medication management and psychological or emotional needs can also influence the funding decision.

To check if someone with dementia may require a full assessment for CHC funding, an initial screening Checklist is carried out. You can review the Checklist, or continue reading for more information.

Dementia and Continuing Healthcare Checklist

The Checklist can be conducted by various healthcare and social care professionals, such as a registered nurse, GP, social worker, or care manager. As mentioned, it considers 11 care domains, including:

1. Breathing*
2. Nutrition
3. Continence
4. Skin integrity
5. Mobility
6. Communication
7. Psychological / emotional needs
8. Cognition
9. Behaviour*
10. Drugs/Mediation/Symptom Control*
11. Altered states of consciousness*

Each of these domains is then rated in relation to the level of care required. The rating system used can be found below:

1. Indicates a high level of care needs
2. Indicates a moderate level of care needs
3. Indicates low or no needs

For a full assessment of whether a dementia patient qualifies, the scores from the Checklist are measured by the local NHS Integrated Care Board who will review the findings. Typically, the following criteria are required:

• 2 or more ‘A’s
• 5 or more ‘B’s (or 1 A and 4 Bs)
• or at least 1 A in a domain with an asterisk*

If the above criteria are met, then the patient will receive a full assessment carried out by a multidisciplinary team (MDT)

Do dementia sufferers have to pay care home fees?

Dementia care is not free. Most patients (or their families) will have to pay for some of the care they receive. However, if a patient’s health needs are significant enough to qualify for CHC funding, their care costs will be covered in full by the NHS.

CHC funding focuses on health needs, which are more likely to occur as dementia progresses. For example, patients with advanced dementia may struggle with communication, mobility and personal care which, as mentioned earlier, can increase the chances of receiving CHC funding.

If a patient is not eligible for CHC funding, there are often alternative methods of care funding available. NHS-funded nursing care or local authority funding might be available for those who don’t qualify for CHC funding. However, the latter is means-tested, unlike CHC, which is free at the point of need.

When should someone with dementia go into a care home?

Determining the right time for a person with dementia to move into a care home is a deeply personal decision, but certain signs may indicate it’s necessary for their safety and well-being. These signs include:

• Safety risks

Patients who become prone to wandering or are unable to navigate daily activities may require more support.

• Behavioural changes

Aggression, confusion, and difficulty with personal care may necessitate a higher level of professional care.

• Caregiver burnout

Caring for someone with dementia can be exhausting, and caregivers often need professional assistance to manage.

• Mobility issues

If mobility declines and the patient is at risk of falls, a care home with professional support can be the best option.

• Wandering uncontrollably

When dementia sufferers become prone to wandering, especially without awareness of the surroundings, moving to a secure care environment can be critical. Read more about care home decisions.

How can dementia patients apply for CHC funding?

If you believe a loved one with dementia may qualify for CHC funding, the first step is to reach out to us here at Farley Dwek. After an initial consultation with our team if we consider that you have reasonable prospects for CHC funding, we can begin to support your application process.

To start, you’ll need to arrange a Checklist by contacting your care home, social worker, or GP. Once this is initiated, Farley Dwek can assist in representing you at the Multi-Disciplinary Team (MDT) meeting as an advocate. Learn more about our MDT Advocacy Service, to see if you fulfil the criteria.

If the initial Checklist application for CHC funding is successful, you will be progressed onto a full assessment conducted by an MDT. During the full assessment, the Decision Support Tool (DST) will be used again to evaluate your eligibility.

At this stage, the number of care domains assessed increases from 11 to 12, with the additional domain being “Other significant care needs,” which the assessor will evaluate. The entire process from initial referral to MDT should not take longer than 28 days.

What happens if you are eligible for CHC funding?

If your loved one is deemed eligible for CHC funding, you will receive a letter from your local NHS Integrated Care Board confirming their eligibility and the level of care they require. Funding will either be paid directly to the care provider or set up as a personal health budget (PHB), which you can manage on their behalf.

Farley Dwek can also assist with reviewing past care home fees for retrospective claims, ensuring you recover any costs already paid before or after death if your loved one was eligible for CHC funding at that time.

Can you get CHC funding for dementia?

If we hadn’t made it clear, YES. It is more than possible for dementia patients to receive CHC funding, but eligibility depends on the severity, complexity and intensity of their needs and the level of care that is required to manage them. The application process can often be long-winded and confusing.

At Farley Dwek, we can provide an initial assessment to determine whether your loved one may qualify, saving you time and hassle. If our experts determine that there are reasonable prospects of a strong case, we can take on the application, helping to cover care home fees or recover costs already incurred.

For more information on how to get CHC funding for dementia, contact our team on 0161 272 5222 or contact us for free initial advice.