Can you get NHS Continuing Healthcare at home?

In short, yes. If you have long-term, complex health needs, you may be eligible for free health and social care arranged and paid for by the NHS – this is NHS Continuing Healthcare at home, often shortened to NHS CHC or simply CHC.

For thousands of families across the UK, dealing with CHC can feel overwhelming. Recent reports from charities such as Age UK show fewer approvals and smaller budgets, making it more important than ever to understand how the system works.

At a glance

• Definition and scope: NHS Continuing Healthcare (CHC) provides fully free health and social care, arranged and paid for by the NHS, for adults aged 18 or older with a main health need caused by a disability, accident, or illness.
• Home support and eligibility: Eligibility depends only on the assessed care needs, not a specific medical diagnosis, and approved care plans can be provided in a person’s home instead of moving to residential care.
• Assessment indicators: A team of professionals assesses needs using four main factors – type, level, difficulty, and unpredictability – along with a national Decision Support Tool that covers 12 areas of care.
• Application and appeals: The process starts with a checklist and a formal assessment by your local Integrated Care Board (ICB), and families can request a review or appeal if the initial funding request is denied.

What is NHS Continuing Healthcare?

NHS CHC is ongoing care arranged and funded by the NHS for people aged 18 or over who have been found to have a primary health need resulting from disability, accident, or illness.

Can the NHS pay for care at home?

Yes. Just because someone is eligible for CHC, it does not mean they have to move into a care home. CHC covers all the health and related social care a person needs, whether they receive care at home, in a care home, or elsewhere.

The NHS covers all the costs so that the person can receive medical care and daily support in familiar surroundings. For example, a home-based CHC package could include care workers visiting to help with washing, dressing, and getting out of bed, or home adaptations for safety and mobility.

Ultimately, there will never be a single plan that fits everyone, which is why the care package is agreed on and arranged by the local NHS Integrated Care Board (ICB) based on the person’s formal assessment.

Is NHS CHC funding available across the UK?

No. Funding is limited to England, Wales, and Northern Ireland. In Scotland, NHS continuing healthcare is for hospital-only needs. Anyone aged over 65 in Scotland can get free personal and nursing care via local councils, regardless of income or assets. In the first instance, contact your local council for a care needs assessment.

Who is eligible for CHC funding?

CHC is available to anyone 18 or older with a primary health need due to a disability, accident, or illness. But there is a clear line between care that the NHS pays for and care that falls to the local authority.

If the NHS is responsible for someone’s care, it is provided free of charge. If the local authority is responsible, the person may have to go through a means test. A primary health need, therefore, means that a person’s care falls under the NHS side of the line.

However, eligibility does not depend on having a particular diagnosis. A team of health and care professionals will assess you, and will consider someone’s characteristics using four indicators:

• Nature: What the needs are, how they affect the individual, and what type of interventions are needed to manage them.
• Intensity: How much support is needed and how severe the needs are, including whether ongoing care is required.
• Complexity: How needs interact with other conditions, and how much skill is needed to monitor, treat, and manage them.
• Unpredictability: How needs change, how hard they are to manage, and what risks there are if care isn’t provided quickly.

As eligibility depends on your assessed needs, those needs may change, and so may your eligibility.

What conditions qualify for continuing healthcare?

There is no official list of conditions that automatically qualify someone for CHC. It isn’t simply a tick-box exercise to determine eligibility. In fact, two people with the same diagnosis can have very different care requirements, resulting in one person qualifying for support while the other doesn’t.

People with serious or advanced conditions often have complex or unpredictable healthcare needs. These needs, some of which are listed below, may make them eligible for CHC.

• Dementia and Alzheimer’s disease: Severe memory and understanding issues combined with challenging behaviour, trouble eating or drinking, mobility issues, or continence needs.
• Parkinson’s disease: Mobility, medication, swallowing, cognition, and other needs.
• Motor neurone disease (MND): Progressive loss of mobility, breathing problems, trouble communicating, swallowing difficulties, and the need for complex support.
• Multiple sclerosis (MS): Mobility, continence, skin, medication, and other healthcare needs.
• Stroke and acquired brain injury: Mobility, cognition, communication, behaviour, feeding, or seizures.
• Severe neurological conditions: Other progressive or complex neurological conditions may require high levels of ongoing healthcare management.
• Advanced cancer and terminal illness: People who are rapidly deteriorating and approaching the end of life can be considered through the CHC Fast Track pathway.
• Severe respiratory conditions: Significant support with breathing, oxygen, or other respiratory interventions.
• Other complex or multiple health conditions: Eligibility can be based on several conditions working together, not just one diagnosis. For example, someone may have mild dementia, diabetes, reduced mobility, and frequent infections.

What are the 12 NHS CHC care domains?

The 12 NHS CHC care domains are assessed using a national Decision Support Tool (DST) completed by a Multidisciplinary Team (MDT) – a group of health and social care professionals who work together to evaluate a person’s needs and plan their care.

• Breathing: Whether someone needs respiratory support or equipment.
• Nutrition: Any difficulties with eating, drinking, swallowing, or if specialised feeding is needed.
• Continence: How bladder and bowel needs are managed.
• Skin and tissue integrity: Condition of the skin, managing wounds, pressure sores, and daily prevention risks.
• Mobility: How safely someone can move, any transfer needs, and the risk of falls.
• Communication: Whether someone can clearly convey their needs and understand others.
• Psychological and emotional needs: Anxiety, depression, distress, and emotional well-being.
• Cognition: Memory, understanding, decision-making, and awareness of safety.
• Behaviour: Actions or reactions that create safety risks or need skilled intervention.
• Drug therapies and medication: How complex, monitored, or risky it is to manage regular or emergency treatments.
• Altered states of consciousness: Managing unpredictable episodes like seizures, blackouts, or fainting.
• Other care needs: Any other important healthcare needs not covered above.

How do you apply for CHC funding at home?

A healthcare professional involved in your loved one’s care can help start the application process. Or you can contact your local Integrated Care Board (ICB) to ask about their local referral pathways and arrangements.

Before you get in touch with anyone, it helps to be prepared. Gather recent medical records, care notes, and details about your loved one’s daily health and support needs. Make a list of the care and support required to ensure there is a clear picture of your situation from the start.

Once the ball is rolling, the application process for CHC funding has several clear stages:

• Request an NHS Continuing Healthcare assessment.
• An initial CHC Checklist will show if a full assessment is needed.
• If a full assessment is needed, an MDT team reviews the person’s needs.
• The team completes the Decision Support Tool.
• The team recommends whether the individual has a primary health need.
• The ICB decides eligibility.
• If eligible, the NHS and the individual agree on a care and support package.

What is fast track NHS continuing healthcare?

Fast-track NHS continuing healthcare is available if a person’s health is deteriorating quickly or if they are in the final stages of life. This ensures appropriate care and the correct support package can be put in place as soon as possible – often within 48 hours.

Fast-tracking could be important for families looking after a loved one at home. That’s because the CHC process can take weeks. The Fast-Track Pathway (FTP) avoids those delays because a GP, consultant, or nurse can complete the FTP tool directly, bypassing the usual checklist and DST steps, so funding can start more quickly.

How much care will NHS CHC pay for at home?

There is no standard or fixed number of funded homecare hours for CHC. The care package for each individual is bespoke, so if they are eligible, they could receive anything from a few hours a day to round-the-clock 24/7 live-in care, depending on what the MDT determines is necessary to keep the person safe and healthy at home.

Can you be refused CHC even if you have a serious illness?

Yes, you can. Even if an individual has significant health needs, they can still be denied funding. Remember, a person might have a serious condition but still not meet the primary health need threshold. Alternatively, someone with several conditions could qualify because their care needs are more complex, more intensive, or more unpredictable.

As frustrating as this might be, you can appeal the decision if you are denied CHC funding. The appeal process varies depending on where you live, but here are the main steps:

• Request a review: Contact your local NHS Integrated Care Board (ICB) in writing within six months to appeal the eligibility decision.
• Local resolution meeting: The ICB may invite you to discuss your concerns and review evidence. Bring any new documents supporting your case.
• Independent review: If unsatisfied, you can request an Independent Review Panel (IRP) run by NHS England, separate from your local ICB.
• Further actions: If you still disagree, contact the Parliamentary and Health Service Ombudsman for a final review.

Expect a 6-month timeframe while appealing, but regions across the UK may differ in steps, meeting formats, response times (28–60 days), and forms required for appeals.