Eligibility for NHS continuing healthcare isn’t based on whether you have a specific health condition.

To get NHS continuing healthcare you must:

• have ongoing significant physical and/or mental health needs
• and having taken account of all your needs, it can be said that the main aspects or majority part of the care you need is focused on addressing and/or preventing health needs.

Speak to your healthcare provider, doctor or social worker if you think you might be eligible for NHS continuing healthcare. They can make a referral to the relevant ICB.

You can also approach your ICB and explain why you believe you should be considered for NHS continuing healthcare.

Visit the NHS website to find your local ICB

There's a process staff must follow and tools they must use to decide your eligibility for NHS continuing healthcare. 

1. If your ongoing needs are clear and you have significant health needs, there are times when NHS staff or a member of the social work team should consider whether you may be eligible for NHS continuing healthcare. These situations include:

• if staff believe, after a period of rehabilitation following a hospital stay, that your condition is unlikely to improve and you have significant health needs
• before deciding you need NHS-funded nursing care in a nursing home
• when your health or social care needs are being reviewed as part of a community care assessment
• if your physical or mental health deteriorates significantly and your current level of care seems inadequate
• when your nursing needs are being reviewed – this should happen annually if you live in a nursing home
• if you have a rapidly deteriorating condition and may be approaching the end of your life.

You should be fully involved and your views should be considered at all stages of the assessment process. You can also ask a relative or carer to help and support you throughout.

2. The assessment process usually starts with the completion of the Checklist tool by a nurse or a social worker trained to complete it. This identifies whether you need to have a full NHS continuing healthcare assessment.

In some situations listed above, it will be clear to health and social care staff that your needs do not indicate NHS continuing healthcare at this time. If health and care staff agree, they should record this in your notes, with their reasons. If there is any doubt between staff, they should complete the Checklist.  

If your condition is getting worse rapidly and you may be approaching the end of life, staff may decide to submit a proposal for you to be fast-tracked for NHS continuing healthcare, which follows a quicker process.

3. If you’re referred for a full assessment, evidence will be collected from all relevant health and social care professionals about your physical, mental health and social care needs.

4. A team of health and social care professionals will meet to look at this evidence, complete a Decision Support Tool, and make their recommendation on whether or not you’re eligible. You and/or your representative can attend and take part in this meeting.

5. Their recommendation is given to the Integrated Care Board (ICB) responsible for agreeing and funding your care package. Except in exceptional circumstances, the ICB confirms their recommendation. 

6. The ICB should write to you with their decision and explain the reasons for it.

If you’re found to be eligible for NHS continuing healthcare:

• The ICB will discuss with you what care and support you need – this could relate to care at home or in a care home.
• You have the right to ask for a Personal Health Budget, which can give you more choice over the services and care you receive. However, this can't be used to pay care home fees but you can use it to pay for live in care.
• The package of care and support that's agreed on will be reviewed after three months and then at least every year. The primary purpose of the review should be to make sure your care plan is still suitable and meet your needs. It's expected that in most cases there'll be no need to reassess eligibility.
• If your care needs change in the future, your funding arrangements may also change. You have a right to challenge this decision.

If you are not eligible for NHS continuing healthcare, the ICB can (with your permission) refer you to your local authority who can discuss with you whether you may be eligible for support from them. If you are not eligible for NHS continuing healthcare but still have some health needs, then the NHS may still pay for part of your package of support.

This is known as a ‘joint package of care’. One way in which this is provided is through NHS-funded nursing care (see ‘NHS-funded nursing care’ section below). The NHS might also provide other funding or services to help meet your needs.

If the local authority is involved in funding some of your care package then, depending upon your income and savings, you may have to pay them a contribution towards the costs of that part of your care package.

Get in touch with the adult social services department of your local council and ask for a care needs assessment.

There’s no charge for a care needs assessment and you’re entitled to one regardless of your income, savings or level of need.

You can arrange a care needs assessment on behalf of a relative or friend, but they have to agree to the assessment (unless they don't have the capacity to make or communicate that decision themselves). 

You can apply for a care needs assessment by contacting your local council.

A social care professional will usually come to see you to find out how you're managing everyday tasks. You may be offered an assessment online or over the phone – if you feel this isn't right for you, ask for a face-to-face assessment. They'll consider:

• your health, and what you can and can't do, or struggle to do
• your cultural and religious background and support network
• your current living arrangements
• how you'd like to be supported

information about your needs from your carer, if you want them to be involved in your assessment.

The assessor will also talk to other professionals who care for you, like your GP or nurse, if you’re happy for the council to do so. This is to make sure everyone is on the same page with the support you need.

Your local council must do their best to help you. They should consider what support you need right now, and what might help in the future.

Think about the kind of help you need. Be specific, for example:

• ‘I need someone to help me get up and dressed in the mornings’
• ‘I need help to shower regularly’
• ‘I need to be reminded to take my medication’

Think about your cultural, social, religious and emotional needs too, for example:

• ‘I want to go to my place of worship once a week’
• ‘I want to visit my brother twice a month’

Ask a friend or carer to be with you at your assessment if you can.

The local council must provide you with someone to support you if you can’t speak up for yourself or have difficulty understanding others. This only applies if you don't have a friend or carer there to help you.

Local councils have their own assessment procedures, but they follow national criteria to decide who's eligible for care and support. In making their decision, they'll look at whether you're unable to do, or have difficulty with, daily living tasks, and whether this has a significant impact on your wellbeing. 

Do you have care and support needs as a result of a physical or mental condition?

Are you unable to achieve two or more desired outcomes? 

Is there, or is there likely to be, a significant impact on your wellbeing?

The daily living tasks include things like: 

• eating properly
• going to the toilet 
• being safe at home 
• keeping your home clean and safe 
• seeing family and friends 
• going to work, volunteering, education or training
• using services in your area. 

If you have eligible needs, your local council has a legal duty to meet them.

If you have savings and assets of more than the amounts shown below, you’ll have to pay for your own care in full ( in bold) or in part (in italics):

Region Upper savings threshold for any local council funding in 2021/22 

Lower savings threshold for maximum local council funding in 2021/22

England -                        £23,250             £14,250

Wales- £24,000 (care at home) or £50,000 (care in a care home) both levels are the same

Scotland -                       £29,750             £18,500

Northern Ireland -       £23,250              £14,250

If your savings are above the upper limit (shown in the middle column of the table), you’ll have to pay your full care costs yourself until your savings have fallen below that threshold.

But it’s still worth contacting your local council or trust, as you still have the right to a free care needs assessment, regardless of your financial situation.

After the assessment, a care plan should be agreed with you and a copy given to you. 

This will detail what needs you have and what could help to meet those needs.

Then there will be a means test to find out how much you need to contribute towards your care and support.

A non means tested and tax free Allowance.

Anyone aged over 65 with a continuing need for personal care because of a physical or mental disability can claim Attendance Allowance (AA). If eligible, you’ll receive weekly amounts of either £57.30 (if you need care during the day) or £85.60 (for care day and night). 

You can apply by completing an online form.

www.gov.uk/attendance-allowance

The Personal Independence Payment (PIP) replaced the Disability Living Allowance as a tax-free, non-means tested benefit. It provides financial assistance to anyone between the ages of 16 and 64 dealing with long term ill-health or disability.

The amount you might receive will vary between £22.65 and £145.35 per week, depending on your individual needs, which will be assessed by a health professional. You can claim for PIP or Attendance Allowance, but not both. Apply for PIP by calling the Department of Work and Pensions on 0800 917 2222.

If your savings are less than £16,000 you may qualify for reduced council tax payments. With a formal diagnosis of dementia, you may even become exempt. 

If you already claim a single occupancy reduction, you won’t lose this entitlement if you have a live-in carer. To find out more, you should contact your local authority.

There are two parts to Pension Credit, both based on your income. The first, called Guaranteed Credit, is designed to top up your state pension if your weekly income falls below a minimum threshold.

The second is Savings Credit, which you might receive in addition to Guaranteed Credit, or on its own. It’s a payment that rewards you for making some provision for your retirement. 

The quickest & easiest way to apply for Pension Credits is by calling the Department for Work and Pensions on 0800 99 1234.

If you need to fund your long-term care and have already paid off, or nearly paid off, your mortgage, an equity release scheme is one option to consider.

There are two main types:

• lifetime mortgage arrangements; and
• home reversion plans (where part or all of the property is sold).

There are two main types of lifetime mortgage.

An interest roll-up mortgage. You get a lump sum or are paid a regular amount and are charged interest that’s added to the loan. This means you don’t have to make any regular payments. The amount you borrowed, including the rolled-up interest, is repaid at the end of your mortgage term when your home is sold.

An interest-paying mortgage. You get a lump sum and make either monthly or ad-hoc payments. This reduces, or stops, the impact of interest roll-up. Some plans also allow you to pay off capital, if you want to. The amount you borrowed is repaid when your home is sold at the end of your mortgage term.

With a home reversion plan, you sell all or part of your home at less than its market value in return for a cash sum.

You then stay on in your home as a tenant, paying no rent.

You can often sell parts of your home over time. For example, 25% now followed by another 25% in a few years’ time.

There is no day-to-day interference and no restrictions in treating the house exactly as before, as a private home to live in freely.

Most equity release providers are members of the Equity Release Council (formerly known as Safe Home Income Plans or SHIP) and provide what’s called a no-negative-equity guarantee – alongside a range of other standards.

This means that under a lifetime mortgage your total debt is guaranteed to never be more than the value of your property and won’t be passed on to your family.

n annuity is a type of insurance policy that provides a regular income in exchange for an upfront lump sum investment.

When they’re used for long-term care, they provide a guaranteed income for life to pay for care costs.

he price of a plan is based on how much income you need and the insurance company’s assessment of how long you’re likely to need it for.

How much you pay upfront will depend on:

• your age
• current annuity rates
• the level of income you need
• whether you need an income that stays level or increases over time
• your health and life expectancy (the poorer your health or shorter your life expectancy, the cheaper the plan will be).

 The income from the plan is tax free if it’s paid directly to a rcare provider.

Most care plans provide an income that increases either with inflation or a set amount each year to help you cope with future rises in care costs.

For an extra cost you can also put in a ‘capital protection’ clause. This allows your family to get some of the lump sum payment back if you were to die early.

You can also opt for a deferred needs care annuity

This is a type of immediate needs annuity where a lump sum payment is paid at outset, but no income is received from the annuity until after a specified waiting period, typically anything from 12 to 60 months.

Care fees due during this ‘deferred’ period will need to be paid from other resources.

The advantage of a deferred needs care annuity is that for the same level of care fees, the cost can be significantly lower than that of an immediate needs annuity but it still covers the risk of having to pay care fees for a long period of time after the chosen deferred period.

Moving into a smaller, less expensive property could free up capital. 

While moving home at this stage of life may be a wrench, it could also prove an opportunity to move closer to family or to find a property that’s easier to manage as you get older.

Even if you need to fund your own care initially, you may not be permanently self-funding. Once your assets drop below the relevant threshold, you may qualify for local authority funding.

If you believe this to be the case, you will need contact the local authority. They will conduct  a needs assessment and financial assessment .

This scenario is more likely if you’reself-funding care in your own home, as the value of your main property is not taken into account in the means test.