Dementia can be a challenging journey for both the person living with it and their loved ones. Dementia care home costs can add to the stress but there may be help available from the NHS. In this guide, we’ll explore how you can get NHS funding for dementia care for your loved one.

 

Does Someone With Dementia Have To Pay For Care?

Not everyone with dementia gets free care and in most cases, they will be expected to contribute towards the cost. However, the NHS offers Continuing Healthcare (CHC) funding that covers full care costs for those with complex needs. CHC funding is not based on savings and requires an assessment.

 

What is NHS Continuing Healthcare?

NHS Continuing Healthcare or CHC is a package of care that the NHS fully funds for people with significant healthcare needs. CHC can cover care home fees if the person is deemed eligible after assessment. It is funded by the local integrated care board, also known as the ICG.

 

Does Dementia Qualify for NHS Continuing Healthcare?

Having a diagnosis of dementia doesn’t guarantee NHS Continuing Healthcare (CHC) funding. CHC funding focuses on individuals with complex health needs that are considered a "primary health need." This means if your loved one has complex needs caused by dementia, they could be eligible for CHC. These additional needs would be significant and ongoing and may include things such as:

• Needing help with all daily activities
• Managing severe behavioural symptoms
• Requiring regular medical interventions

 

How To Get CHC Funding For Dementia

To request a CHC assessment for your loved one, you can talk to their GP, a nurse, or another healthcare professional involved in their care. They can guide you through the process, which might involve visits from healthcare specialists to assess their needs.

Securing CHC funding for dementia involves a two-step process; the initial assessment, based on an eligibility checklist and then the full assessment.

 

Dementia and Continuing Healthcare Checklist 

Before a full assessment, a healthcare or social worker will use a checklist to see if your loved one might qualify for CHC funding. The dementia and continuing healthcare checklist looks at key areas of care to see if your loved one needs a full assessment. These key areas include:

• Mobility
• Communication
• Medication use
• Breathing 
• Nutrition
• Continence
• Cognition
• Skin integrity
• Psychological and emotional needs
• Behaviour
• Drug therapies

 

This brief assessment of health needs can happen face-to-face or over the phone. It will tell the health professional whether it is appropriate to move on to the full assessment of eligibility for NHS continuing healthcare.

 

CHC Assessment

If your loved one’s initial check says a full CHC assessment is needed, a health professional will contact you to schedule it within 28 days. The assessment should include all of the medical team involved in your loved one’s care. The medical panel complete a Decision Support Tool (DST) the panel will focus on the same areas as the checklist and will consider other important needs. For example, if your loved one with dementia has challenging behaviour, they might ask about things like aggression, safety risks, and current management methods.

 

What Happens After the Assessment?

The NHS will make a decision about funding after 28 days and there are three outcomes:

• Full funding
• Joint funding by the NHS and your loved one’s local authority
• No funding

 

If your loved one is granted CHC funding, it is usually reviewed within three months of acceptance and then annually. This is to ensure your loved ones receive the correct level of care if their needs change over time. 

If CHC funding is denied, you can request a review or an independent review panel (IRP) to reassess the case. You’ll need to gather additional evidence and clearly outline why you believe the decision was incorrect.

 

Get More Advice About Dementia Care Fees

Getting NHS funding for dementia care can make a big difference for your loved one and your family. While the process can be complex, there's support available. You can find out more information about how care home funding works, and details about funding for dementia care homes while helpful organisations like the  Alzheimer’s Society offer advice on how to prepare for CHC assessments.

 

Select Healthcare provides specialist dementia care services in our care homes across England. If you’d like to know more about our dementia care homes, contact us for more information.

 

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