Who Qualifies for continuing care in the NHS?

The person being assessed should have a comprehensive assessment by any of a range of the healthcare professionals involved in their care (called a multidisciplinary team). There should be clearly identified professionals who will co-ordinate the process.
The team will consider each of the healthcare needs of the person you're looking after. These are:

• behaviour
• cognition (understanding)
• communication
• psychological/emotional needs
• mobility
• nutrition (food and drink)
• continence
• skin (including wounds and ulcers)
• breathing
• symptom control through drug therapies and medication, and
• altered states of consciousness

Those carrying out the assessment should look at what help is needed, how complex these needs are, how intense and unpredictable these needs can be, as well as any risks that would exist if adequate care was not provided. For each of these issues a decision is then made about the level of need. The levels are 'priority', 'severe', 'high', 'moderate' or 'low'.
Your own views and those of the person you're looking after should also be taken into account when the assessment is carried out.
If the person you're looking after has priority needs in particular areas or severe needs in at least two, then NHS continuing healthcare should be provided. Someone can also qualify for NHS continuing care if they have a severe need in one area plus a number of other needs, or a number of high or moderate needs. In these cases the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
Review
A case review should be carried out three months after the original decision, even if the person you're looking after did not receive a full assessment. Following that first review, further reviews should be carried out at least every year.
Decisions on NHS continuing care are made on individual facts and circumstances for each person, but here are some examples of people who qualify:

1. Alan has been diagnosed with Alzheimer’s disease and it has reached an advanced stage. He lives at home with his son and needs assistance with all personal care tasks such as washing and eating. He has both bowel and urinary incontinence, and needs constant supervision to ensure his safety.
2. Marie is in her 50s. She has had a severe stroke and is currently in hospital but will soon be discharged. A urinary catheter has been fitted and, as she has lost her swallowing reflex, a tube will be fitted so that she can take food in through her stomach. She is at risk of developing pressure sores so needs to be moved carefully at regular intervals.
3. Dan suffered brain damage after being involved in a road accident. He is unable to walk or communicate, has severe respiratory problems and frequent epileptic fits. After a long period of time in hospital, he was moved to a care home that gives nursing care.

Decisions about NHS continuing healthcare
The decision-making process to establish whether NHS continuing healthcare should be delivered is complicated. If you and the person you're looking after think that NHS continuing care was wrongly refused, see Problems with getting NHS continuing care, below.
If you have your own web site or blog, I'd be extremely grateful if you could add a link to www.claimbankchargesback.co.uk - The more people using the site, the better it will become! Please tell your friends and family about us, and help them claim their own bank charges back.