CHC Funding for Dementia: Essential Family Guide

TL;DR: Dementia is the most common condition behind CHC applications in England, yet 80.5% of standard CHC assessments are refused (NHS England, 2024-25). Dementia families face three structural disadvantages — the "snapshot" assessment, familiarity bias in carers, and ICB budget pressure — but Paragraphs 162–166 of the National Framework make clear that well-managed needs are still needs. Document fluctuation, request care records, and challenge refusals with a domain-by-domain evidence pack.

Why Are Dementia Families Losing CHC Claims?

If your loved one has dementia and you're trying to secure NHS Continuing Healthcare (CHC) funding, you're not alone. Roughly 1 million people in the UK live with dementia today, and 70% of all care home residents in England have dementia or severe memory problems (Alzheimer's Society, 2025). Dementia is, by a significant margin, the single most common condition behind CHC applications. And yet dementia families are disproportionately refused funding — often on grounds that don't hold up to scrutiny.

This isn't a coincidence. It's a pattern.

The reasons behind it are structural. The way CHC assessments are conducted, the way needs are described, and the way "well-managed" care is interpreted all create specific disadvantages for people living with dementia. Understanding these disadvantages — and knowing how to counter them — is the single most important thing you can do to protect your family's claim.

So what does the system actually look like? In 2024-25, NHS England processed 51,981 standard CHC assessments and refused 80.5% of them (NHS England, 2025). Worse, eligibility rates swing from 7.3% in some ICB areas to 42.5% in others — a gap Age UK described as an "extreme postcode lottery" in its December 2024 parliamentary briefing (Age UK, 2024). For families whose ICB is currently tightening eligibility, see our analysis of the ICB CHC eligibility cuts sweeping through 2025-26.

This guide explains why dementia cases are treated differently, how to evidence needs that the assessment process tends to understate, and what to do if your loved one has already been refused. It draws on the NHS National Framework for NHS Continuing Healthcare (2022, revised 2023), relevant case law, and real-world advocacy experience.

If you're unsure whether your loved one might qualify, our CHC Eligibility Checker is a good starting point. For a broader overview of the eligibility criteria, see our guide on whether dementia qualifies for CHC. But if dementia is in the picture, this article will give you a much deeper understanding of what you're dealing with.

Why are dementia families disproportionately rejected?

Dementia care in the UK now costs an estimated £42 billion per year, projected to climb to £90 billion by 2040 — and the cost per person with severe dementia exceeds £80,000 annually (Office of Health Economics / Alzheimer's Society, 2024). When the NHS approves CHC, it picks up that bill entirely. When it refuses, families and councils pick it up. That financial pressure shapes how dementia claims are assessed — and not in families' favour.

To understand why dementia claims fail more often than they should, you need to understand how the assessment system works — and where it breaks down.

CHC eligibility is decided using a tool called the Decision Support Tool (DST), which evaluates a person's needs across 12 care domains. Each domain is scored at one of five levels: no needs, low, moderate, high, or severe. The overall picture of need — particularly the interaction between domains — then determines whether the person has a "primary health need." For the procedural detail on how this plays out at an MDT assessment, see our step-by-step walkthrough.

In theory, this should work perfectly well for dementia. People with moderate to advanced dementia typically have significant needs across multiple domains: cognition, behaviour, psychological and emotional needs, communication, mobility, continence, and often nutrition and skin integrity as well. Specialist dementia care home fees now run to £1,564–£1,585 per week for nursing-level dementia care (LaingBuisson, 2026) — costs the NHS covers entirely if CHC is awarded.

In practice, three things consistently work against dementia families:

1. The "snapshot" problem

Dementia is a fluctuating condition. A person with dementia might appear calm and cooperative during an assessment visit that lasts an hour — and then experience severe agitation, confusion, or distress for the other twenty-three hours of the day. The DST assessment, particularly when conducted as a single meeting, tends to capture the person at their best rather than at their most challenging.

That snapshot problem is compounded by the fact that people with dementia are often at their most settled when they're in a familiar environment with familiar staff providing consistent routines. The very things that manage their condition — structured care, experienced staff, medication — can mask the severity of the underlying need.

2. The familiarity bias

Care home staff who work with a person every day sometimes become so accustomed to managing challenging behaviour that they stop recognising it as challenging. When asked during an MDT assessment whether the person has behavioural needs, a carer might say "Oh, he's fine most of the time" — because to them, redirecting a confused resident away from the front door six times a day, managing refusal to eat, or dealing with nocturnal wandering has become routine.

This isn't the carer's fault. It's a natural consequence of skilled, compassionate care. But it means the assessment record can dramatically understate the level of need.

3. Financial pressure on Integrated Care Boards

There's no polite way to say this: CHC funding is expensive, and ICBs are under enormous budgetary pressure. Dementia cases, which often involve years of ongoing care, represent some of the highest-cost packages. Research by Age UK (December 2024 parliamentary briefing) found ICB eligibility rates ranging from 7.3% to 42.5% — evidence of a well-documented institutional tendency to find reasons to refuse, especially where the cost will be sustained over a long period.

This doesn't mean assessors are acting in bad faith. But it does mean the system has structural incentives to find reasons to refuse, and dementia cases — where needs can be reframed as "social" rather than "health" needs — are particularly vulnerable. We've seen this pattern play out repeatedly in our casework: families whose loved ones clearly have severe health needs being told those needs are "social care."

What is the "well-managed needs" trap and how is it misused?

Of all the issues that affect dementia CHC claims, the "well-managed needs" argument is the most damaging and the most frequently misused. Paragraphs 162–166 of the NHS National Framework for NHS Continuing Healthcare (2022, revised 2023) explicitly state that "well-managed needs are still needs" — yet our deep-dive on well-managed needs shows it remains the single most common reason families lose claims they should win.

How the trap is set

Here's how it works. Your loved one is in a care home. They're receiving 24-hour care from trained staff. Their medication is administered on time. Their challenging behaviour is managed through careful routines, de-escalation techniques, and environmental design. As a result, they appear relatively settled.

The ICB assessor looks at this picture and concludes that the person's needs are "well-managed" — and therefore not severe enough to qualify for CHC.

What the Framework actually says

This reasoning is explicitly prohibited by the National Framework. Paragraphs 162–163 state clearly:

"The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs."

The Framework goes further. It requires assessors to consider what the person's needs would look like if the care were removed. The question isn't "How does this person present right now, with a full care team around them?" The question is "What level of care does this person require, and what would happen if it weren't provided?"

For someone with advanced dementia, the answer to that second question is almost always: they would be at serious risk of harm. They might wander into danger, refuse food and fluids, become severely agitated, fall repeatedly, or be unable to manage any aspect of their personal care.

How to challenge it on the record

If an assessor has used the phrase "well-managed needs" as a reason to score a domain lower than it should be, challenge it directly. Quote paragraphs 162–163. Ask the assessor to document what would happen if the care were withdrawn. In our experience supporting families through MDT assessments, this exercise alone can shift the scoring significantly. We've helped families overturn refusals simply by asking assessors to complete this "care removed" analysis on the record.

How "well-managed needs" distorts specific domains

The well-managed needs trap doesn't affect all domains equally. In dementia cases, it's most commonly applied to:

• Behaviour: "He doesn't show aggression because staff know how to manage him." The correct interpretation is that he requires constant skilled intervention to prevent aggression — which is a high-level need.
• Cognition: "She follows routines well." The correct interpretation is that she requires a fully structured environment to function — the routine is the care, not evidence of independence.
• Psychological and emotional needs: "He seems content most of the time." The correct interpretation is that his contentment depends on continuous emotional support and familiar surroundings — remove them and severe distress is likely.

In each case, the presence of effective care is being used as evidence of low need, when it's actually evidence of high need being successfully met.

Which DST domains matter most for dementia?

A single Priority domain or two Severe domains is enough to evidence a primary health need under the National Framework — and yet only 19.5% of standard CHC assessments now end in eligibility (NHS England, 2024-25). Why the gap? Because most dementia families don't know which DST domains carry the most weight, or what evidence to bring to each. Get the domain strategy right and the same clinical picture can produce a very different scoring outcome.

While every person with dementia is different, there are specific DST domains where dementia-related needs most commonly reach the "high" or "severe" threshold. Understanding these domains — and knowing what evidence to gather for each — is essential.

Domain	No/Low	Moderate	High	Severe	Priority
Behaviour	No challenging behaviour	Some difficult behaviour, manageable with prompting	Frequent challenging behaviour needing intervention	Severe behavioural disturbance, risk to self/others	Behaviour poses immediate serious risk
Cognition	No cognitive impairment	Some memory or orientation difficulties	Significant impairment affecting daily decisions	Severe impairment, unable to make most decisions	Cognitive state causing immediate risk
Continence	Continent or self-managed	Occasional incontinence, minimal help needed	Frequent incontinence requiring regular assistance	Doubly incontinent, full care required	Continence issues causing skin breakdown or distress
Communication
Psychological
Mobility
Nutrition
Skin
Breathing
Drug Therapies
Consciousness
Other Needs

The table below shows how advanced dementia typically scores across the most relevant DST domains. From our casework with over 200 dementia families, these are the patterns we see most consistently.

A single Priority domain or two Severe domains strongly indicates a primary health need under the National Framework (2022). Advanced dementia routinely hits five or more domains at High or Severe simultaneously — which is why it's one of the strongest clinical presentations for CHC eligibility.

Cognition

This is often the central domain in dementia cases. It covers awareness of time, place, and person; the ability to make decisions; memory; and the ability to understand and process information.

A person with moderate to advanced dementia will typically have severe cognitive impairment. They may not recognise family members, may be unable to understand where they are or why, may have no concept of time, and may be entirely unable to make decisions about their care.

What to evidence: Results of cognitive assessments (MMSE, ACE-III, MoCA), instances where the person has been unable to recognise family or staff, examples of disorientation, inability to participate in care decisions, need for constant prompting and supervision.

Behaviour

This domain covers behaviour that is challenging, risky, or difficult to manage. In dementia, this can include aggression (verbal or physical), agitation, wandering, repetitive behaviours, resistance to care, inappropriate social behaviour, and sundowning.

What to evidence: Incident reports, behaviour charts, occasions where additional staff were needed, interventions used (de-escalation, distraction, medication), frequency and duration of episodes, risk assessments, any injuries sustained by the person or staff.

Psychological and emotional needs

Dementia frequently causes anxiety, depression, fear, paranoia, and emotional lability. These are not simply "mood" issues — they are direct consequences of the neurological damage caused by the disease.

What to evidence: Observations of distress, crying episodes, expressions of fear or confusion, refusal to engage, withdrawal from activities, need for one-to-one emotional support, any psychiatric input or medication for psychological symptoms.

Unpredictability (across all domains)

Unpredictability isn't a domain in its own right, but it's one of the four key characteristics that determine whether a need is a "health" need. In dementia, unpredictability is often the strongest argument for CHC eligibility.

Take a typical day: a person with dementia may be calm one hour and severely agitated the next. They may eat well at lunchtime and refuse all food at dinner. They may sleep through the night for a week and then begin wandering at 2am every night for a month. This unpredictability means that care must be available at all times, and staff must be trained to respond to rapidly changing situations.

What to evidence: Records showing variation in behaviour, mood, or function over time. Care home daily records are invaluable here. The more you can show that the person's needs change without warning, the stronger your case for CHC.

How do you evidence needs that fluctuate?

Dementia is, by NICE's definition, a progressive condition characterised by fluctuating cognitive and behavioural symptoms — yet the Department of Health & Social Care's National Framework explicitly requires assessors to consider the "full range of needs over a reasonable period," not just a single snapshot. The gap between what the Framework requires and what assessments actually capture is where most dementia claims are lost.

One of the greatest challenges in dementia CHC cases is that the assessment process tends to capture a single moment in time, while dementia — by its nature — produces needs that vary from hour to hour and day to day.

The Framework acknowledges this directly. It states that assessors must consider the full range of needs over a reasonable period, not just the needs observed during the assessment itself. But in practice, this principle is frequently ignored unless you actively provide the evidence.

Here is how to build a picture that captures fluctuation:

Keep a care diary

If your loved one is at home, keep a daily diary of their care needs for at least two to four weeks before any assessment. Record:

• What time they woke and went to bed
• Any episodes of confusion, agitation, or distress
• What they ate and drank (and any refusals)
• Any falls, near-misses, or safety concerns
• Any instances of wandering or attempting to leave
• What level of help they needed with washing, dressing, toileting, and eating
• Any changes in behaviour or mood — however small they seem

If your loved one is in a care home, ask the home for copies of their daily care records for the same period. These records are your property (or your loved one's) and the home must provide them on request.

Request incident reports and behaviour charts

Care homes are required to record incidents — falls, injuries, aggressive episodes, safeguarding concerns. These reports are gold dust for a CHC application because they provide dated, contemporaneous evidence of need.

Ask for all incident reports for the past six months. If the home uses behaviour charts or ABC (Antecedent-Behaviour-Consequence) records, request copies of these as well.

Gather clinical evidence

Request copies of recent clinical assessments, consultant letters, GP summaries, and any mental health or psychiatric input. A consultant's letter confirming the diagnosis, stage, and prognosis of the dementia carries significant weight in an assessment.

If cognitive testing has been carried out (MMSE, ACE-III, or similar), obtain the results and include them in your evidence pack. A score of 10 or below on the MMSE, for example, indicates severe cognitive impairment that is difficult for an assessor to dismiss.

Use video evidence (with consent)

This is controversial, but increasingly accepted. If your loved one has episodes of severe agitation, distress, or challenging behaviour that would be difficult to convey in writing, a short video can be profoundly powerful evidence. You must ensure you have appropriate consent (which may need to come from someone with power of attorney if the person lacks capacity) and that the recording is made respectfully.

A two-minute video of a person in acute distress can communicate more to a panel than ten pages of written description.

What is the "nature, intensity, complexity and unpredictability" test?

The legal test for CHC eligibility is whether the person has a "primary health need" — and the four characteristics that define it are where most dementia cases are won or lost. The Nuffield Trust's 2024 review of CHC found that decision-makers are often inconsistent in how they apply this test, with local resolution requests overturning roughly 1 in 6 refusals at the first appeal stage (Nuffield Trust, 2024). The four characteristics, as defined in the National Framework:

• Nature: What type of needs are involved? Do they require clinical knowledge, skills, or oversight?
• Intensity: How much care is needed, and how frequently?
• Complexity: How do the different needs interact with each other? Do they create additional challenges when combined?
• Unpredictability: How rapidly or unexpectedly can the person's condition or needs change?

For dementia cases, each of these characteristics typically points strongly toward a health need.

Nature

Dementia is a progressive, terminal neurological disease. The care it requires isn't simply "social" — it involves understanding of cognitive impairment, behaviour management, risk assessment, medication management, and often clinical interventions for co-morbid conditions. The National Framework is clear that the nature of a need should be assessed by considering what type of care it demands, not simply whether it's currently being provided by clinical staff.

Intensity

People with moderate to advanced dementia typically require care around the clock. They can't be left unsupervised. They need help with every activity of daily living. This level of intensity is rarely matched by conditions that are classified as "social" needs.

Complexity

Dementia rarely exists in isolation. It commonly co-occurs with mobility problems, continence issues, swallowing difficulties, skin integrity problems, and cardiovascular conditions. The interaction between cognitive impairment and these other needs creates a level of complexity that goes well beyond what social care is designed to address. A person who has both severe cognitive impairment and mobility problems, for example, can't understand instructions to "stay seated" — making their falls risk qualitatively different from that of someone with mobility problems alone.

Unpredictability

As discussed above, this is often the strongest characteristic in dementia cases. The fluctuating nature of dementia means that needs can change without warning, requiring staff who are trained and available to respond at any time. The National Framework states that unpredictability alone can be sufficient to establish a primary health need if it requires a level of care that goes beyond what a local authority could reasonably be expected to provide.

How to apply the test in your evidence pack

When you're gathering evidence and preparing for an assessment, frame everything through these four lenses. For each piece of evidence, ask yourself: does this demonstrate the nature, intensity, complexity, or unpredictability of my loved one's needs? If it demonstrates more than one, say so explicitly.

Practical evidence-gathering guide for dementia

Gathering the right evidence is the most important thing you can do to support a CHC claim. The Nuffield Trust's 2024 analysis of NHS England CHC data found that 13% of local resolution requests result in eligibility being awarded — roughly 1 in 6 refused decisions overturned on first appeal (Nuffield Trust, 2024). The single biggest driver of that overturn rate is evidence the original assessment didn't have. Here's a practical checklist for dementia cases:

Medical evidence

• Consultant letters confirming diagnosis, stage, and prognosis
• Cognitive assessment results (MMSE, ACE-III, MoCA)
• Medication list (particularly anti-psychotics, sedatives, or anti-anxiety drugs)
• GP summaries and any referrals to mental health services
• Hospital discharge summaries (if applicable)
• Speech and language therapy assessments (particularly regarding swallowing)
• Physiotherapy or occupational therapy assessments

Care records

• Daily care notes from the care home (at least four weeks, ideally three months)
• Incident report forms (falls, injuries, aggression, safeguarding)
• Behaviour charts and ABC records
• Night check records (showing wakefulness, wandering, or distress overnight)
• Food and fluid intake charts (showing refusals or inadequate intake)
• Weight monitoring records (unexplained weight loss is common in dementia)
• Repositioning charts (for people with limited mobility)

Your own evidence

• A detailed care diary (if the person is at home)
• A written statement describing a typical day — and a bad day
• Specific examples of behaviour that required skilled intervention
• Photographs or video evidence (with appropriate consent)
• Statements from other family members who are involved in care

Professional assessments

• Social services care needs assessment
• Mental Capacity Act assessments
• Best interests decision records
• Deprivation of Liberty Safeguards (DoLS) documentation
• Any safeguarding investigation reports

How to present your evidence

Do not simply hand over a stack of papers. Organise your evidence by DST domain. For each domain, provide:

1. A brief summary of the need (one to two sentences)
2. The evidence that supports it (referenced by document name and date)
3. An explanation of why this need meets the "high" or "severe" threshold
4. A note on how the need interacts with other domains

This structured approach makes it much easier for assessors and panel members to follow your argument. It also demonstrates that you understand the Framework and the assessment criteria — which, in our experience helping families prepare for MDT assessments, tends to produce markedly better outcomes. We've seen domain scores shift by one or two levels when families present organised, referenced evidence compared to families who attend with loose paperwork.

Our DST and MDT Preparation Pack includes templates for exactly this kind of structured evidence presentation, tailored specifically to dementia cases.

What should you do if CHC has been refused?

If your loved one with dementia has been refused CHC funding, don't accept the decision without challenge. NHS England's own statistics show that in Q4 2023-24, 596 local resolution requests were submitted nationally and 13% resulted in eligibility being awarded (Nuffield Trust, 2024). The overturn rate climbs higher when families present evidence the original assessment didn't have. If your loved one already has CHC and you're worried about losing it at the annual review, that's a related but distinct process.

Step 1: Request the rationale in writing

The ICB must provide a written explanation of why CHC was refused. This should include the DST scoring for each domain and the panel's reasoning. Review this carefully and look for:

• Domains where you believe the scoring is too low
• Evidence of the "well-managed needs" fallacy (paragraphs 162–163 of the 2022 National Framework)
• Failure to consider the full range of fluctuating needs
• Failure to consider the interaction between domains
• Evidence that was submitted but not reflected in the scoring

Step 2: Request a local review

You have the right to request a local review of the decision. This is not a re-assessment — it is a review of whether the original decision was made correctly. When requesting the review, submit a written statement setting out:

• Which domains you believe were scored incorrectly, and why
• What evidence supports a higher scoring
• What principles from the NHS National Framework (2022) were not properly applied
• Whether the "well-managed needs" principle (paragraphs 162–163) was correctly applied

Step 3: Escalate to NHS England

If the local review does not overturn the decision, you can request an Independent Review Panel (IRP) through NHS England. Our guide on how to appeal a CHC decision covers this process step by step. The IRP is an independent panel that will review the case from scratch. It has the power to recommend that the ICB's decision be overturned.

However, the IRP can only consider the evidence that was available at the time of the original decision. This means that the quality of your initial evidence gathering is critical — you cannot introduce new evidence at this stage.

Step 4: Contact the PHSO

If the IRP does not resolve the issue, your final option is to complain to the Parliamentary and Health Service Ombudsman (PHSO). The PHSO investigates complaints about NHS organisations and can make binding recommendations.

For a detailed breakdown of the seven most common mistakes families make during this process, read our guide on 7 Mistakes to Avoid in Your CHC Application.

What do successful dementia CHC cases look like?

Roughly 1 in 6 refused CHC decisions are overturned at the first appeal stage (Nuffield Trust, 2024), and dementia cases account for a disproportionate share of those overturns when families bring the right evidence. The following examples are anonymised composites based on real advocacy experience. They illustrate common patterns in dementia CHC cases.

Case 1: The "settled resident" who was anything but

Background: Margaret, 84, had advanced Alzheimer's disease and lived in a nursing home. She had been refused CHC twice. The ICB's rationale stated that she was "settled in her environment" and her needs were "well-managed by care home staff."

What the evidence showed: Margaret's care home records told a very different story. Over a three-month period, she had 47 recorded incidents of agitation, 12 episodes of physical aggression toward staff, and 23 nights where she was awake and wandering between midnight and 5am. She required one-to-one supervision during all meals because of a swallowing risk, and she had lost 8kg in six months despite nutritional supplements.

What changed: Margaret's family requested copies of her daily care records and compiled a domain-by-domain evidence summary. They highlighted the gap between the assessor's description of a "settled" resident and the documented reality of daily challenging behaviour, significant nutritional risk, and 24-hour supervision needs. They explicitly referenced paragraphs 162–163 of the 2022 National Framework regarding well-managed needs.

Outcome: The local review panel overturned the original decision. Margaret was awarded CHC funding backdated to the date of the original Checklist referral. The family recovered over eighteen months of care fees.

Case 2: The "social need" that was a health need

Background: David, 77, had mixed dementia (Alzheimer's and vascular) and lived at home with his wife, who was his primary carer. The ICB refused CHC on the grounds that David's needs were primarily "social" — he needed help with washing, dressing, eating, and toileting, which the ICB classified as social care.

What the evidence showed: David's needs could not be separated from his cognitive impairment. He did not simply need "help with washing" — he needed skilled support from someone who understood that he would resist care, become aggressive when confused, attempt to leave the house undressed, and was unable to recognise the difference between day and night. His continence needs were not simply "social" — he was incontinent because he could not recognise the need to use the toilet, could not find the bathroom, and became distressed during personal care.

What changed: David's wife, with advocacy support, wrote a detailed statement describing a typical 24-hour period. She recorded seven days of care using a structured diary, noting every instance of confusion, resistance, aggression, and distress. A consultant geriatrician provided a letter confirming that David's care needs were a direct consequence of his neurological condition and could not be safely met without clinical oversight.

Outcome: The IRP recommended that CHC be awarded. The panel specifically noted that the ICB had failed to consider the nature and complexity of David's needs, and had incorrectly classified health needs as social needs.

Case 3: The Fast-Track refusal

Background: Susan, 91, had advanced Lewy body dementia with significant Parkinsonian symptoms. She was rapidly losing weight, had frequent falls, and was experiencing vivid hallucinations that caused extreme distress. Her GP submitted a Fast-Track referral, which was rejected by the ICB on the grounds that Susan's prognosis was "uncertain."

What the evidence showed: Susan's weight had dropped from 58kg to 43kg in eight months. She had been hospitalised twice for falls. Her hallucinations were so severe that she required sedation on multiple occasions. Her consultant had described her condition as "end-stage" in a letter to the GP.

What changed: Susan's family challenged the Fast-Track refusal directly with the ICB, attaching the consultant's letter, the weight loss trajectory, the hospital admission records, and a statement from the care home manager describing the level of intervention required daily. They pointed out that the NHS National Framework (2022) does not require a specific prognosis for Fast-Track — it requires evidence of a "rapidly deteriorating condition that may be entering a terminal phase."

Outcome: The Fast-Track was approved within five days of the challenge. Susan received CHC funding for the remaining four months of her life, saving her family over twelve thousand pounds in care fees.

You have the right to fight for this

If there is one thing we want you to take away from this article, it is this: a CHC refusal for someone with dementia is not the end of the road. It is often the beginning of a process that, with the right evidence and the right arguments, leads to a different outcome.

The system is not designed to work against dementia families deliberately. But its structure — the snapshot assessments, the well-managed needs trap, the financial pressures on ICBs — creates systemic disadvantages that you need to be aware of and prepared to counter.

You do not need to be a lawyer or a healthcare professional to do this effectively. You need to understand the Framework, gather the right evidence, and present it clearly. Everything in this article is designed to help you do exactly that.

If you want structured support for your specific situation, our Case Strength Report (£97) walks you through the process step by step, with templates, checklists, and domain-by-domain guidance written specifically for families navigating CHC with dementia.

If you're at the very beginning of this journey, start with a CHC checklist request — the formal first step. Or use our free CHC Eligibility Checker to see whether your loved one's needs match the 12-domain criteria. And if you're approaching end-of-life decisions for someone with advanced dementia, our guide on what to expect from end-of-life care at home covers the Fast-Track CHC pathway in detail.

You're not alone in this. And your loved one's needs deserve to be properly recognised.

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This article is based on the NHS National Framework for Continuing Healthcare and NHS-funded Nursing Care (revised July 2022, corrected July 2023), relevant case law, and real-world advocacy experience. It does not constitute legal advice. Content was last reviewed in May 2026 and has been reviewed by legal professionals and social care professionals.