Free CHC Toolkit: Essential Dementia Resources

What is NHS Continuing Healthcare and how does it work?

The funding programme most families never hear about

NHS Continuing Healthcare (CHC) is a programme that pays 100% of care costs for people whose primary need is a health need. It covers care home fees, nursing care, personal care, specialist equipment, and accommodation. There is no means test. Your relative's savings, property, and income are irrelevant. If the criteria are met, the NHS pays everything.

Around 60,000 people in England receive CHC at any one time (NHS Continuing Healthcare Statistics, 2023-24). However, the number who qualify but never receive it is far larger. Most families discover CHC only after paying care home fees privately for months or years. In our experience, the most successful CHC applications come from families who request the checklist early — ideally before a care home placement, not after. The NHS does not volunteer this information. Hospital discharge teams rarely mention it. Care homes have no obligation to tell you.

What CHC covers

CHC is not a top-up or a partial contribution. It replaces self-funding entirely. When CHC is awarded, the NHS pays for:

• Full care home fees, including accommodation and personal care
• Nursing care provided by registered nurses
• Specialist dementia care and supervision
• Equipment and adaptations required for the person's condition
• Care at home, if the person remains in their own home with a suitable package

Anyone with assets above £23,250 must pay for their own care in full under the standard means test (Care Act 2014). Notably, that threshold rises to £100,000 from October 2025 (Health and Care Act 2022, section 140). CHC bypasses the means test completely. It does not matter whether your relative has savings of £500 or £500,000.

Why this matters for dementia families

Specialist dementia care home fees run to £1,400+ per week (Laing Buisson Care of Older People UK Market Report, 2024). That is over £73,000 per year. Average life expectancy after a dementia diagnosis is 8-10 years (Alzheimer's Society, Living with Dementia Report, 2023), and the advanced stages when care costs are highest can last months or years. Without CHC, families exhaust life savings, sell property, and lose inheritances paying for care the NHS should have funded.

The single most important thing you can do is find out whether your relative qualifies. The rest of this toolkit shows you how.

Does dementia qualify for CHC?

The short answer

Yes. Dementia is one of the strongest clinical presentations for CHC eligibility, particularly in its moderate and advanced stages. The question is not whether your relative has a diagnosis of dementia. The question is whether their day-to-day care needs are driven primarily by their health condition. In advanced dementia, they almost always are.

How the assessment works

CHC eligibility is determined using a 12-domain assessment (NHS National Framework (2022)). Each domain is scored from No Needs to Priority. The 12 domains are: Behaviour, Cognition, Communication, Psychological and Emotional Needs, Mobility, Nutrition, Continence, Skin Integrity, Breathing, Drug Therapies, Altered States of Consciousness, and Other Significant Care Needs.

A single Priority score in any domain, or two or more Severe scores across domains, strongly indicates a primary health need (National Framework for NHS Continuing Healthcare, 2022). That finding triggers full NHS funding.

Where advanced dementia scores highest

Advanced dementia routinely generates Priority or Severe scores across five, six, or seven domains simultaneously. The domains where it typically scores highest are:

• Cognition — complete disorientation, loss of memory, inability to recognise family members, loss of decision-making capacity
• Communication — severely reduced or absent speech; often entirely non-verbal
• Behaviour — agitation, aggression, resistiveness to care, wandering, and distress requiring active clinical management
• Continence — full incontinence requiring clinical continence management, not just pad changes
• Nutrition — swallowing difficulties and aspiration risk requiring clinical oversight; aspiration pneumonia is one of the leading causes of death in advanced dementia
• Skin integrity — immobility creates serious pressure sore risk requiring nursing intervention and active wound management

In contrast, most conditions affect one or two domains at high levels. Advanced dementia affects multiple domains simultaneously. That multi-domain pattern is exactly what the framework treats as a primary health need.

Fast Track CHC at end of life

When a person with dementia is entering a terminal phase, Fast Track CHC applies. A GP or consultant can trigger it. The target decision time is 24 hours, and no multidisciplinary team assessment is required (National Framework for NHS Continuing Healthcare, 2022). If Fast Track is granted, the NHS pays 100% immediately. Families should ask explicitly whether Fast Track is appropriate. Do not wait for the clinical team to suggest it.

What does Attendance Allowance cover and what doesn't it?

What Attendance Allowance is

Attendance Allowance (AA) is a non-means-tested benefit for people aged 65 and over who need help with personal care or supervision because of a physical or mental disability, including dementia. It pays at two rates: £72.65 per week (lower rate, for daytime or night-time care needs) or £108.55 per week (higher rate, for both daytime and night-time care needs) (DWP, Attendance Allowance rates, 2024-25).

AA is paid directly to the person with care needs. Savings and income are irrelevant — Attendance Allowance is not means tested. There is no requirement to spend it on care. For many families, it is the first benefit they claim after a dementia diagnosis, and often the only one anyone tells them about.

What AA does not cover

AA is designed for care needs at home. It is not a substitute for care funding. At £108.55 per week at the higher rate, it covers a fraction of the cost of specialist dementia care at £1,400+ per week (Laing Buisson Care of Older People UK Market Report, 2024). Families who rely on AA alone are covering less than 8% of care home costs.

Therefore, AA stops when the person moves into a care home funded by the local authority (Care Act 2014). If the local authority is paying for the placement — because the person's assets have fallen below the means test threshold — AA is withdrawn after four weeks.

The critical distinction most families miss

AA does not stop if care is funded by the NHS through Continuing Healthcare. CHC is NHS funding, not local authority funding, and the AA withdrawal rule does not apply. A person receiving CHC can continue to receive Attendance Allowance on top of full NHS-funded care.

This creates a bridging role. While waiting for a CHC assessment — which can take weeks or months — AA provides income. If CHC is awarded, AA continues. If CHC is refused, AA continues until local authority funding replaces it.

Many families claim AA and stop there, not knowing that CHC exists. AA is worth pursuing. It is not a reason to stop asking whether the NHS owes your family far more.

Why do you need both types of Lasting Power of Attorney?

Two separate documents, two separate purposes

A Lasting Power of Attorney (LPA) is a legal document that lets a person (the "donor") appoint someone they trust (the "attorney") to make decisions on their behalf. There are two types, and they are entirely separate:

Property and Financial Affairs LPA lets the attorney manage bank accounts, pay bills, sell property, and handle investments. It can be used while the donor still has mental capacity — with their permission — or after they lose it.

Health and Welfare LPA lets the attorney make decisions about medical treatment, care arrangements, daily routine, and where the person lives. It only activates when the donor has lost the mental capacity to make those decisions themselves.

Accordingly, both must be registered with the Office of the Public Guardian before they can be used. Registration currently takes approximately 20 weeks (Office of the Public Guardian, 2024). You cannot register an LPA after the person has lost capacity. Choosing the right LPA certificate provider is essential to avoid delays. The time to act is now.

Why Health and Welfare LPA matters for CHC

The Health and Welfare LPA is the document that gives you legal standing in the NHS system. Without it, you are a concerned relative. With it, you are a legal decision-maker. The practical difference is significant:

• You can attend multidisciplinary team (MDT) assessments and present evidence about daily care needs
• You can request a CHC checklist assessment from the Integrated Care Board
• You can challenge hospital discharge decisions you believe are unsafe
• You can consent to or refuse medical treatment on the person's behalf
• You can make formal complaints and pursue appeals through the NHS system

Without a Health and Welfare LPA, family members have no legal standing at discharge meetings, no right to attend MDT assessments as a decision-maker, and no formal basis to challenge clinical decisions.

Do not wait for a crisis

Dementia is a progressive condition. There is no reliable way to predict when capacity will be lost. If your relative still has capacity to understand what an LPA is and to choose their attorney, register both types immediately. Waiting until a hospital admission or care home placement creates exactly the situation the LPA was designed to prevent: a family with no legal authority at the moment they need it most.

What are your rights at hospital discharge?

The NHS must screen for CHC before discharge

A hospital cannot discharge your relative to a self-funded care home placement without first completing the CHC checklist (National Framework for NHS Continuing Healthcare, 2022). This is not discretionary. NHS bodies must screen for CHC eligibility at discharge whenever the person may have a primary health need.

Nevertheless, in practice, discharge teams frequently skip this step. Wards are under pressure to free beds, and if the person is discharged as self-funding, the cost falls on the family, not the NHS. As a result, families who do not know the checklist exists never ask for it.

If the discharge team has not initiated a CHC checklist, request one directly from the Integrated Care Board (ICB) in writing. A written request creates a formal obligation for the ICB to respond.

Challenging an unsafe discharge

You have the right to challenge any discharge you believe is unsafe. The hospital must produce a written discharge care plan addressing all identified care needs before discharge takes place (NICE Guideline NG27, 2015). If the plan is inadequate or fails to account for nursing needs, object formally.

Contact the hospital's Patient Advice and Liaison Service (PALS). PALS can convene a formal review between you, the discharge team, and the ward. If you hold a Health and Welfare LPA, invoke it explicitly and state that you do not consent to discharge. That gives your objection legal weight.

Discharge to Assess does not remove CHC rights

Many hospitals use Discharge to Assess (D2A) pathways, moving the person to a temporary care setting rather than keeping them in hospital. D2A does not remove the right to a CHC assessment. The assessment follows the person. Request a CHC checklist from the ICB in writing as soon as D2A begins. If CHC is awarded, funding applies retrospectively from the date the primary health need was present (National Framework for NHS Continuing Healthcare, 2022).

Never sign self-funding paperwork before the checklist is done

Care homes present admission contracts at the point of admission. Those contracts commit you to paying fees. If you sign before the CHC checklist has been completed, reversing that takes months. Do not sign. Request the CHC checklist first. You have the right to insist the NHS completes its screening obligation before any financial commitment is made.

Ready to check if your relative qualifies?

You now know more about NHS care funding than most families discover in months of paying privately. Here is what you have learned:

NHS Continuing Healthcare can cover 100% of your relative's care costs. There is no means test. Dementia — particularly moderate and advanced dementia — frequently qualifies. The assessment framework exists. The funding is real. Around 60,000 people receive it right now.

You also know what the NHS will not tell you: that this funding exists, that your relative may be eligible, and that every week without an assessment is a week your family pays for care the NHS may owe.

Every month without a CHC assessment is money leaving your family's assets that does not come back without a retrospective claim.

The single most important action you can take right now is to check whether your relative qualifies.

Our CHC eligibility checker takes 3 minutes. It asks straightforward questions about your relative's care needs and tells you immediately whether a formal CHC assessment is worth pursuing. No medical knowledge required. No obligation. No cost.

You do not need to understand the 12-domain framework in detail. You do not need to hire a solicitor. You need to answer a few questions about your relative's daily care needs, and you need to do it now — not next week, not after the next hospital appointment, not when things get worse.

If the checker indicates your relative is likely eligible, we will show you exactly what to do next: how to write to the ICB, what to include, and how to ensure the NHS cannot ignore your request.

Three minutes. That is all it takes to find out whether your family is owed funding worth over £73,000 per year.