If You are Eligible for Continuing Healthcare Your Benefits May be Affected

Some benefits will change when you become eligible for continuing healthcare. If you receive Attendance Allowance (AA) or Disability Living Allowance (DLA) in a care home with nursing, these will normally stop 28 days after continuing healthcare begins, however DLA will not normally stop if you are not receiving care from a qualified nurse or if you receive care in your own home. If DLA is stopped, the DLA higher rate mobility component will continue to be paid over to Motability’s service providers in relation to a hire purchase or contract hire of a ‘Motability’ vehicle, where relevant. If AA or DLA benefits stop, other disability-related premiums may also be affected.

Top Tip: If you are in receipt of either AA or DLA when you become eligible for continuing healthcare it is advisable to contact the AA and DLA units on 08457 123456 to inform them of the change.

Continuing Healthcare is Not Just for Nursing Home Residents

Continuing healthcare is not restricted to any particular setting and can be received anywhere, including in your own home. This principle was clarified by case law in 2003 during the retrospective review process. Some Strategic Health Authorities at the time had been rejecting requests for review from residents of care homes without nursing before this point was clarified. Although far fewer continuing healthcare assessments are carried out for people in care homes without nursing than care homes with nursing, assessments must be based on the individual’s assessed care needs, regardless of where that care is delivered or whether the setting is appropriate. Our experience has shown that some assessment teams still struggle to apply this important principle.

Top Tip: If you receive continuing healthcare in your own home the NHS must pay all costs related to your assessed health and social care needs, but it does not have to pay your rent, mortgage, food or usual utility bills. In certain situations it may be appropriate for the NHS to pay a contribution toward your utility bills if, for example, you need to run specialised equipment in order to meet your care needs.

Continuing Healthcare is Not for Life

Continuing healthcare is based on an assessment of care needs and how those needs should be met rather than on a specific diagnosis, meaning it is common for these needs to change over time. For this reason if you have been assessed as eligible for continuing healthcare, you can expect your needs to be reviewed 3 months from the original decision and annually thereafter.

This does mean that it is possible for individuals to ‘drop out’ of NHS funding at a later stage despite presenting with very similar needs. A typical example of this is where someone with dementia who is able to self-mobilise and presents with challenging behaviour which requires constant monitoring, is then immobilised by a fall or stroke. In that situation although the diagnosis (dementia) has not changed and in fact the person’s health has worsened, the management of their needs has become less intense and therefore, the person is assessed as no longer having a primary health need.

This type of scenario is obviously one that many people struggle to accept, and there is a growing campaign amongst charities and patient groups that people with degenerative conditions should not be made to have their eligibility status reviewed.

Top Tip: If you are in situation whereby eligibility for continuing healthcare is being withdrawn, it is important that you request a thorough explanation in writing from your Clinical Commissioning Group as to why they believe you are no longer eligible. If you disagree, you can challenge that decision.

Contacting your Clinical Commissioning Group

If you are trying to get into contact with the Clinical Commissioning Group dealing with your case, don’t forget that you can go to NHS Choices Service Search at: http://www.nhs.uk/service-search and type in your postcode to find the CCG’s within your local area, and their contact details.