Care Home Fees and NHS Continuing Healthcare: Claiming What You Are Owed
Published 19th of May 2012·Updated 28 April 2026
Reviewed by: Reviewed for accuracy April 2026
If a family member has paid for care home or nursing care costs that should have been funded by the NHS, they may be entitled to a full refund. NHS Continuing Healthcare (CHC) is a package of care arranged and fully funded by the NHS for adults with complex health needs, and many eligible people are wrongly denied it or never assessed in the first place.
Short Summary
NHS Continuing Healthcare is free at the point of use. Unlike local authority care funding, it is not means-tested and your assets or savings are irrelevant. If you meet the clinical criteria, the NHS must fund your care in full.
Thousands of families have reclaimed care home fees paid over previous years after successfully challenging a wrong CHC decision. Backdated refunds can run to tens of thousands of pounds.
The NHS uses a tool called the Decision Support Tool to assess eligibility. The assessment looks at health needs across 12 care domains. A primary health need, or a combination of high-level needs across domains, may establish eligibility.
Challenging a refusal is your right. If you believe an assessment was wrong, you can request a review, escalate to an Independent Review Panel, and ultimately appeal to the Parliamentary and Health Service Ombudsman.
What is NHS Continuing Healthcare and who qualifies?
NHS Continuing Healthcare (CHC) is a package of ongoing care that is arranged and fully funded by the NHS for adults in England who have a "primary health need." Similar schemes exist in Wales (NHS-funded Nursing Care), Scotland and Northern Ireland.
A primary health need is established when a person's care needs are primarily driven by their health rather than social factors. The NHS assesses eligibility using a formal framework called the Decision Support Tool, which evaluates needs across 12 domains including behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition and continence.
You do not have to live in a care home to qualify. CHC can also fund care provided in a person's own home. Eligibility is based entirely on health needs; income, savings and property are irrelevant.
How do you apply for NHS Continuing Healthcare?
The process typically starts with a checklist assessment carried out by a healthcare professional such as a nurse, social worker or GP. If the checklist indicates possible eligibility, a full multidisciplinary assessment is carried out. This involves a team of health and social care professionals who complete the Decision Support Tool.
You, or the person being assessed, have the right to be involved in the assessment process and to see the completed documentation. A family member or carer can attend as an advocate.
If you believe a family member should have been assessed but never was, contact their GP, care home manager or the local Clinical Commissioning Group (now known as Integrated Care Board) to request an assessment.
What happens if you are wrongly denied CHC funding?
A refusal does not mean you are not eligible. NHS CHC decisions are frequently challenged and overturned. The process for challenging a decision is:
- Local review: request a formal review of the decision from the Integrated Care Board that issued it. You have 6 months from the date of the decision to request this.
- Independent Review Panel: if the local review does not resolve the issue, you can escalate to an Independent Review Panel hosted by NHS England.
- Parliamentary and Health Service Ombudsman: if the review process does not produce a satisfactory outcome, you can refer the case to the Ombudsman.
Consider seeking help from a solicitor or specialist advocate who handles CHC cases. Some operate on a no-win, no-fee basis. NHS England also publishes detailed guidance on the appeals process at england.nhs.uk.
Can you claim back care home fees that were already paid?
Yes. If a person was paying care home fees during a period when they should have been eligible for CHC funding, a successful retrospective review can result in a refund of all fees paid during that period. These retrospective claims can cover a period of several years in some cases and refunds can amount to tens of thousands of pounds.
The process for a retrospective claim follows the same route as a current eligibility challenge. Contact the Integrated Care Board responsible for the area where the person was receiving care and request a retrospective assessment.
| Stage | Who handles it | Time limit to request |
|---|---|---|
| Local CHC review | Local Integrated Care Board | Within 6 months of decision |
| Independent Review Panel | NHS England | After local review completed |
| Ombudsman complaint | Parliamentary and Health Service Ombudsman | Within 12 months of the decision |
| Retrospective assessment | Local Integrated Care Board | No absolute time limit, but earlier is better |
Where can you get free help with a CHC claim?
Several organisations offer free guidance on NHS Continuing Healthcare:
- NHS England: publishes the full national framework and guidance on assessments and appeals at england.nhs.uk.
- Age UK: provides free information and support for older people and their families navigating CHC (ageuk.org.uk).
- Beacon: a free CHC advocacy service funded by NHS England that can help families through assessments and appeals (beaconchc.co.uk).
- Citizens Advice: can provide general guidance on challenging NHS decisions and navigating the process.
Frequently Asked Questions
Is NHS Continuing Healthcare means-tested?
No. CHC is funded entirely by the NHS regardless of your income, savings or property. This distinguishes it from local authority social care funding, which is means-tested with a capital threshold (currently £23,250 in England as of 2026, though this is subject to change). If you qualify for CHC, the NHS pays all care costs in full.
Can you claim CHC funding for care at home rather than in a care home?
Yes. NHS Continuing Healthcare can fund care packages delivered in a person's own home as well as in a care home or nursing home. The type of setting is not a factor in eligibility; only the level of health need matters.
What is the National Framework for NHS Continuing Healthcare?
The National Framework is the official document that sets out how CHC eligibility is assessed in England. NHS England published the most recent version in 2022. It defines the criteria, the Decision Support Tool and the process for reviews and appeals. You can download it free from england.nhs.uk.
How long does a CHC assessment take?
A checklist assessment is usually completed within a few days. A full multidisciplinary assessment should be completed within 28 days of the checklist indicating possible eligibility. Integrated Care Boards are required to inform you of the outcome in writing after the full assessment.
What should I do if I think my relative was wrongly denied CHC in the past?
Start by gathering as much documentation as possible: care records, medical records, any previous assessment paperwork and invoices for care fees paid. Then contact the Integrated Care Board for the area where the care was provided and request a retrospective eligibility assessment. If you find the process difficult to navigate alone, contact Beacon (beaconchc.co.uk) for free advocacy support.