NHS Continuing Healthcare for Live-In Care: A Full Guide

For families funding 24-hour home care, NHS Continuing Healthcare (CHC) can be transformative — it covers the full cost of care, with no means test, wherever that care is delivered. Yet it's one of the most misunderstood and underused forms of NHS support. This guide explains what CHC is, how the 'primary health need' test works, and how to navigate the assessment process to fund live-in care at home.

What Is NHS Continuing Healthcare?

NHS Continuing Healthcare (often shortened to CHC or "continuing care") is a package of care arranged and funded entirely by the NHS for adults who have significant ongoing health needs. Unlike local authority social care — which is means-tested and may require you to contribute from your savings, income, or property — CHC is free at the point of use. If you're eligible, the NHS pays 100% of your care costs.

Crucially, CHC is about the type of need, not where you live. It can fund care in a nursing home, a residential home, or — importantly for many families — a professional carer living in your own home.

Does CHC Fund Live-In Care at Home?

Yes. This is one of the most valuable but least-known facts about CHC. Because the funding follows the person rather than a building, an eligible individual can choose to receive their care at home through a live-in care arrangement instead of moving into residential care. For people who want to stay in familiar surroundings — and for those with conditions like advanced dementia where routine and environment matter enormously — this can be life-changing.

In some cases CHC is delivered as a Personal Health Budget (PHB), which gives you more control over how the funding is used and which provider delivers your care. If you're considering this route, it's worth discussing it explicitly with your assessor, as not every NHS team proactively offers home-based options.

Eligibility: The 'Primary Health Need' Test

There is no fixed diagnosis or condition that automatically qualifies someone for CHC. Instead, eligibility rests on whether you have a primary health need — meaning your day-to-day care needs are mainly driven by your health, rather than by ordinary social or personal care needs.

Assessors weigh up four key characteristics of your needs:

• ✓ Nature — the type of needs you have and their effect on you
• ✓ Intensity — how severe your needs are and how much support they require
• ✓ Complexity — how your needs interact, making them difficult to manage
• ✓ Unpredictability — how much your needs fluctuate and the risks this creates

The 12 Care Domains

During a full assessment, your needs are scored across 12 "care domains". Each domain is rated from no needs through to priority needs. A single "priority" score in certain domains, or several "severe" scores, usually indicates a primary health need.

The Assessment Process, Step by Step

1. The Checklist (initial screening) — A nurse, doctor, or social worker completes a short screening tool. It deliberately sets a low threshold, so passing it doesn't mean you're eligible — it simply means a full assessment is justified.
2. The full assessment — If you pass the Checklist, a multidisciplinary team (MDT) of at least two professionals completes the Decision Support Tool, scoring your needs across the 12 domains. This should happen within 28 days of the Checklist.
3. The recommendation — The MDT recommends whether you have a primary health need. The Integrated Care Board (ICB) then makes the final funding decision.
4. Care planning — If eligible, the NHS works with you to agree a care package — including the option of live-in care at home or a Personal Health Budget.
5. Review — Your eligibility is reviewed after 3 months, then at least annually, as health needs can change over time.

In urgent situations — for example, a rapidly deteriorating condition or end-of-life care — a Fast Track pathway can put funding in place within days, bypassing the full assessment.

What If You're Turned Down?

CHC decisions are not final. If you believe the outcome is wrong, you can request a local review by the ICB, and if you're still unhappy, ask NHS England for an Independent Review Panel. Keep copies of all assessments, ask for the completed Decision Support Tool, and don't be afraid to challenge scores that don't reflect the reality of day-to-day care. Many families overturn an initial refusal on appeal.

Other Funding Options

If you don't qualify for CHC, other support may still help fund live-in care — including a local authority needs assessment, Attendance Allowance, and NHS-funded Nursing Care (FNC) for those in nursing homes. For a full breakdown of costs and how to pay for care, read our live-in care costs and funding guide.

Frequently Asked Questions

Have more questions? Visit our full FAQ page or get in touch.

How to Get Started

If you think you or a loved one may be eligible for CHC, ask your GP, hospital discharge team, or social worker to arrange a Checklist screening. Once funding is in place, we can help you set up high-quality live-in care at home. Complete a free care assessment and our team will guide you through your options.