NHS Continuing Healthcare for dementia: how eligibility is decided

Dementia does not by itself qualify a person for NHS Continuing Healthcare (CHC) in England, and it does not rule them out either. The National Framework says the decision should rest on the needs identified, not on a condition such as Alzheimer's disease or dementia. What can lead to CHC funding is the care that dementia creates day to day: the risk that comes from disorientation, behaviour that needs a skilled response, distress that does not settle and needs that interact with each other. This guide explains how those needs are recorded in the Decision Support Tool (DST), why well-managed needs still count and how families can describe them.

There are no national figures for dementia on its own, because NHS England's CHC statistics do not record diagnosis, as the Alzheimer's Society notes. Across all conditions, 17.4% of standard assessments in 2025/26 ended with the person found eligible, so the evidence the team sees matters.

Does dementia qualify for NHS Continuing Healthcare?

CHC is a package of ongoing care arranged and funded solely by the NHS for an adult assessed as having a primary health need. It can be provided in any setting, including a care home or the person's own home, and it is not means-tested: financial issues should not be considered in the eligibility decision.

Practice Guidance note 34 in the National Framework (revised 2022) is direct: the recommendation should not be based on a specific condition, naming Alzheimer's disease and dementia among its examples, but on the needs identified. That others with a similar condition were found eligible does not mean everyone with it will be, so each person is assessed in their own right. NHS.uk says the same: eligibility depends on assessed needs, not on any particular diagnosis.

The legal test is in regulation 21(7) of the Standing Rules Regulations 2012: are the nursing or other health services the person needs, taken in their totality, more than incidental or ancillary to the accommodation a council would have to provide, or of a nature beyond what a council could be expected to provide? If so, the person has a primary health need and must be found eligible. The Framework also says there should be no discrimination by type of health need, whether physical, mental or psychological, so needs that come from dementia are weighed like any other.

How dementia shows up in the 12 DST care domains

The DST has 12 care domains. Dementia most often touches cognition, behaviour and psychological and emotional needs, but it can also create needs in communication, nutrition, mobility, continence, skin and medication. The team records each need where it belongs and chooses a level from the evidence. The table below is a prompt for what to look for, not a prediction of any level.

Cognition (reaches severe)

The DST says this domain applies to acquired and degenerative disorders among others, and that the key question is the degree of risk to the person. Paraphrasing the current form (October 2026): at high, the person may have frequent short-term memory problems and some disorientation and finds it hard, even with help, to make decisions about key parts of life, which puts them at high risk of harm, neglect or health deterioration. At severe, memory loss or disorientation is marked, the person cannot assess basic risks even with help and depends on others to anticipate basic needs and protect them from harm. The form also asks the team to consider a specialist referral and to apply the Mental Capacity Act wherever capacity is in question.

Behaviour (reaches priority)

This domain is wider than many families expect, because the form's list goes well beyond aggression: passive non-aggressive behaviour, severe disinhibition, intractable noisiness or restlessness, resistance to necessary care and treatment (but not a capacitated choice to refuse it), severe fluctuations in mental state and inappropriate interference with others. Wandering is also taken into account here. The team describes when the behaviour is likely, how often it happens, how long it lasts and its impact.

At high, the behaviour poses a predictable risk to the person, others or property that planned interventions reduce but do not always remove. At severe, the risk is significant and needs a prompt, skilled response that may fall outside the plan. At priority, the risk is immediate and serious and needs an immediate skilled response at all times.

Psychological and emotional needs (stops at high)

These needs should be considered whatever the underlying condition. Where cognitive impairment stops a person expressing distress, the team should record that and make a professional judgement from the overall evidence. The form notes that someone at severe in cognition may not be able to consciously withdraw from care, so other signs of distress need careful thought. The top level covers mood disturbance, hallucinations, anxiety or distress with a severe impact on health or well-being. Our guide to the 12 DST care domains describes every level in the other domains.

One condition, several domains

Families are sometimes told that dementia can only be counted once. That is wrong. Practice Guidance note 30 calls the belief in a “no double-scoring rule” a common misconception, and the DST guidance, in its section on recording current and anticipated needs, uses cognitive impairment as its example: a level in cognition and associated needs in other domains, each recorded and weighted in its own right.

Note 30 adds that challenging behaviour linked to cognitive impairment must still be recorded in the behaviour domain. The cognition page of the form agrees: where cognitive impairment affects behaviour, the team takes it into account in the behaviour domain so the link between the two is clear.

Well-managed needs: why a calm day still counts

In a good care home, dementia care can look settled: no incidents and a resident who seems content. That calm can be the result of skilled work, and the Framework says the decision should not marginalise a need just because it is successfully managed. Well-managed needs are still needs. Only where good management has permanently reduced or removed an ongoing need, so that active management is reduced or no longer required, does it bear on eligibility.

The Framework's own example is about behaviour: a support plan manages challenging behaviour so well that there are no recorded incidents of risk. Those needs should still be recorded and taken into account. The DST guidance on well managed needs goes further: where psychological or similar interventions are addressing behaviour, the team should consider the present-day need if that support were withdrawn and reflect it in the behaviour domain.

The principle has limits. The same section says well-controlled conditions should not be recorded as if medication or routine care were absent, and needs managed with medication may belong in the drug therapies domain. Practice Guidance note 23 also warns that behaviour can look worse in the wrong environment: a person may be disoriented and sleep badly in an acute hospital, then settle in a care home or at home without particular support. In that case the need may have reduced rather than be well managed.

What helps is showing the work: what staff do to prevent distress or incidents, how often and with what skill. Providers may not record this in detail, so the team may ask for a detailed diary over a suitable period. Our free 7-day care diary is set out by domain for exactly this.

Assessments in hospital: why timing matters

CHC sometimes comes up while a person is in hospital. The Framework says that in the vast majority of cases screening should happen after discharge and a period of recovery in a familiar setting or an intermediate placement. It warns that a screening or assessment in an acute hospital is unlikely to reflect a person's longer-term needs accurately. If a CHC Checklist or full assessment is proposed on a ward, it is reasonable to ask whether it can wait until the person is settled and how their needs will be met in the meantime.

When dementia is progressing

Dementia can change over time. The DST guidance on recording current and anticipated needs covers a more slowly deteriorating condition where needs can reasonably be expected to increase soon: the levels are set on current needs, but the likely change is recorded and taken into account. That can mean eligibility now, before the deterioration has happened, or a date for an early review, which Practice Guidance note 34 also asks the team to consider.

Where a person has a rapidly deteriorating condition that may be entering a terminal phase, an appropriate clinician can use the CHC Fast Track Pathway Tool instead of the Checklist and DST, and the ICB must accept a properly completed tool. The Framework says “rapidly deteriorating” should not be read narrowly as a specific or short time left. Fast Track turns on that end-of-life test, not on dementia or challenging behaviour as such.

Consent, capacity and the family's voice

A person with dementia may not be able to consent to their information being shared. The DST guidance says capacity is decided under the Mental Capacity Act 2005 and a best interests decision may be needed, so that everyone who may be eligible can be considered. Difficulty expressing views does not by itself mean a person lacks capacity.

A family member without a lasting power of attorney or deputyship for health and welfare cannot give or refuse consent for the person. Even so, the Framework's definition of a representative includes any friend, unpaid carer or family member supporting the person, and once the right basis for sharing is in place their views are taken into account. An attorney for property and financial affairs should also receive a copy of the completed DST to carry out their duties. Our guide to the CHC MDT meeting covers what you can say on the day.

If CHC funding is agreed: the care home and top-ups

If the ICB decides the person is eligible, the NHS arranges and funds the whole package, including care home accommodation where that is part of the overall need. NHS.uk says CHC packages cannot be topped up the way council-funded places can. If the current home costs more than the ICB usually pays and a move is proposed, evidence that a move is likely to harm the person's health or well-being should be discussed with the ICB. Age UK notes that frailty or mental health needs can be reasons to stay.

Reviews: eligibility is not permanent

The first review should take place within three months of the decision, then at least once a year. The Framework warns reviewers not to mistake well-managed care for a reduction in day-to-day needs, which it says may be particularly relevant for a progressive illness, although it accepts that with some progressive conditions needs can reduce over time. Neither the ICB nor the council should withdraw from existing funding without a joint reassessment and consultation with the person. Any proposed change should be put in writing, and alternative funding should be agreed before the existing funding stops.

How to describe dementia needs before the MDT meeting

The team weighs your account alongside care records, and it helps when the two line up. Specific detail carries more weight than general impressions:

• Describe a typical day and a bad day, including nights: what happens, how often, for how long, how many staff are needed and what happens if nobody steps in.
• Show the work behind the calm: redirection, one-to-one time, two carers for personal care and set routines.
• Gather the records: behaviour charts, incident logs, the care plan, risk assessments, falls, swallowing and weight records and any dementia nurse or psychiatry letters. Practice Guidance note 22 lists this kind of evidence, including diaries covering a good day and a bad day.
• Ask for the person's own view to be recorded in Section 2 of the DST, and for any disagreement with the levels to be recorded in Section 5.
• Ask for a copy of the completed DST with the ICB's decision and reasons.

If putting it into words is the hard part, you can write one domain free from your own description and see how it reads before the meeting.

If the answer is no

If the ICB decides the person is not eligible, the letter should give its reasons and say how to ask for a review. You can ask the ICB for local resolution and then ask NHS England for an independent review. See CHC refused: local resolution and the IRP and work out the typical dates with our time limits calculator. If the person lives in a care home with nursing, NHS-funded nursing care may still apply, because it is considered once CHC has been ruled out. The council can also assess social care needs.

Free independent advice on CHC is available from Beacon on 0345 548 0300, which NHS.uk lists, and the Alzheimer's Society publishes a booklet on when the NHS pays for care.

Common questions