CHC Decision Challenge
Understand the decision, identify areas that may need further consideration, and prepare a clear, evidence-led response.
What the tool does
A CHC decision can be difficult to understand. This tool helps you work through what happened and identify questions or potential areas of disagreement without assuming that a particular outcome is guaranteed.
Tell us about the decision
Record the outcome, assessment and any information you have been given.
Review the care needs
Work through the relevant CHC domains and describe what actually happens day to day.
Identify potential issues
Compare the information provided with the recorded assessment and the overall picture of need.
Prepare your response
Use the findings to formulate clear questions and a structured request for reconsideration.
It’s about the whole picture
CHC isn’t simply about counting domain scores. The assessment needs to consider the totality of an individual’s needs and the four key characteristics used within the framework.
The 12 CHC domains
The tool can help you consider the areas covered by the Decision Support Tool and, importantly, how individual needs may interact.
Start your CHC Decision Challenge
You don’t need to upload your paperwork. If you have your DST or decision letter, you can use the information in it to make the assessment more precise.
If you've been told someone isn't eligible for CHC, it can be difficult to know what to do next.
We'll take you through all 12 care domains, one at a time. You can compare what the DST recorded with what you believe was actually happening.
You don't have to use clinical language. Tell us what happened in real life. If you don't know a DST level, simply say so.
Breathing
Look at the breathing support, treatment, monitoring and risk involved — not simply whether the person has a respiratory diagnosis.
What did the DST record?
Let's look at what happened in practice
Nutrition – food and drink
Consider eating and drinking support, swallowing, supervision, monitoring, supplements and the consequences of poor intake.
What did the DST record?
Let's look at what happened in practice
Continence
Consider the actual continence care required, including frequency, dependence, skin risks, equipment, catheter or bowel management and complications.
What did the DST record?
Let's look at what happened in practice
Skin and tissue viability
Consider pressure damage, wounds, skin fragility, dressings, repositioning, prevention and the level of skilled care or monitoring required.
What did the DST record?
Let's look at what happened in practice
Mobility
Look beyond whether someone can walk. Consider transfers, repositioning, equipment, number of carers, frequency, falls, risk and fluctuating ability.
What did the DST record?
Let's look at what happened in practice
Communication
Consider the person's ability to communicate needs, understand information and make themselves understood, and the care consequences when communication is limited.
What did the DST record?
Let's look at what happened in practice
Psychological and emotional needs
Consider the person's emotional and psychological needs, how often support is required, and what intervention or supervision is necessary.
What did the DST record?
Let's look at what happened in practice
Cognition
Consider how cognitive impairment affects everyday care, safety, decision-making, recognition of needs and the level of supervision required.
What did the DST record?
Let's look at what happened in practice
Behaviour
Consider what behaviours occurred, their frequency and severity, triggers, risks, intervention, staffing and unpredictability — not simply whether behaviour was described as challenging.
What did the DST record?
Let's look at what happened in practice
Drug therapies and medication
Consider the complexity of medication, monitoring, side effects, risks, routes of administration and the level of skilled intervention required.
What did the DST record?
Let's look at what happened in practice
Altered states of consciousness
Consider episodes of altered consciousness, how often they occur, how long they last, what monitoring is needed and what intervention or risk follows.
What did the DST record?
Let's look at what happened in practice
Other significant care needs
Use this domain for significant needs that do not fit neatly elsewhere. Focus on what care is required, how often, how complex it is and what happens if it is not provided.
What did the DST record?
Let's look at what happened in practice
Now step back and look at the whole picture
The National Framework says the overall picture matters. This isn't about adding up scores. Tell us what you think about the nature, intensity, complexity and unpredictability of the needs, and how they interact.
What are the needs and what sort of care is required?
How much care is required, how often and for how long?
How do different needs interact or make care more complicated?
Can needs change suddenly or require unexpected intervention?
You've completed the review
We've looked at the information you provided using transparent, rule-based checks. This is an indication of areas that may warrant further review — not a CHC eligibility decision.
We'll email you everything you've recorded
Your full report includes each domain, the DST outcome you entered, your view, the detail you provided, potential review points and suggested questions.
Your email is used to send the report and is recorded as a report request. Your CHC answers are not stored by this tool.
Useful Carentis resources
Useful Carentis resources
If you’re dealing with CHC, the decision is often only one part of a much bigger care and funding picture.
NHS Continuing Healthcare
Understand CHC, the assessment process and what funding can cover.
→NHS-funded nursing care
Find out how nursing care funding works when CHC isn’t awarded.
→Care home funding
Explore the wider routes for paying for care and meeting care costs.
→Paying for care
Understand the different ways care may be funded and what to look at next.
Not sure what help you may be entitled to?
Use the Carentis Benefits Calculator to explore possible financial support alongside your care funding options.