Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains why the setting in which care is delivered does not determine NHS Continuing Healthcare eligibility. It covers the exclusion of setting from the decision, the common misconception about nursing homes, eligibility at home and in supported living, the distinction between eligibility and decisions about where care is delivered, and how to challenge a decision that relies on setting.
Does the care setting affect CHC eligibility
Setting is expressly excluded from the eligibility decision, yet it remains one of the most common reasons families are told they do not qualify. Being in the wrong type of home is not a lawful basis for refusing funding.
What the Framework says
The National Framework is explicit that eligibility is not determined by the setting in which care is delivered, the type of provider, or who is funding the care at the time. Eligibility rests on the totality of assessed needs analysed through the four key characteristics. A decision turning on setting has not applied the test.
The nursing home misconception
The most common version is that funding is only available in a nursing home. It is not. Registration status describes what a provider is set up to deliver, not what an individual needs. Many people in nursing homes are not eligible, and people living in residential homes, in supported living and in their own homes are.
Eligibility at home
People are regularly found eligible while living at home, sometimes with very substantial packages including two carer calls and waking night support. What changes with setting is what the funding covers, not whether it is available. At home the assessed care package is funded but ordinary living costs are not.
Where setting legitimately matters
Setting is relevant to how needs are met, not to whether the person is eligible. Once eligibility is established, the Integrated Care Board must decide how to meet assessed needs safely and sustainably, and setting is properly part of that. The error is importing that second question into the first.
The circular argument
A particular pattern is worth watching for. A person is told they are not eligible because they are in a residential rather than nursing home, and separately told they cannot move to a nursing home because they are not eligible for funding. That circularity is not a lawful approach to either question and should be named as such in writing.
How to challenge it
Where a decision or a conversation relies on setting, ask for it in writing. Then ask the Board to identify the assessed needs relied on and the reasoning applied to nature, intensity, complexity and unpredictability. A decision made on setting is a specific and identifiable defect rather than a matter of general disagreement.
Key takeaway
Setting is excluded from the eligibility decision. It is relevant to how needs are met once eligibility is established, not to whether they qualify. Get any setting-based reasoning in writing, because it is one of the clearest defects to identify.
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Frequently asked questions
Do you have to be in a nursing home to get CHC?
No. Setting is expressly excluded from the eligibility decision. People are eligible in residential homes, supported living and their own homes, and many people in nursing homes are not eligible.
Can you get CHC at home?
Yes, including with substantial packages involving two carer calls and overnight support. What changes at home is what the funding covers, since ordinary living costs are not included, rather than whether it is available.
Does setting matter at all?
Yes, but to how needs are met rather than whether the person is eligible. Once eligibility is established, the Board decides how to meet needs safely and sustainably, and setting is part of that.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.