Free Evaluation – Just Caring Legal

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Our free Just Caring Legal online questionnaire is to assist you in taking the first steps to claiming NHS Continuing Healthcare funding. Please note this is not legal advice, nor have you entered into a contractual agreement with Just Caring Legal.

NHS CHC is a package of care arranged for and funded solely by the NHS where there is a primary need for ‘healthcare’. There is no financial means test. This is different to social care which is providing assistance with daily living such as washing and dressing and this is means tested.

To establish if the Claimant has a primary health need and could be eligible to receive free funding to pay for care, it is essential to answer questions about the Claimant’s health needs.

The questions are as brief as possible to start with to get an indication on whether the Claimant could be eligible.

Please only answer the questions if you are making a current application for NHS CHC funding or appealing against a recent ineligibility decision.

If you are seeking a retrospective refund of wrongly paid care fees, please telephone Just Caring Legal on 0191 5561078.

Once Just Caring Legal receives your answers, solicitor Rosalind Hughes will call you to discuss the merits of taking your application or appeal forward.

Please note Just Caring Legal will only collect your personal data above including your email address and telephone number with your consent in line with data protection/GDPR and for the purpose of determining whether you could be eligible for full NHS CHC only and Just Caring Legal will not share your information with any third party.

If your case does not proceed with Just Caring Legal, your data will be deleted.

You are entitled to:

see any information Just Caring Legal hold about you and correct it if it’s wrong
request your data is deleted
request your data is not used for certain purposes

1.Full name of the Claimant? *

First

Last

2.Age of the Claimant? *

3.If the person who is completing this questionnaire is not the Claimant and the person incurring care fees, please provide your name and contact telephone number.

4. Breathing: Is there a history of chest infections? Do they have wheezing or shortness of breath? Are they breathless on sitting or are they breathless when walking? Are they prescribed oxygen or inhalers? Do they have COPD or chronic asthma? (Please give details below, which of the above applies to the Claimant? Please give as much detail as possible) *

5. Nutrition: What assistance does the Claimant need with eating or drinking? Can they eat independently or do they require supervision, reminding, coaching or encouragement? Would they eat or drink if they were not assisted or prompted? Do they refuse food or do they require their food to be cut up? Do they require a plate guard? Do they use adapted cutlery or require thickened fluids? Do they require mashed up/soft or liquidized food? Have they got a PEG feeding tube or any other form of feeding tube? Do they have a fortified diet or require a supplement for drinks? Do they have Speech and Language Therapy or a dietician? Do they have swallowing/choking difficulties or are they are losing weight? If so, how often are these episodes? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

6. Continence: Can they take themselves to the toilet? Are they incontinent of urine or faeces or both? Are they aware they need to go to the toilet? Is incontinence due to restricted mobility? Do they wear incontinence pads? Do they suffer regularly from urinary tract infections and have they been prescribed anti-biotics? If so, how often? Do they suffer from constipation and are they prescribed aperients? Do they suffer from loose stools? Are they under the care of the Continence Service? Do they have a self-retaining catheter in place? Are they intermittently catheterized? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

7. Skin Integrity: Are there any skin conditions requiring treatment such as Eczema, Psoriasis, Dry skin sores, Ulcers on the skin or Pressure areas? Is the Claimant under the care of the Tissue Viability Service/nurse? Do they have pressure sores and have they become infected? Do they have dressings regularly done by the nursing home nurse and/or district nurse? Do they have a pressure relieving mattress and/or cushion? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

8. Mobility: Can they walk independently and weight bear? Do they walk with a walking stick, tripod, zimmer frame, wheelchair or a combination of both? Do they use a stand aid or a hoist? Do staff assist them when getting in and out of bed? Are limb contractures evident? Do they suffer pain on movement? Have they had falls? If so, how many? Are they under the falls service and do they require pressure mats to alert you/staff to their movements? Have they sustained injury as a result of their falls and was any medical treatment required as a result? Did they need to attend hospital as a result of a fall? Do they require additional staff in the home/care home due to attempts to move around on their own? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

9. Communication: Can the Claimant speak? Can they communicate effectively or is their speech muddled? Can they make their needs known? Can they say when they are in pain or ask for a drink if they are thirsty? Do they speak in a confused manner? Can they communicate non-verbally by pointing to things and making gestures? Does the Claimant have a sight or hearing impediment? Is there any expressive or receptive dysphasia? Can they answer closed questions? Does tiredness affect their speech? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

10. Psychological: Does the Claimant suffer from any mental health problems such as depression, Schizophrenia, anxiety or distress? Is there suicidal ideation? If they are distressed, how to they indicate distress and how often? Are there long periods of stability or does their mood fluctuate? Do they hallucinate and, if so, how often? Do the hallucinations cause distress? Is the Claimant often tearful? How do they respond to reassurance? Are they under the care of any local mental health services/practitioners? Is appetite affected or compliance with medication? What interventions are required to manage anxiety or mood fluctuations? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

11. Cognition: Have they got the capacity to make simple decisions? Are they confused? Is there a mental health diagnosis and are they oriented to time and place? Can they assess risk? Is short term/long term memory impaired? Do they recognise family and friends? Do they know the difference between other residents and staff? Can they follow simple instructions or make simple choices around food or what to wear? Can they plan and then perform a task? Do they understand hazards? Do they have insight into their healthcare needs? (Please give details below and please confirm which of the above applies to the Claimant? Please give as much detail as possible) *

12. Behaviour: Does the Claimant demonstrate any behavioural problems? Are there any triggers and has there been any involvement from Community Mental health services? Do they demonstrate difficult behaviour and if so, how often does this difficult behaviour occur? Are there incidences of verbal or physical aggression, noisiness, restlessness, wandering or Disruptive behaviour? Do they display disinhibited behaviour such as the use of bad language, taking their clothes off inappropriately, making unwanted advances to others? Does the Claimant refuse or resist care or medication? Are they often wandering or disturbing others during the night? Have they had interventions or one to one support? Are they responsive to this? (Please give details below. Which of the above applies to the Claimant? Please give as much detail as possible) *

13. Medication: Are they prescribed any medication and do they depend on staff to administer their medication? Do they require medication for pain control? What is the medication for? Do they refuse their medication at any time? If so, how often and how does this manifest itself? Does the Claimant see their GP regularly and, if so, how often? Do they require regular injections? If so, what for and how often? (Please give details below, which of the above applies to the Claimant? Please give as much detail as possible) *

14. Altered States of Consciousness: Do they suffer from epilepsy and do they have fainting attacks? Do they have a history of strokes? Do they suffer from TIAs? Have there been episodes where they have lost consciousness? (Please give details below and confirm which of the above applies to the Claimant? Please give as much detail as possible) *

15. Details of other needs:

Your Email *

Town *

Your Contact Number *

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Thank you for taking the time to provide the requested information.

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