The continuing healthcare checklist scorer

The checklist is scored to a published rule, and you should normally be given the chance to be there when it is done. Mark the eleven domains the way you expect them to be marked and see whether the threshold for a full assessment would be met, and which domains it turns on. Then you know what to be specific about.

Eleven domains, each marked A, B or C. The descriptions are shortened from the form's column headings, and the form's own wording governs. Four domains carry a priority level.

1. Breathing (priority domain)

C. Normal breathing, or shortness of breath that does not limit daily living.B. Shortness of breath or a condition needing inhalers or a nebuliser that limits some daily activities.A. Breathes through a tracheotomy they can manage themselves or with carer support, or breathing needs of that order.

2. Nutrition: food and drink

C. Eats and drinks adequately by mouth, perhaps with supervision, prompting or a special diet.B. Needs feeding and takes half an hour or more, or takes nothing by mouth but is fed adequately by artificial means.A. Swallowing difficulty needing skilled help to keep the airway safe; fluids given under the skin by trained carers; nutrition at risk with significant unintended weight loss or gain; or a feeding tube with problems needing skilled review.

3. Continence

C. Continent, or continence care that is routine day to day.B. Routine care that needs monitoring to reduce risks, such as catheters or double incontinence.A. Continence care that is problematic and needs timely, skilled intervention beyond routine care.

4. Skin and tissue viability

C. No risk of pressure damage; a risk needing preventive care once a day or less; discoloured intact skin or a minor wound; or a skin condition checked less than daily.B. Risk of skin breakdown needing preventive care several times a day; partial-thickness pressure damage that is responding to treatment; or a skin condition needing at least daily treatment or checks.A. Partial-thickness pressure damage not responding to treatment; full-thickness pressure damage, even if responding; or a specialist dressing regime that is responding to treatment.

5. Mobility

C. Independently mobile, or able to weight-bear with some help or equipment.B. Not able to weight-bear consistently, or unable to weight-bear but able to cooperate with transfers.A. Completely unable to weight-bear and unable to help with transfers or repositioning, or needs careful positioning because of pain or risk.

6. Communication

C. Communicates clearly, or needs some assistance to communicate.B. Communication about needs is difficult, or sometimes unreliable even with help.A. Unable to reliably communicate needs at any time, in any way, even with every practicable step taken.

7. Psychological and emotional needs

C. Needs not affecting health and well-being, or mood, anxiety or distress that has an impact but responds to prompts, distraction or reassurance.B. Mood disturbance, hallucinations, anxiety or distress that do not readily respond to reassurance and have an increasing impact; or withdrawal from most attempts to engage them in care or daily activities.A. Symptoms with a severe impact on health or well-being, or withdrawal from any attempt to engage them in care planning, support or daily activities.

8. Cognition

C. No impairment, or impairment needing some supervision with more complex daily activities.B. Impairment needing some supervision, prompting or help with basic care; some awareness of needs and risks.A. Impairment such as frequent short-term memory loss and disorientation, with awareness of only a limited range of needs and risks.

9. Behaviour (priority domain)

C. No challenging behaviour, or incidents that a risk assessment says pose no risk.B. Challenging behaviour in a predictable pattern that skilled carers can manage without risk.A. Challenging behaviour that poses a predictable risk to self, others or property, with planned interventions reducing but not removing it.

10. Drug therapies and medication (priority domain)

C. Symptoms managed effectively; medication that needs supervision or prompting but is taken; or mild, predictable pain that does not affect the provision of care.B. Medication given by a nurse, carer or care worker because of non-compliance, the type of medicine or the route; or moderate pain in a predictable pattern, or symptoms with a moderate effect on other domains or on care.A. A medication regime given and monitored by someone specifically trained, because of risks from fluctuation, effectiveness or side-effects; or moderate pain or symptoms with a significant effect on other domains or on care.

11. Altered states of consciousness (priority domain)

C. No altered states of consciousness, or a history that is effectively managed with low risk.B. Occasional episodes, monthly or less, needing supervision to reduce the risk of harm.A. Frequent episodes needing supervision, or occasional ones needing skilled intervention.

Worked out on your device. Nothing is sent anywhere.

What it decides, and from where

The domains, the three columns and the threshold are from the NHS continuing healthcare checklist published on GOV.UK, July 2022 edition, and its guidance notes. The four priority domains are the ones the form marks with an asterisk. The descriptions beside each column are shortened from the form's headings, and the form governs.

Our continuing healthcare page explains what a positive checklist leads to and what a negative one can be challenged with.

What it will not do

It will not tell you whether someone is eligible, because the checklist cannot. Eligibility is decided at the full assessment against the primary health need test. It does not score the decision support tool used there, which has its own levels and a twelfth domain for other significant care needs.

And it cannot see the person. The marks are yours, and the value of making them first is knowing which ones the practitioner will need evidence for.

Common questions

Does this tell me whether the NHS will pay for care?

No. The checklist is a screening step, and a positive result means a full assessment, not eligibility. What this shows is whether the marks you expect would cross the published threshold for that assessment, and which domains carry the result, so you know what the conversation with the practitioner turns on.

What is the threshold?

From the checklist guidance: a full assessment is required where two or more domains are marked A; five or more are marked B, or one A and four B; or a priority domain is marked A. The priority domains are breathing, behaviour, drug therapies and altered states of consciousness. Below that, a full assessment may occasionally still be appropriate.

Why are the descriptions so short?

They are brief versions of the column headings on the form, enough to tell A from B from C. The practitioner uses the form's full wording, and the decision support tool used at the full assessment has longer descriptors and a twelfth domain. Read the form itself before the meeting; the link is under the result.

Is anything I mark stored?

No. The marks stay in your browser, nothing is transmitted or logged, and closing the tab discards them. There is no account and no email box. The result is the count in each column, whether the threshold would be met, and the reason, with a link to the page that explains what follows.

What is said at the checklist is what gets scored. The discipline of saying how often, how long, what the risk is and whether it happens at night is the one our wording checker teaches for a different form. If the answer is no, the council's means test applies instead, and our care fees band estimator shows which band it would use.

How we make money: This tool is free, asks for nothing, and earns us nothing. Our how we make money page explains where the site's income comes from.