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6 July 2017 | Comment | Article by Lisa Morgan

My relative is being assessed for continuing healthcare using a Decision Support Tool (DST). But what is a DST?

When a family member is being admitted into a care home, they should be assessed for NHS Continuing Healthcare funding prior to entering the home. For further information on this matter please read our previous blog post: My relative is in hospital and requires long-term care – what should happen now?

When someone is assessed for Continuing Healthcare funding, the responsible health authority will initially use a checklist assessment. A checklist is a screening tool which determines whether a patient’s needs warrant a full assessment. The threshold for the checklist is set relatively low.

If the checklist assessment is positive, and it is deemed that a person’s needs are of a level to warrant a full assessment, the health authority will then use an assessment tool called a decision support tool.

A decision support tool is the full assessment used to investigate whether a person’s needs are primarily healthcare needs and would support eligibility for NHS Continuing Healthcare. A decision support tool is also designed to measure the level of an individual’s needs in each of the 12 care domains.

The 12 care domains considered by the decision support tool are:

  • Behaviour – this domain looks at whether or not someone displays any challenging behaviour. For example, are they aggressive towards care staff and/or other residents; do they refuse care; do they display inappropriate behaviour such as undressing in communal areas or urinating in public places; are they wandering around the care home requiring constant monitoring by care staff.
  • Cognition – this domain looks at someone’s mental capacity. For example, do they need assistance from care staff to wash and dress; are they confused; do they suffer from long-term or short-term memory loss; are they often confused about what time or day it is; can they assess risks; are they able to make decisions for themselves.
  • Psychological and emotional needs – this domain will look at whether someone has a history of depression; their mood, i.e. do they suffer from mood swings; do they have suicidal thoughts; are they withdrawn from activities or social interaction.
  • Communication – this domain will look at how well someone can communicate with other people. For example, are they physically able to talk; do they wear hearing aids or glasses; if they are not able to talk do they use visual aids e.g. body language. If they are able to communicate, then the content of conversations and if they find it difficult to find the correct words.
  • Mobility – this domain will look at difficulties they might have getting around. For example, can they walk independently or do they require the use of walking aids; if they do use walking aids, do they require care staff to assist them; are they completely immobile; do they require care staff to assist them with getting out of bed/chair and if so, can they assist care staff when they are being moved.
  • Nutrition – this will consider their nutritional intake and how this is given. For example, do they need assistance when feeding/drinking; are they fed artificially i.e. through a PEG feeder; are they at risk of malnutrition; have they lost a significant amount of weight over a short time.
  • Continence – this domain will look at their toileting needs. For example, are they continent or incontinent; do they suffer from urinary tract infections and/or constipation; are they fitted with a catheter.
  • Skin integrity – this domain will look at the condition of someone’s skin. For example, do they suffer from dry skin; do they need care staff to apply cream; do they need care staff to monitor their skin closely to ensure that it does not breakdown; do they suffer from pressure sores.
  • Breathing – this domain looks at whether or not someone requires assistance with breathing or suffers from shortness of breath.
  • Drug therapies and medication – this domain looks at what medication is being taken and how it is taken. For example, does medication need to be administered by care staff; do the side effects need to be monitored; whether or not someone refuses their medication; do they suffer from pain.
  • Altered states of consciousness – this domain looks at whether or not someone suffers from, or has a history of, strokes or fits.
  • Other needs – this domain will look at any other needs that did not fit into any of the domains above. For example, are they suffering from cancer or do they have significant sleeping difficulties.

The DST is completed by assessing the level of need required within the domains listed above. There are six levels which a person’s needs could fall into: priority, severe, high, moderate, low or no needs. For more information on how the decision support tool may indicate NHS Continuing Healthcare eligibility, please read our previous blog NHS Continuing Healthcare: What Makes Someone Eligible.

When assessing if a person should be eligible for NHS continuing healthcare funding, the health authority will also look at the primary health needs and whether a person’s needs are intense, complex and/or unpredictable. A person’s primary health needs are considered once all of the care domains have been assessed by the Clinical Commissioning Group (CCG) (Health Boards in Wales), and prior do a decision on eligibility being made.


In conclusion, all health authorities must determine eligibility for full funding based on the criteria within the National Framework. A decision must be made based on a detailed assessment of all of the patient’s care needs across all care domains which form the decision support tool. If you think someone you know may be eligible for continuing healthcare, or wish to know more, please contact a member of our nursing care team on 02920 391 129 or visit our Nursing Care pages.

Author bio

Lisa Morgan


Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 40 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.


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