What Questions Will the NHS Continuing Healthcare Assessor Ask?

Understanding the questions an NHS Continuing Healthcare assessor is likely to ask is one of the most effective ways a family can prepare for the assessment process. The questions follow the structure of the Decision Support Tool (DST), a 12-domain framework that assessors use to evaluate whether a primary health need exists.

The 12 assessment domains and what assessors ask

For each domain, the assessor will ask questions designed to establish the level of need: None, Low, Moderate, High, or Severe/Priority. The following gives families a guide to what to expect.

Behaviour

Questions here explore whether the person has behaviours that challenge, including aggression, agitation, self-harm, wandering, or resistance to care. Assessors will ask how frequently these occur, how severe they are, and whether they place the person or others at risk.

Cognition

This covers the person's ability to understand, remember, make decisions, and process information. Assessors may ask about memory, orientation, capacity to consent, and whether cognitive impairment creates safety risks.

Psychological and emotional needs

Questions here cover anxiety, depression, distress, and emotional wellbeing. Assessors will ask whether psychological needs require professional intervention and whether they interact with other care needs.

Communication

Assessors will ask about the person's ability to express needs, understand others, and seek help. This includes verbal and non-verbal communication, and whether communication difficulties create risk.

Mobility

Questions cover the person's ability to move safely, including transfers, falls risk, and whether moving requires specialist equipment or more than one carer.

Nutrition, food, and drink

This domain covers swallowing difficulties (dysphagia), feeding assistance, unintentional weight loss, and whether nutrition management requires clinical oversight such as PEG feeding or thickened fluids.

Continence

Assessors ask about continence management, frequency of episodes, skin integrity related to incontinence, and whether management requires skilled nursing care.

Skin integrity

Questions here cover wounds, pressure areas, fragile skin, and any skin conditions requiring clinical management. The frequency and complexity of dressing changes is particularly relevant.

Breathing

This covers any respiratory conditions, oxygen dependency, use of suction or ventilation, and whether breathing difficulties require clinical management.

Drug therapies and symptom control

Assessors will ask about medication complexity, symptom management, whether the administration of drugs requires clinical oversight, and whether symptoms are difficult to control or unpredictable.

Altered states of consciousness

This includes seizures, episodes of unconsciousness or near-unconsciousness, and any conditions causing fluctuating levels of awareness. Assessors will ask about frequency, severity, and risk.

What to keep in mind

Assessors visit once. If the person is having a relatively settled day, the needs they observe may not reflect the typical reality. Families should be prepared to give specific examples: dates, incidents, frequency, rather than general descriptions. Evidence and detail matter far more than a general impression.