Decision Support Tool self-check
The 12 domains.
CHC eligibility is decided by scoring the person's care needs across twelve clinical domains. Two domains scored Severe or one at Priority generally indicates eligibility. The DST is not used in isolation: the multi-disciplinary team also considers the nature, intensity, complexity and unpredictability of the overall needs.
This self-check is for orientation only. It does not replace the formal NHS assessment. Take the result to the multi-disciplinary team meeting as a basis for discussion.
01 · BEH
Behaviour
How does the person's behaviour affect their care needs?
- 0No needs
- 1Low: agitation or anxiety managed by reassurance
- 2Moderate: occasional aggression, requires intervention
- 3High: regular challenging behaviour requiring specialist input
- 4Severe: behaviours pose immediate risk to self or others
- 5Priority: behaviour endangers life or carer safety routinely
02 · COG
Cognition
How does cognitive impairment affect care delivery?
- 0No needs
- 1Low: mild confusion, follows instructions
- 2Moderate: needs prompting for routine tasks
- 3High: severe disorientation, cannot make basic decisions
- 4Severe: cognitive state requires 24h supervision
03 · PSY
Psychological / Emotional
What level of psychological need is present?
- 0No needs
- 1Low: occasional low mood
- 2Moderate: persistent depression requiring intervention
- 3High: significant psychiatric needs, specialist support
04 · COM
Communication
Can the person communicate their needs?
- 0No needs
- 1Low: occasional difficulty making themselves understood
- 2Moderate: needs interpretation by familiar carer
- 3High: cannot reliably communicate basic needs
05 · MOB
Mobility
How does mobility affect care?
- 0No needs
- 1Low: needs supervision walking
- 2Moderate: needs equipment + 1 carer
- 3High: needs equipment + 2 carers for transfers
- 4Severe: bedbound, requires repositioning to prevent harm
06 · NUT
Nutrition
How is the person fed and hydrated?
- 0No needs
- 1Low: needs prompting
- 2Moderate: needs assistance to eat
- 3High: PEG feeding or significant swallowing difficulties
- 4Severe: complex feeding regimen, parenteral nutrition
07 · CON
Continence
How are continence needs managed?
- 0No needs
- 1Low: occasional incontinence
- 2Moderate: regular incontinence, requires routine care
- 3High: total incontinence or catheter + complications
08 · SKI
Skin and tissue viability
Are there pressure or wound concerns?
- 0No needs
- 1Low: dry skin, vulnerable
- 2Moderate: superficial pressure damage, healing
- 3High: deep tissue injury, regular specialist dressing
- 4Severe: multiple wounds, infection risk, surgical involvement
09 · BRE
Breathing
Are respiratory needs present?
- 0No needs
- 1Low: stable inhalers
- 2Moderate: oxygen at home, regular review
- 3High: tracheostomy or BiPAP requiring specialist input
- 4Severe: ventilator-dependent or unstable respiratory state
10 · MED
Medication and symptom control
How complex is medication and symptom management?
- 0No needs
- 1Low: oral medication, stable
- 2Moderate: regular review, multiple medications
- 3High: complex regime, syringe driver, frequent adjustment
- 4Severe: rapidly changing symptom profile, specialist palliative input
11 · ASC
Altered states of consciousness
Are there episodes of altered consciousness?
- 0No needs
- 1Low: rare, brief
- 2Moderate: regular episodes requiring response
- 3High: frequent episodes, ongoing seizure activity
- 4Severe: minimally conscious state, complex management
12 · OTH
Other significant care needs
Any other clinical need not captured above?
- 0No needs
- 1Identified specialist need not covered by other domains
After the self-check
What do the scores mean in practice?
The National Framework treats one domain at Priority OR two domains at Severe as a strong indicator of eligibility. Other combinations are weighed against the nature, complexity, intensity and unpredictability of the overall need.
For a free independent review of your case, contact Beacon CHC, the NHS-funded advice service.