Paying for care home fees is often misunderstood and care and support services have never been free for the elderly. The misunderstanding is because people often think care home fees come under  healthcare from the NHS which is free. However care home costs are considered social care. Everyone has to contribute something towards care home fees and many have to pay the full cost.

The difference between Health and Social Care funding

Social care includes personal care such as washing, bathing, dressing, toileting and managing continence, assistance with daily living (shopping, administering medication, social stimulation etc.) and maintaining independence (assistance with mobility and equipment etc.) Social care does not require trained health professionals and care homes do not employ nursing staff.

Health care includes the treatment of disease, and illness, which needs to be administered or supervised by a trained health professional. Nursing homes have to employ a registered nurse 24 hours a day.

Local Authority social care funding criteria

Many people don’t realise there are two interdependent criteria for social care funding. You need to meet both to be eligible.

Care home costs being enjoyed by residents

Care home costs being enjoyed by residents

1. Needs criteria

The local authority will identify your care needs and check they meet a nationally agreed set of criteria. Basically you must have a significant or critical level of needs. This usually means that you need a high level of supervision and support for personal care and things like drug administration and/or food preparation every day, to qualify for social care funding. BUT even if you do have a significant or critical level of need, you must also meet the local authority’s financial criteria.

2. Financial criteria

You will have to fully fund your care home costs if you have more than £23,250 savings and capital. This includes property no longer occupied by you, unless it is occupied by the following as their main and only home, which they have occupied continuously prior to your move into a care home:

  • Your partner, spouse or civil partner (except where you were estranged)
  • A lone parent who is your estranged or divorced partner
  • A close relative or member of the family who is:
  • Aged 60 or over or
  • is a child under 18 or
  • Is incapacitated

If you have between £14,250 and £23,250 you will have to make a contribution from your savings/ capital as a tariff income of £1 for every £250. A contribution from income will also be required.

If your savings and capital are below £14,250 you will not need to make a contribution from capital. However, a contribution from your income will need to be made.

NHS funding criteria

The assessment process begins with a National screening tool called the Continuing Healthcare Checklist, and must be carried out by a trained health or social care professional. If you are assessed as eligible for funded nursing care, you will receive a standard rate of £110.89 a week from the NHS to pay towards your nursing care (amount correct at April 1st 2015)) This is paid directly to the care home and will be deducted from the local authority’s contribution. It will therefore not reduce the amount you have to pay yourself.

If you are paying for your own care home fees, the funded nursing care contribution is deducted directly from the cost of the care home fees before you pay and therefore reduces your care home costs.

The Continuing Healthcare Checklist will indicate whether a full assessment is indicated. If you disagree with a decision not to proceed to full assessment for NHS continuing healthcare following completion of the checklist, you can ask for the decision to be reconsidered.

To be eligible for NHS continuing healthcare, you must be assessed by a multi- disciplinary team of health and social care professionals as having a “primary health need”.

Whether or not you have a primary health need is assessed by looking at all of your care needs and relating them to:

  • what help is needed
  • how complex these needs are
  • how intense or severe these needs can be
  • how unpredictable they are, including any risks to the person’s health if the right care isn’t provided at the right time

Eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition.

You should be fully involved in the assessment process, kept informed, and have views about your needs and support taken into account. Your family should also be consulted where appropriate.

If you are considered eligible for full NHS continuing healthcare funding, it can be used to fund a package of care and support to meet all your assessed needs including personal care, mental health and physical needs. NHS continuing healthcare can be provided in a hospital, nursing home, residential care home or in your own home.

Paying for care home fees is a complex subject. Further information can be found below

Paying For Care

Age UK

Alzheimer’s Society