How to get help paying for care home fees

If you’re wondering how you can get help with your care home fees, this helpful guide will outline your options

Are you eligible for local authority care or NHS Continuing Care?

If you’re disabled, elderly or have a long-term health condition that means you need support with day-to-day tasks, your local authority might help with some or all of the costs. If you have a disability or complex medical condition that means you have mostly healthcare needs rather than social care needs, you might qualify for NHS Continuing Care funding. Even if you don’t qualify for NHS support, you may still be eligible for local authority funding.

What can a local authority do to help?

As well as providing places in residential care homes, local authorities can help people with care needs to stay in their own homes. They can provide everything from carers, meals and transport, to home modifications and equipment that help with the tasks of daily living.
But your local council will only pay for these services if you pass a means test. If you don’t qualify for help, you’ll need to pay for some or all of it yourself.

What can NHS Continuing Care do?

If you need a lot of nursing support, NHS Continuing Care can arrange and fund your care for you. It’s designed to help you with health-care needs that result from disability, accident or illness. If you qualify, it should meet the full cost of your care including the full fees of a nursing home or hospice, although the care can also be provided at home.

NHS Continuing Care – are you eligible?

The only sure way to know if you’re eligible for free NHS Continuing Care is to ask your GP or social worker to arrange an assessment. Most people with long-term care needs don’t qualify for NHS Continuing Care. There’s no clear-cut list of health conditions or illnesses that qualify for funding and not everyone with ongoing health needs will be eligible. The assessment is quite strict, and being frail isn’t enough. But don’t let that put you off. Free healthcare could be worth thousands each year, so it’s important to find out where you stand.

There are plenty of grey areas and whether or not you qualify often depends on where you live, since all local authorities have different budgets and different eligibility criteria.

NHS funding covers personal care and healthcare costs, such as paying for specialist therapy or help with bathing or dressing. It may also include accommodation if the care is provided in a care home, or support for carers if you’re being looked after at home.

Funding varies by region, so you’ll need to check with your local Health Board, Clinical Commissioning Group, or Health and Social Care Trust to see what’s covered.

NHS Continuing Care

First of all, you’ll get an initial screening to see if you’re eligible for funding. It’s usually carried out in hospital or at home by a nurse, doctor, social worker or other healthcare professional. They’ll assess your general health and care needs.

If the initial screening shows you may be eligible for free NHS Continuing Care, you’ll need to have a more thorough assessment. It will be carried out by a multidisciplinary team of two or more health- and social-care professionals who are involved in your care.

The team will mark your care needs as ‘priority’, ‘severe’, ‘high’, ‘moderate’ or ‘low’.

If you have at least one priority need or two severe needs, you should qualify for funding. If you have one severe need and a number of other high or moderate needs, you may also be eligible.

What can you do if you don’t agree with the assessment

Ask your local Health Board, Clinical Commissioning Group, or Health and Social Care Trust for a review of the decision. If it was based on an initial screening only, request a full assessment. You should be given an opportunity to contribute to the review, and to see all the evidence that was taken into account.

You may also be able to appeal if you’ve already been paying for care-home fees and think you should have received NHS funding. To do this, speak to your social worker or health practitioner, and ask for a retrospective assessment.

If you’re not eligible for NHS funding, you may be eligible for local authority funding.

Local authority funding – are you eligible?

Your local authority will decide whether you’re eligible for funding, normally from the social services department.This will depend on your savings and assets. You can find out the thresholds. If you have savings and assets of more than the following you’ll have to pay for your own care:

Savings threshold for local authority funding 2013/14

However, it’s still worth going ahead and contacting the local authority – everyone has the right to a needs assessment, regardless of their financial situation.

Getting a local authority care-needs assessment

Before it can help, your local council must carry out an assessment of your care needs. It’s called a ‘needs assessment’ or a ‘care assessment’, it’s free and it’s your legal right to have one. A financial assessment to determine who should pay for any services you might need comes afterwards.

If you live in Northern Ireland, your local Health and Social Care Trust will carry out a social care-needs assessment.

You can also assess your own care needs or complete an assessment for someone else. This sets out in your own words the care you think you, or a person you care for, may need.

If your local authority agrees with this self-assessment, you’ll be able to access the same range of support services as if you’d been through a full care-needs assessment from a local authority specialist.

Having identified your care needs and established that they meet the council’s eligibility criteria, your local authority has a legal duty to provide the service. They’ll then carry out a financial assessment, called a ‘means test’, to establish how much, if anything, you should contribute towards the cost.

You can find out more about means testing in the Money Advice Service guide.

The outcome of the financial assessment is that the local authority will either:

• Agree to meet the full cost of your care needs

• Agree to meet some of the cost (and you’ll need to top up the rest), or

• Leave you to fully fund your care

Your local authority is legally obliged to provide certain levels of assistance if you’re entitled to state – or part-funded – care, while there’s no such legal obligation if you pay for your own care.

If you disagree with your local authority’s decision not to pay for your care services, or you don’t think you’ve been offered enough support to meet your needs, you should challenge the decision.

All information accurate at time of publication

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This article is provided by the Money Advice Service.