Understanding Dementia Care Funding in Wales
Navigating the financial landscape of care for a loved one with dementia can be daunting. A diagnosis of dementia does not, in itself, guarantee free care home accommodation in Wales. The system primarily distinguishes between a 'social care' need and a 'healthcare' need. The critical factor determining who pays for care is an assessment of the individual's primary needs.
If the primary need is determined to be a health need, the full cost of care, including accommodation, should be covered by the NHS through a package called NHS Continuing Healthcare (CHC). If the need is primarily social, funding is determined by the local authority through a financial assessment, also known as a means test.
The Role of NHS Continuing Healthcare (CHC)
The most significant funding source to understand is NHS Continuing Healthcare (CHC). This is a package of care arranged and funded solely by the NHS for individuals aged 18 or over who have significant and ongoing healthcare needs. CHC is not means-tested; it is based entirely on the complexity, intensity, and unpredictability of your health needs. If you are eligible for CHC, it will cover 100% of your care home fees, including board and accommodation.
The CHC Assessment Process
To be considered for CHC, an individual must undergo a two-stage assessment process:
- The Checklist: A trained health or social care professional uses a screening tool called the CHC Checklist to see if a full assessment is required. This is a relatively low threshold.
- The Full Assessment: If the checklist indicates a full assessment is needed, a multidisciplinary team (MDT) of health and social care professionals will evaluate the person's needs. They use a framework called the Decision Support Tool (DST) which examines various care domains, such as Breathing, Nutrition, Continence, Skin Integrity, Mobility, Communication, and Cognition. The MDT makes a recommendation to the Local Health Board (LHB) about eligibility, which the LHB then uses to make the final decision.
A diagnosis of dementia is relevant to the assessment, particularly in the domains of Cognition and Behaviour, but it is the overall picture of needs that determines eligibility.
What if You Don't Qualify for CHC?
If an individual is not eligible for CHC, the responsibility for funding falls to the local authority and the individual. The local authority must conduct a financial assessment (means test) to determine how much the person has to contribute towards their care costs.
The Financial Assessment (Means Test) in Wales
As of the 2024/2025 financial year, the key capital thresholds in Wales are:
- Upper Capital Limit: £50,000. If your capital (savings, investments, and some property) is over this amount, you are generally expected to fund your own care (you will be a 'self-funder').
- Lower Capital Limit: There is no lower capital limit in Wales. Instead, a weekly income from capital between £0 and £50,000 is assumed for the calculation.
The assessment will look at both your capital and your income (e.g., pensions, benefits). Certain types of income and capital are disregarded. If you have to contribute from your income, you must be left with a weekly Personal Expenses Allowance (PEA).
Can Your Property Be Included?
For many, their home is their most significant asset. The value of your property is usually included in the financial assessment unless a spouse, partner, or certain other relatives still live there. There is also a mandatory 12-week property disregard period when you first move into a care home permanently. During this time, the value of your home is not included in the assessment, giving you time to decide what to do with the property.
Other Potential Funding: Funded Nursing Care (FNC)
If you are not eligible for CHC but have been assessed as needing nursing care in a care home, you may be eligible for NHS Funded Nursing Care (FNC). This is a weekly, non-means-tested payment from the NHS directly to the care home to help cover the costs of the nursing care provided by a registered nurse. This is a contribution towards your fees, not a full payment like CHC.
Funding Routes Comparison
To clarify the differences, here is a comparison table:
| Feature | NHS Continuing Healthcare (CHC) | Local Authority Funding | NHS Funded Nursing Care (FNC) |
|---|---|---|---|
| Who Pays? | The NHS (Local Health Board) | The individual and/or Local Authority | The NHS (Local Health Board) |
| What's Covered? | 100% of care and accommodation costs | Contribution-based on a means test | A flat-rate weekly payment for nursing tasks |
| Eligibility | Primary need is a 'health need' | Assessed as needing care and unable to self-fund fully | Assessed as needing care from a Registered Nurse |
| Means-Tested? | No | Yes | No |
Planning and Next Steps
Understanding these pathways is crucial for families. It is highly recommended to seek advice early. Here are some key actions to consider:
- Request an Assessment: If you believe your loved one's needs are primarily health-based, insist on a CHC assessment.
- Lasting Power of Attorney (LPA): Ensure an LPA for both Health and Welfare and Property and Financial Affairs is in place. This allows a chosen person to make decisions if the individual with dementia loses capacity.
- Seek Advice: Don't hesitate to get independent financial advice or support from charities like Alzheimer's Society or Age Cymru.
For official information, refer to the Welsh Government's guidance on Continuing NHS Healthcare.
Conclusion
In summary, the answer to 'do dementia sufferers have to pay care home fees in Wales?' is not a simple yes or no. A dementia diagnosis alone does not trigger free care. The key determinant is the outcome of a needs assessment. If the primary need is health-related, NHS CHC provides full funding. If not, funding is determined by a local authority means test against the £50,000 capital limit. Understanding this distinction is the first and most important step for any family navigating the cost of dementia care in Wales.
