The Truth Behind 'Free' Care
Scotland's Free Personal and Nursing Care policy is a major benefit for many, offering peace of mind by covering the cost of essential personal care tasks. However, the term can be misleading if not fully understood. While things like bathing, dressing, and nursing support are covered, this does not extend to all aspects of a person's care, particularly accommodation in a care home or other 'hotel' costs.
The policy was first introduced for those over 65 in 2002 and later extended to all adults in need in 2019, regardless of age, income, or capital. This means that anyone assessed as needing personal or nursing care will receive it without being charged for those specific services by their local authority. The crucial factor is a needs assessment, which determines the type and level of care required.
The Two-Step Assessment Process
To access any council-funded support, whether free or chargeable, the first step is a care needs assessment carried out by the local authority's social work department. This is a vital process that determines what a person can and cannot do independently. It is not means-tested and is entirely free of charge.
- Care Needs Assessment: A social care professional will visit to discuss how the individual is managing daily tasks, their health conditions, and their living situation. They will create a care plan outlining the support needed.
- Financial Assessment (Means-Test): This is the second step and is only conducted after the needs assessment. It looks at income, savings, and assets to determine what contribution, if any, the individual must make towards non-personal care services and care home accommodation.
Understanding Care Home Costs
For those requiring a place in a care home, the financial picture becomes more complex. While the personal and nursing care component is free based on the needs assessment, accommodation and living costs are means-tested.
Self-Funders
If an individual's capital (including savings, investments, and property) exceeds the upper capital limit (currently £35,500), they will be considered a 'self-funder'. This means they are responsible for paying the full cost of their care home fees. The council will still pay the Free Personal and/or Nursing Care payments directly to the care home, but the individual must cover the remaining balance.
Local Authority Funding
If capital is below the lower capital limit (currently £22,000), the council will help pay for the care home fees. Between the lower and upper limits, a tariff income is calculated and added to other income for the assessment. The individual must still contribute most of their income towards the fees, retaining a small weekly personal expenses allowance (around £35.90).
Third-Party Top-Ups
In cases where a local authority is funding a placement but the chosen care home charges more than the council's standard rate, a third party (like a family member) must pay a 'top-up' fee to cover the difference. The resident cannot pay this fee themselves unless in exceptional circumstances.
Paying for Care at Home
For those receiving care in their own home, the funding rules are slightly different. Property is not included in the financial assessment for home care services.
- Free Personal Care: Services like bathing and dressing are free, regardless of income or savings.
- Chargeable Services: Help with housework, shopping, or laundry is not covered by the free policy and may be subject to a financial assessment. The charging policies for these services can vary between local councils.
Non-Means-Tested Benefits
Several benefits can provide crucial support for care costs, regardless of income or savings. In Scotland, the new Pension Age Disability Payment is replacing Attendance Allowance for new applicants.
- Pension Age Disability Payment: A tax-free, non-means-tested benefit for people who have reached State Pension age and have care needs due to a disability or health condition. It is paid at either a lower or higher rate depending on the level of care required. You can use this money towards care costs or for anything that makes life easier.
A Side-by-Side Look at Care Costs in Scotland
This table provides a clearer overview of how different types of care are funded.
| Feature | Local Authority Funded Care | Self-Funded Care |
|---|---|---|
| Financial Assessment | Required. Determines contribution towards non-personal care and accommodation costs. | Required for eligibility, but you pay the majority of costs yourself. |
| Personal & Nursing Care | Free. The council pays the assessed rates directly to the provider. | Free. The council pays the assessed rates directly to the provider. |
| Care Home Accommodation | You contribute from your income and potentially capital, down to a personal expenses allowance. | You pay the full cost, minus the Free Personal/Nursing Care contribution. |
| Home Care Services | Free for personal care. Non-personal care services (like laundry or shopping) may be charged based on a separate financial assessment. | You pay for all care services, though may be eligible for non-means-tested benefits. |
| Benefits | May be eligible for Pension Age Disability Payment (replacing Attendance Allowance), which can be taken into account during the financial assessment for care fees. | May be eligible for Pension Age Disability Payment to offset costs. |
| Third-Party Top-Ups | May be required if you choose a care home above the council's rate. | Not applicable, as you are already funding the full cost. |
For more detailed, up-to-date guidance on care options, funding, and assessments in Scotland, visit the Care Information Scotland website. This resource provides comprehensive, trusted information to help you and your family navigate the care landscape.
Conclusion
While Scotland offers a generous Free Personal and Nursing Care policy, it is inaccurate to state that all elderly care is free. Families should be aware of the distinction between personal and nursing care and other costs, such as accommodation in care homes or non-personal home care services. The process begins with a needs assessment, which then informs what financial support is available. Understanding these nuances is key to planning for the future and ensuring your loved ones receive the right level of support without unexpected financial strain.
