The different routes to funding nursing care
There are several pathways to getting help with nursing home fees in England, and it is vital to understand which one may apply to you or your loved one. Depending on the nature of a person's needs and their financial situation, funding could come from the NHS, the local council, or be covered privately.
Pathway 1: NHS Continuing Healthcare (CHC)
NHS Continuing Healthcare (CHC) is a comprehensive package of care provided by the NHS. If you are assessed as having a 'primary health need', all your care home fees, including accommodation, will be covered by the NHS. A 'primary health need' means that the majority of your care is focused on addressing and preventing health needs due to a significant physical or mental health issue. Eligibility is not based on a specific diagnosis but on the complex, intense, and unpredictable nature of your needs. An assessment by a multidisciplinary team is required, and if you are deemed eligible, all care costs are free, and there is no means test.
Pathway 2: NHS-funded Nursing Care (FNC)
For those who require the services of a registered nurse in a care home but do not qualify for full CHC funding, the NHS provides NHS-funded Nursing Care (FNC). This is a non-means-tested, flat-rate contribution paid directly to the nursing home towards the cost of the registered nursing care. This means your income and savings will not affect your eligibility for FNC. It is important to note that this contribution covers only the nursing element of care; accommodation and other personal care costs must still be paid by the individual or the local council, depending on a financial assessment.
Pathway 3: Local authority funding (means-tested)
If you are not eligible for NHS Continuing Healthcare, your local council will carry out a care needs assessment, followed by a financial assessment (or means test). This assessment considers your income and capital to determine how much, if anything, you must contribute towards your care costs. In England, the capital thresholds are as follows:
- Over £23,250: If your capital is above this amount, you are expected to pay for all your care home fees as a 'self-funder'.
- Between £14,250 and £23,250: The local council will provide some financial support, and you will contribute from your income plus a tariff income from your capital.
- Under £14,250: The council provides financial support, and you contribute from your income (with a Personal Expenses Allowance left for you).
Your main or only home is not included in the financial assessment for temporary stays or home care. However, if you are moving into a care home permanently, the value of your property is usually included, unless certain relatives, such as a spouse or dependent, continue to live there. This can be a significant factor in determining your funding eligibility.
Pathway 4: Self-funding
If your capital is over the upper threshold, you will be a 'self-funder'. This means you are responsible for paying the full cost of your nursing home care. If you are a self-funder and your capital drops below the £23,250 threshold, you should notify your local council and request a new financial assessment. The council must assist with funding once your capital falls below the limit, as long as you meet the eligibility criteria for care.
The process for assessing care needs and finances
Securing financial assistance for nursing home care involves a structured, two-part assessment process. Understanding each step is crucial for navigating the system effectively.
1. Care needs assessment
This initial assessment, carried out by your local authority's adult social services, is available to everyone, regardless of their financial status. The purpose is to determine what care needs you have and how they impact your daily life. An assessor will discuss your physical, mental, and emotional needs with you. Even if you plan to self-fund, it's beneficial to have this assessment as it formally identifies your care needs and ensures any state assistance, like FNC, is considered.
2. Financial assessment
Following a care needs assessment, a financial assessment is conducted to work out your contribution. This looks at your income (e.g., pensions, benefits) and capital (e.g., savings, investments, property). Some income, such as certain disability benefits, is disregarded. The value of your property may be included, which can have a major impact. For those who cannot or do not wish to sell their home immediately, a deferred payment agreement may be an option, where the council pays fees which are then recovered later, usually from your estate.
Comparison of funding routes
To clarify the different funding pathways for nursing home care in England, here is a comparison table:
| Funding Type | Eligibility Basis | Financial Assessment | How Costs are Covered |
|---|---|---|---|
| NHS Continuing Healthcare (CHC) | A 'primary health need' due to complex health needs | None | Pays 100% of nursing home fees, including accommodation |
| NHS-Funded Nursing Care (FNC) | Need for registered nursing care, but not eligible for CHC | None | Pays a flat-rate contribution directly to the care home for nursing care |
| Local Authority Funding | Meets care needs criteria and capital is under £23,250 | Means-tested | Pays some or all fees, depending on individual income and capital |
| Self-Funding | Capital is over £23,250 | Means-tested (results in paying own fees) | Pays 100% of nursing home fees until capital drops below threshold |
Key considerations and planning
Proper planning is essential when considering nursing home care. You can find more information about financial planning for later life on the MoneyHelper website. Be aware of the rules surrounding 'deprivation of assets', where a council may still count money or property you have given away to avoid paying for care. It is crucial to seek independent financial advice if you are considering transferring assets. Always engage with your local council's adult social services department early to understand the assessment process and your potential eligibility for support.
Conclusion
In England, the concept of 'free' nursing home care is largely a myth, except for those with very specific, complex health needs funded entirely by the NHS through Continuing Healthcare. For the majority, care is funded through a combination of local authority support (based on a means test), a flat-rate NHS contribution for nursing care, and personal payments. The cost is heavily dependent on individual financial circumstances and the outcome of both a care needs and financial assessment. Early planning and seeking professional advice are the best approaches to navigate these complex arrangements.
