The core assessments determine funding
In the UK, securing funding for nursing home care begins with two critical assessments: a care needs assessment and a financial assessment (or means test). A local authority or Integrated Care Board (ICB) will conduct these to determine what type of care is required and how it will be paid for. The rules for eligibility and funding thresholds can vary depending on which country of the UK you live in.
NHS continuing healthcare (CHC)
NHS Continuing Healthcare (CHC) is a package of care for adults with significant ongoing healthcare needs. It is arranged and fully funded by the NHS and is not means-tested, meaning your income and assets are not considered. To qualify, you must be assessed as having a 'primary health need'. This is a very high threshold and is based on a complex and intense assessment process using a 'Decision Support Tool'. The assessment looks at the nature, complexity, intensity, and unpredictability of your needs. If eligible, the NHS will cover all your care home fees, including accommodation. Many people find it challenging to qualify for CHC, and having a diagnosis like dementia does not automatically make you eligible.
NHS-funded nursing care (FNC)
For those who do not meet the strict criteria for full CHC funding but still have a registered nursing need in a nursing home, the NHS may provide a flat-rate contribution known as NHS-funded Nursing Care (FNC). FNC is not means-tested and is paid directly to the nursing home. For the year starting 1 April 2025, the standard weekly rate is £254.06 in England. This payment covers the cost of nursing care provided by a registered nurse, but it does not cover accommodation or other living costs, which may still need to be paid by the individual or the local authority.
Local authority means-testing
If you are not eligible for full NHS Continuing Healthcare, your local authority will carry out a financial assessment (means test) to determine if you can receive financial support for your social care needs. The means test evaluates your income, savings, and assets. In England, the thresholds for 2025 are: if you have capital above £23,250, you are a 'self-funder' and must pay your own fees. If your capital is between £14,250 and £23,250, you will contribute, with the council covering the rest. If your capital is below £14,250, the council provides financial support, and you contribute based on your income. The value of your home is typically included in this assessment unless a spouse or dependent still lives there. Deferred Payment Agreements are available for homeowners who can’t pay their fees upfront.
The self-funder pathway
If your assets and savings exceed the upper limit set by your local council, you will be classed as a 'self-funder' and are responsible for paying your own care home fees. Self-funders can explore various options, including using savings, investments, or selling their property. It's crucial to seek expert financial advice before making significant decisions. Beware of 'deprivation of assets,' where local authorities may challenge the deliberate giving away of assets to avoid care costs. Self-funders may still be eligible for FNC if they meet the clinical criteria.
Funding variations across the UK nations
Funding rules for nursing home care differ across the UK, adding to the complexity. The primary difference lies in the provision of personal and nursing care.
Scotland
In Scotland, personal and nursing care is free for all residents aged 65 and over who have been assessed as needing it by their local council. However, this free care does not cover accommodation costs, which are still subject to a means test with its own thresholds.
Wales and Northern Ireland
Wales and Northern Ireland have systems broadly similar to England, based on needs assessments and means tests, though capital limits differ. In Wales, there is a single capital limit of £50,000 for financial assistance.
A comparison of UK funding options
| Feature | NHS Continuing Healthcare (CHC) | NHS-Funded Nursing Care (FNC) | Local Authority Funding |
|---|---|---|---|
| Means-Tested? | No | No | Yes |
| Covers Accommodation? | Yes, fully | No | Yes, if eligible |
| Funding Threshold | Based on assessed 'primary health need' | Based on assessed need for a registered nurse | Based on capital and income thresholds |
| Who Pays? | The NHS | The NHS (flat-rate contribution) | Local Council (may require resident contribution) |
The importance of specialist advice
Navigating the care system and its funding can be overwhelming. It is strongly recommended to seek expert advice from organisations like Age UK or a specialist financial adviser to understand all your options. They can provide guidance on the assessment process and help ensure you are claiming all the benefits and support you are entitled to. For more detailed information on your rights and the eligibility process, the official guidance on the government website is a good starting point.
Conclusion
While the concept of free nursing home care in the UK is largely a myth, several funding avenues exist depending on your circumstances. Eligibility is determined through a series of official assessments, and the level of support varies significantly based on your health needs and financial situation. Understanding the differences between NHS Continuing Healthcare, NHS-funded Nursing Care, and means-tested local authority support is the first step towards securing appropriate and affordable care.
