Understanding the Care Needs Assessment
The gateway to publicly funded care, and often a nursing home placement, is a comprehensive care needs assessment carried out by the local council’s adult social services department. This evaluation is not based on age or diagnosis alone, but on how a person’s condition affects their daily functioning and overall well-being. Anyone who appears to have care and support needs is entitled to this assessment, regardless of their income or savings.
The UK-Wide Framework
While each of the UK's four nations—England, Scotland, Wales, and Northern Ireland—have specific legal frameworks, the core principle remains consistent: to determine if an individual's needs meet national eligibility criteria. An assessor, often a social worker or occupational therapist, will meet with the individual and, with their permission, their family or carers, to discuss their circumstances. The discussion will cover a wide range of daily activities and challenges. It is crucial for families to be open and detailed during this process to ensure all needs are captured accurately.
Eligibility Criteria in England
In England, eligibility is governed by the Care Act 2014. To qualify for a nursing home, a person must meet three specific conditions:
- Needs must arise from a physical or mental impairment or illness: The need for care must be a direct result of a health condition, such as dementia, a physical disability, or a long-term illness.
- Inability to achieve two or more daily outcomes: The individual must be unable to complete at least two of the nationally defined daily tasks. These are detailed below.
- Significant impact on well-being: The inability to achieve these outcomes must have a significant impact on their overall well-being, as defined by the Care Act.
Daily Outcomes Assessed (England)
The assessor will evaluate the person's ability to perform tasks related to several key outcomes, including:
- Maintaining personal hygiene: The ability to wash and manage personal grooming.
- Managing toilet needs: Including any continence issues.
- Managing nutrition: This covers preparing and consuming food and drink.
- Dressing appropriately: Putting on and taking off clothes without assistance.
- Moving around safely: The ability to get around their home safely, which can include moving from a bed to a chair.
- Maintaining a habitable home environment: Keeping the home safe and clean.
- Developing and maintaining relationships: The ability to engage with others and avoid social isolation.
- Accessing the community: Safely getting to and using facilities like shops or public transport.
The Financial Assessment (Means Test)
Following the care needs assessment, if a nursing home is deemed the most suitable option, a financial assessment is conducted. This determines how much an individual will need to contribute towards the cost of their care. It is important to note that the needs assessment is independent of financial circumstances, but eligibility for funding is not.
Financial Thresholds in England
As of 2025, there are two primary financial thresholds to be aware of:
- Above the Upper Capital Limit (£23,250): If an individual's savings and capital (including property, unless disregarded) exceed this amount, they are expected to fund the full cost of their nursing home care as a 'self-funder'.
- Below the Lower Capital Limit (£14,250): If savings and capital are below this amount, the local authority will usually cover the cost of care, with the individual contributing a portion from their income (e.g., pensions) towards the fees.
- Between the Limits: For individuals with assets between £14,250 and £23,250, the council will still contribute, but the individual is expected to pay a proportion of their savings towards their fees.
Important Financial Considerations
- Property Disregards: The value of a person's home may be disregarded under certain circumstances, for instance, if a partner or dependent relative still lives there. However, if the resident is the sole occupant, the property is usually included in the financial assessment.
- Deprivation of Assets: Councils are legally allowed to investigate if an individual has intentionally transferred or given away assets to avoid paying for care. This is a complex area and legal advice is often recommended.
NHS Continuing Healthcare (CHC) Funding
Some individuals may not be required to pay for their nursing home care at all. This is the case if they are eligible for NHS Continuing Healthcare (CHC) funding, which covers the full cost of care for those with a 'primary health need'.
CHC Eligibility Criteria
Eligibility for CHC is not based on a specific diagnosis but on the nature, complexity, intensity, and unpredictability of an individual's care needs. The assessment is conducted by a multidisciplinary team of healthcare professionals and considers the following:
- Nature: The specific health conditions and the type of care required.
- Complexity: How needs combine and interact with each other.
- Intensity: The amount and level of professional support required.
- Unpredictability: The risk of sudden changes in condition that require immediate, skilled intervention.
If the majority of a person's needs are healthcare-related, they may be eligible for full NHS funding. This is an entirely separate and non-means-tested process.
The Nursing Care Component
Even if not eligible for full CHC funding, residents of a nursing home who have been assessed as requiring nursing care may be entitled to NHS-funded nursing care (FNC). This is a set weekly contribution towards the cost of nursing care provided by a registered nurse. FNC is paid directly to the nursing home and is not means-tested.
Key Factors Determining Eligibility: A Comparison Table
| Assessment Criterion | Local Authority Funded Care | NHS Continuing Healthcare (CHC) |
|---|---|---|
| Primary Need | Social care needs, such as help with washing and dressing. | Healthcare needs, focused on clinical supervision and medical intervention. |
| Assessment Body | Local council adult social services department. | Integrated Care Board (ICB) via a multidisciplinary team. |
| Criteria | Meets national eligibility criteria based on inability to perform daily tasks and impact on well-being. | Has a 'primary health need' based on the complexity, intensity, and unpredictability of health needs. |
| Funding | Means-tested; individual may pay all, some, or none of the costs based on assets. | Not means-tested; fully funded by the NHS. |
| Key Focus | Enabling independence and social participation. | Managing and mitigating health risks and conditions. |
| Regular Review | Care plans are reviewed regularly to ensure needs are still met. | Eligibility and care package are regularly reviewed to assess if needs and status have changed. |
What to Do Next: Navigating the Process
Initiating the Process
The first step is to contact your local council's adult social services to request a care needs assessment. This can be done by the individual themselves, a family member, or a professional like a GP. The council is legally obliged to carry out an assessment for anyone who appears to need care. For those with significant medical needs, especially after a hospital stay, a discussion with hospital discharge teams or a GP can prompt a referral for a CHC assessment.
During and After the Assessment
- Prepare for the visit: Make a list of all the challenges the person faces with daily living, no matter how small they seem. Having a relative or advocate present is highly advisable.
- Receive the outcome: The council will provide a written record of the assessment detailing the needs identified and whether they meet the eligibility criteria. The report will also outline a recommended care plan.
- Dispute the decision: If you disagree with the outcome of either the care needs or financial assessment, you have the right to challenge it through the council's complaints procedure. There is also a formal appeal process for NHS Continuing Healthcare decisions.
For more detailed information on navigating the care system and understanding your rights, visit the independent charity Age UK's guidance on getting a care needs assessment: https://www.ageuk.org.uk/information-advice/care/arranging-care/care-needs-assessment/
Conclusion
Understanding what qualifies a person for a nursing home in the UK involves navigating a two-tiered system of needs and financial assessments. Eligibility is not a straightforward matter of age or illness, but a complex evaluation of how a person's condition impacts their daily life and well-being. By engaging with the local council for a care needs assessment, and potentially pursuing an NHS Continuing Healthcare assessment for complex medical needs, families can determine the right pathway to securing the necessary support and funding for long-term care.
