The first step: Requesting a care needs assessment
The initial and most crucial step towards qualifying for a care home in the UK is to undergo a care needs assessment, conducted by the adult social services department of your local council. This assessment is free and is available to anyone over 18 who appears to need care and support, regardless of their income or savings. The purpose is to determine what care services would best meet your needs, which could include care at home, a package of support, or a move into a care home.
What the assessment involves
During the assessment, a social care professional, such as a social worker or occupational therapist, will visit you, typically in your home. They will discuss how you are managing daily tasks and consider various factors, including:
- Your overall health, including any mental or physical conditions.
- Your ability to perform daily living tasks, like washing, dressing, and eating.
- Your current living arrangements and support network.
- Your personal goals and preferences for how you would like to be supported.
The national eligibility criteria (England)
For those in England, the assessment is guided by the national eligibility criteria under the Care Act 2014. To be deemed eligible for local authority support, including a care home, three conditions must be met:
- Your needs must arise from, or be related to, a physical or mental impairment or illness.
- As a result of these needs, you are unable to achieve two or more of the specified outcomes, such as maintaining personal hygiene, managing nutrition, or moving safely around your home.
- There is a significant impact on your overall wellbeing because you cannot achieve these outcomes.
The assessor must determine whether your inability to perform these tasks causes you significant pain, distress, or anxiety, or if it puts you or others at risk.
The next step: Understanding the financial assessment
If the care needs assessment concludes that a care home is the most appropriate option, the council will then conduct a financial assessment, also known as a 'means test'. This determines how much you need to contribute towards the cost of your care. The amount you pay depends on your income, savings, and assets, including property.
Financial thresholds (England)
In England, your capital (savings and investments) is assessed against certain thresholds:
- Above £23,250: If your capital exceeds this amount, you are a 'self-funder' and expected to pay your own fees until your capital falls below this limit.
- Between £14,250 and £23,250: The council may provide financial support, but you will also pay a contribution based on your income plus a 'tariff income' calculated from your capital.
- Under £14,250: The council provides financial support, with your contribution based only on your assessable income.
It's important to know that certain benefits may be disregarded during this assessment. You should contact the council a few months before your capital nears the upper threshold to initiate the process.
Your home in the financial assessment
The value of your property is a significant factor in the financial assessment, but certain circumstances can lead to it being disregarded:
- Disregarded: If your spouse, civil partner, a relative over 60, or a dependent child still lives there, its value is ignored.
- Not Disregarded: If you are moving permanently into a care home and no one meeting the criteria remains in the property, its value will likely be included in your capital.
If you need to use your property's value to pay for care, you may be eligible for a Deferred Payment Agreement, where the council covers your fees and is repaid from your estate later. Attempts to give away assets to avoid care costs can be deemed 'deliberate deprivation of assets' and may still be included in the assessment.
Alternative funding: NHS Continuing Healthcare
For those with severe, complex, and ongoing health needs, the NHS may cover the full cost of care through NHS Continuing Healthcare (CHC). Eligibility for CHC is based solely on a person's health needs, not their finances, and requires a separate assessment by a multidisciplinary team. This can fund a care home placement completely.
Additionally, if you require nursing care but do not qualify for CHC, the NHS provides a non-means-tested contribution directly to the nursing home through NHS-funded nursing care.
Understanding regional variations
It is crucial to be aware that the criteria for both needs and financial assessments vary across the UK.
- Wales: The Social Services and Wellbeing (Wales) Act 2014 sets out national eligibility criteria. Funding thresholds also differ from England.
- Scotland: A different system is in place, focusing on the level of risk to a person's independent living. Funding thresholds are also distinct.
- Northern Ireland: Assessments are managed by the Health and Social Care (HSC) Trust, with its own specific eligibility factors and thresholds.
Comparison table: Local authority vs. NHS funding
| Feature | Local Authority Funding | NHS Continuing Healthcare (CHC) |
|---|---|---|
| Basis for Eligibility | Care needs assessment showing 'eligible needs' related to physical or mental impairment. | Primary health needs of a complex and ongoing nature, not means-tested. |
| Means-Tested | Yes. A financial assessment determines your contribution based on income and capital. | No. Funding is based purely on health needs, regardless of financial status. |
| Funding Source | Your local council, potentially supplemented by your own contribution. | Your local Integrated Care Board (ICB) funds the full cost of care. |
| Property Inclusion | Property value may be included in the financial assessment unless disregarded. | Property and savings are not considered. |
| First Step | Request a care needs assessment from your local council. | Request an initial screening from your ICB or ask your council to refer you. |
Planning for the future and next steps
Understanding who qualifies for a care home in the UK can be complex, and preparing for the process is essential. Gathering financial details, identifying specific care needs, and involving family or an advocate can make the assessment more effective. If you are a self-funder, it is still advisable to contact your local council when your capital starts to fall, to ensure a smooth transition to council funding if needed.
Ultimately, the assessment process is designed to ensure that you or your loved one receives the most appropriate level of care. Seeking advice from impartial sources, such as charities specialising in elderly care, can provide valuable support throughout this journey. For comprehensive information and guidance, visit the Age UK website.
