Paying for care

Social care is means tested so most people have to pay something towards the care that they receive. Those who have income and savings over a certain threshold will pay the full cost.

If the person is receiving care or services whilst at home, the value of the house where they live will not be taken into account when calculating how much they have to pay. Neither would the value of the house be counted if they went for a temporary stay in residential care.

However if they move into a care home on a permanent basis, their home will be included along with income and savings in the means test, unless certain other people are still living there. They will be expected to pay the care home fees in full until their total assets reduce to a certain level.

If they have substantial and ongoing care needs and have been assessed as having a primary health care need they may be eligible for NHS Continuing Health Care funding which means that all of the care costs, either at home or in a residential setting, will be paid for by the NHS.

It is important to understand the rules about paying for care and to consider getting some independent financial advice as any choices you make could have far reaching implications. You can find general advice about paying for care home fees on the First Stop website.

How much will I pay for social care whilst in my own home?
Can disability benefits be taken into account?
The person I care for wants to remain at home but their house is too big
Paying for residential care
Will the person with care needs have to tell their home to pay for residential care?
What if they don’t want to sell their house or are having difficulties with getting a buyer?
Can family help with care home fees if they want to?
What happens to the benefits of people moving into residential care?
My father was self-funding but will soon need help with paying the fees, what happens now?
The person I care for would like to give me their house or a large sum of money
What is NHS Continuing Healthcare (CHC) funded care?
The person I care for is not eligible for NHS funding but they do need some nursing care
Are there any other ways of paying for social care?
Watch a video about paying for care at home

How much will I pay for social care whilst in my own home? 

When social care is arranged through the local council, they will carry out a financial assessment for the person needing the care and support. In the case of the person being one of a couple, the local authority cannot include capital or income belonging to the other partner.

For the purposes of the financial assessment, the council will want to know about a person’s income and savings as well as any other assets. They will enquire about capital that the person may have had in the past but has since disposed of. For example, if someone had sold a property to move in with family but no longer has the capital; or if money has been moved into a family Trust. The council may still decide to include that amount of money in their calculations if they believe it to have been a deliberate ‘deprivation of capital’, to avoid paying for future care.

If a person has over £23,250 of savings (including assets) they will be considered to be a ‘self-funder’ and will have to pay for all of their own care. The person can still ask the council to arrange their care and support but there will be an arrangement fee on top of the cost of the care.

Someone with capital of between £14,250 and £23,250, may receive some local authority funding but will be expected to contribute to the cost on a decreasing level as the savings go down.

When the savings reach £14,250, you can only be charged a certain amount from your income. In their calculations the council must ensure that you are left with a guaranteed minimum to live on.

Find our more information about funding care and support at home on the First Stop website.

South Gloucestershire council and Bristol City council have produced information about how they work out how much someone will have to pay towards their care at home. There is more detailed information about the way Bristol City council works out charges on the Bristol City council website.

Find out about arranging support at home in our practical support section.

Can disability benefits be taken into account?

Yes, if the person gets a disability related benefit like Disability Living Allowance, Personal Independence Payment or Attendance Allowance, this will be taken into account in the means test. It is expected that the person will use this to contribute towards their care costs.

If the council takes these benefits into account they also need to do an assessment that looks at the extra costs that someone has as a result of disability. This is called disability related expenditure. This means that when they work out the amount you will be left to live on, they take into consideration these additional costs.

The person I care for wants to remain at home but their house is too big

They could sell their home if it is larger than they need and move somewhere smaller and more manageable. This could free up some money to pay for care costs. This could work well for someone who is not eligible for help from the local council or who prefers to fund their own care. Find out more about down sizing your home to fund long term care on the Money Advice Service website.

Paying for residential care

Paying for a care home is expensive and if you live with the person you care for, you may have particular concerns about how you will be affected. Aside from the emotional implications there are also practical things to think about. You can find a guide to care home fees and the treatment of couples on the First Stop website.

Many people moving in to care are worried about having to sell their home. You can find a guide to how property is treated on the First Stop website.

South Gloucestershire council and Bristol City council have produced information about paying for residential care. There is more detailed information about the way Bristol City council works out charges on the Bristol City council website.

Will the person with care needs have to sell their home to pay for residential care?

If moving to a care home is being considered, the person with care needs should have a care needs assessment from their local council. If the council agrees that a care home would be best for them. They will carry out a financial assessment to see if the council should help you pay the fees.

The financial assessment looks at: a person’s income, including certain benefits, capital including the value of their home if they own it, and savings.

The council can decide whether to take into account the value of the property, and how much of its value to include. What happens will depend on your circumstances. The value of your home must not be taken into consideration if certain other people live there as their main or only home before your move to a care home, and continue to live there. These people include:

• your spouse, civil partner or partner
• a close relative who has a disability or is over 60
• a child aged under 16 who the care home resident is liable to maintain

This is known as mandatory property disregard.

The council can also choose to ignore the value of your property in other circumstances, as long as the person with care needs is not deliberately avoiding paying care home fees. For example, if you had given up your home to care for them and now have nowhere else to live.

If the person that you care for has savings of less than £23,250 but they own their former home they may be eligible for some funding for the first 12 weeks of moving into a care home.  There is information about paying for care on Bristol City Council and South Gloucestershire Councils websites.

What if they don’t want to sell their house or are having difficulties with getting a buyer? 

All councils now have to offer something called a deferred payment arrangement to eligible people. This means that the council will fund care costs and will recover the costs once the house has been sold. This could be in the person’s lifetime or after their death. Eligibility depends on the person meeting certain criteria so not everyone is able to benefit from this option.

Another option might be to rent out the property if there are others savings to draw on to pay for care. Rental income alone is not going to cover care home fees.  Becoming a landlord brings with it responsibilities and the rented house will need to be maintained. Management of this is likely to fall to the carer, so the time and expense involved needs to be taken into consideration.

If the person needing care has less than £23,250 in other capital, the local authority may assist with costs for the first 12 weeks of permanent care. This will be dependent on the local authority agreeing that the move into care was necessary. After the 12 weeks disregard, any further help with fees would be through the deferred payment arrangement. Find out more about care home fees and the treatment of property on the First Stop website.

Can family help with care home fees if they want to?

This would be entirely optional. Even in the case of married couples, the local council would not expect a spouse to contribute out of their own money. If you have a joint savings account and other joint assets the council will want to work out the share belonging to the person in need of care. First Stop  has produced a guide to care home fees and couples.

Unless the person is self-funding they will be limited in their choice of care home. The local authority will give them a personal budget, which is how much they are prepared to pay towards the fees. If the person wants to move into a more expensive home this may be possible if a third party (usually a friend or relative) is willing to top up the fees. 

However this could amount to £100 or more per week which is a big commitment. Some care homes ask families of self funders to sign a contract agreeing to pay any top-up fees in the event of savings being depleted and the local council having to fund the placement. This is because they know their fees are above the amount the council are willing to pay and they are protecting everyone’s interests for the future.

 

What happens to the benefits of people moving into residential care?

In most cases the daily living component of personal independence payment (PIP), attendance allowance and the care component of disability living allowance (DLA) stops if someone moves into a care home, but there are some exceptions. If the person with care needs is paying their own care home fees without any funding from the local council they can still get these benefits. The mobility component of PIP and DLA are not usually affected by a move into a care home but there are some exceptions.

If the person that you care for gets NHS continuing healthcare funding this is likely to affect their benefits. It will depend on whether they are living at home, in a residential care home or a nursing home. If they get a disability benefit like attendance allowance they will need to let the Disability Benefits Centre know. A state pension is not affected by NHS continuing healthcare funding but pension credit may be.

Means tested benefits may be affected by a move into a care home but many benefits can continue to be paid. Contact the offices that pay the person’s benefits to let them know about the move and to find out how their benefits could be affected.

My father was self-funding but will soon need help with paying the fees, what happens now? 

Contact your local council at least a few months before their savings dip to £23,250. As the council agrees that a place in a care home is needed, council funding should be agreed. If the care home is more expensive than they would usually fund they may expect the person to move to a cheaper alternative unless it can be argued that the home they are in is the only one that can meet their needs.

The person I care for would like to give me their house or a large sum of money 

If the person you care for is considering giving away their house or other asset, they need to be aware of the ‘deliberate deprivation of assets’ rules. If the local council thinks that the asset has been given away to avoid paying for care home fees or care costs they can treat the person as still owning the asset and its value can still be included in the means test. More about this from Age UK

What is NHS Continuing Healthcare (CHC) funded care?

Everyone knows that the NHS pays for your care in hospital and sometimes for a short period after discharge, either at home or in a reablement setting. What is less well known is when a person’s on-going care arrangements are fully funded by NHS Continuing Healthcare funding. This fully funded care can be provided in the person’s own home or in a care home setting.

To be eligible for NHS funding the person must be over 18 and have substantial and ongoing care needs. They must have been assessed as having a ‘primary health need’, which means that on balance, their needs are greater than just social care.  For example, the fact that someone needs total help with washing and dressing is regarded as a social care need. If their condition requires a high level of nursing or specialist input, their health needs may be viewed as predominant.

If someone is disabled or has been diagnosed with a long-term illness or condition, this doesn’t necessarily mean that they will be eligible for NHS funding. Most people with long-term care needs don’t qualify because the assessment is quite strict. The assessment considers the severity, complexity and risk factors associated with the individual’s condition.

The first step is to have an initial screening and a Checklist Tool is used to decide whether the person should be referred for a full assessment.

The Checklist Tool is usually completed when a nurse, doctor, other qualified healthcare professional or social worker is assessing or reviewing your health or social care needs. If an urgent package of care is required, due to a rapidly deteriorating condition, a fast track tool can be used.

After the initial screening, your local clinical commissioning group will write  to confirm whether or not they are going to complete a full assessment for NHS continuing healthcare.

A multi-disciplinary team uses a Decision Support Tool to assess the needs of the person you care for and this covers 11 different types of need, for example; mobility, nutrition and behaviour.  Carers, and others close to the person being assessed, are asked for their views and it is important to take an active part by providing information about your experience of the person’s needs. It is advisable to work through a copy of the Decision Support Tool and make detailed notes of your own.  You can also see what others have written and check it against your own experience, in case NHS funding is refused and you wish to appeal.  Find the decision support tool on the government website.  

If you do qualify for NHS funded care, the package of support will be arranged in what is agreed to be the most appropriate setting, either at home or in a care home

There will be periodic reviews, so if their needs change in the future it is possible the funding could be withdrawn.

The person I care for is not eligible for NHS funding but they do need some nursing care

Some people who don’t qualify for NHS Continuing Health Care funding may be able to get something called ‘NHS funded nursing care’, this is a weekly contribution that can be paid towards nursing in a care home. If the person is resident in a care home that is registered to provide nursing care, and has been assessed as requiring a registered nurse, they may qualify for NHS funded nursing care.

If you are paying for your own care in a nursing home, the home should arrange for the NHS to pay the Funded Nursing Care element. Make sure that amount has been deducted from the fees you pay.

Find out more about NHS funded nursing care on the NHS website.

Are there any other ways of paying for social care?

Yes, there are other options. The rules can be complicated and often there are downsides so it’s important to make sure you have all the information that you need and perhaps consider getting independent financial advice. See Money Advice Service website for more information on funding long term care options.

Watch a video about paying for care at home

This video produced by the NHS talks about working with paid carers at home as an alternative to residential care.