Paying for Care in England
Paying for Care in England
|
|
|
Paying for Care in England Understanding how care is funded can feel daunting, particularly at a point when decisions are being made under pressure. The rules are complex, and many people are unsure whether care should be paid for privately, funded by the local authority, or covered by the NHS. This page provides an overview of how care funding works in England, the key thresholds that apply, and the situations in which support may be available. The Two Main Funding Routes For most adults, care is funded in one of two ways. Where care needs arise primarily from difficulties with daily living — such as washing, dressing, eating or supervision — responsibility usually sits with the local authority under the Care Act 2014, subject to a financial assessment. Where care needs arise primarily from health, responsibility may rest with the NHS, which commissions services through the local Integrated Care Board (ICB). Understanding the boundary between these two routes is critical, as the financial implications are very different. Local authority care is means-tested. NHS-funded care is not. Local Authority Funding and Financial Assessments If residential care is needed, the local authority must first carry out a needs assessment to determine whether it has a duty to meet those needs. If residential care is considered appropriate, a financial assessment will then determine how much, if anything, the individual must contribute towards the cost. In England, individuals with capital above £23,250 are generally expected to pay the full cost of their care. Where capital falls below this threshold, the local authority may contribute. Capital between £14,250 and £23,250 is treated as generating “tariff income”, while capital below £14,250 is disregarded. Income is also taken into account, including pensions and most benefits, although certain income is disregarded. Individuals in residential care must be left with a Personal Expenses Allowance, currently just over £30 per week, for personal use. Personal Budgets and Direct Payments Where the local authority has a duty to meet eligible care needs, it must calculate a personal budget. This represents the total cost of meeting those needs and includes the individual’s assessed contribution and the amount the local authority will pay. The budget must be sufficient to meet the needs identified in the care plan and should be set in a transparent and timely way. A personal budget may be managed by the local authority, by a third party, or taken as a direct payment. Direct payments allow individuals to receive funds from their personal budget to arrange their own care and support, offering greater choice and flexibility. They are subject to certain conditions and are not usually available for permanent residential care. Where care workers are employed directly, legal responsibilities apply, and the local authority has a duty to provide advice and support. Personal budgets and direct payments must be reviewed regularly to ensure they remain appropriate, and they can be challenged where they are insufficient to meet assessed needs. Property and Paying for Residential Care Property ownership is often the greatest source of anxiety when care is needed. In some circumstances, the value of a property is included in the financial assessment. In others, it must be disregarded — for example, where a spouse, partner or qualifying relative continues to live in the home. When someone first enters permanent residential care, the value of their home is normally disregarded for an initial period of twelve weeks. This allows time to consider options and avoids rushed decisions. Where a property is later taken into account, deferred payment agreements may be available, allowing care fees to be deferred until the property is sold or after death. Self-Funding Care Where a person’s capital exceeds the upper threshold, they are classed as a self-funder and are responsible for arranging and paying for their own care. Self-funders may still be entitled to benefits such as Attendance Allowance or Pension Credit, and it is important to ensure these are claimed where appropriate. If a self-funder’s capital later falls below £23,250, the local authority should be contacted in advance so that assessments can be carried out without delay. A change in funding status does not, in itself, justify a move to a different care home, and any proposed move must properly take account of the individual’s wellbeing. Choice of Accommodation and Top-Up Fees Where the local authority is contributing to care costs, it must ensure that at least one suitable care home option is available within the individual’s personal budget. Individuals may choose a more expensive home if a third party is willing and able to pay a top-up, but top-ups must only be requested where the personal budget is genuinely sufficient to meet assessed needs. Top-up arrangements should always be approached with care, particularly where affordability may change over time. Care That May Be Free of Charge Some care is not means-tested and should be provided free of charge. This includes short-term rehabilitation or reablement following hospital discharge (often for up to six weeks), NHS-funded nursing care for those living in nursing homes, and mental health aftercare provided under section 117 of the Mental Health Act. Most significantly, where an individual has a primary health need, the NHS may be responsible for funding care in full through NHS Continuing Healthcare, regardless of income or assets. NHS Continuing Healthcare Many families assume that paying for care requires either self-funding or means-tested local authority support. In fact, individuals with complex, intense or unpredictable healthcare needs may qualify for NHS Continuing Healthcare. This funding is not means-tested and can apply in any setting, including at home or in a care home. Eligibility is based on the overall nature, intensity, complexity and unpredictability of needs, rather than diagnosis or financial circumstances. Where CHC applies, the NHS is responsible for the full cost of care, commissioned through the relevant Integrated Care Board. Short-Term and Temporary Care Different financial rules apply depending on whether care is short-term, temporary or permanent. Short-term and temporary placements are often intended to support recovery or a return home and may attract different charging rules, including continued protection for housing costs and minimum income guarantees. Ensuring the correct category is applied from the outset is important, as this can significantly affect what someone is asked to pay. Deprivation of Assets Local authorities may consider whether assets have been deliberately disposed of in order to avoid care charges. This is a complex area, and not every transfer of assets amounts to deprivation. Intention and foreseeability are key considerations, and the local authority must be able to demonstrate that avoiding care charges was a significant motivation. Seeking advice before making decisions about property or finances can help avoid unintended consequences. How ARROW Can Help Many people contact ARROW because they want clarity rather than conflict. Whether the question is about who should be paying for care, whether NHS Continuing Healthcare should be considered, or whether the correct funding route is being applied, early, informed advice can prevent unnecessary expense and stress. If you would like a clear, professional view on how care should be funded in your circumstances, you are welcome to get in touch for an initial conversation. |
