What contribution do I have to make towards my care costs, and when?

Published 29/04/2019

Please note: This article was published prior to July 2022, and some information may be outdated.

The responsibility for funding care costs is often a battle between the Local Authority and NHS, as each fights to protect its budget and keep costs down. It can be difficult for families to navigate the rules underpinning funding responsibilities, particularly when neither the Local Authority nor the NHS is transparent about the facts.

Critical: you need to understand the difference between social care and healthcare

Simply put, social care is provided by the Local Authority and is means-tested – ie you may have to contribute to the cost of care; healthcare/nursing care is provided by the NHS, is not means-tested, and is free for all at the point of use (ie when you need it).

It’s vital to remember that:

It is unlawful for the Local Authority to do any kind of means-testing or financial assessment before it has been properly established that the individual does not require care from the NHS; and
Your relative should not be asked to pay any care fees until an NHS Continuing Healthcare assessment has been done.

If the NHS has completed a Continuing Healthcare assessment and found that an individual does qualify for NHS Continuing Healthcare Funding (CHC), then the all the cost of care, accommodation and their social needs, should be paid in full by the NHS. That can save families, on average, at least £35,000 per annum in care home fees! In some more expensive care homes weekly fees are £1,500 a week, which represents a massive saving of £78,000 per year, if your relative qualifies for CHC.

Caution: Healthcare needs can change. Just because an individual is in receipt of NHS Continuing Healthcare Funding does not necessarily mean that this free funded care will continue indefinitely. Regular assessments ought to be carried out by the NHS, and funding can be withdrawn if an individual’s healthcare needs no longer meet the eligibility criteria for free funded CHC. Read our blog: Are you worried that Continuing Healthcare Funding may be withdrawn? If you are worried that CHC might be withdrawn, get help and visit our one-to-one page.

But, if the NHS Continuing Healthcare assessment has concluded that an individual does not qualify for NHS funding, then that person may be asked to contribute towards the cost of their care. The amount an individual is expected to pay is determined by the value of their capital and/or assets.

Thresholds for contribution fall into the following three categories:

If the value of your assets, including property, amounts to more than £23,250, you will be expected to fund the cost of all your care in full (self-funding). You are not obliged to undergo any means-testing by the Local Authority, and can simply state you are self-funding.
If the value of your assets, including property, is between £14,250 and £23,250, you will be expected to contribute towards the cost of your care under the Tariff Rules. At the moment, this is calculated at £1 per week for every £250 of capital you own, and part thereof, between £14,250 and £23,250.
If the value of your assets, including property, falls below £14,250, the Local Authority will fund the cost of your care up to the approved rate; you will be expected to contribute only from your income (e.g. pension). If your fees exceed the approved rate, you will be asked to pay a “top-up” to bridge the gap, or find a cheaper placement.

Don’t Forget: If your assets are below £14,250, the Income Protection Principle dictates that your weekly income should not fall below the Minimum Income Guarantee, or MIG. In 2019 the MIG is £189 per week for a single person who qualifies for pension credit. For couples, if one or both of you has reached Pension Credit qualifying age, your individual MIG is £144.30 per week. For further reading on the subject look at:

(https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs46_paying_for_care_and_support_at_home_fcs.pdf)

Important: the Local Authority cannot take into account the value of your property and assets during the first twelve weeks of care. This is called the “Property Disregard“. If you have been paying for your care and there has not been any involvement by the Local Authority, the Property Disregard starts from the point at which assistance is requested, NOT from the date of admission to care. So, if you were self-funding for three years before the value of your assets fell below the upper threshold (£23,250), the twelve week Property Disregard should be applied from the point at which the Local Authority does its first assessment of your financial situation. You should not pay care fees during these twelve weeks.

Do I have to sell my property to pay for care?

No, you cannot be forced to sell your home.

Thousands of families have reportedly sold their homes to pay for care, when they didn’t need to!

This is a common trap, so don’t make the same mistake.

The first question when looking at going into a care home is not what private assets or funds you have available to pay for the care home fees. The starting point should always be whether your relative has a ‘primary health need’ which would entitle them to an assessment for NHS Continuing healthcare funding (CHC) – ie FREE funded care paid for in full by the NHS. So, if you are being asked about funding care home fees from the outset ie about your relative’s ‘wealth not health’, then you need to change the conversation around to discussing their ‘health not wealth!’

As above, if your relative does not qualify for CHC and has assets (including property) valued in excess of the current threshold of £23,250 – then, unless they have other private means available (eg savings, other assets, income, pension or an investment policy etc.), they may have to sell their property to meet the costs of the care home charges.

If the value of your relative’s assets fall between £23,250 and £14,250, and they have to contribute to their care home fees, then selling their property is often the only way people can afford to meet their payment obligations to the Local Authority, if they have no other means available.

However, the Local Authority cannot force you to sell your property (or take its value into consideration for means-testing) if your relative’s partner (or former partner) still lives there, or a dependent under 16, or relative over 60, or someone incapacitated lives there, or someone else owns the property eg a spouse or trust.

Our tip: Negotiate! If your relative is struggling to pay the Local Authority’s charges for care, and they don’t want to sell their property for whatever personal or financial reason, ask the Local Authority about their Deferred Payment Arrangement scheme (DPA). Essentially, under a DPA, the Local Authority will agree to continue paying the care fees for the time being, but will defer (ie delay) repayment of their fees until the property has been eventually sold at a future date. The care fees will then be recouped by the Local Authority out of the sale proceeds once sold, or from the individual’s estate after death. However, before entering into a DPA, we would recommend taking independent financial advice, as such an arrangement may have adverse tax implications.

For further reading around the subject:

Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…

Your mum has ‘social’ needs, so she won’t get funding…

“So will you be self funding?”

BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare

Keep this handy: Jargon busting – a quick guide to some of the key terms…

Tagged Categories: Care fees, Care homes and hospitals, CHC funding, NHS Continuing Healthcare

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11 Comments

Amy Bickerstaff May 22, 2019 at 9:46 am

https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/

Denise, you need to appeal and challenge them. I took our CCG to the Parliamentary Ombudsman and won.

Anne May 21, 2019 at 5:29 pm

I have been told that if my father qualifies for continuing healthcare then he will need to move from his current nursing home as it cost £1200 a week and this is more than CHC allows. We would be happy to pay a top up to keep him in the current home but have been told this isn’t allowed. The nursing home is not at all fancy but we live in London and this is the cheapest in short travelling distance- 2 miles from my mother’s house. Please could you advise is it true that CHC is only worth£850 and would he have to move homes?
Thank you

Amy Bickerstaff May 22, 2019 at 9:56 am

It is not true. Challenge them.

Sarah May 15, 2019 at 5:24 pm

I've posted on here before and you have helped me so much. We have had various CHF assessments all but one done incorrectly. We will never get anything from that despite my father being close to death, he just isn't 'quite ill enough' we have been told more than once !
On hospital discharge we used up savings that my parents had which were above the threshold so that they are down at the lower threshold of the permitted values now. I previously posted about social services ignoring us. It took from Jan to May now in order for them to get back to my repeated warnings that our money was running out.
We are currently dealing with local authority social workers for Social Care (he gets funded nursing care but refused CHF) .
Like other comments I read on here we have the 'let's just do a financial assessment' comment before anything.... I am ready to provide this but I am still asking to see a care plan. The social worker contacts my mother saying my father can remain in his home 'but you have to pay a top up of x' , or 'he can go here but it will be a top up of x'.
I understand that I can have access to this care plan which should detail his medical needs and from that then we can look at which homes he could go to, either his current home or another home that the LA should pay for provided its within his care needs. I am not looking for hairdressing or flowery walls, i need a profiling mattress, tilt chair, hoist, 24 hr nursing, MEDICAL needs. I just want to check that I am correct in insisting I see this.
The social workers want to send various care home representatives to perform assessment after assessment on my father (terminal prostate cancer, metastasised to his bones, stroke that has resulted in left side paralysis, diabetes, the start of vascular dementia, a million medications per hour including 2 forms of morphine). He is currently very sick with this weeks new complaint being a swollen arm that the GP cannot diagnose and wants to monitor. Each one of these assessments need to be attended by myself and my mother . Like everyone else on here I am fed up with it. The illness is nothing compared to dealing with the care that surrounds these very sick patients.
So am I right in asking for this care plan? it seems there isn't one? there's more effort being placed on asking my mother to apply for benefits so that she can get pension credit, all of which I think is just to have a look at her savings which are not part of my fathers assessment i know (I won't be going that route thanks).
Grateful for any advice. Thanks

Care to be Different May 16, 2019 at 9:20 am

Hi Sarah - Just because they have refused him full funding does not mean that your father is not eligible for it and if his needs are so intense and complex then it is worth investigating this further. Please do get in touch if you want to discuss this with us. 0161 979 0430 Kind regards

Amy Bickerstaff May 14, 2019 at 12:55 pm

Once a person is in receipt of Continuing Health Care ( CHC) from the NHS, the NHS is liable for all social care too. They may try to say that isn’t true but it is clearly stated in the CHC documentation. My local CCG battled with me over my husband’s care. They lost, they had to admit that they were responsible for his health and social care too.

Denise Podlewska May 22, 2019 at 8:31 am

Can you point me to the part in the CHC documentation where it says they pay for social care too? I know I will have a battle on my hands as I am refusing to pay the "monthly invoices" that the home send to me and NHS say they will not pay any more.

Denise Podlewska May 14, 2019 at 1:04 pm

The NHS CHC in charge of mum ( she moved to be nearer to me) said they will not pay another penny more and if the home want more, she will have to move back to their city which is over an hour away. Mum is 97! I was shocked at their reply that homes can do this. "We don't pay for social care, just nursing" And the home keep sending the bills every month. They always send hair/chiropody on a separate invoice because I pay that.

Debbie Carrie May 14, 2019 at 11:04 am

My sister is still in hospital waiting to be rehoused near her family and for a suitable care provider to be selected.
Mandy had a brain aneurysm and a severe stroke 26th Aug 2018. This has left her without capacity, long and short term memory loss and completely blind. She is 53 years old. She has been granted Continued Health Care funding but the commissioners have put forward care agencies who deal with elderly and learning disabilities, Mandy has neither of these she has a brain acquired injury and is blind. I have researched care companies and have found two who deal with Mandy’s condition and who are willing to take her care package on. I put this to CHC and they have told me the companies I think meet Mandy’s needs best are too expensive. Please can you give me advice on how to deal with their decision.

Denise Podlewska May 14, 2019 at 10:15 am

I see above that "If the NHS has completed a Continuing Healthcare assessment and found that an individual does qualify for NHS Continuing Healthcare Funding (CHC), then the all the cost of care, accommodation and their social needs, should be paid in full by the NHS. " My mum is in receipt of NHS CHC and the nursing home still want over £500 per month from me, becuase the NHS do not pay enough!! This is an extract from a letter from the manager:"The additional £80 per week ‘Lifestyle Choice’ is well below what it would normally be but is the difference between the payment we receive for providing care and what it actually costs us to provide 24 hour nursing care. It is well documented and researched countrywide that local authorities and CCG’s are not meeting the costs of care nationally and that social care is in crisis. The CCG’s understand this and have allowed us to charge a ‘lifestyle choice’ for several years. If we accepted the minimum fees offered we would not be able to provide the standard of care that we currently do or be able to provide additional training for our staff to ensure they are able to meet the needs of our residents. " They charge me extra for other things that my mum does not receive. Its appalling. I have refused to pay for two years and when mum finally passes, I expect a huge argument from them.