Funding your relative's care - who pays?

If you are fighting for your relative’s entitlement to NHS Continuing Healthcare Funding, you need to understand the fundamental difference between social care needs and healthcare needs.

An individual with a ‘primary healthcare need’ is entitled to a free fully-funded package of care provided by the NHS to cater for all their assessed healthcare needs and accommodation.  It is not means-tested.

Social care is provided by the Local Authority (through Social Services) and is means-tested. Therefore, your relative may have to pay for their social care needs if they have capital or assets in excess of £23,250.

However, before any consideration of funding or social care needs are even discussed, your relative should first be assessed as to whether or not they have a primary healthcare need and are eligible for NHS Continuing Healthcare Funding (or ‘CHC’ for short).

A ‘primary healthcare need’ relates to care provided to an individual aged 18 or over, to meet their health and associated healthcare needs as a result of a disability, accident or illness.

Primary healthcare needs are nursing or healthcare needs which are ‘more than incidental or ancillary to the provision of accommodation which the Local Authority Social Services are under a duty to provide, and are of a nature beyond which the Local Authority is legally expected to provide’. For further information, read paragraphs 49 to 51 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised 2018).

As will become apparent once you embark upon the CHC assessment process, the issues concerning whether care falls under the category of healthcare or social care is all about finances and who is going to pay for it! 

Both Clinical Commissioning Groups and Local Authorities have budgets to spend on care.  It is not uncommon for each organisation to try and pass responsibility for paying your relative’s care to the other, batting them back and forth.

Social care needs are often described as ‘activities of daily living’, such as help with feeding, washing, hygiene and mobility. Whereas healthcare needs often requiring 24 hour nursing care, due to their nature, intensity, complexity and unpredictability.

If your relative has a primary health need, then the NHS should pay for ALL of your relative’s assessed care needs including their care home fees.  It doesn’t matter whether they are cared for in their own home or in a care/nursing home. The setting where care is provided is irrelevant. Nor should your relative be asked to pay a ‘top-up’ fee towards any shortfall in what their assessed needs cost and what the Clinical Commissioning Group pay for their care. The shortfall should be paid the CCG, not your relative!

Your relative may have been sufficiently prudent to put aside savings to provide for their old age later in life. But if turned down for NHS CHC Funding, they will then be subjected to Local Authority means-testing as to funding their social care needs. If above the threshold of £23,250, they will be forced to self-fund their care from private means and often ‘nest-egg’ fund created over a lifetime of saving, may be drained in no time at all to pay for their care needs.  Indeed, the press have reported that many thousands of people have had to sell their home to pay for their care, or else see their lifetime savings wiped out.

Here’s a recent comment on our Facebook page which sums up first-hand what some families are going through:

“Me and my dad are realising our fight for my mum has actually nothing to do with my Mum’s health and welfare or her health and nursing care needs. We are actually fighting the NHS, CCG and the nursing home about money, and who is going to pay? The CCG say she does not have primary health care needs, the social services agree, and the nursing home say they cannot allow her to stay at her nursing home unless someone pays for her care. The whole system is flawed and in my opinion, and truth, no one who claims to care for these elderly and vulnerable people should ever be allowed to state anywhere they care for people. They only care about money”.

Funding your relative’s care home fees can be financially crippling if they have to contribute to, or self-fund, their all of their care.  Most care/nursing homes are run as a commercial business, and therefore, quite simply, if the resident/patient cannot afford to pay, then often the care home will threaten to end the contract and put them out on the street. Some care homes might be more ruthless than others! Others may just threaten ‘eviction’ when families are at their most vulnerable, using it as leverage to secure private funding, knowing full well that the family will want to keep their relative in a secure caring environment.

Remember: If your relative has not been successful with their application for CHC, then they should consider appealing. Regardless, they should automatically be considered for NHS-funded Nursing Care instead (‘FNC’). FNC is available if your relative is a patient in a nursing home, and has nursing needs which are provided by a registered nurse. FNC is paid at a weekly rate of £158.16 towards the cost of their nursing care needs.

For further information on the subject, read our blogs:

Have you considered NHS-funded Nursing Care (FNC)?

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