The cost of care

Paying for replacement care, whether at home or in a residential setting, can be very expensive, even though care workers themselves are often paid at or near the national minimum wage. Paying for care is often something families worry about most. It is important to know what options you might have in regard to funding care so that care can be provided when it is necessary.

The rules about who pays for what care are complex and vary between the four countries of the UK. In Scotland, for example, health and social care is free, although there is a means-test for accommodation and living expenses.

Each local authority should provide information about paying for care to those needing care and to their carers in their area. This will include advice for self-funders.

We cover care costs in detail in some of our online and face-to-face courses, but here is a brief overview as a starting point. 

In England, Wales and Northern Ireland there are three main ways in which care costs might be paid:

  • Privately funded – the person needing the care is a “self-funder”
  • Local authority funded – a means-test decides how much the local authority will contribute towards your care costs
  • NHS continuing healthcare funding (CHC) – when your care needs are deemed to be health care needs rather than social care needs and therefore all costs are covered by the NHS rather than the individual

Local authority funding is dependent on two assessments: an assessment of the person’s care needs and then a financial assessment to see what financial contribution will be made. The local authority will only contribute towards care to meet eligible needs under the Care Act. 

The financial assessment is complex and the thresholds vary between countries. The calculation takes into account both income and capital. It is important to note that the assessment just applies to the person needing the care, so the finances of the carer or any family member are not taken into account. This does not stop family members sometimes choosing to top up residential care fees through a third-party arrangement.

The family home

Families worry about the value of the family home being part of the financial assessment, but the home only comes into the calculation if the person needing care will no longer be living there, and there is no spouse or partner or certain other vulnerable family members who have been living there and still need it as their home. To avoid the necessity of selling a property there are ways of borrowing money for care costs from the local authority as deferred payments secured as a charge on the house, or in a “loan-style agreement”.

NHS continuing healthcare funding is relevant when the primary need is for health care rather than social care. Even though the need for care is because of a health condition, the type of care needed is usually mostly social care such as help washing and dressing, reminders and supervision to keep safe, rather than health care such as qualified nursing support. The application process is usually started by a health or social care professional, but an individual can request a CHC assessment from the local Integrated Care Board. There will be an initial checklist to see if a full CHC assessment is needed. 

More details can be found at https://www.england.nhs.uk/healthcare/