Funding for care and other important considerations
The following information has been developed by CHS Healthcare. We are the largest independent care advice and support service in the UK for families who need care in their own home or need to choose a care home.
Finding the right care for yourself or your relative is a very important decision and you may have questions about how that care will be paid for. This document has been developed as a guide regarding different rules and regulations for the funding of care in England.
We also explain how an individual can ensure, in advance, that trusted individuals are appointed to make decisions in your/their best interest, if you/they lose capacity to do this themselves. This is called a Lasting Power of Attorney (LPA). We explain what this is in more detail and why it is important to prepare in advance.
It may be that you or a relative has been admitted to hospital, perhaps for the first time, or perhaps readmitted several times. You, or a relative, may need additional care and support when returning home, or it may be time to consider the different care home options available, perhaps now, or for the future.
You or your relative may have come into the hospital because of a sudden medical event or crisis, such as a fall, confusion or general deterioration. Sometimes, the change that brought you or your relative into hospital might be more gradual.
Whilst hospital staff will focus upon meeting medical needs with care and treatment, it is important to consider, as soon as possible, what will happen after hospital treatment is completed.
- Will you/they be able to return to your home and continue in the same way as before?
- Will you/they need additional care and support?
- Is there an interim solution so that any future requirements can be assessed in a more relaxed environment?
You will have professional support with this decision, from a social worker or a member of the hospital team.
Care need assessment
Working with you/your relative, a discharge plan may be put in place to ensure you/your relative is safe, and how any ongoing treatment needs will be met. It may be judged that a care needs assessment is required. This is the first step in assessing what level of care and support is required.
All hospitals are now required to run a model called discharge to assess. This means you or your relative may be moved from hospital to another care setting (usually community based, depending upon your needs, this could be your own home, or a care home) where further assessments take place. You may receive additional support before a decision is taken about your care and support in the longer term. This is considered good practice, allowing more time for recovery and ensuring patients are in a community based setting, rather than hospital, while assessments are planned and carried out.
Services to support those staying in their own home
There are many services to support you to stay in your own home. Services can include:
- domiciliary or home care and personal assistants
- meals delivered to your home
- day-centre attendance and respite care
- live-in care services
- rehabilitation services
- specialist disability equipment
- adaptations to your home
- community alarms and other types of assistive technology.
Care needs assessment
Arranging a care needs assessment
Your local authority is responsible for carrying out a care needs assessment, which is usually undertaken by a social worker. Having a care needs assessment may have been discussed in hospital, but if not, once your relative is back at home, you can contact your local authority and request one.
You can talk to a hospital/community social worker about organising a care needs assessment.
How is a care needs assessment carried out?
The assessor will consider you/your relative’s capacity using a strengths approach: assessments should identify the strengths an individual has which could be mobilised to help them achieve their outcomes.
A strengths-based approach recognises personal, family and community resources that individuals can make use of.
The assessor will look at several different areas, including being able to prepare food, eat and drink, being able to wash and dress independently, manage the toilet and keep the home safe and clean. If you/your relative is not able to achieve specific outcomes (in other words, to do essential things for their health and well-being), they may be assessed as having eligible needs.
What happens next?
Having eligible needs does not mean your relative is automatically entitled to funding for care to meet those needs. This is because support with tasks like washing and meals is defined as social care, and unlike healthcare it is not universally free of charge.
Your local authority will carry out a ‘means test’ to consider your (or your relative’s) assets. Your assets includes savings, but does not include a home if the assessment is for you or your relative to return home, or if a spouse remains in the home.
You may qualify for funded care in your own home, but if you are not eligible because you have savings, your social worker will still draw up a care and support plan setting out how your needs can be met.
The principle is that everyone should receive the support they need to stay safe and remain in their own home, providing they are able to do so. However funding this will be within the support costs and resources that are available.
Finding out about relevant local services
There may be good local services available where you live which can help you to fulfil your needs, such as centres providing meaningful and accessible activities, befriending and practical support services. Some may be free of charge and others may include a fee. They may be provided by your local authority; however, many are provided by charities and private organisations.
Considering a care home
It may be that you or your relative have decided, due to health needs, that it is time to consider a package of care at home, or a residential or nursing placement. It may be that an acute hospital setting is no longer required, and an interim re-enablement placement is a more appropriate setting until you or your relative build confidence and feel ready to return home. Even if you may feel such a step is not likely to be an immediate one, it may be helpful to have the background information we provide here.
Funding of care home fees
There are three main categories in terms of funding for care homes:
Income/capital over £23,250
If your income and capital (including your house) are more than £23,250 you may be expected to pay for your own care. People in this category are sometimes called self-funders. In some circumstances, the value of your
home is not counted (disregarded), typically because your spouse or partner is living there.
What is a 12 Week Property Disregard?
The value of your property is disregarded from the means test for the first 12 weeks of permanent admission to a care home providing other assets are below the higher capital limit. In this instance, for up to 12 weeks or until the property sells, the Local Authority will cover the costs of the home and carry out a means tested assessment to determine how much you have to contribute towards the fees from your own income, such as pensions and attendance allowance. The funding the Local Authority provides for the 12 weeks is not repayable.
What are my options after the 12 Week Property Disregard?
It is advisable to seek specialist financial and legal advice. Options may include the following:
- Deferred Payments Agreement (at the discretion of the local authority) A deferred payment agreement is an arrangement with the local authority that lets people use the value of their homes to help pay care home If you’re eligible, the council will help to pay your care home bills on your behalf. You can delay repaying the council until you choose to sell your home, or until after your death. You will sign a legal agreement with the council, saying that the money will be repaid when your home is sold.
- Reviewing Pension Credit and Attendance Allowance
- Care Fee Income (annuity) Plans
- General Investment
Capital between £14,250 and £23,250
If you have capital between £14,250 and £23,250, you may be entitled to some funding, but will be expected to contribute towards the costs of your care.
Capital below £14,250
If your capital is below £14,250, you may receive local authority funding. You will still be expected to contribute any available income (including pension), but will retain £24.90 per week as a personal allowance.
If you qualify for full local authority funding, it is worth bearing in mind that funding is capped, as public funds are limited. This means that your choice of residential or nursing home will be limited to the homes which can meet the need, at fees within a level that the local authority is able to fund.
Your choice will be greater if you can consider care homes in a wider area (although transport links to the home are likely to be an important factor for family and friends).
Third Party Contribution (top up fees)
There is also an option referred to as a Third Party Contribution (sometimes called a top-up fee). If you find a care home whose fees exceed the local authority funding rate, family members can ‘top up’ the contribution to meet the fees. This is an option if a family wishes to pay for their preferred accommodation, which is higher than the level the local authority can fund.
Many families do this to achieve a greater choice of care home options, but it is important to consider whether you will be able to do this in the medium- to long-term (to avoid you or your relative having to move if you are no longer able to top-up fees).
It is also important to consider that a top up fee cannot be paid using the patient’s money; it must be a ‘third party contribution’, for example, paid for out of other family members’ funds.
Please note: If you qualify for full local authority funding, the local authority will only fund placements at the agreed local authority rate and will not enter into negotiations regarding any other amount.
Paying for your own care
Are you paying for your own care?
Self-funders have a wider choice of possible care home options, however will need to consider how long they are able to afford the residential/nursing home fees before their financial resources run out.
It is therefore beneficial to discuss with the home of choice in advance how long you, or your relative, would be required to self-fund prior to funds depleting. This is to ensure, if and when funds are depleted, the home is willing to accept the local authority rate and you or your relative can remain in your home of choice.
You can talk to a CHS Healthcare adviser: our specialist service provides advice and support on all aspects of care including funding for care homes and making choices. Please note, however, CHS Healthcare are not financial advisers.
Other funding and benefits
NHS-Funded Continuing Healthcare
This is continuing healthcare funding, for those individuals who have high- level or complex healthcare needs (or rapidly deteriorating end of life care needs), rather than social care needs.
The first step in the process is called a CHC Checklist Tool. Routinely, the CHC checklist will take place in a community setting, be it a care home or the person’s own home. On occasion, it may take place in a hospital setting.
If you or your relative qualify the next step is a full assessment, called the Decision Support Tool (DST). This is a much more detailed assessment, with several different professionals (multi-disciplinary team) carrying out a full review of needs.
If your relative is assessed as being eligible for continuing healthcare funding, that funding may be used to pay for care in their home, or a care home place, dependent on their needs.
If you or your relative qualifies for continuing healthcare funding, it will be re- reviewed after 12 weeks to ascertain whether the client still qualifies.
You can speak to a doctor, nurse or social worker and they will be able to advise you on whether it is appropriate for your relative to have a CHC Checklist.
More information about NHS continuing healthcare funding can be found here: www.gov.uk/government/publications/national-framework-for- nhs-continuing-healthcare-and-nhs-funded-nursing-care
PLEASE NOTE: Under 1% of patients that are screened for CHC funding will be eligible.
NHS Nursing Contribution (Funded Nursing Care)
If you require nursing care, subject to an assessment from a registered nurse, you may be eligible for help towards nursing costs. This is known as NHS Funded Nursing Care (FNC). It is not means-tested and is paid directly to the care home.
The NHS funded Nursing Care standard weekly rate has increased from
£158.16 to £165.56 for 2019 to 2020. The higher rate of NHS Funded Nursing Care will increase from £217.59 to £227.77 per week for 2019 to 2020, although this only applies to people who were already on the higher rate in 2007 when the single band was introduced.
Attendance Allowance Benefit
£58.70 – Lower Allowance
£87.65 – Higher Allowance
This is a non-means-tested benefit that can be used to pay towards care costs. The lower rate is paid if care is needed either by day or night, and the higher rate where 24-hour care is needed.
- You are not eligible to receive Attendance Allowance after the first four weeks of residence in a care home, if you are in receipt of local authority funding, unless it is interim funding or a Deferred Payments
- If you are self-funding you can continue to claim Attendance
- If you are under 65 and have care needs, Attendance Allowance is replaced by a Personal Independence Payment (PIP).
A fact sheet on Attendance Allowance can be found in the following link: