Who Pays for Care Home Fees?
Families often ask me this question—especially when they see savings and inheritance disappearing to cover care costs. It’s an important topic, but the answer isn’t always straightforward. Let me break it down for you.
The Three Categories of Care
When it comes to long-term care, there are three main scenarios:
- Social Care Needs: If someone needs help because of age-related decline (mental or physical) but not primarily a medical condition, this is classed as Social Care. If you have assets above the means-test threshold (£23,250 in England), you pay for your own care. If your assets are below the threshold, your local council contributes.
- Social Care + Nursing Needs: If you need care and also nursing support for a medical condition, the NHS provides a fixed contribution called NHS-funded Nursing Care. For 2025/264 in England, this is £254.06 per week. The NHS covers nursing costs only—not accommodation or general care fees.
- Primary Health Need: If your need for care is mainly due to a medical condition, the NHS covers everything: care fees, nursing, and accommodation. This is called NHS Continuing Healthcare. No contribution from you or the local authority.
Eligibility for NHS Continuing Healthcare
You qualify if you have a Primary Health Need, assessed under the National Framework. Eligibility can change over time, so reviews are important:
- After hospital discharge
- At annual care reviews
- If your condition deteriorates rapidly
The Assessment Process
Your local Clinical Commissioning Group (CCG) carries out the assessment using:
- Fast Track Tool – for urgent cases or end-of-life care
- Checklist Tool – initial screening
- Decision Support Tool (DST) – detailed scoring across 11 domains (e.g., cognition, mobility, nutrition, breathing, wounds, medication needs)
The more severe or priority-level needs you have, the more likely you’ll qualify. Decisions are usually given within two weeks and can change as your condition changes.
What If You Disagree?
You can challenge the decision:
- Start with the CCG’s local resolution process
- If still unhappy, request an appeal
If you believe someone was wrongly assessed in the past, you can request a retrospective review—though claims before April last year are time-barred.
Can You Reclaim Care Fees?
Yes—if it’s decided the patient should have qualified for NHS Continuing Healthcare, care fees (including accommodation) can be refunded, even if the patient has left the care home or passed away.
Need Help?
This isn’t my area of expertise, but my friends at Compass CHC can help.