NHS Care Home Funding – Understanding NHS Continuing Healthcare
NHS care home funding can be a vital lifeline for many families. Care homes in England cost on average £949 per week, with nursing home fees reaching £1,267 per week. These figures represent a substantial financial commitment for many families.
The NHS can, however, cover these costs under specific health-related circumstances. Many of our clients ask us: "Will the NHS pay for care home fees?" Your health needs determine the answer.
NHS Continuing Healthcare (CHC) is a complete care package that covers all care home fees for those who qualify. CHC funding differs from local authority support as it is not means-tested - your financial situation is irrelevant if you meet the health criteria, which is based on your health needs. When eligible for NHS care home funding, your care home placement becomes completely free, and the NHS pays the full fee.
We aim to provide clear, straightforward information about when the NHS pays for care home fees through Continuing Healthcare, the qualification process, and alternative options if you don't meet the criteria. Whether you're looking into options for yourself or a family member, understanding the difference between health and social care funding is essential for making informed decisions about care provision.
To discuss NHS care home funding call 0113 320 5000
When will the NHS pay for care home fees?
In instances where the NHS will pay for care home fees, funding is delivered through a dedicated programme for people with significant health-related needs.
Our team believes that understanding this funding system is vital for families making care decisions.
What is NHS Continuing Healthcare (CHC)?
NHS Continuing Healthcare (CHC) is a complete care package arranged and fully funded by the NHS for adults aged 18 or over with complex, ongoing healthcare needs. Unlike standard social care, CHC covers all care costs, regardless of where that care is provided. Whether in your own home, a care home, or another setting.
CHC is healthcare that goes beyond what your local council can legally provide. It serves individuals whose primary need is health-related rather than social care. This distinction matters because healthcare is free, while social care requires means-testing.
Who qualifies for NHS care home funding?
Eligibility for CHC depends entirely on your healthcare needs rather than any specific diagnosis or condition. To qualify, you must be assessed as having a "primary health need".
The assessment evaluates several key factors:
- Nature - the characteristics and type of your needs
- Complexity - how your needs interact, making care needs more challenging
- Intensity - the severity, quantity, frequency and duration of interventions needed to meet your needs
- Unpredictability - how difficult your needs are to anticipate, and how they fluctuate
For example, those requiring constant, timely, and skilled intervention might qualify. Although there is no specific condition which would qualify, those with challenging behaviour arising from severe dementia could qualify, as could a person needing skilled intervention to manage epileptic seizures. There is no “one size fits all” and an individual needs assessment is always required for those who may qualify. Those near the end of life with rapidly deteriorating health may be fast-tracked through the CHC assessment process, typically receiving care within 48 hours.
How CHC differs from other types of care funding
The main distinction of CHC is that it's completely free and not means-tested. Your financial circumstances, income, savings, or home ownership have no bearing on eligibility. Only your health needs matter.
In contrast, council-arranged social care depends on financial assessments. Meanwhile, NHS-funded Nursing Care (FNC) provides only a standard weekly contribution (£254.06 as of April 2025) toward nursing costs for those in care homes who need a registered nurse but don't qualify for full CHC funding.
CHC is also comprehensive - covering all care needs including accommodation in a care home, whereas other funding options might only cover specific aspects of care. The National Framework for Continuing Healthcare is published by the Department of Health and Social Care and sets out best practice for eligibility assessments. Local Integrated Care Boards (ICBs) manage the assessments and funding provision.
Understanding these differences can significantly impact your financial planning for care, especially since CHC removes the burden of care costs entirely when approved.
Understanding the CHC assessment process
The CHC assessment is pathway to determine if your healthcare needs qualify for NHS care home funding. Understanding each step will help you approach this process with greater confidence.
The Decision Support Tool explained
The Decision Support Tool (DST) forms the foundation of CHC assessments. This national document is intended to ensure that all care needs are evaluated before an eligibility recommendation is made. The DST examines 12 care domains, including:
- Breathing
- Nutrition
- Continence
- Skin integrity
- Mobility
- Communication
- Psychological needs
- Cognition
- Behaviour
- Drug Therapies and Medication: Symptom Control
- Altered states of Consciousness
- Other significant needs
Each domain receives a rating. These can range from "no needs" through to "priority," based on your condition's severity. These ratings then assist in the making of a recommendation as to what the overall funding decision should be The DST evaluation typically follows after a positive NHS Checklist, which is a screening tool used to decide if a full eligibility assessment is required.
What is a 'primary health need'?
The concept of "primary health need" is essential to CHC eligibility yet often misunderstood. Put simply, this means that your health care needs are more than just incidental to your social care needs.
To establish a primary health need, assessors look at four key characteristics:
- Nature - the type and characteristics of your needs
- Complexity - how your various needs interact
- Intensity - the severity and extent of support required
- Unpredictability - how difficult your needs are to anticipate
You'll typically qualify automatically if you receive a "priority" rating in any domain or "severe" ratings in at least two domains.
Who carries out the NHS care home funding assessment?
A Multidisciplinary Team (MDT) conducts the full assessment. This team must include at least two professionals from different healthcare backgrounds or one healthcare professional plus one social care assessor. This commonly involves nurses, social workers, and it’s preferable that they are already familiar with your care.
During the assessment, you have the right to participate and should receive reasonable notice to prepare. The assessment should focus wholly on your individual needs.
What happens if you're denied NHS care home funding?
If your application for NHS care home funding is unsuccessful, you can appeal the decision by requesting local resolution within six months of receiving the decision. If still dissatisfied, you can ask for an Independent Review from NHS England.
You might also qualify for partial funding through NHS-funded Nursing Care or local authority support.
What if you don't qualify for CHC?
If your CHC application is unsuccessful, you still have options for support. Local authorities offer an alternative funding route, though it operates differently from NHS care home funding.
Means-tested care home funding from local authorities
When your health needs don't meet the threshold for CHC, your local council may provide support if you qualify financially. Council support differs fundamentally from NHS care home funding - it's means-tested, examining both your income and capital assets before determining eligibility. While CHC focuses solely on healthcare needs, local authority funding primarily considers your financial situation.
How income and assets affect your eligibility for NHS care home funding
Your total capital determines financial eligibility. Currently, if your assets exceed £23,250, you'll typically need to fund care yourself. With assets between £14,250 and £23,250, you'll contribute proportionally, while those with less than £14,250 won't have these assets counted - though you'll still contribute from income.
Your council considers income (including pensions and benefits) separately. After your contribution from eligible income, they cover remaining care costs. Certain income remains protected, including:
- Disability Living Allowance mobility component
- Personal Independence Payment mobility component
- War widows' special payments
What is the Personal Expenses Allowance?
The Personal Expenses Allowance (PEA) ensures you keep some income for personal items not covered by care fees. This weekly allowance - currently £28.25 - remains yours regardless of care costs. Even those fully funded by their council maintain financial independence for personal expenses such as clothing, toiletries, and gifts.
Do you have to sell your home to pay for care?
This common question has nuanced answers. Your home isn't counted as capital if:
- Your spouse/partner still lives there
- A relative aged 60+ lives there
- A disabled relative lives there
- A dependent child under 18 lives there
The council may also decide to disregard your home on a discretionary basis.
Options like deferred payment agreements allow you to delay selling your home. This council-offered scheme provides a loan against your property value, payable when your home eventually sells or upon death. The 12-week property disregard means your home isn't counted as capital for the first 12 weeks after permanently entering care.
CHC vs Funded Nursing Care (FNC)
The differences between NHS care home funding options need careful consideration when planning care. For those who don't meet CHC criteria, another type of support exists that may help with care costs.
What is NHS Funded Nursing Care?
NHS Funded Nursing Care (FNC) is a weekly payment made directly to nursing homes that covers registered nursing care costs. The standard FNC rate in England is currently £254.06 per week, with a higher rate of £349.50 available for those who qualified before October 2007. FNC provides support for people who need nursing care but don't qualify for full CHC funding.
To be eligible for FNC, you must reside in a nursing home and require care from a registered nurse. Unlike means-tested social care, FNC eligibility doesn't depend on your financial circumstances.
How FNC is different from CHC
The main difference between these funding types concerns what they cover. CHC pays for all care costs in full, while FNC only contributes toward the nursing elements of your fees. CHC is available in any setting - your own home, a care home, or elsewhere - whereas FNC applies only to care within nursing homes.
The assessment process also differs. CHC requires proving a "primary health need" through detailed assessment, but FNC eligibility is determined by reference to your placement. You should be considered for CHC first, to avoid a situation where you’re awarded FNC but you could actually be eligible for CHC.
Can you receive both FNC and local authority support?
Yes, you can receive both FNC and local authority funding at the same time. When FNC covers only nursing aspects, your local authority may fund remaining social care needs, subject to means-testing. The important distinction is that FNC pays for healthcare needs that local authorities legally cannot fund.
In practice, this often creates a three-way payment arrangement between:
- The NHS care home funding (paying FNC directly to the home)
- Your local authority (paying some care costs after means-testing)
- You (contributing based on your financial assessment)
- Example - Dementia care and nursing home fees
Dementia creates particular challenges for funding. Many people with dementia don't qualify for CHC despite having significant needs. This happens because their needs might be classified as "primarily social" rather than health-related, despite requiring substantial care.
For someone with dementia in a nursing home, the funding arrangement might include FNC for nursing elements while other care costs fall to local authority funding or self-funding. This creates inconsistency in funding decisions, with charities like Alzheimer's Society noting many people unfairly miss opportunities for full funding.
We advise always requesting written fee breakdowns from nursing homes showing exactly how FNC payments affect your overall costs. Without this clarity, you risk the home effectively receiving payment twice. Once from you and again from the NHS.
NHS care home funding options explained
NHS care home funding requires careful consideration of all available options. NHS Continuing Healthcare offers valuable support for those with a primary health need, covering all care costs regardless of financial circumstances. Eligibility depends solely on health needs rather than specific diagnoses, with assessments examining the nature, complexity, intensity, and unpredictability of care requirements.
Alternative funding routes exist for those who don't qualify for full CHC support. Funded Nursing Care provides partial assistance specifically for nursing elements, while local authority funding becomes available based on financial assessment. Your home remains protected in several circumstances, particularly when family members continue living there.
We understand the importance of distinguishing between health and social care funding for your financial planning. The assessment process may seem daunting, but knowing your rights throughout helps ensure fair consideration of all health needs. If your initial application is unsuccessful, you can appeal.
Taking timely action is essential when pursuing appropriate funding. Each situation needs individual assessment, and early intervention often produces better outcomes. If you find the process challenging or receive a rejection you believe is unfair, speak with one of our experts who will provide trusted guidance through the NHS care home funding criteria.
While care funding systems follow strict guidelines, presenting your case properly significantly impacts success rates. With this knowledge about CHC, FNC, and local authority options, you can approach care funding decisions with confidence about potential financial support available to you or your loved ones.
Contact us to discuss NHS care home funding
We have a dedicated NHS Continuing Healthcare Funding expert who understands the complexity of NHS care home funding. Call James Urquhart-Burton on 0113 320 5000, or email @email to discuss how we can support you.
