Who pays for care home fees in England?

What are the three ways care home fees are paid?

Every care home place in England is funded through one of three routes, or a mix of them. The person pays, the council pays after testing their money, or the NHS pays after testing their health needs. Which route applies is decided by two different questions asked by two different bodies. The council asks about savings and income. The NHS asks about care needs.

The rest of this page walks through each route in turn. The first two are described in outline only, because their detailed rules and thresholds change and the live figures belong on gov.uk. The third route is where this site does its real work, because it is governed by a written national rulebook and it is the one families hear about least.

When do you pay your own care home fees?

A person pays their own fees, in full, when the council means test finds their savings and income above its threshold, or when nobody ever asked the council or the NHS to assess them. That second group is bigger than it should be. Families in a crisis take the first available bed, sign the contract the home puts in front of them, and start paying. The funding questions come later, if they come at all.

Self-funding is a lawful and sometimes sensible choice. It usually brings a wider choice of homes and a faster move. What it should never be is a default reached because no one mentioned the alternatives. Before anyone signs as a self-funder, two checks are worth the time: ask the council for a care needs assessment and a means test, and ask whether the person's health needs might qualify for NHS funding.

Paying already does not close the door. Where there is evidence the person should have been considered for CHC at the time but was not, there is a formal route to request an assessment of that past period, explained in our guide to retrospective CHC claims, and ICBs should generally only consider care provided from 1 April 2012 onwards (PUPoC guidance).

When does the council pay for care home fees?

The council pays some or all of the fees when two things line up. The person's needs meet the council's criteria for care and support, and the means test on their savings and income puts them below the charging threshold. The means test has detailed rules on what counts as capital, when a property is included, and how much a person contributes from income. Those rules carry exact figures, the figures change, and the current versions are published on gov.uk. We do not repeat numbers here that we cannot keep verified.

What matters for this page is the shape of the route. Council funding is conditional on money. It is the route most families are shown first, and for many people it is the right one. The trap is treating it as the only route, because there is a different public body whose funding decision ignores money entirely.

When does the NHS pay for care home fees?

The NHS pays when the person's main need for care is a health need. The scheme is called NHS Continuing Healthcare, or CHC, and it is governed by the National Framework, a published Department of Health and Social Care rulebook. Where CHC is awarded, the Framework glossary describes "a complete package of ongoing care arranged and funded solely by the NHS" (National Framework glossary, page 167). Our guide to what NHS Continuing Healthcare is explains the scheme and the eligibility test in plain English.

The setting does not decide the outcome. The Framework says CHC may be provided in any setting, including a care home, a hospice or the person's own home, and that eligibility is not determined by the setting where the care is provided or by who delivers it (National Framework, page 24). A diagnosis does not decide it either. The same page says the diagnosis of a particular disease or condition is not in itself a determinant of eligibility. The test is the level and type of the person's day-to-day care needs, taken in their totality.

There is also a lower NHS award called NHS-funded nursing care, or FNC, paid where a person's needs sit below the CHC bar. It is a smaller award than full CHC, and our guide to NHS-funded nursing care covers who gets it and how it interacts with the fees.

Why did nobody tell us about CHC?

If you have been paying fees for months and are only now reading the letters CHC, the anger is reasonable. Nothing on the care home invoice mentions a health-based funding route, and the money conversation usually arrives long before the health-needs one. So here is the sentence families most need to see, exactly as the rulebook prints it:

"Financial issues should not be considered as part of the decision on an individual's eligibility for NHS Continuing Healthcare."

National Framework, page 24

Read that again against your own experience. Whatever the house is worth, whatever the savings are, none of it should enter the CHC decision. The decision runs on assessed care needs under a written framework, and the same rulebook promises that funding responsibility should never simply fall into a hole between the two public bodies:

"There should be no gap in the provision of care. People should not find themselves in a situation where neither the NHS nor the relevant local authority (subject to the person's means and the person having needs that fall within the eligibility criteria for care and support) will fund care, either separately or together."

National Framework, page 22

None of this means everyone qualifies. The bar is a high one, and this page will not pretend otherwise. It means the question should be asked, on the record, for anyone whose care is driven by health needs. Asking costs nothing, and the screening threshold was designed to be generous, as the next section shows.

How do you find out if CHC applies?

The route in is a short screening called the Checklist. A practitioner scores 11 areas of daily need, and certain score combinations trigger a full assessment. The National Framework says the Checklist threshold "has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity" (National Framework, page 40). Our guide to the CHC Checklist sets out the 11 domains, the scores and the trigger rules.

A positive Checklist leads to a full assessment by a multidisciplinary team using the Decision Support Tool, and the ICB then makes the funding decision. The Framework says the time from the ICB receiving a positive Checklist to its eligibility decision should not exceed 28 calendar days in most cases (National Framework, page 55). While any of this is pending, the guidance says the person should not be left without appropriate support while they await the outcome (Checklist guidance, paragraph 27).

If you want a picture of where a case stands before asking for the formal screening, our free screener asks 18 plain-English questions about the same areas of daily care and shows whether a full assessment looks due. It takes about three minutes, and it gives you something concrete to put in front of the GP or the care home when you ask for the Checklist.

Whichever of the three routes ends up paying, ask the health question before the money question. The means test can wait a week. A funding route that ignores the means test entirely deserves to be checked first.