Types of care home:

All establishments providing accommodation with personal or nursing care are now described as ‘care homes’. The main types of care home are residential and nursing homes.

‘Residential homes’ provide accommodation and help with personal care such as washing, dressing and using the toilet.

‘Nursing homes’ provide personal care and there will also be one or more qualified nurses there at all times. These are sometimes referred to as ‘care homes which provide nursing care’.

Some homes have dual registration and provide both residential and nursing care. Some care homes cater specially for people with learning disabilities, sensory disability or specific physical or mental illnesses. Homes for elderly people with some form of dementia are sometimes referred to as ‘EMI’ homes – EMI stands for ‘elderly mentally infirm’ or ‘elderly mentally ill’.

The Care Quality Commission (CQC) has responsibility for the registration and inspection of care homes. CQC Inspection Reports are available for most care homes.

Funding:

Depending on your needs and financial status, the local authority and/or NHS may partly or fully fund your care. Contact Social Care Services who will arrange an assessment to decide what type of care you will need and how it will be funded. With additional help and support in place, it may be possible to remain at home. Your views must be considered during this process.

If the local authority is likely to help with funding a care home for you, your choice may be limited – for example, the funding may not be enough to cover the cost of more expensive homes. Always contact Social Care Services to clarify your position.

If you are paying the full cost yourself, you do not have to go through the local authority. However, if there’s a chance that you may need help with fees in the future, it’s best to have your needs assessed before making private arrangements.

What should I look for when choosing a care home?

Location:

• Are you familiar with the area?
• Is it near to facilities such as shops, parks or places of worship?
• What about transport? Can it be reached by relatives and friends?

Appearance:

• Is it too big or too small for you? A large home may offer a wider range of social activities, a small one may feel more homely.
• Does it seem friendly and welcoming?
• Is it well cared-for? Does it look comfortable and smell clean?
• Is it accessible? Is there a lift? Is it wheelchair friendly?
• Is there a sitting-out area or garden?

Personal needs:

• Is there a choice of rooms? Are all the rooms en-suite?
• Can residents bring their own furniture and belongings?
• Can residents choose what to wear and what time they bathe, get up and go to bed?
• Will it be necessary to change GP or your local hospital for treatment? How are medical appointments and travel to them organised?
• Do services such as hairdressers, chiropodists and health professionals such as dentists and opticians visit the home regularly?

Life in the home:

• Do residents seem happy, well cared for and occupied?
• What are the meals like? A visit at mealtimes will give an idea of the quality, quantity and service of food.
• Is there a choice of menu? Are special diets catered for?
• Are there any restrictions on visiting times or numbers of visitors? Can visitors have meals or stay overnight?
• What leisure activities are available? Does the home offer outings?
• Can pets be accommodated? Can pets visit?

Staff:

• How are you greeted? What is your first impression?
• How do staff talk to residents – are they friendly and polite? How do residents respond? Are there staff who speak your language?
• Do staff respect privacy – knock/ask permission before entering residents’ rooms?
• What are the staffing levels at day and at night?
• Are residents escorted to appointments by staff?
• How are staff trained to deal with particular conditions such as dementia or sensory impairments?
• Can residents choose if they have a male or female carer?

Further questions:

• Does the home have a waiting list? If you really like a home, it’s worth joining the list, or if necessary join several waiting lists to get a place.
• Are there any extra charges for outings, laundry, hairdressing etc?
• Are there trial stays? If so, for how long?
• What happens if someone becomes more dependent through illness or becomes incontinent, for instance?
• What support does the home provide in relation to end-of-life care?
• Do they provide copies of their specification for care or written contract for residents? (If a local authority provides funding, they would have the contract with the home).
• How much notice is needed if someone wants to leave?
• Is it mandatory to get a Covid-19 vaccination in the care home?
• What does the care home do if a resident or staff member has a positive Covid-19 test?
• Can you read or look at the IPC (Infection Prevention and Control) policy of the home?

Further information:

National organisations which can provide information on finding and paying for care include:
Age UK Advice Line: 0800 678 1602 – www.ageuk.org.uk
Care Quality Commission (Monitors, inspects and regulates care homes): 03000 616 161 – www.cqc.org.uk
Independent Age: 0800 319 6789 – www.independentage.org

Disclaimer: Please note inclusion on our list does not imply recommendation or endorsement by Carers’ Resource.

If you need further information or would like to discuss any aspect of your caring role, please contact Carers’ Resource. We can provide this information in another format, please contact us to discuss your requirements.

Here we outline the main points relating to paying care home fees in England – the situation is different in Scotland, Wales and Northern Ireland. More details can be found in the final section, ‘Further Information’.

First steps… an assessment of your needs

Contact your local council’s social care department to arrange an assessment of your needs (telephone numbers are in ‘Further Information’). This provides an opportunity to discuss in detail your personal situation, including your health, how you are coping and what sort of help you are likely to need in the future. If it is decided that a care home will best meet your needs, the council will advise on suitable homes locally, and tell you how much they will contribute for the level of care you require.

You may be planning to fund your own care, ‘self-funding’, but you are strongly advised to have your needs assessed before moving into a care home. It is important to discuss the implications of what may happen if your money runs out – sometimes this can happen sooner than anticipated, particularly if your health deteriorates and it is necessary to pay for additional care.

Registered Nursing Care Contribution (RNCC) – also called Funded Nursing Care (FNC).

If you have been assessed as needing the care of a registered nurse in a care home, the NHS will pay (from 1 April 2024):

• Standard rate: £235.88
• Higher rate: £324.50 (the higher rate only applies if you were receiving the higher rate in 2007 before the single standard rate was introduced)

RNCC is paid directly to the home. It is important to have a contract with a care home setting out terms and conditions relating to accommodation, board and personal care and whether the nursing care element is included. For example: if the cost of the care home is quoted as £800 per week, you must ask if this figure includes the RNCC element, currently £235.88

If you are self-funding:

• If the £800 per week does include RNCC, your self-funding contribution would be £564.12 and the NHS would pay £235.88 (£800 minus £235.88 = £564.12).
• If the £800 per week does not include RNCC, you would be liable to pay the full £800 and the NHS will pay RNCC, £235.88, directly to your care home. The home would then receive a total of £1035.88 to cover all aspects of your care.

If you are partly self-funding:

• Where the total fee is split between a care home resident and the local council, the RNCC is deducted from the council’s share of the payment. The care home must show you how the RNCC reduces the total fees. If you don’t see any difference, check your contract and ask them about it.

RNCC is not paid if you have to go into hospital but you may still have to pay for your care home place during this time. RNCC does not affect your entitlement to Attendance Allowance.

Some people who have a more complex medical condition which needs ongoing specialist treatment may have the full cost of their care, including their care home fees, paid for by the NHS. This is known as NHS Continuing Health Care. If you think you may qualify for this type of care, contact relevant health providers such as hospital staff, your local GP or health authority as you will need a health assessment. It can be very difficult to qualify for NHS Continuing Care. It is important not to confuse NHS Nursing Care Contributions with NHS Continuing Health Care. Carers’ Resource can provide further information on NHS Continuing Health Care.

Next, you will have a financial assessment with your local council. The council will look at your income and capital and decide how much you may have to pay towards your care home fees.

Examples of income:

• Private and/or State Pension
• Benefits such as Pension Credit, Attendance Allowance, care component of Disability Living Allowance or daily living component of Personal Independence Payment

Your capital could include:

• savings
• investments
• property – including your home or land

It’s important to make sure you are currently getting all the benefits you are entitled to as the financial assessment of any contribution to your care home fees will be calculated on the assumption you are receiving all relevant benefits.

No matter how much you have to pay towards fees, you must be left with your own personal expense allowance, currently £30.15 per week, to spend as you wish.

There are upper and lower limits of capital which determine who will pay care home fees.

• If you have savings and capital of less than £14,250, you will not have to use any of this money to pay towards your care home fees. However, you will have to contribute all of your weekly income towards the fees (there may be some exceptions depending on your individual circumstances), except for £30.15 per week which you can keep for personal items.
• You will pay the full cost of care if your capital exceeds £23,250.
• If your capital is between £14,250 and £23,250, you and the council will jointly pay. This is how it works: For every £250 of capital over £14,250, £1 per week will be deducted from the council contribution, and will be paid by you instead.
• If your capital is less than £23,250 but your weekly income amounts to more than the care home fees and personal allowance added together, you will have to pay for your care.

Many people are naturally concerned if they share their capital or property with someone else. If they’re a couple sharing a home, will they have to sell their home?

Joint capital

You may share capital with another person or persons – a joint account in a bank or building society, for example. You will be treated as having an equal share of a joint account but only your share will be used in any calculations relating to your care costs. Having your own account(s) may simplify matters when your finances are assessed.

Jointly owned/occupied property

The value of your property will not count as capital if the following people will continue to live there (even if the house is in your name):

• husband, wife, civil partner, or someone you live with as a partner
• a close relative who is 60 or over, OR disabled
• one of your children, aged under 18 (including adopted children)
• your ex-husband, ex-wife, ex civil partner or ex-partner if this person is a single parent

The council may also choose not to count your house as capital if your carer lives there.

When your house does not count as capital:

The value of your home is not counted for the first 12 weeks after you move into a care home. This helps if you are planning to sell your home or if you are staying in a care home for a short time for respite or convalescence or for a trial period. This is called the ‘three month property disregard’.

If you are in a position where your house does count as capital but you don’t want to sell it, the local council can allow you to enter into a ‘deferred payment agreement’. So long as you have capital of less than £23,250 apart from your home and do not have enough income to pay care home fees, the council can effectively give you a loan which will be paid back when your property is eventually sold. Interest may be charged on the loan. Please contact your local council for further information regarding the rate of interest. Go to www.gov.uk/find-your-local-council for their contact details.

Deliberately trying to avoid care home payments:

You should not deliberately give away your assets such as savings or your home in order to avoid care home costs – this is sometimes known as deprivation of assets. The council and the Department for Work and Pensions (DWP) are entitled to look closely at such transactions and there is no time limit as to how far back they can investigate. If they consider there has been a deliberate ‘deprivation of assets’, they can treat the amounts involved as if they were still owned by you.

What happens next?

Following assessments of your care needs and finances, the council will be able to identify which care homes would be best suited to you and the means of paying for your care. Even if the council is funding your care, you do not necessarily have to accept a home which they have chosen – you have the right to find your own home, as long as its services and charges meet with the council’s approval.

Moving to another area

You may want to move to a home which is outside your local council’s area – to be nearer family, for example. If you have been assessed as needing care and your local council has agreed to pay for you, then they are responsible for your fees if you choose a care home somewhere else.

Third party ‘top-ups’

If the care home you choose costs more than the council would usually pay for someone with your needs, you will have the choice to ask someone (usually a friend or relative) to make up the difference. This is called a ‘third party top-up’.

The law says you are not allowed to make this additional payment yourself (except in very specific circumstances) as you have already been financially assessed to pay what you can afford.

Further Information

View our information on NHS Continuing Healthcare in our Help at Home page.

Age UK factsheets:

• Paying for permanent residential care (FS10)
• NHS Continuing Healthcare and NHS-funded nursing care (FS20)
• Finding, choosing and funding a care home (FS29)
• Property and paying for residential care (FS38)
• Paying for care in a care home if you have a partner (FS39)
• Deprivation of assets in social care (FS40)
• How to get care and support (FS41)
• Paying for short-term and temporary care in a care home (FS58)

Factsheet orders and Advice Line: 0800 678 1602 – orders@ageuk.co.uk

Online: www.ageuk.org.uk

Independent Age factsheets:

• Paying care home top-up fees
• Can I protect my assets if I need care?

Order and Helpline: 0800 319 6789

Online: www.independentage.org

Department of Health and Social Care

NHS Continuing Healthcare and NHS Funded Nursing Care: Public Information Leaflet. Available online at: www.gov.uk/government/publications/

Local authorities Health and Adult Social Care

(Contact for an assessment of care needs and arrangements for paying for care)

North Yorkshire County Council: 0300 131 2131
Bradford Metropolitan District Council: 01274 435400
Leeds City Council: 0113 222 4401

Please note: This factsheet is for general guidance only. We try to ensure our information is up to date and accurate, but please be aware that it is subject to change. You may wish to take independent professional advice before making any decisions regarding care home fees.

References: This factsheet was compiled with the help of information contained in factsheets published by Age UK and Independent Age.

If you need further information or would like to discuss any aspect of your caring role, please contact Carers’ Resource. We can provide this information in another format, please contact us to discuss your requirements.