Paying care fees: Be careful what you read

Paying care fees: Be careful what you read

Choosing Between True and False

What you read about care fees may lead you to being wrongly charged

There are many websites and guides available about paying care fees, but they don’t all give you the full picture. Many are actually misleading – even if they don’t mean to be. So be careful when you’re researching on behalf of yourself or a relative.

Most information published on the web and elsewhere about care fees and care funding focuses first on means testing and local authority funding. However, this often leads families down the path of paying for care when it’s not appropriate.

Many families are also given misleading information by the health and social care authorities themselves. This is clear from the experiences of hundreds of families who contact us.

Whether or not you pay for care does not depend on your financial situation. It depends on your care needs. That’s something few families seem to be told.

It’s an assessment for NHS Continuing Healthcare that actually decides who is responsible for paying for care – not whether a person has savings or a house. This principle is reinforced in the National Framework for NHS Continuing Healthcare and is also supported in the new Care Act 2014, including when a person is being discharged from hospital.

In most guides and books about care and care matters, NHS Continuing Healthcare is usually given just a very small mention as an ‘aside’ – if indeed it gets any mention at all – and this exacerbates the problem. The undue focus on local authority funding, capital thresholds and means testing is exactly what has led to the tens of thousands of retrospective claims for NHS Continuing Healthcare in recent years – not to mention untold distress to families when they realise their relatives should not have been means tested in the first place.

By assessing for financial means first, instead of for NHS Continuing Healthcare eligibility, a local authority (and those working within it) are putting themselves in a potentially unlawful position, as the care needs they are potentially taking responsibility for may be beyond the legal limit for local authority care. This is clear in case law, including the Coughlan case, but sadly often seems to be ignored by both the NHS and local authorities.

So if you’re reading information online or elsewhere about care fees, or receiving advice about paying for care, remember that it first has to be properly established who is actually responsible for paying (i.e. the NHS or the local authority).

Another common thread in many guides to care fees is Funded Nursing Care (FNC). Very often families will read, or be told, that this payment may be available to help with care fees. What they should be told is that FNC is only awarded after an assessment for NHS Continuing Healthcare – and it is given to people with some nursing care needs who don’t qualify for full Continuing Healthcare funding. Families report that FNC is instead often given without any reference to full funding – and this means a person may be wrongly paying for the majority of their care themselves.

Read more about Funded Nursing Care (FNC)

Read more about NHS Continuing Healthcare


  1. Eric Barrow 2 years ago

    My mother has been assessed for continuing health care funding and turned down for it, I think unfairly, however she is to be moved from hospital into a nursing home and I am being pressurised by social services to complete a means test for my mother. I thought nursing home fees were paid by the nhs, would anybody be able to let me know if I have this wrong

    • Care to be Different 2 years ago

      Hi Eric – sadly this is not the case. However, you might wish to look at appealing the decision no to grant funding. We can assist with that if you wish us to look at it. Regards

      • Eric Barrow 2 years ago

        Many thanks for your reply. We did appeal the dst result last Friday with the result given that my mother was not entitled to continuing health funding but was entitled to further nursing funding of around £155 per week and to be placed in a nursing home with 24 hour nursing care. Looking at the Coughlan case conclusion that the vast majority of nursing home residents should be receiving fully funded nhs care I am confused as to why my mother should be denied this, after all it is not a care home or residential home she will be going into

        • Care to be Different 2 years ago

          Hi Eric – I am afraid that this is not the case inspite of Coughlan. You do have the right to appeal further to NHS England if you wish. Do come back to us if you need any further support or guidance with this. Regards

  2. Chantal 5 years ago

    Care homes should have a contract but the care home where our friend for whom we have POA asked us to sign a contract that had nothing to do with people with dementia in March 2014. We refused to sign it and asked to have it amended to suit people with dementia. We are still waiting so in effect have signed no contract. Our friend went in in Feb 2014.

    • Angela Sherman 5 years ago

      Is the home an EMI registered home, Chantal? (EMI = Elderly Mentally Infirm; this should be shown on their registration if they are.)

  3. Roger Wharton 5 years ago

    Thank you for posting this article. It is very informative and leads usefully to other sources of information. One aspect I have come across that is not mentioned is the ability for Care Homes to charge for additional g-fess for services that are not covered by the ‘free at the point of delivery’ principle. I believe it is is alluded to in statutory guidance but have not yet been able to track it down. In practice, though, I see that CCGs around the country interpret this in different ways. For instance in the London area, CCGs limit ‘additional service charges’ to hairdressing and alcohol. In Norfolk, they take a broader approach and allow other faciilties such as wide screen tv, larger rooms and so on. This is leading to a different approach across the country and is confusing potential residents. We need to have a common policy on this so that residents and Care Homes are not disadvantaged. I would be grateful for more guidance about this.

    • Angela Sherman 5 years ago

      Care homes should have a contract with a resident highlighting clearly what is and isn’t included for the quoted fees. It’s my understanding that, as long as the actual contract is legal, care homes can decide what they will and won’t include. When it comes to NHS Continuing Healthcare funding, though, the resident should be covered for all care relating to the assessed care needs, plus accommodation, food, etc. There may be additional services that are chargeable, such as chiropody (unless it’s part of the car package already), hairdressing, etc.

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