The issue of paying for care is a ticking time bomb. It has been a topic of government reports and investigation for over ten years, but sadly it has been kicked into the long grass by successive governments. There is less money, fewer people in the profession and more people needing care as they age. Sadly last week’s BBC Panorama programme ‘Crisis in Care’ showed the critical need for an overhaul of our current system.
I am a solicitor who has worked in the area of NHS Continuing Healthcare for over 14 years. I am, sadly, seeing first hand through my clients the system we have and how it is causing harrowing distress to families across the country. Families often have to make a quick and difficult decision to place a loved one in care. One of the most crucial questions I am asked by families is ‘how do you pay for care?’.
Whilst there have not been any significant changes in England to paying for care, in Wales, the Welsh Government has implemented changes which have made a real difference to those who require care. In Wales, the point at which people have to pay the full cost of care (set out below) has been nearly doubled since 2016 rising to £50,000, but in England it’s remained at £23,250. The Welsh Government has also capped the cost of care at home to £90 per week, meanwhile in England there is no cap.
The care system in England and Wales can be complicated and often difficult to understand, but here’s the answer I usually give.
The care system in England and Wales depends upon your health and what level of help and support you need. The value of your savings, assets and income and what local authority or NHS Funding you might be entitled to. There are also variations in England and Wales. You could end up paying for all of your care, some of it or nothing at all.
Who pays for care?
Care fees are paid in three main ways:
- Social Services: The local authority funds some of the care and the person being cared for contributes from their income, but a relative or friend of a resident may also contribute an additional fee, known as a third party top up fee.
- Self-funding: The person being cared for pays all the cost of their care due to the level of capital and income they have.
- NHS funding: If a person in care has nursing needs, they will receive a contribution towards the cost of care. If the person has significant care needs, the NHS will pay the full cost of care.
Social Services/ Self-funding
To decide if you are eligible for financial support, social services will carry out a financial assessment to determine if you should pay for your own care. In England and Wales there are capital limits (thresholds for savings and assets) which you need to be under for social services’ support.
As stated above, the upper capital limit in England is £23,250 (and £50,000 in Wales). If your capital (savings and assets) is over the capital limit, you will be a self-funder and will pay the full cost of your care.
In England, if your capital is between £23,250 and £14,250 (a lower capital limit), you have to contribute towards the cost of care; £1 for every £250 of savings between the amounts. If you are below the lower capital limit (£14,250 in England and £50,000 in Wales), you will be entitled to the maximum support from social services. You won’t need to contribute from your capital, but you will be expected to contribute from your income. The basic rule is that all your income is paid towards the care, except for a weekly Personal Expenses Allowance of £27.75 (£29.50 in Wales).
A common concern for families is where one spouse/partner requires long-term care. It is only the person who requires care that is financially assessed, therefore it is only their income or capital which can be taken into account. The family home should not be taken into account and if there is a private or occupational pension, 50% of the pension should be disregarded from the income assessment. Social Services can apply their own discretion if they feel that a higher percentage should be applied. Age UK has a good guide of what is included in a financial assessment for residential care.
Selling the family home
In some situations your home will not be taken into account by social services. For example, if the home is still occupied by your partner, spouse, a relative aged 60 years or over, a child of yours under 18 or a relative who is disabled. If you do not want to sell your home you can ask the local authority for a deferred payment agreement. This will delay paying the cost of your care until you die or could be a temporary arrangement to give you time to sell your home when you choose to do so.
NHS funding is not dependent on your financial position. If you need a residential placement with nursing and your nursing needs are not at a high level, you will be entitled to a contribution from the NHS towards your care. This is referred to as NHS funded Nursing Care or formerly Registered Nursing Care Contribution. This is paid directly from the Clinical Commissioning Group or Health Board in Wales to the nursing home.
If you have a high level and type of care, you may be entitled to full funding from the NHS. This is known as NHS continuing healthcare. Not many people know about it, so it’s important to find out if you’re eligible and get an assessment. Hugh James represent thousands of people in pursuing NHS Continuing Healthcare claims and have reclaimed over £125m in care fees.