Paying for Care

When you have over £23,250 in savings, you will have to pay the full cost of your care. We provide advice and support to enable you to make informed decisions about arranging and paying for care, including claiming the appropriate benefits, requesting NHS continuing healthcare assessments (when appropriate) and planning to safeguard your future care for when your capital dips below this threshold.

It is important to highlight that it is the financial circumstances of the person who needs the care that are relevant, NOT the finances of their husband, wife or partner. Any jointly held assets (such as joint bank accounts) will be split 50/50.

If your savings are below £23,250 you may be entitled to some financial support from the local authority to pay towards your care. However, you will still be expected to make a contribution from your income or capital. When your savings drop below £14,250 you will only be expected to contribute from your income.

• NHS Continuing healthcare funding is available to some individuals who have complex healthcare needs. It is not means tested and is a fully funded package of care. Whether a person is eligible for CHC funding is assessed by scoring their needs using high, moderate and low-level descriptors in a two-stage assessment process. If the first stage checklist is ‘passed’, a full ‘Decision Support Tool’ document is completed at a meeting involving the person, their family members/representatives and health and social care professionals.
• Some people who are not eligible for full CHC funding, are eligible for Funded Nursing Care (FNC) which is paid by the NHS for the nursing element of nursing home fees. The contribution is paid directly to the care home and enables care home residents with specific healthcare needs to benefit from direct nursing care and services.
• Judy Timson, our clinical advisor is a registered general nurse and former continuing healthcare assessor provides advice and support to clients who are navigating NHS continuing healthcare funding. For more information on how we can help, please see HERE. Continuing Healthcare Solicitors in Warwick - Moore and Tibbits Solicitors

A personal budget is a statement prepared by the local authority as part of the care planning process. This statement sets out the amount the cost to the local authority or NHS of meeting an adult’s needs, the amount local authority or NHS will pay towards this amount (if appropriate), and the amount the adult must pay towards the cost (if appropriate). If you decide to take control of arranging your care, your personal budget can be ‘converted’ into either a personal health budget, if you are funded by the NHS, or a direct payment if your support is provided through your local authority.

Personal health budgets can be used for ongoing care and support for those eligible for NHS Continuing Healthcare (CHC), children and young people’s continuing care, and aftercare services under section 117 of the Mental Health Act. Personal health budgets can also be used as a ‘one-off’ for specific outcomes and to support children and young people with education, health and care plans (EHCPs). 

Direct payments are payments made by the local authority to a person with care and support needs. These payments are the same amount that the local authority is paying towards meeting care and support needs but paid to the person ‘directly’ for them to pay for their own care.

If a person is requesting direct payments, they must have the mental capacity to request these and manage the payments to pay for their care. The individual can also nominate a person to support them and access support to set up and manage the payments.  If the individual lacks capacity, a person authorised under the Mental Capacity Act 2005 (i.e. a deputy or Lasting Power of Attorney) must be involved.  The local authority do not have to meet needs by direct payments, and they must be satisfied that direct payments are appropriate for the person. There may be conditions attached to direct payments which if breached, can mean the direct payments are ended. 

Sometimes, a person’s preferred accommodation is beyond what the local authority is willing to pay, or what is accounted for in the ‘personal budget’ they calculate. In these circumstances, someone else such as a friend or family member (and sometimes charities), can make up the difference between the local authority contribution and the home’s fee. This is known as a third-party top-up fee and it is important to get financial advice before agreeing to pay someone’s top-up fees.

It is not lawful to pay a ‘top-up’ for eligible health and social care needs that are funded under continuing healthcare.  The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you’re assessed as needing from the NHS.  These private services should be provided by different staff and preferably in a different setting.

If you own a home and have previously lived alone, the value of that home will be taken into account. If your home is shared by your husband or wife, or certain circumstances apply, then it will not be counted in the financial assessment and will be ‘disregarded’.

If you own your home and move permanently into a care home, you may be able to take out a Deferred Payment Agreement with the local authority. This is basically a loan from the local authority, set against your property, which means that you do not need to sell your home immediately to pay for your care although interest will be applied to the loan.

The Care Act 2014 has introduced some changes to Deferred Payment Agreements. We always recommend that you seek legal advice when applying for this legally binding agreement and we provide comprehensive advice based on a full consideration of your circumstances.

Section 117 aftercare includes the support services provided to individuals after having been sectioned under sections, 3, 37,45A, 47 or 48 of the Mental Health Act 1983, to support their mental health disorder and avoid re-admission. This can include funding for their health, social care and supported accommodation needs.

Section 117 aftercare requirements are individualised and regularly reviewed. Aftercare should only stop when the services related to the patient’s mental health disorder are no longer required.