NHS Funding for Care Homes: What You Are Entitled To

Many families who contact us about care are not aware of the full range of NHS funding available to them. Some are eligible for free care but have never been told to apply. Others have been turned down once and assumed that was the final word.

This guide explains the main NHS funding routes for care home residents, who qualifies, how to apply, and what to do if you are refused. We have supported many families through this process at our homes in Lincolnshire and the Isle of Man, and we know how much difference the right funding can make.

NHS Continuing Healthcare: full funding for those who qualify

NHS Continuing Healthcare (CHC) is the most significant funding route. If your loved one qualifies, the NHS pays the full cost of their care, including accommodation and personal care. Not just the nursing element. Everything.

It is funded by the NHS rather than the local authority, and it is available to people whose primary need for care is driven by health rather than social circumstances. The key word is "primary." If someone is in a care home mainly because of a complex health condition like advanced dementia, motor neurone disease, complex stroke or end-stage cancer, they may meet the threshold.

CHC is not means-tested. Assets, savings, and property are irrelevant. If the health need is there, the funding should follow.

"We have seen families paying tens of thousands of pounds a year out of their own pocket when they were entitled to full NHS funding. In almost every case, they simply were not told to apply. Part of our job is making sure that does not happen to the families who come to us." — Pearl Healthcare

How is CHC eligibility assessed?

The assessment process uses a tool called the NHS Continuing Healthcare Decision Support Tool. It looks at a person's needs across twelve care domains:

• Behaviour
• Cognition
• Communication
• Psychological and emotional needs
• Mobility
• Nutrition (food and drink)
• Continence
• Skin integrity
• Breathing
• Drug therapies and medication
• Altered states of consciousness
• Other significant care needs

Each domain is scored as no needs, low, moderate, high, severe, or priority. The assessment looks at the overall picture, particularly at whether any needs are present that are described as "nature, intensity, complexity, or unpredictability" in a way that indicates a primary health need.

The assessment is carried out by a multidisciplinary team, typically including a nurse and a social worker, and should involve the person themselves and their family.

What triggers an assessment?

Assessments should happen automatically when certain circumstances arise, including:

• Discharge from hospital into a care home
• A significant change in health needs
• A care review that identifies increased health complexity
• A request from the person, their family, or their care home

In practice, assessments do not always happen automatically. Families often need to ask. If you believe your loved one may have a primary health need, request a CHC screening assessment through their GP, the hospital discharge team, or the Integrated Care Board (formerly Clinical Commissioning Group) in their area.

We are experienced in supporting families through this process at our homes across Lincolnshire and the Isle of Man. We can help you understand whether it is worth pursuing and who to contact.

What happens if CHC is refused?

Initial refusals are common. The process is complex, assessments are not always conducted consistently, and families who do not challenge decisions often miss out on funding they are entitled to.

If CHC is refused, you have the right to request a review. The process is:

1. Request a copy of the completed Decision Support Tool and all assessment documentation
2. Ask for written reasons for the refusal
3. Submit a local review request to the Integrated Care Board within three months
4. If the local review is unsuccessful, escalate to the Parliamentary and Health Service Ombudsman

It is also worth knowing that CHC can be backdated. If someone was eligible in the past but was never assessed or was incorrectly refused, families can apply for a retrospective review going back up to three years in some cases. If your loved one was in a care home before they passed away and was never offered a CHC assessment, it is worth looking into this.

Independent advocacy organisations, such as the Beacon CHC advisory service, can help families navigate the appeals process.

NHS-funded Nursing Care: a smaller but important contribution

For people who do not qualify for full CHC but are living in a nursing home and have nursing needs, the NHS pays a flat weekly contribution called NHS-funded Nursing Care (FNC).

FNC is paid directly to the nursing home and covers the registered nurse element of care. It does not cover accommodation or personal care. The rate is reviewed annually. [FLAG: insert current FNC rate at time of publishing]

FNC eligibility is usually assessed as part of the CHC process. If someone is found not to meet the CHC threshold but is in a nursing home, FNC should be considered automatically.

It is worth noting that our homes are registered as residential care homes rather than nursing homes, so FNC does not apply to our residents. CHC, however, can apply in any registered care setting, including ours.

Fast-track CHC: urgent end-of-life cases

Where someone has a rapidly deteriorating condition and may be approaching the end of their life, a fast-track CHC assessment can be completed within 48 hours rather than the standard process, which can take weeks.

A healthcare professional, such as a GP, consultant, or specialist nurse, completes a fast-track tool setting out the clinical picture. If approved, funding starts immediately.

If your loved one is in this situation and you are not sure whether a fast-track referral has been made, ask the clinical team directly. Our palliative care team works closely with GPs and specialist nurses and can help coordinate this where appropriate.

Local authority funding: means-tested support

While not NHS funding, local authority funding is the other major route families rely on. It is means-tested, so assets and income are taken into account.

In England, if a person's assets fall below £23,250 they may qualify for local authority funding. The local authority will carry out a financial assessment and a care needs assessment, and if eligible, they will pay care costs up to their standard rate. [FLAG: confirm threshold is current at time of publishing]

If the care home of their choice charges more than the local authority rate, a third-party top-up can bridge the gap. This is typically paid by a family member.

Local authority funding and CHC can interact. If someone starts as a local authority-funded resident and their health needs later escalate significantly, a CHC assessment should be triggered. The local authority has a responsibility to flag this, though again, families often need to prompt the process.

What about the 12-week property disregard?

If someone moves into a care home and owns a property, the value of that property is disregarded from the means test for the first 12 weeks of their permanent stay. This gives families time to make decisions about the property without being pushed into an immediate sale.

After 12 weeks, the property value is included in the financial assessment unless it is occupied by a spouse, partner, or dependent relative, in which case it continues to be disregarded.

Key questions to ask when exploring NHS funding

• Has a CHC screening or full assessment ever been carried out?
• If refused, were we given written reasons and information about how to appeal?
• Has fast-track CHC been considered if the condition is deteriorating rapidly?
• Is the person in a nursing home where FNC may apply?
• Has a local authority financial assessment been completed?
• If circumstances change, who will trigger a reassessment?

How we can help

When families contact us about care at our homes across Lincolnshire and the Isle of Man, funding is almost always part of the conversation. We are not financial advisers, but we know the system, we understand the process, and we will point you in the right direction at every step.

If you believe your loved one may be eligible for CHC, or if you want to understand your options before making any decisions, get in touch with our team. We will talk it through with you honestly.