Do People with Dementia Have to Pay Care Home Fees?

The rules can feel complicated, so it is important to request the appropriate assessments and obtain a clear explanation of the decision.

Does dementia mean care is free?

A dementia diagnosis does not automatically mean that the NHS or local authority will pay all care home fees.

A person’s dementia may affect the type and level of care they need, but funding decisions are based on a full assessment. This looks at the person’s care needs, health, daily living and finances.

In England, the local authority generally considers contributing towards social care costs when a person has capital below £23,250, although the exact assessment depends on the person’s circumstances and the type of care required.www

The value of a person’s home may be treated differently depending on their circumstances, including whether a partner or certain qualifying relative continues to live there. It is important to obtain individual advice rather than assume that the property will or will not be included.

What assessments are needed?

There are usually two separate assessments:

Care needs assessment

The local authority assesses what help the person needs with daily living, safety and wellbeing. This may cover:

• Washing and dressing.

• Eating and drinking.

• Mobility.

• Managing medication.

• Communication.

• Memory and orientation.

• Behavioural or psychological needs.

• Staying safe at home.

• Maintaining relationships and activities.

Financial assessment

If the person is eligible for support, the council may carry out a means test. This looks at income, savings, investments and other relevant financial information.

The financial assessment is free and normally takes place after a needs assessment.

When might the NHS pay care home fees?

Some people with dementia may qualify for NHS Continuing Healthcare. This is not awarded because of a diagnosis alone. It is based on whether the person has a primary health need following a full assessment.

If someone qualifies for NHS Continuing Healthcare in a care home, the NHS may pay the care home fees covered by the agreed package. If the person receives care at home, NHS Continuing Healthcare can cover assessed health and associated care needs.ageuk

People whose condition is rapidly deteriorating and may be entering a terminal phase may be considered for the Fast Track pathway. An appropriate clinician must complete the Fast Track assessment.

Ask the GP, community nurse, social worker or another healthcare professional whether an NHS Continuing Healthcare Checklist should be completed.

What is NHS-funded nursing care?

NHS-funded nursing care is different from NHS Continuing Healthcare.

It may apply when:

• The person lives in a registered nursing home.

• They have been assessed as needing care from a registered nurse.

• They do not qualify for full NHS Continuing Healthcare.

The NHS pays a contribution towards the nursing element of the placement. The person or local authority may still need to pay other care home costs.

Ask the care home or NHS team to explain exactly what is covered.

What if the person has no money?

If a person cannot afford care, they should not simply be left without support. The local authority should complete a needs assessment and financial assessment.

Depending on the result, the council may contribute towards care costs. However, a person’s contribution is calculated individually, and families may need to consider whether the council’s usual rate covers the full fee charged by the chosen care home.

Before agreeing to a placement, ask:

• What is the weekly fee?

• What does it include?

• Is the fee likely to increase?

• Who will pay the difference if the council’s contribution is lower?

• Are there additional charges?

• What happens if the person’s needs increase?

Do not sign a third-party top-up agreement without understanding the financial commitment.

Can someone with dementia remain at home?

A care home is not the only option. Depending on the person’s needs and safety, support may be provided at home through:

• Home care visits.

• Live-in care, where suitable.

• Community nursing.

• Respite care.

• Day services.

• Family and unpaid carers.

• Equipment and home adaptations.

The right option depends on the person’s preferences, needs, risks and available support.

If you are arranging dementia care in West Sussex, Ashton Care can discuss practical care options and help you identify the questions to ask about funding and support. We cannot decide whether someone qualifies for NHS or council funding, so eligibility should be confirmed with the relevant NHS or local authority team.