NHS Continuing Healthcare and paying for care: what UK families miss

The £100,000 question most families answer wrong

In England, whether the state pays for a care home place turns on two systems that families frequently confuse: NHS Continuing Healthcare (fully funded care, free at the point of use, based on health needs) and local authority means-tested support (based on money). Getting the first assessed properly can mean the difference between paying nothing and paying £60,000 a year. Yet NHS Continuing Healthcare is under-claimed, poorly explained, and frequently refused on the first attempt. This guide separates the two systems and shows where the money actually is. (Rules differ in Scotland, Wales and Northern Ireland; this focuses on England, with notes where the devolved nations diverge.)

NHS Continuing Healthcare: free care, if the need is health-led

NHS Continuing Healthcare (CHC) funds the full cost of care — including the care home fees — for adults whose need is primarily a health need rather than a social one. It is not means-tested: a millionaire and a pensioner with nothing qualify on identical criteria, which are about the nature and complexity of the need, not the diagnosis. Someone with advanced dementia, complex continuing conditions, or unstable and unpredictable needs may well be eligible.

The process starts with a Checklist screening, and if that is passed, a full Decision Support Tool assessment by a multidisciplinary team scoring needs across domains (behaviour, cognition, mobility, nutrition, continence, skin, breathing, drug therapies, and more). Two practical truths every family should know: first assessments are refused far more often than the evidence justifies, and families have a formal right to request a review and to appeal. Do not treat a "no" as final — CHC decisions are among the most successfully appealed in the whole care system. If full CHC is refused, ask specifically about NHS-funded Nursing Care (a flat weekly contribution toward the nursing element in a nursing home), which is a separate, lower award that many more people qualify for.

The means test: the £23,250 and £14,250 thresholds

If care is deemed a social rather than health need, the local authority applies a financial assessment. In England the capital thresholds have long stood at:

• Above £23,250 in capital — you are a "self-funder" and pay the full fees yourself.
• Between £14,250 and £23,250 — the council contributes, and you also pay a "tariff income" of £1 per week for every £250 of capital in this band.
• Below £14,250 — capital is ignored (though most income still counts toward the fees), and the council funds the balance.

These figures have been frozen for years and reforms have been repeatedly announced and delayed; always confirm the current thresholds, as a higher cap and a lifetime cap on care costs have been legislated at various points and their commencement has shifted.

The family home in the means test

The value of your home is disregarded if a spouse or partner still lives there, or a relative who is over 60, under 16, or disabled. It is also disregarded for the first 12 weeks of a permanent care home stay, giving families breathing room. If none of the disregards apply, the home counts as capital — which is exactly the situation the Deferred Payment Agreement exists to soften.

The Deferred Payment Agreement: keeping the home

A Deferred Payment Agreement (DPA) lets a self-funder whose main countable asset is the home delay selling it. The local authority pays the care fees and places a legal charge on the property; the accumulated amount (plus modest interest and administration fees the council may charge) is repaid later — usually when the home is eventually sold, or from the estate. The point is not to avoid paying; it is to avoid a forced sale at a bad moment, to keep the option of renting the property out to help cover fees, and to give the family time. Not everyone is eligible (there are rules about remaining capital and the type of property), and interest accrues, so it is a tool to use deliberately — but for the family whose parent''s wealth is entirely in bricks, it is often the difference between a calm transition and a fire sale.

The reliefs families routinely fail to claim

• Attendance Allowance. A non-means-tested benefit for people over State Pension age who need help with personal care — payable regardless of savings, and frequently unclaimed. It can also unlock other entitlements.
• NHS-funded Nursing Care when full CHC is refused but nursing is needed.
• The 12-week property disregard, which councils do not always volunteer.
• Top-up (third-party) arrangements — understanding when a council must offer a placement at its rate without a top-up, so families are not pushed into paying a "top-up" for a place that should have been provided.
• Deprivation of assets rules — the flip side: giving away money or the home to dodge the means test can be treated as "deliberate deprivation" and assessed as if you still had it. There is no fixed lookback period as in the US; the council judges intent, which makes amateur asset-shuffling risky.

The devolved nations, briefly

Scotland provides free personal and nursing care (paid as set weekly contributions) to those assessed as needing it, though accommodation costs are still charged and means-tested. Wales uses a weekly cap on non-residential care charges and its own capital limit for residential care. Northern Ireland runs a broadly England-like system through Health and Social Care Trusts. If you are outside England, confirm your nation''s thresholds — the principles rhyme but the numbers differ.

The order of operations

1. Request a CHC Checklist before assuming you must pay — health-led needs may be fully funded.
2. If refused, ask about NHS-funded Nursing Care and consider appealing the CHC decision.
3. Get the local authority financial assessment and claim every disregard — spouse, 12-week, relatives.
4. Claim Attendance Allowance and any linked benefits.
5. If the home is the main asset, ask about a Deferred Payment Agreement rather than selling under pressure.
6. Take independent financial advice from an adviser accredited in later-life care before committing capital.

Where Curalune fits in

The funding maze runs in parallel with the real task: finding a care home near you that has a place, meets the need, and fits the budget the assessments leave you with. Curalune Care Help prepares a shortlist of 3–5 care homes around your area matched to your situation, with contacts and a ready-to-send enquiry. CHC decisions, thresholds and deferred payment terms are always confirmed with the NHS, your local authority and an accredited adviser — the figures here are indicative and subject to reform.