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19 Community care

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1. Introduction

2. Who decides what sort of care I need?

3. Who pays if I get care in my home?

4. How much will I have to pay?

5. What if I am coming out of hospital?

6. What happens if I need to move into a care home?

7. What if I need nursing care?

If you are in a care home and you need nursing care, the NHS will normally provide it directly, via community nursing, free of charge. But if you’re assessed as needing to move into a care home that provides nursing care, whether you’re moving from your own home, another residential home or from hospital, then an NHS nurse will decide what parts of your care you need a registered nurse for. The NHS will be responsible for paying for that part of your care, regardless of your income or savings.

If you’re assessed as not needing to go into a care home with nursing facilities but you decide to pay to go into one anyway, you won’t be entitled to get the NHS to pay for the nursing care. But if your needs change, your case can be reviewed. 

In England, the nurse will decide whether your nursing needs are low, medium or high and the NHS will pay an amount that matches the level of care you need. This 'banding' should normally be reviewed within three months of going into the home, and then at least once a year after that. In Wales, a flat rate fee is paid for your nursing care.

If you are unhappy with the nurse’s decision, you should contact your local ‘nursing home co-ordinator’ (in England') or ‘care home co-ordinator’ (in Wales). You can contact them through the council or your local trust or board. You can also ask for a decision to be reviewed in the same way as a ‘continuing care’ assessment on coming out of hospital.

Your care plan should set out the services to be provided by the council, for which you may have to pay, and the care paid for by the NHS. Once you’re in the home, you should speak to the home manager if you think they are trying to charge you for parts of your care that are already paid for by the NHS.

What do I have to pay for care home accomodation?

You may have to pay towards the fees for services not paid for by the NHS, such as accommodation and personal care. What you pay is, based on a set of rules that take into account:

  • how much capital you have which includes savings, stocks and shares and property you own; and
  • your income, including money you earn, and any benefits you receive.

The rules on this are complicated and we have set out only the main points here. Organisations such as Age Concern,  Help the Aged and Counsel and Care can give you more information (see 'Further help' for details).

The council looks only at your own income and savings when deciding how much you pay - it cannot take account of money or income that belongs to your husband or wife or family (but see 'What must my husband or wife do for me?').

If you have more than a certain amount of capital (currently £20,500 if you live in England, and £21,000 in Wales), you will have to pay all the fees, whatever your income. You will also normally have to find a care home yourself. If you can't do this, and you have no-one willing to do it for you, the council must help you (but you still have to pay the full fee).

If you have less than a certain amount (£20,500 if you live in England or £21,000 in Wales) or if your savings drop to this level, the council will look at how much you could afford to pay. All your income (except certain items that aren't counted) will have to go towards paying your care costs, apart from a small amount that you must be left with ('a personal expenses allowance'). If your income falls, you should pay less and the council should pick up more of the bill.

8. Will I have to sell my home?

9. What benefits may I claim?

10. What choice of home do I have?

11. What if I want to move to a care home that costs more than the council will pay?

12. What if my move into a home is temporary?

13. What rights do I have when I am in a care home?

14. What if I have difficulty getting the care I need?

15. Further Help

16. About this leaflet

This leaflet is published by the Legal Services Commission (LSC).  It was written in association with Sue Bloomfield, a freelance consumer affairs writer.

The leaflets are regularly updated but the law may have changed since they were printed so the information in them may be incorrect or out of date.

Leaflet Version: May 2019

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