How Do I Pay for Long Term Healthcare?

One in four of us may need long term care or support during our life but few of us like to think about it until it happens. People often have to make quick and difficult decisions about their own or a loved one’s care needs – encouraging clients to think about the options in advance can pay dividends. Below, Lawyer Monthly hears from Spencer Gardner at Coffin Mew, Associate Solicitor on the Court of Protection team, on the possibilities that are available.

Financial assessment:

Care and support services have never been free. Most people have to pay something towards their own care and some will have to cover the costs completely.

Local councils may contribute to the cost of care in some circumstances, but help is means-tested. Who pays depends on the individual’s level of need, how much money the individual has, and the type of care and support required.

Most people needing social care services should start by asking their local authority for an assessment. If the local authority thinks they may need support, it will carry out an assessment of their finances. This assessment will determine whether the local authority will meet all the costs of care, or whether the individual will need to contribute towards their care cost or whether they will have to meet the full costs themselves (referred to as being ‘self-funding’).

Currently, local authorities (in England) won’t provide care services if a person has more than £23,250 in savings and property. Depending on the type of care received and the living arrangements a main residence may not be considered capital. The Government’s plans to put a cap on the care costs one is expected to pay in their lifetime have recently been cancelled so those with sufficient means may have to spend a substantial sum before they arrive at the threshold for state support.


Only the partner requiring care should be means tested. If the former home is occupied by a partner, it should not be included as capital, and, if married, only half a private pension should normally be taken into account. The council has the discretion whether to apply this rule if the person is unmarried. Where savings are held jointly, the local authority will take into account only the 50% of the person needing care. Choice and third party “top-ups”:

It is up to the individual to choose their care home whether or not the council is contributing to their care fees. If the council is paying, the home must be able to meet the person’s assessed care needs, it must comply with terms and standards set by the council, and it should not cost more than the council usually pays for someone with your needs.

Councils vary in how much they pay. If the home chosen is more expensive than the council’s usual rate, someone else need to make up the difference, or “top up”, but the council will want to check they can afford to pay the “top up” throughout the stay at the care home. The resident will not be allowed to use their own capital if it’s below the means test limit.

Deferred payment agreements:

For those faced with having to sell their home to fund care fees the council should lend the money to pay for care, secured against the property via a charge, unless certain exceptions apply – this is referred as a deferred payment agreement. Alternatively letting the property can be considered, though this may not provide the guaranteed level of income required and the responsibility for upkeep of the property will be retained.

NHS continuing healthcare:

Where an individual has a disability or complex medical problem, they might qualify for free NHS continuing healthcare. This is a package of healthcare that’s arranged and funded by the NHS. It can be provided at home, or in a hospital or residential home.

The individual is required to have healthcare needs rather than social care needs. In other words, they require nursing or medical attention rather than a carer. The criteria for this funding is complicated and can be difficult to access, but it can be worth pursuing if you think the person qualifies.

Attendance allowance:

Anyone aged 65 or over and need help with personal care, they may be eligible for ‘attendance allowance’. This is not means-tested and can be used this towards care fees. If the local authority is contributing towards care costs this can no longer be claimed.

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