Alzheimer's Society

Before a person with dementia moves into a care home, it is important to get advice about the kind of care that they will need and their financial situation. The person will need to know how much they will be expected to contribute towards the cost of their care and how their income and savings will be affected. This factsheet should be read in conjunction with Factsheet 431, Benefits rates and income/savings thresholds, which gives details of current capital thresholds.

All homes offering residential or nursing care are now known as care homes. For more information on the different types of care offered by care homes see Factsheet 465, Choices in care. Care homes that provide nursing care are generally more expensive than care homes that provide residential care.

Seek advice on the person with dementia's financial situation and on what benefits they are entitled to before they go into care. See 'Useful organisations' for details of organisations that can advise you.

Different ways of funding care in a care home

• Local authority social services departments are responsible for arranging funding for people who are assessed as needing care in a care home and needing assistance with funding.
• Some people pay their own fees; they may still be able to claim some social security benefits to help with the cost of fees.
• Occasionally, the NHS provides free continuing care in an NHS nursing home or an NHS-funded bed elsewhere for patients who need intensive care. For more information, ask your GP or consultant, or contact the health ombudsman.
• The NHS will cover the costs of the nursing element of any care that a person is assessed as needing.

Help with funding

Assessment of needs

The first step for a person requiring help with paying care home fees, either now or in the future, is to have their needs assessed by the local authority social services department. For more details on how to arrange an assessment and on what this involves, see Factsheet 418, Community care assessment. The local authority can only fund people who have been assessed as needing services. If a person is assessed as needing care in a care home, the local authority will assess them financially to decide how much they will have to contribute towards the cost of that care.

If the local authority decides that the person does not meet their criteria for needing care in a care home, they are not obliged to fund them, however little money the person has. If you disagree with a local authority decision, you can use the local authority complaints procedure. The social services department can explain how to do this.

Financial assessment

If a person is assessed as needing care in a care home, social services will carry out a financial assessment to decide how much that person will have to contribute towards the cost of their care.

The local authority financial assessment takes into account both income and capital.

• Income includes money received regularly − for example, from pensions and benefits.
• Capital includes savings, investments and, in some cases, the value of the person's home.

The person with dementia is only assessed on their own income and capital or on their share of jointly held resources.

Ask the local authority to provide a written explanation of how it has worked out the person with dementia's contribution. You should be clear about what has been taken into account.

Before the move to the home takes place, check what the fees cover so that there can be no misunderstandings with the local authority or the home about any 'extras'.

Points to remember

The government sets minimum and maximum capital thresholds that directly relate to whether individuals are eligible to have their care fees paid by the local authority. The upper and lower thresholds differ slightly depending on whether you live in England or Wales. See Factsheet 431, Benefits rates and income/savings thresholds for the up-to-date savings bandwidths.

• The person with dementia will be expected to claim all the benefits to which they are entitled to help pay their fees.
• If the person holds capital jointly, only their share will be taken into account in the assessment − it will be assumed that their share is 50 per cent, whatever their actual share may be.
• Half of any occupational pension will not be considered by the local authority as income, providing at least half is passed on to a husband or wife still living at home.
• Some benefits, such as the mobility component of the disability living allowance, are not counted as income and some, such as the war widow's pension, are only partially counted.

Price limits for care home places

The local authority will tell you what its usual price limits are for places in care homes offering residential or nursing care. However, if it is not possible to find a home that meets the needs of the person with dementia within the local authority's price range, the local authority should fund the person in a more expensive home.

A home can be chosen in any part of the country. The local authority is only obliged to fund a person up to the limit for their own area, or for the area the person moves to − whichever is the lowest. However, it may agree to pay more for a home if the person's assessment includes the need to move to another part of the country − for example, to be nearer to family.

The local authority may also agree to pay for a place in a more expensive home if a third party, such as a family member or a charity, agrees to pay the difference. However, before making such an arrangement, it is important to decide how increased costs will be met if the fees go up.

Frequently asked questions

Does the person's home have to be sold?

If the person with dementia owns their home, this may be counted as capital and may have to be sold to meet the cost of care home fees. If the home is not sold within a certain period of time, the local authority can put a legal charge on it and claim back what is owed when the house is sold. However, there is a period of 12 weeks' grace after the person decides to become a permanent resident at a home, during which the value of the house is not taken into account.

If the person does not wish to sell their home, or is having difficulty selling it, the local authority may offer a deferred payments scheme. This provides an interest-free loan to cover the amount needed for the care home fees, which is paid back when the person's home is eventually sold.

A person's home will not be taken into account as capital if it is occupied by:

• a husband, wife or unmarried partner
• a close relative under the age of 16, or over the age of 60
• a relative under the age of 60 who is disabled.

The local authority may also ignore the value of the house if it is the permanent home of a carer.

Will the person's relatives be liable?

When the local authority assesses the amount that the person with dementia should contribute to care, it should only consider the income and savings of that individual. However, sometimes a husband or wife is also asked to make a contribution as a 'liable relative'. This is because there is a legal principle that husbands and wives have a duty to maintain each other. No other relative can be classed as 'liable'.

If you find yourself in this position, you may want to consult your local Citizen's Advice Bureau or take legal advice. Alzheimer's Society has a list of solicitors who specialise in such matters. The local authority has no right to assess a husband or wife's finances: it can only ask them to contribute an amount that they can afford. If no agreement can be reached, the local authority may go through the courts to settle 'a reasonable amount'.

The local authority still has to fund the accommodation that the person with dementia has been assessed as needing, whether payments are being made by a liable relative or not.

What if the person is paying privately?

If the person with dementia can afford to pay their fees, they can approach a care home directly and sort out the financial arrangements themselves. However, if they may need help with the fees in the future, are unsure about the type of care they need, or are unable to make the arrangements themselves, they should ask the local authority to assess their needs.

This is because:

• the local authority can only help with future fees if it has assessed the person as needing care in a care home, and has approved the home chosen
• the assessment will provide information about the type of care needed and the services available
• if the person is assessed as needing to be in a care home and is unable to make the necessary arrangements, the local authority has a duty to make the arrangements for them.

If the local authority agrees that the person needs to enter a home, and the home meets all of the local authority's criteria, the local authority can make an agreement with the care home. Such an agreement states that the local authority will start to make a financial contribution towards costs once the person's savings drop to below a certain amount. (See Factsheet 431, Benefits rates and income/savings thresholds for current thresholds.) If no such agreement is made, there may be difficulties should the cost of care in the home be greater than the amount that the local authority is usually prepared to pay.

Other things to remember when paying privately include the following:

• If the person with dementia is not assessed before they enter a home, make sure that an assessment is arranged before their savings get too low.
• If the person is making their own arrangements with the care home, make sure that they are given a contract detailing the home's obligations and fees. It is important to be sure what services are included in the fees, what may be charged as 'extras', and how much notice is given if fees are going to be increased.
• If a person is paying their own fees, make sure they are claiming all the benefits to which they are entitled. They should continue to receive the attendance allowance or disability living allowance (care component) if they have been receiving these.
• If the home chosen provides nursing care, the person will need to have their nursing needs assessed. This is because the NHS funds care provided by a registered nurse (see below) for those assessed as being in need of such care.

Will I have to pay for nursing care?

Under the Health and Social Care Act 2001, the NHS is responsible for providing free nursing care (provided by a registered nurse) in care homes in England.

If a person may need nursing care, a registered nurse (either working at the care home or appointed by the primary care trust) will conduct an assessment of their needs. If they decide that the person's needs should be met in a nursing care home, the NHS will pay towards the nursing element of that care. Even people who are funding their own care will receive this payment. It will not affect their benefits.

In October 2007 the Department of Health changed the nursing bands from three bands (lower, middle and higher) to just one, with a standard weekly rate for people who require any nursing care. The Department of Health has stated that people who were self-funding and were receiving lower or medium band RNCC prior to October 2007 should see a reduction in their weekly care fees. If this has not happened, the Alzheimer's Society would encourage people to query the weekly care home fee with the home. Those who previously received the high band rate will continue to do so unless their circumstances change. In August of 2008, the rates were increased in line with the nurses' pay award. For current rates see Factsheet 431, Benefits rates and income/savings. For more details, see Factsheet 452, Assessments for NHS-funded nursing care.

What do I do if I have a complaint?

If you have a complaint, try to settle it on a personal level first. However, if this is not successful, talk the matter through with someone who can advise you on the best way to proceed, as funding can be very complex. Your local branches of the Citizens Advice Bureau, Alzheimer's Society or Age Concern group, or national bodies such as Help the Aged, Counsel and Care or the Relatives and Residents Association may be able to help. Counsel and Care publishes a helpful factsheet about how to make a complaint.

Each care home has its own complaints procedure. Ask for a copy if you do not already have one. If you still have concerns, contact the Commission for Social Care Inspection in England, and the Care and Social Services Inspectorate in Wales (details at the end of this factsheet).

If you have any complaints about your social services financial assessment or funding, use your local authority complaints procedure. Social services will explain how to do this. If you have any complaints about an NHS-funded nursing care assessment, use the NHS complaints procedure. Ask your local health authority to explain this. (From April 2009, there will be a new unified complaints system for health and social care in England. This means that the same complaints system will be used whether services are provided by the NHS or social services.)

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Useful organisations

Age Concern England

Freepost SWB 30375
Ashburton
Devon TQ13 7ZZ
T 0800 00 99 66 (free helpline every day 8am-7pm)
E use the enquiry form on the website (see below)
W http://www.ace.org.uk/

Provides advice and information for older people in England. Produces factsheets on topics including Finding residential and nursing home accommodation and Local authority charging procedures for care homes. Look in the phone book under 'Age Concern' for your nearest local group.

Age Concern Cymru

Ty John Pathy
13-14 Neptune Court
Vanguard Way
Cardiff CF24 5PJ
T 029 2041 3555
E enquiries@accymru.org.uk
W http://www.accymru.org.uk/

Provides advice and information for older people in Wales.

Benefit Enquiry Line (BEL)

Red Rose House
Lancaster Road
Preston
Lancashire PR1 1HB
T 0800 88 22 00 (free helpline open 8.30am-6.30pm weekdays and 9.00am-1.00pm Saturdays)
   0800 243 544 (textphone)
E BEL-Customer-Services@dwp.gsi.gov.uk
W direct.gov.uk/disability-money

National, free telephone advice and information service on benefits for people with disabilities, their carers and representatives. It is available from 8.30am to 6.30pm weekdays and from 9am to 1pm on Saturdays. Note that advisers can send out forms and give advice but they have no access to personal records.

Care and Social Services Inspectorate Wales

Cathays Park
Cardiff CF10 3NQ

T 01443 848450
E cssiw@wales.gsi.gov.uk
W http://www.cssiw.org.uk/

Inspect and review local authority social services and regulate and inspect care settings and agencies across Wales.

Citizens Advice Bureau (CAB)

Various locations
W http://www.citizensadvice.org.uk/

Your local CAB can provide information and advice in confidence or point you in the right direction. To find your nearest CAB look in the phone book, ask at your local library or look on the citizens advice website (above). Opening times vary.

Commission for Social Care Inspection (England)

33 Greycoat Street
London SW1P 2QF

T 0845 015 0120 (helpline)
E enquiries@csci.gsi.gov.uk
W http://www.csci.org.uk/

Regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England.

Counsel and Care

Twyman House
16 Bonny Street
London NW1 9PG
T 0845 300 7585 (advice line, weekdays 10am-4pm except Wednesdays 10am-1pm)
E  advice@counselandcare.org.uk
W http://www.counselandcare.org.uk/

Provides advice, information and financial support for older people, their families and carers. Produces factsheets on topics ranging from benefits to care homes, including Choosing a care home: fees and funding, Paying care home fees: community care, and Community care and the NHS: a guide to making a complaint.

Help the Aged (England)

207-221 Pentonville Road
London N1 9UZ
T 020 7278 1114
   0808 800 6565 (seniorline freephone, weekdays 9am-4pm)
E info@helptheaged.org.uk
W http://www.helptheaged.org.uk/

Help the Aged (Wales)

12 Cathedral Road
Cardiff CF11 9LJ
T 029 2034 6550
E infocymru@helptheaged.org.uk
W http://www.helptheaged.org.uk/

Provides advice by letter or phone on topics affecting older people, such as benefits, community care and home safety. Produces factsheets on topics including Paying for residential care, and Residential care: problems with local authority funding.

Help the Aged Care Fees Advisory Service

St Leonard's House
Mill Street
Eynsham
Oxford OX29 4JX
T 0500 76 74 76 (8.00am-7.00pm weekdays, 8.00am-2.00pm Saturdays)
W www.helptheaged.org.uk/carefees

Offers free, impartial and confidential financial advice on the best ways of paying for care.

Relatives and Residents Association

24 The Ivories
6-18 Northampton Street
London N1 2HY
T 020 7359 8148
   020 7359 8136 (advice line, weekdays 9.30am-4.30pm)
E info@relres.org
W http://www.relres.org/

Advises relatives and close friends of people in care homes on a range of topics, from how to get an assessment to what to do when problems occur in a home.

Factsheet 468

Last updated: October 2008
Last reviewed: October 2008

Reviewed by: Louise Lakey, Policy Officer, Alzheimer's Society