Care home fees in Northern Ireland
If you need care provided in a residential or nursing home, you may have to contribute towards the cost of your care.
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Paying for care and support in NI
Will I have to contribute towards care home fees?
This will depend on the value of your assets. They must follow regulations that are explained in the Charging for Residential Accommodation Guide (CRAG).
In Northern Ireland, there are two ‘capital thresholds’ (limits for a person’s assets):
- Upper threshold – if the financial assessment shows that your capital is above the upper threshold (£23,250), you will be expected to pay all your own care home fees.
- Lower threshold – if your capital is below the lower threshold (£14,250), the trust will pay all of your care home fees.
- If your capital is above the lower threshold but below the upper threshold, the trust will part-fund your care. This is done on a sliding scale, so the closer to the upper threshold you are, the less the trust will fund.
If you don’t have enough capital to fund the total cost of your care, the trust will also assess your income to decide whether you should contribute towards or pay for your care.
Some assets are not included in the financial assessment. These might include:
- half of an occupational or personal pension, so that it can be given to a spouse or civil partner if they are not living in the same care home (provided that it is given to them)
- personal possessions, including jewellery, furniture and ornaments
- life assurance policies
- your home, in certain circumstances (see below).
Property and the financial assessment for care home fees
If you own your own home, this may be included in the financial assessment to determine who pays your care home fees.
However, your home will not be taken into account if one of the people in the following list also lives, and will continue to live, in the property after you have moved into a care home:
- a husband, wife or civil partner
- a close relative over the age of 60
- a dependent child
- a relative who is disabled or incapacitated.
Who is classed as a relative or close relative is defined in the CRAG document.
If your house is also the permanent home of someone who does not fall into this group but who has been caring for you, your HSC trust has discretion to decide whether or not to include the value of the home in the assessment while they are living there. This applies especially in cases where the carer has given up their own home to care for you.
Where the value of your home is included in a financial assessment, it should not be taken into account for the first 12 weeks of you living in the care home. This is called the ‘12-week property disregard’. This may mean that, during this time, the trust will pay or contribute towards the fees. This grace period can enable the family to arrange to sell the home, or speak to the trust about other options.
Price limits and top-up fees for care home places
There is usually an upper limit on how much the trust will spend on an individual’s care home fees. This is referred to as the ‘usual’ or ‘standard’ rate.
The trust will normally tell you what their limit is. Sometimes they will provide you with a list of care homes in the area that they will fund and you can choose from this list. You may also find a different home in the area yourself that is within the trust’s budget. For more information see Care homes: When is the right time and who decides?
The HSC trust has a duty to meet your assessed care needs. If it is not possible to meet your needs within their price limit, they must fund your care in a more expensive care home.
If you want to stay in a more expensive care home than the HSC trust would usually fund, they may agree to part-fund a place, as long as a third party (such as a relative. friend or a charity) agrees to pay the difference. This difference is between what the HSC trust would usually expect to pay (based on your care needs and the trust’s price limit), and the cost of the more expensive care home. This difference is often referred to as a ‘top-up fee’.
No one should be asked to pay a top-up fee, unless the HSC trust has offered a suitable care home place within its budget that meets your needs, but you (or your carer, deputy or attorney) choose for you to stay in another, more expensive home.
The CRAG states that the person with dementia cannot pay the top-up fee themselves. The HSC trust can ask the third party to pay the top-up fee to them, or to the care home directly.
If you agree to a top-up fee arrangement, it is essential to get written agreement from the HSC trust and the care home. The agreement should include information about:
- weekly care fees
- what will happen if any fees change
- what will happen if fees are not paid
- any other charges you may incur – for example, for hairdressing, podiatry or an optician.
If the top-up fee stops being paid, the HSC trust may move you to a care home within its budget. This new home must meet your assessed needs. To avoid this disruption, it is important to consider whether it is possible to continue to pay the extra amount for as long as is needed, bearing in mind that this might go up over time.
What is a Personal expenses allowance (PEA)?
The Personal expenses allowance (PEA) is the minimum amount of money you must be left with each week when you are contributing towards your care costs. You can’t be charged so much that you have less than this amount left to spend as you wish. It is not a benefit, but your own money, which is protected so you have money available to live on.
There are some circumstances where the trust can increase the amount of the PEA, for example if you are receiving certain benefits.
In Northern Ireland, the Personal expenses allowance rate for 2021/22 is £27.19 weekly.
How do benefits affect care home fees?
Certain benefits, such as the mobility part of Disability living allowance, or Personal independence payment, must not be taken into account in a financial assessment for paying for care. Some other benefits, for example the War widow’s pension, should only be partially counted.
Depending on the outcome of the financial assessment, your benefits may be affected. If you are fully self-funding, you can still receive some benefits (such as Attendance allowance), which can help towards paying care home fees.
If the trust is contributing towards these fees, then other benefits you are entitled to will go towards the cost of care (including your state pension, and any other income). In these cases, you must be left with your Personal expenses allowance (PEA).
It may help to speak to your local Citizen’s Advice or Age NI for a benefits check to find out whether financial help is available. Your carer may also find this useful – in areas such as protecting their pension rights, for example.
Care home fees for self-funders
If you are classed as a self-funder and are paying for your own care home fees, you can approach a care home directly and agree the financial arrangements together. However, you might still want to have an assessment of need by the HSC trust.
An assessment of needs will provide information about the type of care you need and what options are available. This can help you decide whether the care home you are considering is appropriate.
If you did not have your needs assessed when you moved into a care home, it is important to make sure an assessment is arranged. This is especially important if it looks as though your savings will go down over time to below the threshold.
If this happens, it could mean you’ll need HSC trust funding. The trust will only help with future care home fees if your money runs out, and if it has assessed you as needing care in a care home. You can ask the care home manager or a carer for help with arranging a needs assessment.
If you are making your own arrangements with the care home, or if a relative is doing this, you need to make sure that you are given a contract that sets out the home’s obligations and fees. You should be clear about:
- the services that are included in the fees
- what may be charged as ‘extras’
- how much notice will be given if fees increase.
If you are assessed as needing to be in a care home and are unable to make the necessary arrangements yourself, the trust has a duty to make arrangements for you. There will be a cost for this if you are a self-funder.
If you are paying part or all of your own fees, it is important that you are claiming all the benefits you are entitled to. Your carer or a family member may be able to help you with this.
If you need nursing care in a home, you will need to have your nursing needs assessed. The HSC trust can often fund care provided by a registered nurse (see below). You can ask the care home manager or your GP to help you arrange this.
Nursing care costs
Anyone who moves into a nursing home (a care home that has a registered nurse) should be assessed to see if they qualify for a ‘nursing care contribution’ from the HSC trust. This is a payment of up to £100 a week that a person who has been assessed as needing nursing care in a care home, and is capable of paying for the cost of their own care, may be eligible for.
This money will be paid directly to the nursing home, so you may see this reflected in your fees. If the home continues to charge a full fee, they should pass the contribution on to you. If neither a reduction in fees nor a payment is offered, ask the home for a breakdown of the costs.