Paying for care home fees in England

Paying for a care home can be expensive, but you may be eligible to financial help from your local authority. In some cases, you might be able to get financial support from the NHS.

Care home fees if you get funding from the local authority

When paying for care home fees, the local authority will have an upper limit (known as ‘standard rate’) that they will pay for a care home.

Ideally, they will provide a list of care homes in the area within this budget and the person with dementia can choose a home from this list.

Under the Care Act, the local authority must offer at least one care home option that meets the person’s needs, but they should ideally offer more than one. It may not be possible to meet the person’s needs while staying within the standard rate. In this case, the local authority must fund the person’s care in a more expensive care home.

No one should be asked to pay a top-up fee to cover the extra costs of this home.

Care homes: When is the right time and who decides?

Advice and practical tips for carers on when is the right time for a person to be moved to a care home.

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Paying top-up fees for a more expensive care home

The person with dementia (or their carer, deputy or attorney) might want to stay in a more expensive care home. However, the local authority may have already offered a care home place within its budget that meets the person’s needs.

In this instance, the local authority may agree to part-fund the person’s place in a more expensive care home. This can happen as long as a third party (such as a relative or a charity) agrees to pay the difference. This is often referred to as a ‘top-up’ fee. 

Top-up agreements are made with the local authority, who will have a contract with the home.

The local authority must ensure that the person paying the top-up is willing and able to meet the additional cost. This person enters into a written agreement with the local authority. The agreement should include information about what will happen should fees change, or if circumstances change and fees cannot be paid.

What happens if you can't pay top up fees?

If the top-up fee stops being paid, the local authority may ask the person to move to a different care home within its budget. This new home must meet the person’s assessed needs. 

This move can be disruptive to a person with dementia. For this reason, consider if it will be possible to continue paying the extra amount for as long as is needed. Bear in mind that the care home costs might go up over time.

Selecting and moving into a care home

Our booklet will help if you're caring for or supporting someone with dementia and are looking to choose the right care home.

View and download the PDF Order a copy by post

Paying for care home costs yourself

If someone is fully paying their own care home fees, they can agree the financial arrangements directly with the care home. When making these arrangements with the care home, ensure that there is a contract detailing the home’s obligations and fees. This 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.

A person may be assessed as needing to be in a care home, but be unable to make the arrangements themselves. The local authority has a duty to make these arrangements for them. There will usually be a cost for this if the person is a self-funder.

Even if a person with dementia is paying part or all of their own care costs, it is important that they claim all the benefits to which they are entitled. Their carer or a family member may be able to help them with this.

Citizens Advice provides free, independent, confidential and impartial advice to everyone on their rights and responsibilities. Trained advisers offer information on finances in a way that is easy to understand.

If the person is paying for their own care, they may not have had their needs assessed when they moved into a care home. If it looks as though the person’s savings may fall below the upper capital threshold, the person may need local authority funding.

However, the local authority will only help with future care home fees if it has assessed the person as needing care in a care home, rather than homecare. 

This is why it is important for the person to have a needs assessment done, if it looks likely that this may happen. The person can ask the care home manager or a carer for help with arranging a needs assessment.

Paying for care in a nursing home

If the home provides nursing care, the person will need to have their nursing needs assessed. The care home manager or GP could be asked to arrange this assessment.

The NHS can often fund care provided by a registered nurse – in England, the standard rate is £235.88 weekly. Ask the care home what difference the funded nursing care payments will make to the fees, and ensure this is reflected in the contract.

When does the NHS pay for care?

Our booklet explains what NHS continuing healthcare is, who can get it, how assessments are carried out, and what to do if it is not awarded.

View and download the PDF Order a copy by post