Paying for care in Northern Ireland

6. Care home fees

If a person needs care provided in a residential or nursing home, they may have to contribute to the cost of their care. This will depend on the value of their assets (ie their income and capital - see below for more details on what assets are included).

When a person's capital (eg their savings) falls below a lower limit, the HSC trust will pay for their care in full. If the person has capital or savings above the upper limit, they will have to fund all of their care themselves. If they have capital or savings above the lower limit but below the upper limit, the trust will part-fund their care.

This is done on a sliding scale, so the closer to the upper limit a person is, the less the trust will fund.
Where a person does not have enough capital to fund the total cost of their care, the trust will also assess their income to decide whether they should contribute towards or pay for their care.

Financial assessment for care home fees

The trust must carry out a financial assessment in order to work out how much someone should pay for care home fees. They must follow regulations that are explained in the Charging for residential accommodation guide (CRAG).

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 the resident passes 50 per cent on to their spouse or
  • civil partner
  • personal possessions, including cars, furniture, paintings and ornaments
  • life assurance policies
  • the resident's home, if it is occupied by a spouse or civil partner, a relative (as defined in CRAG) who is over 60, or a relative who is incapacitated
  • the value of the resident's home for the first 12 weeks of a permanent move to a care home.

Price limits for care home places

There is usually an upper limit on how much the trust will spend on a person's care home fees. This is referred to as the 'standard rate'. The trust will normally tell you what their standard rate is. Often 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 that is within the trust's budget. 

The HSC trust has a duty to meet the assessed care needs of the person with dementia. Therefore, if someone has needs that can only be met in a more expensive care home than the trust would normally pay for, the trust is obliged to fund the person in that home.

Top-up fees

The HSC trust may agree to part-fund a place in a more expensive care home, as long as a third party - such as a relative or a friend - agrees to pay the difference. This difference is between what the HSC trust would usually expect to pay, based on the person's care needs, and the cost of the more expensive care home. This is often referred to as a 'top-up fee'. 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 with the HSC trust, the home and the resident. The agreement should include information about weekly care fees, what will happen should any fees change or if fees are not paid, and about any other charges you may incur - for example, for hairdressing, podiatry or optometry.

If, for any reason, the top-up fee stops being paid, the HSC trust may move the person with dementia to a care home within their budget. This new home must still meet the person's assessed needs. In addition, the trust must consider whether there would be a physical or psychological impact on the resident if a decision is made to move them to a new home. If you are thinking of paying top-up fees, this is something to bear in mind. To avoid this disruption, it is important to consider whether you will be able to continue to pay the fees for as long as is needed.

No one can be forced into paying a top-up fee, so HSC trusts can only seek top-up payments when there is a genuine alternative of a cheaper home that can meet the person's assessed needs within their budget, but where the person or their carer prefers a more expensive home.

Benefits and care home fees

When the trust is contributing to the cost of someone's care because they do not have enough capital or income to cover the cost on their own, any benefits that they are entitled to, including their state pension, will be used towards the cost of their care. The resident will be left with some spending money, known as a Personal expenses allowance. This cannot be used to pay for care. It is for the person to spend, or to be spent on the person, for additional things such as having their hair cut, toiletries, treats and presents.

If someone has savings over the trust's upper limit, and so is funding all of their care themselves, they will still get their pension and their Attendance allowance or Disability living allowance. These can be used to help pay their care home fees. 

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 the resident may see this reflected in their fees. If the home continues to charge a full fee, they should pass the contribution on to the resident. If neither a reduction in fees nor a payment is offered, you should ask the home for a breakdown of the costs.

Private funders

If someone is classed as a private funder and is assessed by the trust as being liable to pay for all of their care home fees, they can approach the care home directly and sort out the financial arrangements themselves. However, they may still wish to have a community care assessment by the HSC trust for a number of reasons.

  • The trust can only help with future fees if it has assessed the person as needing care in a care home.
  • The assessment will provide information about the type of care needed and the services available. This information may help people who are privately funding decide whether the care home they are considering is appropriate.
  • If the person is assessed as needing to be in a care home and is unable to make the necessary arrangements, the HSC trust has a duty to make arrangements for them.

There are other things to note when paying privately for a care home.

  • If the person with dementia has not been assessed when they enter a home, make sure 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' (eg podiatry services), 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 they are entitled to.
  • If the home chosen provides nursing care, there should be an assessment of any nursing care needs. (see 'Nursing care costs' above).
  • Some people choose to take financial advice to help them look through their various options.