NHS Continuing Healthcare
Who Pays for Care Fees
How NHS Continuing Healthcare, Funded Nursing Care and local authority funding differ, and which one applies to you.
Who pays for care home fees?
Three routes fund care in England. NHS Continuing Healthcare pays the full cost where a person has a primary health need and is not means tested. Funded Nursing Care is a fixed NHS contribution towards registered nursing in a care home. Local authority funding is means tested and charged for. Anyone above the capital threshold with no NHS funding pays privately.
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Families often discover the difference only after paying privately for a long period. The routes are not alternatives you choose between. They are decided in a set order, and CHC has to be considered first, because if it applies the other two become irrelevant.
The three funding routes
Each is assessed differently and each has a different consequence for what a family pays.
- NHS Continuing Healthcare: full NHS funding, not means tested, based on primary health need
- Funded Nursing Care: a flat weekly NHS contribution towards registered nursing in a care home
- Local authority funding: means tested, charged for, subject to capital thresholds
- Self funding: paid in full by the person where no NHS funding applies and capital is above the threshold
- Section 117 aftercare: free aftercare for people detained under certain sections of the Mental Health Act
How to prepare
Before agreeing to fund care privately, it is worth establishing which route has actually been considered.
- Ask in writing whether a CHC Checklist has ever been completed
- Request a copy of any Checklist or Decision Support Tool already carried out
- Check whether Funded Nursing Care is being paid, and from what date
- Keep every invoice and contract, which matters for any retrospective claim
- Ask the local authority to confirm what it has assessed and what it is charging for
Where people often go wrong
- Signing a care home contract before CHC has been screened
- Assuming that owning a home rules out all NHS funding
- Treating Funded Nursing Care as confirmation that CHC was properly assessed
- Paying privately for years without ever asking for a Checklist
- Believing that a past decision cannot be revisited
- Signing a care home contract before CHC has been screened
- Assuming that owning a home rules out all NHS funding
- Treating Funded Nursing Care as confirmation that CHC was properly assessed
- Paying privately for years without ever asking for a Checklist
- Believing that a past decision cannot be revisited
Why CHC has to be considered first
A local authority cannot lawfully meet needs that are properly the responsibility of the NHS. That means eligibility for CHC should be screened before a means tested package is put in place or charged for. Where that has not happened, a retrospective claim can sometimes recover fees for periods when an assessment should have taken place but did not.
Frequently Asked Questions
Is CHC means tested?
No. NHS Continuing Healthcare is free at the point of delivery and is never means tested. Income, savings, pensions and property are irrelevant to the decision. Local authority social care funding is means tested and charged for, which is the source of most of the confusion between the two systems.
What is the difference between CHC and Funded Nursing Care?
CHC funds the whole package of care, including accommodation in a care home, and applies wherever a person lives. Funded Nursing Care is a fixed weekly contribution paid to a care home with nursing, towards the registered nurse element only. A person cannot receive both at the same time.
Can I claim back care fees already paid?
Sometimes. Where care was funded privately during a period in which a CHC assessment should have taken place but did not, a retrospective claim may be possible. Success depends on the records available for that period, so keeping invoices, contracts and care plans matters a great deal.
Does owning a house affect CHC?
No. Property is not considered in a CHC decision at any stage. It is considered in a local authority financial assessment, which is a separate process. If a person is found eligible for CHC, the NHS meets the cost of care regardless of what they own.
This page explains how care funding routes work in England. It is general information rather than legal or financial advice, and it does not replace an assessment of an individual's needs or a financial assessment.