Should You Pay Care Home Fees? A Compassionate Decision Framework

So Should You Pay Care Home Fees?

I'm going to be honest with you straight away: this is one of the hardest conversations I have with families. Not because the law is complicated (though it is), but because it sits at the intersection of three things that don't always align nicely: what you're legally obligated to do, what you can actually afford, and what feels right.

Most families I speak with are already stressed. Your parent or relative is in a care home. You're managing their health, their finances, their dignity, and probably your own guilt about not being able to care for them yourself. Then someone mentions NHS Continuing Healthcare funding, or you get a letter saying the assessment has been refused, and suddenly you're wondering: do I have to pay for this? Can I challenge the decision? What happens if I don't pay?

The answer isn't yes or no. It depends on where you are in the process.

The Real Situation Most Families Face

Let me start with what I see repeatedly. Families receive a care home placement letter. The local authority or NHS tells them their relative isn't eligible for Continuing Healthcare funding. The care home quotes a figure. Maybe it's £800 a week, maybe it's £1,200. And families assume they have to pay it immediately, in full, with no questions asked.

That's not quite how it works.

What actually happens is more nuanced. You have options at different stages. Some of those options involve paying, some involve challenging, and some involve a bit of both while you wait for a proper assessment.

The problem is that nobody explains this clearly. Compass CHC will tell you to challenge everything and recover hundreds of thousands. Age UK will give you a process flowchart. Care To Be Different will tell you to never pay automatically. But none of them really acknowledge what it feels like to be in the middle of this decision, wondering if you're doing the right thing.

Where You Are Matters

The first thing to work out is: what stage are you at?

You've just been told your relative needs a care home placement, and you're waiting for a Continuing Healthcare assessment.

This is the most common scenario I see. Your relative has come out of hospital, or their needs have escalated, and someone has suggested they might be eligible for NHS funding. But the assessment hasn't happened yet. The care home is asking for payment. What do you do?

Here's the thing: you're not obligated to start paying immediately while you're waiting for that assessment. This is where the "gap in care" principle comes in, though nobody ever explains it properly. If your relative was in hospital and is being discharged into a care home, there's often a responsibility gap between the NHS and the local authority about who pays during the assessment period.

In practice, this means you might be able to negotiate with the care home to delay payment, or to pay a reduced rate, while the assessment happens. It's not guaranteed. But it's worth having the conversation. Care homes understand this happens.

Should you pay? Not necessarily. Should you have a conversation with the care home about what's realistic while you wait? Absolutely.

You've had the assessment, and you've been told your relative isn't eligible for Continuing Healthcare.

This is where it gets genuinely difficult. You've been through the assessment process. You've provided evidence. And the decision is no.

Now, you have a choice. You can accept the decision and start paying. Or you can challenge it. Or you can do something in between.

If you're going to challenge, you need to do it within a specific timeframe. And while you're challenging, you still need somewhere for your relative to live. This is where families often feel trapped. They can't afford to pay indefinitely, but they also can't afford not to while they're fighting for a different outcome.

What I'd say here is this: challenging a decision takes time. It can take months. During that time, you need to be realistic about what you can sustain financially. Some families can afford to pay while they challenge. Some can't. Some can pay a reduced rate. Some can negotiate a payment plan with the care home.

The decision about whether to challenge isn't just a legal one. It's a financial one too.

You've challenged the decision, and you're waiting for the outcome.

This is the limbo stage. You're in the appeals process. The care home still needs paying. You don't know how long this will take. And you're exhausted.

Here's what I see: families in this situation often feel guilty. They feel like they should be fighting harder, paying more, doing something more. But the reality is that you're doing what you can. And that's enough.

When Paying Actually Makes Sense

I want to say something that might surprise you: sometimes paying is the right decision.

I know that sounds odd given everything I've just said. But it's true. There are situations where challenging a decision, or trying to negotiate, or holding out for a different outcome, actually causes more harm than good.

If your relative is settled in a care home, and the stress of fighting the decision is affecting their wellbeing, sometimes paying is the compassionate choice. If you've got the financial capacity to pay, and it means your relative can stay in a place where they're happy and safe, that matters.

If you're in a situation where you've got the funds, and the alternative is months of stress and uncertainty, paying might be the right call for your family.

This isn't about giving up. It's about being realistic about what you can sustain, and what's actually in your relative's best interests.

The Conversation with the Care Home

One thing I notice is that families and care homes often talk past each other. The care home sees an unpaid bill. The family sees an impossible situation. Nobody actually has the conversation about what's realistic.

If you're in a position where you're waiting for an assessment, or you're challenging a decision, have the conversation. Tell the care home what's happening. Explain that you're not refusing to pay; you're in a process. Ask what flexibility they can offer.

Some care homes will work with you. Some won't. But you won't know unless you ask.

And here's the thing: care homes are businesses. They need to pay their staff and their bills. So be realistic about what you're asking. If you're asking them to wait six months with no payment while you challenge a decision, that's a lot. If you're asking them to accept a reduced rate while you wait for an assessment, that might be more manageable.

The relationship matters. You're going to be dealing with this care home for potentially years. It's worth investing in a conversation now.

When You Disagree with Your Family

I see this a lot too. One sibling thinks you should challenge the decision. Another thinks you should pay and move on. One thinks you should have never put your parent in a home in the first place.

These conversations are brutal. And they're made worse by the fact that you're all stressed, you're all worried about your parent, and you're all trying to do the right thing.

What I'd say is this: get the facts clear first. Understand what the decision actually says. Understand what challenging it would involve. Understand what you can realistically afford. Then have the conversation about values.

Because that's what it really is. It's not just about money or law. It's about what your family thinks is right. And that's a conversation worth having properly, not in the middle of a crisis.

The Financial Reality

Let me be direct about something. The means testing threshold for care home fees is currently £23,250. If your relative has assets below that, the local authority should fund their care. If they're above it, they pay the full cost until they drop below the threshold.

But that's not the whole story. There are different types of care. There are different funding arrangements. There are situations where your relative might be eligible for NHS-funded nursing care, which is different from Continuing Healthcare.

And there are situations where you need to think about financial planning. If you're going to be paying care home fees for years, you need to think about how that affects your relative's assets, your inheritance, and your own financial security.

This is where getting proper financial advice matters. Not just legal advice about whether you should challenge a decision, but actual financial planning about what you can sustain.

What I Won't Tell You

I want to be clear about something. I'm not going to tell you that you should definitely challenge every decision. I'm not going to tell you that you should never pay. I'm not going to tell you that there's a simple answer.

What I will tell you is that you have options. And that understanding those options, and understanding where you are in the process, makes a difference.

I'll also tell you that you're probably doing better than you think. Most families I speak with are trying their best in an impossible situation. They're not trying to dodge their responsibilities. They're trying to do right by their relative while also being realistic about what they can manage.

That's enough. You're doing enough.

Next Steps

If you're in this situation, here's what I'd suggest:

Get clear on where you actually are in the process. Not where you think you are, but where you actually are. Have you had an assessment? Has it been refused? Are you appealing? Are you waiting?

Once you know that, you can work out what your realistic options are. And you can make a decision that's right for your family, not right according to someone else's rules.

If you want to talk through your specific situation, that's what we're here for. We've helped thousands of families navigate this. We know how complicated it is. And we know that the answer depends on your circumstances, your finances, and what matters to your family.

Because at the end of the day, this isn't just about money or law. It's about your relative's dignity, your family's wellbeing, and making a decision you can live with.

Need support with funding for care homes? check out our services or call us on 0333 987 5118