Frailty, Funding & Finances
Care can be expensive. Domiciliary care, residential care or nursing care. There is a cost whether to you or to the local authority or the NHS.
Finances is not something we want to think about when your loved one or parent is unwell and not coping. The fact that the health and social care budgets are separate can make it confusing.
The more aware you are about the different rules the less of a surprise it will be when finances need to be discussed.
It can feel very personal and unfair. Knowing the right questions to ask is important.
As a GP working in frailty, I was frequently asked by relatives about these issues. Additionally I would be involved in contributing to CHC assessments.
Here are some basics for England (there are some differences across the other nations). For more detail click on the links provided.
1. Recognising and accepting extra care can be hard but important
One of the hardest aspects of living with increasing frailty is recognising you or your relative need more help. Perhaps help on a daily basis. However this is one of the most important steps and providing extra help at home can help maintain independence longer and avoids crises when care provision (often provided by unpaid relatives and friends) breaks down and results in an detrimental hospital admission, often resulting in more dependence.
When you recognise extra care is needed you are entitled to a free “Care Needs Assessment” provided by the Local Authority. This is free whether you are a self funder or not.
If you have a friend or family member looking after you as an unpaid carer, they can get a carer’s assessment to see if they need support to carry on their caring role.
2. Self-funder or not self-funder?
If you are deemed to not be eligible for support with costs of your or your relatives care you are a “self -funder”
You will not be entitled to help with the cost of care from your local council if:
- You have savings worth more than £23,250 – this is called the upper capital limit, or UCL, and will rise to £100,000 from October 2025
- You own your own property (this only applies if you’re moving into a care home)
- You can ask your council for a financial assessment (means test) to check if you qualify for any help with costs but you can pay for care yourself if you do not want that assessment.
Read more about the financial assessment on the government website:
3. Ask about Funded Nursing care
It can be helpful to know about Funded Nursing Care. This is a top up that Self Funders get if their relative meets the requirements for Nursing Care as opposed to Residential care.
You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care.
To get an assessment for this contact your local Integrated Care Board (ICB)
If eligible for funded nursing care it is a top up that is paid at a rate of £209.19 a week often straight to the nursing care provider.
If you moved into a care home before 1 October 2007, and you were on the previous high band, NHS-funded nursing care is paid at a higher rate. In May 2022, the higher rate was set at £287.78 a week and will be backdated to 1 April 2022.
4. Continuing Healthcare Assessment
Continuing Healthcare is when you or your relative’s care and nursing costs are fully funded by the NHS.
Since I started working in frailty in 2015 meeting Continuing Healthcare Assessment requirements has become more difficult. Being honest about likely attainment of CHC is very important to avoid unrealistic expectations, frustration and disappointment.
Eligibility for Continuing Healthcare
To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:
- What help you need
- How complex your needs are
- How intense your needs can be
- How unpredictable they are, including any risks to your health if the right care is not provided at the right time
If you so wish, familiarise yourself the CHC checklist, it is downloadable here:
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
If you are not eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them. You may be eligible for funded nursing care.
5. End of Life Fast-track funding
If you or your relative are rapidly deteriorating and to avoid further delays there is the option Fast Track criteria which means the NHS will fully fund your care if there is limited life expectancy and rapid deterioration.
The fast track tool can be completed in any setting; in a hospital, for example, to expedite discharge to a more appropriate setting such as a nursing home or in the individual’s home, should they wish to remain there.
The fast track tool can be completed by an “appropriate clinician” who will complete the tool providing clear reasons to support their decision. The appropriate clinician is someone who is knowledgeable about the individual’s diagnosis and treatment. The appropriate clinician is:
- The person responsible for the diagnosis, treatment or care of the individual under the National Health Services Act 2006; and
- A registered nurse or registered medical practitioner.
This can be a useful avenue to take to ensure people spend the end of their lives in the most comfortable setting without the worry and stress of financial assessment for them or their family.
There are companies which offer advice and guidance on all aspects of this article such as:
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