Planning for long-term senior care is one of the most complex financial and logistical challenges UK families face. The boundary between NHS health care (free) and social care (means-tested) is one of the most confusing aspects of the UK system. This guide explains the key pathways: NHS Continuing Healthcare, local authority care assessments, care home funding, and support for family carers.
The Funding Gap
Many families assume the NHS will fund residential care for elderly relatives. In reality, NHS Continuing Healthcare only covers those with a primary health need. The majority of care home residents are means-tested by their local authority — and those with assets above £23,250 (England 2026) must fund their own care, potentially including the family home.
NHS Continuing Healthcare (CHC)
NHS Continuing Healthcare is free, NHS-funded care for adults with a primary health need. It can be delivered in a care home or at home. The key points:
- Eligibility is assessed using the NHS Decision Support Tool — it is needs-based, not age or diagnosis-based
- The full CHC assessment must be completed by an NHS multidisciplinary team
- If eligible, the NHS pays for all care costs — accommodation, nursing, and personal care
- If not eligible for full CHC, the person may qualify for NHS-Funded Nursing Care (FNC), which contributes a standard weekly rate toward nursing home fees
- Around 60,000 people in England receive CHC at any one time — far fewer than are potentially eligible
Request a CHC assessment from the NHS or local authority. If refused, you have the right to appeal through the NHS complaints process or via the Parliamentary and Health Service Ombudsman.
Local Authority Care Funding: The Means Test
If a person does not qualify for CHC, their local authority will conduct a financial assessment (means test). The thresholds in England (2026):
| Financial Position | What Happens |
|---|---|
| Assets above £23,250 | Self-funder — pays full care home costs privately |
| Assets £14,250–£23,250 | Partial LA funding — contributes to costs on a sliding scale |
| Assets below £14,250 | Local authority funds care (contribution from income may still apply) |
| Receiving NHS Continuing Healthcare | NHS pays all costs — no means test |
Important: The Family Home
The family home is usually included in the means test — but it is disregarded if a spouse, civil partner, or dependent relative still lives there. If the property is eventually included, the local authority must offer a Deferred Payment Agreement (DPA), allowing care costs to be repaid from the estate rather than requiring an immediate sale.
Types of Care Available
| Care Type | Who Provides It | Funding | Best For |
|---|---|---|---|
| Home care / domiciliary care | LA-commissioned or private agency | LA-funded or self-funded | Those able to stay at home with support |
| Extra care housing | Housing associations | Part-funded, varies | Independent living with care available |
| Residential care home | Private or charitable providers | LA-funded or self-funded | Those needing personal care but not nursing |
| Nursing home | Registered nursing providers | LA + NHS FNC or self-funded | Complex medical needs requiring nurses |
| NHS Continuing Healthcare | NHS-commissioned | Fully NHS-funded | Primary health need (highest care level) |
Support for Family Carers
If you are caring for a relative unpaid, you are entitled to a free Carer's Assessment from your local authority under the Care Act 2014. This can result in respite care, direct payments, or other support. You may also be eligible for Carer's Allowance (£81.90/week in 2026) if you care for someone for at least 35 hours per week and they receive a qualifying disability benefit.
Contact your local authority's Adult Social Care team or call Age UK (0800 678 1602) for independent guidance. Carers UK (carersuk.org) provides extensive resources and a helpline.