Paying for residential and nursing care

When you have care and support needs, a social care practitioner will work with you to develop a care and support plan. This may identify that to meet your needs, you require accommodation in a residential or nursing care setting.

You may have planned ahead to cover the cost of the residential or nursing care, or you may need further information before you can put a plan in place.

This article provides information about paying for residential or nursing care and how to get help to cover these costs if you are eligible. If you are looking for information on the cost of care and support costs to help you stay in your own home, read this article.  For more information on finding a care home, read this article.

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Meeting the cost of residential or nursing care

If you are a resident of South Gloucestershire, we (South Gloucestershire Council) can assess your finances and may contribute to the cost if we agree that you need to move permanently to a nursing or residential care home.

In most cases, you will have to contribute towards the cost of living in a nursing or residential care home from your own income and capital and are liable to pay charges as soon as you move in.

We may help with the costs of the care and support you receive, but how much you pay depends on your financial situation. We will look at your income and outgoings (outgoings are only considered in certain circumstances) together with the amount of savings you have – this is known as a means tested financial assessment. We will carry out the financial assessment with you to to work out your maximum contribution towards your care and support charges.

Once your financial assessment is complete, we will backdate any charges to the date that you moved into your placement.

Once the amount you have to pay towards your care has been assessed, you will be asked to pay your contribution to the residential or nursing home directly and any queries related to billing and payment should be made direct with the home.

Getting a financial assessment

If your social care worker thinks you may be eligible for ongoing care and support, they will ask our Financial Assessments and Benefits Team (FAB Team) to carry out a financial assessment. You should tell your social care worker if someone else looks after your money as they will need to be involved in your financial assessment.

You can request an estimate of the amount that you would have to contribute to your care at any time - contact the Financial Assessments and Benefits Team on 01454 864269 or email to FABTEAM@southglos.gov.uk. You can also use our care cost calculator.

You need to have all the information about your savings, investments and income available as the estimate is subject to confirmation of the information you provide.

You will be asked to complete a statement of your financial circumstances. We will then be able to work out how much you should pay towards the cost. You do not have to tell us about your finances if you do not want to, but if this is the case, we will assume that you are able to afford to pay the full cost of the care and support you receive.

There are some important things to note:

  • if your capital and savings amount to £23,250 or more, you will pay the full amount of the fees -  the value of a property which is not your former home is counted as capital e.g. a second home
  • if your capital and savings amount to less than £23,250, you will be expected to pay most (but not all) of your income for your fees - you may also need to use some of your savings
  • you will be allowed to keep about £25 of your weekly income to spend on personal items e.g. toiletries

We use Government guidelines to work out how much you will pay as follows:

  • your income, that is most of the money you have coming in will go towards the cost of your care and includes things such as welfare benefits, State Pensions and any company (works) or personal pensions
  • your capital - includes any savings in banks and building societies, stocks and shares, investments and other assets such as the value of your former home will be considered. For any savings you have between £14,250 and £23,250 we add £1 for every £250 to your weekly income when we work out your charge.

The value of your former home cannot be included as capital in your financial assessment if anyone listed below still lives there:

  • your husband, wife or partner who has lived with you as though you were married, except where you are estranged
  • a lone parent who is your estranged or divorced partner
  • a relative who is:
    • 60 or over
    • incapacitated
    • a child under 18 and who you are legally required to support

You cannot give away or dispose of your savings, assets or income to qualify for reduced charges. This is known as deprivation and you may still be treated as possessing the savings, capital asset or income, even though you do not have them. For further information,  contact the Financial Assessments and Benefits Team on 01454 864269 or by email to FABTEAM@southglos.gov.uk.

Selling your own home and deferred payment agreements

If your capital and savings amount to less than £23,250, but you own your former home, you may be eligible for some funding for the first 12 weeks of your residential placement. You will then be liable for the full amount of the fees.

We may agree to pay some of the fees and recover the money when your house is sold. This is known as a ‘deferred payment agreement’. Refer to  the article on deferred payment agreements for more information.

Your right to choose and third party top ups

Your care and support plan will identify if a specific type of accommodation is required to meet your needs. In this case you have the right to choose between different providers and/or locations of that type, either in South Gloucestershire or anywhere in England. For example, you may wish to choose to live near where you are living now, to move to a different area to be closer to your family, or to live in a specialist home such as one run by a religious organisation.

The following conditions apply:

  • the accommodation must be of the type specified in your care and support plan and suitable for your assessed needs
  • it would not cost South Gloucestershire Council more than the amount specified in your personal budget
  • the accommodation has space available. It may be necessary for you to go on a waiting list until a place becomes available, and we can arrange for you to go into alternative, suitable accommodation, or receive care at home while you are waiting. This is called an Interim Care Arrangement. Your social worker will tell you how long you are likely to wait but this will only be an estimate and not a guarantee. If the temporary accommodation we have arranged charges more than the amount in your personal budget, we will pay the difference. If you then decide to stay in that accommodation permanently, you will only be able to do so if an additional payment is made (more on this below)
  • the care provider is willing to enter into a contract with South Gloucestershire Council at the rate identified in your personal budget, and on our terms and conditions.

You may choose a nursing or residential care home that costs more than the amount that we would usually pay, or decide to stay permanently in the same setting as your temporary accommodation. There are many reasons why a home may cost more, such as because it is considered to be of a superior standard, for example offering bigger rooms or other additional services. If you do this, the difference between the accommodation’s weekly charge and your personal budget will have to be met. These are called ‘top up payments’.

When planning your admission we will arrange an assessment of your financial circumstances and calculate how much you will be required to contribute towards the cost of your care. You cannot pay the difference yourself from your own income or savings, as this is taken into account in your financial assessment to calculate your contribution.

Instead, someone else (a ‘third party’) such as a relative, friend, or charitable organisation, can make up the difference. There are exceptional circumstances when an individual can act as their own third party, and it may also be possible to defer your top up payment if you own your former home. Refer to the article on deferred payments agreements for more information about this, or speak to your social worker.

We will aim to  ensure that there is more than one affordable setting for you to choose from, and must never force you into having to pay a top up fee because no suitable accommodation is available within the amount in your personal budget.

If you are in hospital, you have the same rights if you are going to move from hospital to accommodation of your choice, but there are some special rules for this. Once the medical staff are sure that you can be discharged from hospital, the law requires that we must arrange your move within a very short period. If the accommodation that you choose does not have a place available, the hospital will not be able to allow you to stay in hospital until a place becomes available and you may need to have an Interim Care arrangement, as set out above.

When considering third party top ups as an option, it is very important that you are aware of the following:

  • The amount set in your personal budget will be reviewed regularly and may increase to ensure the amount is still sufficient to meet your eligible needs. However, we cannot guarantee that the accommodation provider will increase its costs at the same rate or at the same time, and this may affect the level of the top up payment
  • The top up will always be the difference between the care home fees and your personal budget
  • If someone is considering paying a top up fee, we will need to know that they are willing and able to make the additional payment and will continue to do so throughout the residential or nursing stay. We will therefore need to be assured that the person can afford this and will ask them to fill out a financial questionnaire and to sign a written agreement confirming they are willing and able to make the payments. If they cannot satisfy us that they will be able to afford the top up for the likely duration of the stay, we will not agree to arrange care and support in the preferred accommodation. The written agreement must include the following:
    • the amount of the top up payment
    • the amount of the person’s personal budget
    • how often payments must be paid
    • to whom the payments must be paid
    • how an arrangement is to be reviewed
    • the consequences should you be unable to continue to make a payment. This could include moving you to other accommodation
    • the effect of any increases in charges made by the provider
    • the effect of any changes in the financial circumstances of the person paying the top up
  • the person paying the top up should be aware that the top up amount may vary, as providers review their fee levels
  • if the person paying the top up is unable to continue to pay the difference you may have to move to another room within the accommodation or to other accommodation that charges fees that are within the amount set in your personal budget. Any move to other accommodation will only happen after a community care and risk assessment of your needs to make sure that the other accommodation is right for you.

There are special cross-border arrangements if you wish us to arrange for you to live in accommodation in Wales, Scotland or Northern Ireland. Speak to your social worker if you would like us to arrange this.

Funded nursing care

NHS funded nursing care (FNC) is when the NHS pays for the nursing care component of nursing home fees.

The NHS pays a flat rate directly to the care home towards the cost of this nursing care.

Nursing care means input from and supervision by a registered nurse to devise and monitor care plans, provide and administer treatment such as injections, and carry out timely medical interventions. You can find out more about funded nursing care in this article.

Continuing Healthcare

NHS continuing healthcare (CHC) is a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a ‘primary health need’ as set out in the National Framework.

You are assessed by a multidisciplinary team of health and social care professionals on an individual basis dependent upon the nature, intensity, complexity and unpredictability of your health needs. This type of care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen because of disability, accident or illness.

You can read more about CHC in the following article.

Further information and getting independent financial advice

There are lots of places you can get independent financial advice and practical help about meeting future and current care and support costs, as well as general information about money management and budgeting.  The article ‘How to get independent financial advice’ provides more information.

You can also visit the Society of Later Life Advisors (SOLLA) website, which provides information about choosing an accredited member of the Society who has with the expertise to best understand your needs and provide advice that is right for you and your family. Be aware that services may charge.

Age.UK has advice on paying for residential care, and The Money Advice Service explain more about means tests for social care costs on their website, including deferred payments and third party top ups.

Swan advocacy provide advocacy services for adult care matters.

If you or your family have any other questions about your rights to choose accommodation, talk to your social worker.

If you disagree with the amount you have been asked to contribute towards your residential or nursing care, the name and telephone number of the person in the Financial Assessments and Benefits Team who has prepared the calculation will be given on the statement. You should contact this person in the first instance as they may be able to review the assessment. If you wish to make a formal complaint, refer to   this article.

Everyone has the right to be free from harm including financial abuse. If you have any concerns about an adult at risk you must report it by calling 01454 86800. Visit the South Gloucestershire Safeguarding Board website for more information.