Funding Live-in Care

Healthcare funding

NHS Continuing Healthcare

NHS Continuing Healthcare (CHC) is a care package provided and fully funded by the NHS for individuals with complex, on-going health needs. If you are assessed as having a 'primary health need,' the NHS covers the entire cost of your care, whether you are receiving it at home or in a care home. This can include personal care (such as assistance with washing and dressing), nursing care, and other necessary healthcare services. Unlike other forms of care funding, NHS Continuing Healthcare is not means-tested, meaning it is based solely on your healthcare needs rather than your financial circumstances.

Who is eligible for NHS Continuing Healthcare?

Eligibility for NHS Continuing Healthcare is not determined by a specific medical diagnosis. Instead, it is about the nature, intensity, complexity, or unpredictability of your health needs.

You might be eligible if you:

• Have significant on-going physical and/or mental health needs.

• Require care and support primarily focused on addressing health needs.

• Have a condition that is unlikely to improve significantly over time, necessitating long-term healthcare.

Eligibility is assessed through a thorough evaluation process carried out by your local Integrated Care Board (ICB). It is important to note that even individuals with severe disabilities or chronic illnesses may not automatically qualify.

How to apply for NHS Continuing Healthcare

If you think you or a loved one might be eligible for NHS Continuing Healthcare, the first step is to discuss it with your healthcare provider, such as your doctor, nurse, or social worker.

They can initiate the assessment process on your behalf. Alternatively, you can directly approach your local ICB and explain why you believe you should be considered for NHS Continuing Healthcare. For more detailed guidance, you can visit the NHS website to find your local ICB and access relevant resources.

How the NHS Continuing Healthcare assessment works

The NHS Continuing Healthcare assessment is a structured process designed to evaluate an individual's care needs thoroughly. Here is a clearer breakdown of how it typically works:

1. Initial screening – the checklist tool

The process usually begins with a checklist tool, filled out by a nurse, doctor, or social worker. This preliminary assessment helps determine if a full evaluation is warranted. If your on-going health needs are significant, such as after hospital rehabilitation, during a move to a nursing home, or if your condition worsens, this checklist will help identify potential eligibility for NHS Continuing Healthcare. If the checklist indicates that further assessment is needed, the process moves to the next stage.

2. Full assessment – the decision support tool (DST)

If the checklist indicates potential eligibility, a comprehensive assessment is carried out.

This involves:

• Collecting detailed information from healthcare and social care professionals involved in your care

• A multidisciplinary team (MDT) meeting to review this information

• The Decision Support Tool (DST) is used to evaluate your needs across 12 domains, such as behaviour, cognition, and mobility. The DST ensures that all aspects of your health and care needs are considered.

3. Multi-disciplinary team (MDT) meeting

The MDT, comprising various health and social care professionals, reviews the evidence and makes a recommendation regarding your eligibility for NHS Continuing Healthcare. You and/or your representative can attend this meeting to ensure your views are heard and considered.

4. ICB decision

The MDT’s recommendation is sent to the Integrated Care Board (ICB), which makes the final decision and approves the funding for your care package. While the ICB typically follows the MDT’s recommendation, there may be exceptional cases where they make a different decision.

5. Notification of the decision

After the ICB makes its decision, you will receive a written notification explaining the outcome and the reasons for it. If you are found eligible, the ICB will arrange and fund your care package. If not, the ICB will provide a detailed explanation and you have the right to appeal the decision.

6. Fast-track pathway

For those whose condition is rapidly deteriorating and nearing end-of-life, a Fast-Track Pathway is available. This expedited process ensures you receive necessary care quickly, bypassing some of the standard assessment steps.

Understanding this assessment process is crucial for securing appropriate care. If you believe you or a loved one might qualify for NHS Continuing Healthcare, starting the process early can help ensure timely and adequate care.

Self-funding Live-in Care

For many families, self-funding live-in care or paying privately for the care you need is the only option available. If your assets exceed £23,250, you may need to privately fund your care. This threshold is based on a combination of your savings, investments, and, in some cases, the value of your home.

It is important to note that this financial threshold can vary slightly depending on where you live in the UK, so it is advisable to check with your local council for specific details.

How self-funding works

When determining if you need to self-fund, a calculation of total assets are considered. Assets considered in the financial assessment include bank and building society accounts, stocks, shares, most investment products, national savings, and premium bonds. Income from government benefits, as well as any personal or occupational pension plans, are also included. Additionally, the value of property and land (minus any outstanding mortgage) is taken into account. For jointly held assets, they are typically split evenly between the owners, regardless of who contributed more to the asset.

If your assets exceed £23,250 (or the relevant threshold in your area), you will be responsible for covering the full cost of your care. If your assets total less than the lower limit of £14,250 in England, then 100% of your care should be funded.

Given the high costs associated with long-term care, it is advisable to plan ahead. This might involve restructuring your finances, exploring investment options, or considering alternative ways to fund care (such as equity release).

Equity release

For homeowners, equity release is a popular option to fund live-in care without needing to sell the family home immediately. Equity release allows you to access the value tied up in your property while continuing to live there, providing you with the capital needed to fund your care.

Understanding equity release

Equity release refers to a range of products that allow you to access the equity (cash) tied up in your home. The most common form is a lifetime mortgage, where you take out a loan secured against your home, which is repaid when your home is sold, either when you move into long-term care permanently or after your death.

How it works

With a lifetime mortgage, you borrow money against the value of your home, but you don’t have to make monthly repayments. Instead, the loan, plus any interest, is repaid when the property is sold. This option allows you to stay in your home while using its value to fund your care.

Equity release can be a flexible way to access funds, but it is essential to consider the long-term implications, such as the effect on your estate and inheritance. Interest can accumulate over time, reducing the amount of inheritance you leave behind. It’s crucial to seek independent financial advice to understand the full implications and to ensure that equity release is the right option for you.

Choosing the right product

The equity release market offers a range of products, each with its own features and benefits. Working with an independent financial advisor can help you select the right product that meets your needs and circumstances.

Home reversion plans

Home reversion plans offer another way to access the equity in your home, providing an alternative to lifetime mortgages. With a home reversion plan, you sell a part of (or all) of your home to a reversion company in exchange for a lump sum or regular payments. Unlike a lifetime mortgage, there is no interest to pay. Instead, the reversion company receives their share of your home’s value when it is eventually sold.

Care Fees Annuities (or Immediate Needs Annuities)

A care fees annuity, or immediate needs annuity, is designed to provide a guaranteed income specifically for care costs. You pay a one-time payment to purchase the annuity, and it then pays a regular income directly to your care provider. The amount depends on factors such as your age, health, and the initial sum invested. Care annuities offer peace of mind with predictable funding for life, protecting you from the risk of running out of money for care.

Deferred payment schemes

If your home is included in the financial assessment and you wish to defer selling it, you might be eligible for a Deferred Payment Agreement (DPA). This allows you to use your home as collateral for a loan from the council to cover your care costs. The loan is repaid when your home is eventually sold, either during your lifetime or from your estate. The local authority ensures that the money you owe for care is repaid by placing a charge on your property. The charge is removed when the debt is fully paid. It’s worth noting that you typically can’t exceed 70% of your home's value in care fees.

Funding from personal income, savings or investments

Some people are able to fund their care using personal income, savings, or investments. This might involve making adjustments, such as accessing your pension earlier, selling investments, or drawing from other financial resources. It is a flexible approach, but it is important to think about long-term sustainability to ensure your funds will last as long as your care.

Seeking guidance from SOLLA

Navigating the complexities of care funding can feel overwhelming, but you do not have to do it alone. The Society of Later Life Advisers (SOLLA) helps connect families with accredited financial advisors who specialise in later life planning, including care funding. A SOLLA accredited advisor can guide you through the options, helping you make the best decision for you.