Who pays for care home fees in England?
In England, care home fees are paid in one of three ways. The NHS pays in full if the person qualifies for NHS Continuing Healthcare. The council helps if the person’s capital is below £23,250. Otherwise the person pays their own fees, and the NHS may add funded nursing care in a nursing home.
Who pays for care home fees in England?
When a family asks who pays care home fees, the answer in England depends on two tests run by two different bodies. The NHS test, for NHS Continuing Healthcare (CHC), looks at health needs and ignores money. The council’s test looks at care needs and then at money. If neither pays, the person pays their own fees. Some people get a mix, such as council help plus NHS-funded Nursing Care (FNC), an NHS payment towards nursing.
| Who pays | Who decides | What the test looks at | What it covers |
|---|---|---|---|
| The NHS, through Continuing Healthcare | The integrated care board (ICB), the local NHS body for CHC | Health needs only, under the National Framework (the government’s rulebook for CHC) | The full cost of the care, in a care home or at home |
| The council | The local council | Care needs first, then a financial assessment of income and capital | Some or all of the fee, with the person paying a contribution from their income |
| The person (self-funding) | The person and the care home | Capital above £23,250, or nobody has asked for an assessment | The full fee, less any FNC the NHS pays to a nursing home |
Sources: National Framework (July 2022 revision), page 24 and glossary; social care charging circular 2026 to 2027 (DHSC, 17 February 2026).
In 2025 to 2026, councils in England paid an average of £1,251.09 for a week of residential or nursing care. It was highest in London at £1,390 and lowest in the East Midlands at £1,101. These figures come from the adult social care finance report by the Department of Health and Social Care (DHSC), published on 22 October 2026. Self-funders pay whatever their own home charges, which can differ from what a council pays.
When do you pay your own care home fees?
A person pays their own fees in full when their capital is above the upper limit. For 2026 to 2027 that limit is £23,250 (DHSC local authority circular, 17 February 2026). Capital means savings, investments and property. It includes the person’s home once they move into a care home for good, unless one of the home disregards below applies. The council can still arrange the place if asked, although it doesn’t have to. Either way, the person pays the full cost until their capital falls below the limit (Care and Support Statutory Guidance, paragraph 8.13).
Self-funding can start in a hurry, with the first bed available and a contract signed on the day. Paying privately can be a sensible choice, and it can widen the choice of homes. Before anyone signs, though, ask two questions. Has the council assessed the person’s needs and money? Has anyone asked whether their health needs might qualify for NHS funding?
Paying already doesn’t close the door on NHS funding. If the person should have been considered for CHC and wasn’t, you can ask for that past period to be assessed. Our guide to retrospective CHC claims explains how. We can also help you claim back care fees already paid.
When does the council pay for care home fees?
Local authority care home funding comes after two assessments. First the council assesses the person’s care needs, which is free. If it decides those needs should be met in a care home, it carries out a financial assessment of income and capital. A couple can’t be assessed on their joint money, so each person is assessed on their own (Care and Support Statutory Guidance, paragraph 8.8).
| The person’s capital | What happens |
|---|---|
| Above £23,250 | The person pays the full fee. |
| Between £14,250 and £23,250 | The council helps. The person pays from their income, plus £1 a week for every £250 of capital between the two limits. This is called tariff income. |
| Below £14,250 | The council helps. Capital isn’t counted, and the person pays only what they can afford from their income. |
Source: Social care charging for care and support 2026 to 2027, local authority circular, Department of Health and Social Care, 17 February 2026.
When the council helps, the person still pays towards the fee from their income. They keep a weekly personal expenses allowance for their own use. For 2026 to 2027 the allowance rose from £30.65 to £31.80 a week (same circular).
Do you have to sell your house to pay for care?
Not always, and not straight away. Three rules protect the home while the person is in a care home.
The 12-week property disregard
The council must ignore the value of the person’s main or only home for their first 12 weeks in a care home. This applies when the move is permanent and their other capital is below £23,250. During those weeks the council helps with the fees. That gives the family time to decide what to do without selling in a rush (Care and Support Statutory Guidance, Annex B and Annex H).
When the home is ignored altogether
The council must ignore the home’s value while certain people still live there. They must have lived there since before the person moved into care. The Care and Support Statutory Guidance lists them (Annex B, paragraph 34):
- a husband, wife or partner, unless they’re estranged
- a relative aged 60 or over
- a child of the person aged under 18
- a relative who is incapacitated
Councils can choose to ignore the home in some other situations too.
Deferred payment agreements
If the home does count, a deferred payment agreement lets the council pay the care fees now. It recovers the money later from the value of the home, for example when it’s sold or from the estate. The council must offer one to people who meet the rules (paragraph 9.7). The rules include having £23,250 or less in other assets and a home that isn’t disregarded. The council secures the debt with a legal charge on the property.
If the person qualifies for CHC, the house never enters the calculation (National Framework, page 24). So ask the health question before anyone puts a house on the market.
Are next of kin responsible for care home fees?
No. In England the person receiving care is responsible for their own fees. The council assesses that person’s own income and capital. There’s no rule that passes a parent’s care bill to a son or daughter because they’re next of kin.
A relative can become liable by signing something in their own name, such as a top-up agreement or a care home contract as a guarantor. Homes sometimes put these papers in front of families on the day of admission. You can take the contract away, read it, and ask what happens if you don’t sign.
When does the NHS pay for care home fees?
NHS funding for care homes comes in two forms. There’s also a special case for people who have been detained under the Mental Health Act.
NHS Continuing Healthcare
CHC depends on a primary health need, which means most of the person’s care is about meeting or preventing health needs. If the assessment finds one, the NHS pays for the whole care package. The National Framework calls it “a complete package of ongoing care arranged and funded solely by the NHS” (glossary, page 167). It isn’t means tested. It can be provided in any setting, including a care home or the person’s own home (page 24). Our main guide to CHC funding in England explains how to apply. Our guide to the criteria for CHC funding sets out the test in the Framework’s own words.
NHS-funded Nursing Care
FNC is for someone in a care home with nursing who doesn’t qualify for CHC but needs care from a registered nurse. The NHS pays a set weekly amount towards that nursing, straight to the home. From 1 April 2026 the standard rate is £267.68 a week and the higher rate is £368.24 a week (DHSC press release, 9 March 2026). FNC doesn’t apply in residential homes without nursing. The Framework says CHC should be considered first (National Framework, page 9).
Section 117 aftercare
Some people have been detained in hospital under certain sections of the Mental Health Act 1983. They can be entitled to aftercare under section 117 of that Act. The council can’t charge for it (Care and Support Statutory Guidance, paragraph 8.14). Where that aftercare includes a care home place, the person doesn’t pay for the care.
Do you think your relative’s health needs might be high enough for NHS funding? The free check asks short questions about the same areas of care as the Checklist, the NHS screening form for CHC. It shows whether a full assessment looks worth asking for.
What are top up fees and who pays them?
A top-up is the gap between the council’s rate for a place and the fee of a dearer home the person has chosen. A relative, a friend or another third party can pay it. In certain circumstances the person can pay it themselves. Whoever pays must sign a written agreement with the council. It sets out the amount, how it’s reviewed and what happens if payments stop. The council can only ask for a top-up when the person has chosen a dearer home. It must also make sure at least one suitable home is available within the person’s personal budget (Care and Support Statutory Guidance, Annex A).
What happens when the money runs out?
When a self-funder’s capital is falling towards £23,250, contact the council well before it gets there. A needs assessment and a financial assessment both take time. Once capital falls below the limit, the council becomes responsible for helping with the fees, as long as the person’s needs meet its criteria. Ask early whether the current home will accept the council’s rate. If it charges more, the council may ask for a top-up or suggest another home.
Two checks belong in the same conversation. First, if the person is in a nursing home, check that FNC is being paid to the home. Second, ask about CHC again, even if it was ruled out years ago. The Checklist guidance says a new Checklist isn’t needed if someone was found ineligible and their needs haven’t changed. So a change in needs is a good reason to ask for one.
The Framework also says nobody should fall into a gap between the two bodies. In its words: “People should not find themselves in a situation where neither the NHS nor the relevant local authority (subject to the person’s means and the person having needs that fall within the eligibility criteria for care and support) will fund care, either separately or together” (National Framework, page 22).
Can you insure against care home fees?
Some people use a care fees annuity, also called an immediate needs annuity. In return for a lump sum, an insurer pays an agreed income towards the care fees for the rest of the person’s life. Whether that makes sense depends on health, age and the sums involved. The advice should come from a financial adviser regulated by the Financial Conduct Authority. Councils should help people find one (Care and Support Statutory Guidance, paragraph 3.51). Check whether CHC applies before committing a lump sum, because the NHS pays the full cost of care for a person who qualifies.
Is there a 7 year rule for care home fees?
There’s no seven-year rule for council charging. The idea often comes from inheritance tax, which has its own seven-year rule for gifts. For care fees, the Care and Support Statutory Guidance sets no fixed period. It asks whether avoiding care charges was a significant reason for the timing of a gift. It also asks whether the person could reasonably have expected to need care when they made it (Annex E). If the council decides someone gave away money or property to avoid fees, it can charge them as if they still had it. This is called deprivation of assets. Take legal advice before giving away a home or savings with care in mind.
How do you find out if CHC applies?
The first step is usually the Checklist. Any trained health or social care practitioner can fill one in. Ask the GP, the hospital team, the care home or the council’s social worker for one, and put the request in writing. Councils must tell the ICB when it appears a person may be eligible for CHC (Care and Support Statutory Guidance, paragraph 6.80). The Checklist guidance says the threshold “has intentionally been set low”. Our guide to the CHC Checklist explains the 11 areas it scores.
After a positive Checklist, the National Framework says the time to the ICB’s decision should not exceed 28 calendar days in most cases (page 55). Sometimes it takes longer without good reason, and the person is then found eligible. If they paid for care while waiting, the ICB should refund the costs from day 29 (Annex E, pages 178 to 179).
If a decision has already been made, a CHC case review with a written opinion looks at the paperwork so far.
Questions families ask
Is the first 12 weeks in a care home free?
Not entirely. The 12-week property disregard sets aside the value of the home, but nothing else. During those weeks the person still pays a contribution from their income. Any savings between £14,250 and £23,250 still count too, at £1 a week for every £250 between the two limits.
Can I buy my parents’ house to avoid care home fees?
You can buy it at full market value. But the money your parent receives then counts as their capital, so the fees still have to be paid. A sale below market value runs into the deprivation of assets rules explained above. Take legal advice before any transfer.
Can you refuse to pay care home fees?
If the person signed a contract with the home, the fees are a debt under that contract. Refusing to pay can lead to arrears and legal action. Where the council arranges the place, it can recover unpaid charges and, as a last resort, go to the county court. The better route is to challenge who should be paying, starting with CHC.
Do people with dementia have to pay care home fees?
They follow the same rules as everyone else, and there’s no separate dementia fund. The National Framework says a diagnosis “is not in itself a determinant of eligibility” for CHC. So dementia neither qualifies a person nor rules them out. In advanced dementia, care needs can be high in cognition, behaviour, mood, medication and mobility. Those needs are what the assessment looks at.
What is the maximum you have to pay for care home fees?
There’s no set weekly maximum, and each home sets its own fees. A person with capital above £23,250 pays whatever their home charges until their capital falls below that limit. After that, the council’s means test decides their contribution, as the capital limits table above shows. Anyone who has agreed a top-up pays that on top.
This is information, not legal advice. It explains the rules for England, which are set out in the National Framework for NHS Continuing Healthcare.
Sources
- Care Act 2014, legislation.gov.uk, 2014, as amended.
- Care and support statutory guidance (chapters 3, 6, 8 and 9, annexes A, B, E and H), Department of Health and Social Care, updated 30 October 2026.
- Social care charging for care and support 2026 to 2027: local authority circular, Department of Health and Social Care, 17 February 2026.
- Better community care thanks to nursing funding boost (press release), Department of Health and Social Care, 9 March 2026.
- Adult social care finance report, England: 2025 to 2026, Department of Health and Social Care, 22 October 2026.
- National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, Department of Health and Social Care, July 2022 revision, corrected July 2023.
- Inheritance Tax: gifts (the 7 year rule), GOV.UK, read 13 November 2026.
- NHS continuing healthcare checklist: guidance, Department of Health and Social Care, updated 20 October 2026.