NHS Continuing Healthcare Funding for Care Homes: What Families Need to Know

One of the most important and most misunderstood aspects of NHS Continuing Healthcare is that it covers the full cost of care home fees. Not a contribution. Not the nursing element only. The full cost.

For families paying residential or nursing home fees privately, this can represent a saving of £50,000 to £100,000 or more per year.

Does NHS Continuing Healthcare cover residential care home fees?

Yes. If a person qualifies for NHS Continuing Healthcare, the NHS funds their care in full, regardless of whether they are living in a residential care home, a nursing home, or at home with community care. The person's savings, property, and income are completely irrelevant.

This is fundamentally different from local authority social care funding, which is means-tested. NHS Continuing Healthcare is a health entitlement. It exists because the person's primary need is health-related, not because they cannot afford to pay.

What is the difference between NHS Continuing Healthcare and Funded Nursing Care (FNC)?

Funded Nursing Care (FNC) is a lower level of NHS contribution paid directly to a nursing home for people who do not meet the full NHS Continuing Healthcare threshold but who require registered nursing input as part of their care. The current FNC rate is approximately £235 per week.

FNC is not the same as NHS Continuing Healthcare. Under FNC, the person (or local authority) still pays the remainder of the care home fees. Under NHS Continuing Healthcare, the NHS pays everything.

Can a person be assessed for NHS Continuing Healthcare while already in a care home?

Yes. An NHS Continuing Healthcare assessment can be requested at any point: before, during, or after a care home placement. If a person is already paying for care and there is reason to believe they may meet the NHS Continuing Healthcare threshold, a referral for a Checklist can be made.

Integrated Care Boards are responsible for NHS Continuing Healthcare assessments in the relevant area. A request can be made directly to the ICB, or through a GP or community nurse.

What if care home fees have already been paid privately?

If a person was paying privately for care home fees during a period when they should have qualified for NHS Continuing Healthcare, a retrospective claim can be made to recover those costs. This applies even if the person has since passed away. Retrospective claims can go back up to 14 years in some circumstances.

Can the NHS direct which care home the person lives in?

In some cases, the ICB may have preferred providers or standard rates. However, under a Personal Health Budget arrangement, the person (or their representative) can choose their own care home, provided the care meets their assessed needs and is within a reasonable cost envelope. SG67 can advise on Personal Health Budgets and how to use them effectively.