This is part seven of a series on planning and paying for long-term social care in later life.
We’ve previously covered:
- The gap between social care need and provision.
- How the social care funding means-test works.
- The social care thresholds that determine your funding eligibility.
- How you can estimate care home costs for future planning.
- A case study showing how social care costs impact retirement finances.
- The financial products best suited to paying for social care.
In this final post, we cover free sources of support that can help everyone fund their care.
Long-term social care is not free at the point of delivery, unlike NHS treatment. Most social care is means tested – with complexity, arbitrariness, and under-provision shot through the system like tracer dye revealing contamination.
Very few people will get all the help they need. However there are some little-known free social care options that are universally available.
These avenues of support typically depend on your need, not your bank balance.
They fall into three main categories:
- NHS-funded care
- Home adaptations and equipment
- Non-means tested benefits
Let’s briefly review each free social care category. I’ll also link out to useful sources of further information.
NHS Continuing Healthcare (CHC)
NHS Continuing Healthcare can fully fund your care and accommodation – if you qualify for it. You may qualify if you require complex, ongoing care to manage severe and unpredictable illness or disability.
You won’t necessarily be made aware of CHC, even if you’re eligible. The first formal step is to ask your GP for a CHC assessment.
However I recommend finding out more about the process first, through the Beacon social enterprise.
Why? Because qualifying for CHC is known to be difficult – so much so that NHS England fund Beacon to help guide people through it.
CHC has been replaced in Scotland by Hospital-Based Complex Clinical Care. This scheme only covers people receiving long-term care in hospital.
NHS-funded Nursing Care (FNC)
If you don’t qualify for CHC then the next stop is NHS-funded Nursing Care. This may cover your nursing care fees if you live in a care home that provides registered nursing care.
FNC pays a standard rate for nursing directly to your care home. The rate varies by UK nation.
Your home should demonstrate how this money will reduce your bill.
If you’ve had a CHC assessment then you should also get a FNC verdict. Contact your GP if this hasn’t happened.
Nursing care in your own home is provided free of charge by community nursing services. It should be arranged by your GP if you don’t qualify for CHC.
NHS Intermediate Care
The NHS Intermediate Care service is meant to help you recover your independence and get back to normal after a hospital stay, short illness, or fall. Intermediate Care also gives you a chance to assess your needs when you’re considering a permanent move into residential care.
Care is free but short-term – lasting up to six weeks. It can be provided in your own home, a care home, or community hospital.
Hospital staff should arrange intermediate care for you before you leave. Speak to the discharge coordinator if that isn’t happening.
If you’re discharged without a care plan then contact social services. The hospital isn’t responsible for your care once you leave.
Speak to your GP (or local authority social services) if you need help because of a fall or illness at home.
If you don’t make a full recovery after six weeks of intermediate care then you should receive a plan to transfer to another service. That may involve paying for long-term care yourself.
Intermediate care is also known as re-ablement or aftercare.
Section 117 mental health after-care
Anyone detained under Section 3 of the Mental Health Act 1983 has a right to receive free aftercare once they’re discharged from hospital.
A care package must be provided by the local authority and the NHS so long as the person requires ongoing support that is:
- Connected to their mental health condition
- Reduces the risk of their condition worsening
Support can include paying for care at home or in residential accommodation. An aftercare plan should be provided before you leave hospital.
Home adaptations and equipment
Home adaptations include stair lifts, ramps, walk-in baths, grab rails, lever taps and so on.
Essential adaptations and equipment costing less than £1,000 each are likely to be provided for free in England. The limit is £1,500 in Scotland and considered on a case-by-case basis in Northern Ireland and Wales.
Contact your GP or local authority1 for an occupational therapy assessment or a full care needs assessment.
Means-tested Disabled Facilities Grants are available for more expensive adaptations. The amounts and specifics vary by home nation.
For ideas on adaptations and equipment that can help maintain independence, check out these lists:
Universal benefits
You should also look into some applicable benefits that aren’t means tested nor widely known:
Up to £89.60 a week is available if:
- You’re over State Pension Age
- Physically or mentally disabled
- Need someone to help care for you
If you permanently live in a care home, Attendance Allowance is not available if you receive local authority support.
Personal Independence Payment (PIP)
This is similar to Attendance Allowance but is only available for people aged between 16 and the State Pension Age.
There are two parts:
- Help with daily living tasks – pays up to £89.60 a week
- Help with mobility – pays up to £62.55 a week
You may be eligible for one or both components.
Other benefits
Age UK maintain a wider list of relevant benefits.
Money Helper also have a good care needs benefits page. It’s particularly strong on council tax discounts and exemptions.
Many people don’t claim all the benefits they’re entitled to. Use a benefits calculator to ensure you don’t miss out:
- Age UK benefits calculator
- Entitled To benefits calculator
Carer’s benefits
Thankfully carers can get help too. You don’t have to be related to or living with the person you care for.
£67.60 a week may be available if you care for someone 35 hours or more a week. That person must also be eligible for certain benefits such as the Attendance Allowance.
If you qualify for Carer’s Allowance you’ll get National Insurance credits, too. Scroll down to the Carers’ section.
Carer’s Allowance can have a knock-on effect on other benefits. See the link to the benefits calculator on this government page.
The government also lists more benefits available to carers.
You may be eligible for the Carer’s Allowance Supplement if you live in Scotland.
Carer’s credit
Carer’s Credit helps people who care for someone at least 20 hours a week.
The credits increase the value of your State Pension by filling gaps in your National Insurance record.
Carer’s respite care
Local authority funding is available to enable carers to take a break occasionally. As ever, you must be assessed to qualify.
This NHS page lists organisations that can assist with carer’s breaks including charitable support.
Carers UK offers advice and guidance to unpaid carers.
Free personal care
Personal care is available for free in Scotland and Northern Ireland.
Personal care is a defined set of services including washing, getting dressed, going to the toilet, meal preparation and medication.
For those in care homes, your local authority pays a set rate for personal care and nursing care in Scotland.
A set rate is also available for nursing care in a home in Northern Ireland.
Personal care and nursing care is only available for free if your care needs assessment recommends you for it.
Charitable grants
The final free social care option is to apply for charitable grants. Turn2us has created a searchable database.
Care thee well
Needless to say, you can also explore all of the routes listed above on behalf of a loved one.
But for our part, that’s the end of Monevator’s series on long-term social care.
Researching it has been a sobering experience. I dare say reading it hasn’t been a barrel of laughs either.
If you knew little about long-term social care previously, then I hope the series has made it less of an amorphous threat.
If your research is more urgent then I hope these posts have provided some help when you need it most.
Take it steady,
The Accumulator
Bonus appendix: social care funding – the diagram
This flowchart graphically simplifies the complexities of the social care system:
- Health and Social Care trust in Northern Ireland. [↩]
This has been an incredibly useful series of articles and I have never seen so much relevant information consolidated into one place. I can’t imagine the time that TA (and also The Planalyst) must have put into compiling it. In particular I think that this article on support available to all according to need, and the last by the Planalyst on self-funding options, are likely to be the most personally relevant to the typical Monevator reader, who is likely to be a self-funder. Of course, it is very possible that we will encounter the social care system not only on our own account, but also on behalf of our family and other relatives whose financial position may be very different.
@TA – Thanks as ever for all your work. Not relevant to me as my parents are both dead and I’m 56 so I reckon (hope!) I’ve got another 20 years before it becomes the issue… But bloody hell, what a mess. Surely they’ll sort something out in that time?
Agree with DavidV, a very useful series of articles. I would add though that even for self funders, many of these benefits are not means tested, so well worth considering them.
Just one comment on PIP, I belive that this continues beyond state retirement age if it was granted before then. ie someone receiving PIP does not need to re-apply for Attendance Allowance once they reach state pension age. I have a relative in receipt of PIP and this is my understanding, but would welcome confirmation on this.
Naeclue@3
If PIP is in payment before SPA it can indeed continue after SPA (so no need to apply for AA).
The Daily Living element of PIP can be reassessed after SPA, and if the claimant’s health has worsened and their care needs increased – it is possible for the award to be increased.
However, the Mobility element of PIP is fixed at SPA, and the award cannot be increased after SPA (the rationale being that AA does not have a mobility component).
There is a helpful guide on both PIP and AA on the Citizens Advice site, e.g:
https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/
It can be helpful to get help with an AA or PIP application from your local advice charity or Age UK.
Re Carers Allowance (CA).
In addition to the 35 hrs caring requirement, there is an earnings limit of £128 pw. Those earning above this amount are not eligible to receive CA.
CA stops at SPA, as the state pension and CA are deemed to be overlapping benefits by HMG.
This article doesn’t mention that benefits like PIP, Attendance Allowance and Carers Allowance also allow a claim for a substantial council tax reduction to be made, an example:
https://www.ealing.gov.uk/info/201103/benefits_and_financial_support/2121/council_tax_reduction_scheme
Reality is there is a lot of help available for care at home in various fragmented schemes.
I agree this is a really terrific set of articles. My initial reaction though is that navigating a way through the quagmires and thickets of what is available, what one might be entitled to, and how to get it, seems so daunting and soul-destroying it might be preferable simply to do without state provision where that is at all possible – and yes, I realize in most cases it won’t be (possibly including in my case, if I get to be in dire need). But there must be a point where the stress and hassle of dealing with these agencies begins to outweigh any welfare they are offering. Why we’re not out on the street with pitchforks about this situation I don’t know; it’s an absolute scandal that at a time of life when one is least able to deal with this kind of Kafkaesque institutional infrastructure, that’s what there is.
A bit of clarification on Neverland’s post @5.
The Council Tax reduction (CTr) scheme is means tested and not available to households with over £16k of savings (and for some local authorities less than that). It is designed to help low income households. It has replaced the old Council Tax Benefit scheme, and each local authority sets their own rules and eligibility for low income working age claimants.
An award of PIP or AA does not necessarily enable a CTr claim. It is assessed on household income (as Housing Benefit is, and Council Tax Benefit was).
However, for those low income households eligible to claim CTr, the receipt of a disability benefit (such as PIP) will increase the amount of their CTr.
https://www.citizensadvice.org.uk/housing/council-tax/check-if-you-can-pay-less-council-tax/
https://www.entitledto.co.uk/help/council-tax-reduction
We have direct family experience of this thicket. And it was an eye opener. CHC is a magic unicorn. For most practical purposes it doesn’t exist.
Despite bed bound paralysis, extensive needs and additional impacts of drug treatments on other capability one patient I know still doesn’t qualify for CHC just the nursing top up for private care home provision until assets are depleted. The system today. Can pay will pay. Fortunate in context that they are not plundered too badly on extra fees for cross subsidy to LA patients. Many are. The politics to practically change it are a different conversation which I will mostly avoid starting a squabble about here.
IMHO – almost everybody genuinely requiring the nursing version of social care – lifting, washing, extensive treatment, monitoring etc. outside an acute clinical setting is in this category. Nursing top up yes. Full CHC funding probably no. Thus prompted (shocked) by direct experience to know more about how impaired and ill you *actually* need to be to get CHC. I went and read up on it as my few examples had been – odd.
I was not especially surprised when the younger patient with chronic nursing needs and a long life expectancy ahead measured in years did not get it. Definitely want an excuse not to approve full funding for that one. And the other patient with a week to live but lesser nursing needs – did get it. This drew a wry smile. Retrospectively approved for the week before death. Can’t say we never do it. Somebody scored a point on the board for a low cost case delivered. And what do points mean. Management off your back about metrics.
I read the very long and jargon rich NHS policy document on CHC assessment. You have to be very impaired across many dimensions simultaneously and score well (badly) on all of them – and make it through a multi-level committee challenge of the scoring process. The whole thing – the criteria and the multi-layer process is designed to sift out the needy down to the fewest and neediest. For the purpose it is in fact designed for – winnowing down to a budget with multi-disciplinary teams of “not managers or politicians” it is a thing of beauty – a triumph of the UK civil service blame deflection process uber alles mentality. An apparently defensible process obscuring an unwelcome or potentially even indefensible outcome. As an exercise in getting the most care to the most people in trouble with the least bother to them it is a horror show born of the artificial division with the NHS and social care along with bed blocking and much else. Not that it’s easy to fix. Oh imagine the shameless shroud waving sound bite political row and the headlines if someone removed this – not actually really available in practice – service. As it is – it exists and can be pointed at and the cost is somewhat under control. Low level bureaucratic waste of clinical staff’s time is bad but acceptable to our political overlords. Public pain grappling with it is private and not politically salient. Absolutely classic civil service solution to a political disconnect between what voters like the sound of and what voters are willing to pay for for other people’s families.
I am being a bit cynical – I am sure there are a few people for whom CHC comes through and is of genuine help – but there is too much waste, false hope, uncertainty and assessment harm embedded around it for me to be at all comfortable with it as it is today. When pandemic catch up blows through and the social care funding flips over perhaps there is an opportunity for progress. We shall see.
@GMO thanks for your comments on CHC.
I’m at the other end of this “experience”, trying to help/encourage neighbours to get an assessment for an elderly man who has advanced dementia. He has lost, effectively, all his faculties and is 24/7 bed bound. Care home cost is £1100/week (this in Yorkshire) + extras, and they have not even been offered NHS nursing care. Perhaps this is in fact because the care he gets seems to basically involve sedating him and shutting the door so people can’t hear him cry for help. Not really “nursing”, is it?
Perhaps it is just that elderly spouses who are not internet savvy do not know where to go for help.
I add my voices to all those who have commended this excellent series of articles. Let’s hope momentum grows to back a better system.
@Alice Holt I was getting ready to jump in with caveats to some of these comments, but you beat me to it. 😀
Thanks to those for the kind words about this series overall. It makes the effort put in to ensure we covered as much information as accurately as possible worth it.
I would also echo the feel of the majority of comments here: let’s hope the whole system gets a much-needed overhaul. So that it doesn’t need a whole series of lengthy articles to explain how social care works (in theory) in the future.
@gmo (8) My experience with my late mother certainly does nothing to dispel your impression that those with the shortest life expectancy are most likely to receive CHC funding. See my comment number 18 on this earlier article in the series https://monevator.com/social-care-costs/ .
Thanks everyone for your feedback and insight.
@ GMO – I think you’re right that too many schemes seem designed to exclude, not to help. It’s hard to avoid concluding that their central purpose is to provide a fig leaf for government failure. Not just in social care either. The Ukrainian visa scheme is another example. Windrush compensation yet another. Window-dressing that provides the impression of action while actually leaving people to rot.
Allow me to add my thanks and appreciation for this “road map” through the maze of social care funding. This is the most comprehensive analysis of the system’s allowances that I’m aware of. Thank you again for your efforts to bring it all together (delightfully jargon free) in one place.
Thanks for the great series. Reassuring to know that this resource is here for the future.
A really great set of articles on a difficult to quantify subject. It’s the first time I have seen this issue dissected and broken down into tangible and well thought out financial terms. I will certainly use this method to make my own calculations. Well done you.
Crumbs, that’s all taken some work. I dread to think how many hours of research went into this. It’s a good job you’re FIRE’d!
Sadly, this is an area I may need to look into in the not-too-distant future. I may need to read it a dozen or so times for my poor little head to get around it all, but I appreciate the resource. Well done to everyone involved in putting this together.
Why is it always “contact your GP” for every sneeze in UK??
It is local council who deals with social care not GP!