The three routes, plainly
- Local authority social care. Means tested. The council assesses need and then assesses what the person can afford to contribute.
- NHS-funded Nursing Care. A contribution towards the nursing element of care for a resident in a care home with nursing who is not eligible for NHS Continuing Healthcare. Source: Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
- NHS Continuing Healthcare. The NHS arranges and funds the whole package of assessed health and associated social care needs. Not means tested. Source: Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
The order matters. The framework's position is that eligibility for NHS Continuing Healthcare is considered first, and NHS-funded Nursing Care is only considered once CHC eligibility has been ruled out. Source: Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
Why the means testing difference matters
NHS Continuing Healthcare is not means tested, and local authority care is. That single difference is why the same person, with the same needs, can face a very different bill depending on which route they end up on. It is also why the assessment is worth taking seriously rather than treating as paperwork.
Eligibility for NHS Continuing Healthcare is decided by the integrated care board, informed by a multidisciplinary team assessment. We are not part of that assessment and cannot attend it, and nothing here predicts or implies a decision.
NHS-funded Nursing Care
If the person lives in a care home that provides nursing and is not found eligible for NHS Continuing Healthcare, the integrated care board should consider NHS-funded Nursing Care, which is paid to the home towards the registered nursing element of the care. It does not cover the fees as a whole. Source: Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
The 28 day rule for PIP and Attendance Allowance
This is a mechanism, not advice on any individual case, and it is worth knowing before a move rather than after.
- Where the care home placement is funded by a local authority or by the NHS, payment of Attendance Allowance, and of the daily living component of Personal Independence Payment, generally stops after 28 days in that accommodation. Source: GOV.UK, Attendance Allowance, what happens if you go into hospital or a care home. and The Social Security (Personal Independence Payment) Regulations 2013, regulations 28 to 32 (care home and hospital residents).
- Where the person pays the fees themselves in full, payment generally continues. Source: GOV.UK, Attendance Allowance, what happens if you go into hospital or a care home.
- The days can be linked across stays, so short periods at home between spells in funded accommodation do not necessarily reset the count. Source: The Social Security (Personal Independence Payment) Regulations 2013, regulations 28 to 32 (care home and hospital residents).
We are not a benefits adviser and this depends on the exact funding arrangement, so check the specific case with the DWP or a free adviser such as Citizens Advice, Age UK or a local welfare rights service before you assume either outcome.
What to record before any assessment
Whatever route the funding takes, the assessment turns on a description of care needs. The most useful thing you can do this week is write down what actually happens: frequency, duration, how many people, what equipment, and what has gone wrong when help was late.
Our free typical day record sheet gives you the structure. The CHC Family Evidence Pack turns your answers into a written statement across the 12 domains, with the letter that matches the stage you are at.
Questions families ask
Is NHS Continuing Healthcare means tested?
No. NHS Continuing Healthcare is not means tested. Local authority social care support is means tested, which is why the two routes feel so different to a family. Source: Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
What is NHS-funded Nursing Care?
It is a separate, smaller contribution towards the nursing element of care for a resident in a care home with nursing who is not eligible for NHS Continuing Healthcare. It is considered after CHC eligibility has been ruled out. Source: National Framework, last updated 27 October 2022.
Does going into a care home affect PIP or Attendance Allowance?
It can. Where a care home placement is funded by a local authority or by the NHS, payment of Attendance Allowance, and of the daily living component of PIP, generally stops after 28 days in that accommodation. Where the person pays their own fees in full, it generally continues. This is a mechanism, not advice about a particular case. Source: GOV.UK, Attendance Allowance, going into hospital or a care home, and the Social Security (Personal Independence Payment) Regulations 2013, regulations 28 to 32.
Can NHS Continuing Healthcare be provided at home?
Yes. It is a package of care based on assessed need, not a placement, and it can be delivered in a person's own home as well as in a care home. Source: National Framework, last updated 27 October 2022.
Sources
- Department of Health and Social Care, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, last updated 27 October 2022.
- The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, Part 6.
- GOV.UK, Attendance Allowance, what happens if you go into hospital or a care home.
- The Social Security (Personal Independence Payment) Regulations 2013, regulations 28 to 32 (care home and hospital residents).
- NHS website, NHS continuing healthcare, nhs.uk/conditions/social-care-and-support-guide.