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How to Pay for Home Care in London
Council funding, direct payments, NHS Continuing Healthcare and self-funding, explained without the jargon. This is the question almost every family asks first.
General information, not financial or legal advice. Thresholds and benefit rates in England change each April, so check the current figures on GOV.UK or with your council before you rely on them.
Start with a needs assessment. It is free, and it is a right.
Anyone who appears to need care and support is entitled to a needs assessment from their local council under the Care Act 2014. It does not matter how much money you have, and you do not have to be on benefits to ask. It is free, and asking for one does not commit you to anything.
Request it from the adult social care team at your borough: Lewisham, Southwark, Tower Hamlets, Bromley, Greenwich, Richmond, Kingston or Hillingdon, depending on where the person lives. You can also start it online on GOV.UK.
The assessment establishes what support someone needs. A separate financial assessment, the means test, establishes who pays.
The means test, in plain terms
If the council agrees someone has eligible needs, it then looks at their capital and income. There are two thresholds in England:
- Above the upper capital limit, you pay the full cost yourself. You are a self-funder.
- Between the two limits, the council contributes and you pay a means-tested share.
- Below the lower limit, your capital is disregarded, though income is still taken into account.
One point that surprises many families: for care in your own home, the value of the home you live in is not counted as capital. That is different from residential care, where it usually is after a period. It is one of the reasons home care is worth costing properly before assuming a care home is the only affordable option.
Ask for the assessment even if you are certain you will self-fund. It establishes a formal record of need, it can unlock equipment, adaptations and a carer's assessment, and it puts you in the system if circumstances change. Families who skip it often regret it eighteen months later.
Direct payments
If the council is funding some or all of the care, you can usually take that as a direct payment rather than letting them commission it. The money goes to you, and you choose the provider.
This matters because a council-arranged package puts you with whichever agency holds the contract. A direct payment lets you choose a provider you have actually met. If you would like us to provide care under a direct payment, tell your social worker.
NHS Continuing Healthcare
NHS Continuing Healthcare, usually called CHC, funds the whole care package where someone's needs are primarily health needs rather than social care needs. Two things make it important:
- It is not means tested. Capital and income are irrelevant.
- It can cover care at home, not only in a nursing home.
It is assessed through a checklist and then a full multidisciplinary assessment. It is widely known to be difficult to obtain and it is refused often, but it is very much worth pursuing where someone has significant clinical needs — for example after a major stroke, or with a progressive neurological condition. Ask the GP, district nurse or hospital discharge team to complete a CHC checklist.
Fast-track CHC
Where someone has a rapidly deteriorating condition and may be approaching the end of life, a fast-track application can put funding in place in days rather than months. A clinician completes it. If you are arranging palliative care at home, ask about this immediately rather than waiting.
Benefits worth claiming
Attendance Allowance
For people over State Pension age who need help with personal care or supervision. It is not means tested, it is not taxable, it does not depend on National Insurance contributions, and it is not affected by savings. It is paid at two rates depending on whether help is needed during the day, at night, or both. It is one of the most under-claimed benefits in the country. Claim through GOV.UK.
Personal Independence Payment
The equivalent for people under State Pension age, also not means tested.
Carer's Allowance
For someone providing a substantial number of hours of unpaid care each week. There are earnings limits, and claiming it can affect the benefits of the person being cared for, so check before claiming.
Council tax reductions
A person assessed as severely mentally impaired, which includes many people with dementia, may be disregarded for council tax purposes, and the household may qualify for a substantial reduction or exemption. It can be backdated. Very few families know this exists.
A carer's assessment, for the person doing the caring
If you provide regular unpaid care, you have your own right to a carer's assessment, separate from the assessment of the person you care for. It can lead to practical support including respite care, and it is free. Ask the same adult social care team.
Self-funding
Many families pay privately, either because they are above the threshold or because they want to choose the provider and start quickly rather than wait for an assessment. If that is you, the things worth insisting on from any agency are a written schedule of costs before you commit, clarity about the minimum visit length, what happens with bank holidays and mileage, and how much notice is needed to change or cancel.
We give you a written figure after the free home assessment. We do not quote a rate over the phone before anyone has seen the situation, because that number is a guess and it always changes.
Common questions
Will my parents have to sell their house to pay for care at home?
For care in your own home, the value of that home is not counted in the financial assessment. Property is generally only taken into account for permanent residential care, and even then there are disregards, for example where a spouse still lives there. This is one of the most common misunderstandings in the whole subject.
How long does a council needs assessment take?
It varies by borough and by urgency. A hospital discharge is usually expedited. If you are waiting and the situation is deteriorating, say so clearly and in writing, and ask about interim arrangements.
Can we start private care while waiting for funding?
Yes, and many families do because they cannot wait. Keep records of what you have paid, because in some circumstances funding can be backdated to the date of the request.
Is Attendance Allowance affected by savings?
No. Attendance Allowance is not means tested and is unaffected by savings or income. Many people who are entitled to it never claim it.
Is home care cheaper than a care home?
It depends entirely on how many hours are needed. A few visits a week is far cheaper. Round-the-clock care can cost more than a residential placement for one person, though live-in care for a couple is usually much cheaper than two placements. We will give you honest figures rather than steer you.
Where can we get independent advice?
Age UK, Carers UK and Citizens Advice all give free independent guidance, and your council's adult social care team must provide information and advice under the Care Act. We are a care provider, so take our summary as a starting point and check the detail with someone independent.
Talk it through with Jackie
No call centre and no obligation. Tell us what you are dealing with and we will tell you honestly whether we can help.