The responsibility for paying your residential care fees may fall upon you, your local council, the NHS or be shared between one or more of you.
Who pays what depends whether your needs are social care (personal) or health needs (and many people in residential care have both) and on your ability to pay.
There is a clear legal divide between the duty to provide for social care needs (local councils) and health care needs (the NHS).
Local council funding
Social care services, including those provided in a residential setting, are arranged by local councils and are chargeable. The amount you pay depends on your personal circumstances.
Your local council will carry out a financial assessment to determine how much you can afford to pay towards your residential care fees. They will also tell you the maximum they will pay for someone to live in residential care.
If you choose a residential care home that charges over this limit, you must find a third party, e.g. a relative, to pay the ‘top up’ fees (you are not allowed to do this yourself from savings).
If you are going into residential care, the financial assessment will differ from when you were receiving non-residential care and support. For example, depending on your circumstances, the value of the home you were living in prior to needing residential care may now be taken into account.
Paying for a permanent care home place in Wales (Age Cymru, April 2022)
Can I refuse to have a financial assessment?
You do not have to agree to a financial assessment; however, if you refuse one, your local council will not contribute towards your residential home fees.
Continuing NHS Healthcare
NHS healthcare is always free at the point of provision.
If your care is a mixture of nursing and personal care, the NHS will only fund the healthcare/nursing element of your care, leaving the local council and/or you to cover the cost of having your social care needs met.
If you have a complex medical condition which means your need for support and care primarily relates to your health, you might qualify for Continuing NHS Healthcare. In this situation, the NHS will cover the entire cost of your nursing home fees.
The Welsh Government has a publication called What is Continuing NHS Healthcare (April 2022).
If your needs are primarily social care needs and you are not eligible for local council funding because your savings or income are too high or you were unwilling to undergo a financial assessment, you are a ‘self-funder’.
As a self-funder, you can approach a residential care home directly and sort out the financial arrangements yourself.
If, or when, the time comes that your savings fall below a certain level (£50,000 in 2022), you can still approach your local council for financial assistance.
Paying for residential care is a substantial long-term commitment. MoneyHelper offers some guidance on the subject.