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Health and Wellbeing
A Health and Well-being Wales Partner

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 on your individual care and support needs and financial circumstances, including your capital assets. It is established by a financial assessment undertaken as part of the care planning process. There will be instances when:

  • the local authority or the NHS pays all the care home fees.
  • both the local authority and NHS contribute towards the care home fees.
  • you are not eligible for local authority financial support because of the level of your capital assets e.g. savings, investments, and property, and therefore pay all the care home fees. You are referred to as a ‘self- funder.’    
  • you are eligible for local authority financial support because of the level of your capital assets but may pay a charge depending upon your eligible income.

Local authority funding

What are ‘additional’ costs / ‘top-up’ fees?

Each local authority agrees a weekly fee with care homes and will only pay for a more expensive home if there are special reasons. The weekly fee rate varies between local authority, and you should be able to access this information from your local authority.

If you are eligible for local authority financial support, the local authority is required to give you a genuine choice (more than one option) of suitable accommodation within its set weekly fee. If there is no suitable accommodation to meet your assessed needs in full the local authority must arrange a placement at a more expensive setting and adjust its funding accordingly. You, or a third party, must not be asked to pay an additional cost towards the cost of a care home place to meet your assessed needs.

If suitable accommodation is offered by the local authority but you prefer an alternative, more expensive care home then an arrangement will need to be made to meet the difference in cost. This is referred to as an additional cost arrangement or “top-up” fee.

For example: The local authority contribution is £600 per week, the care home fee is £700 per week, the top-up fee is £100 per week.

What are ‘supplementary’ / ‘additional’ charges’?

You may decide to purchase supplementary / additional services and products available at the residential care home for example a daily newspaper, hairdressing, manicure, or you may request something extra and personal to you. These supplementary / additional services and products are not part of the care and support plan, and therefore not covered by the care home weekly fee. This may be referred to as ‘supplementary’ or ‘additional’ charges. You should be made aware beforehand that you are required to pay for these services, how much they cost and how you will be expected to pay.


If your needs are primarily social care needs and you are not eligible for local authority 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 2023), you can still approach your local authority for financial assistance.

Paying for residential care is a substantial long-term commitment. MoneyHelper offers some guidance on the subject.

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).


Last updated: 31/01/2024