07. What if I need nursing care?

If you are in a residential home and you need nursing care, the NHS will normally provide it directly, via community nursing, free of charge. But if you’re assessed as needing to move into a nursing home to meet your nursing care needs, whether you’re moving from your own home, another residential home or from hospital, an NHS nurse will decide what parts of your care require a registered nurse. The NHS will be responsible for paying for that part of your care, regardless of your income or savings.

If you’re assessed as not needing to go into a nursing home but you decide to pay to go into one anyway, you won’t be entitled to get the NHS to pay for the nursing care. But if your needs change, your case can be reviewed. 

In England, the nurse will determine whether your nursing needs are low, medium or high and the NHS will pay the corresponding level of fees to meet those needs. (In Wales, a flat-rate fee is paid for your nursing care). This should normally be reviewed within 3 months of going into the home, and then at least every year.

If you’re unhappy with the nurse’s decision, you should contact your local ‘nursing home co-ordinator’ (‘care home co-ordinator’ in Wales) at the council or your local health Trust or Board in the first instance. You can also ask for a decision to be reviewed in the same way as a ‘continuing care’ assessment on coming out of hospital.

Your care plan should set out the services to be provided by the council, for which you may have to pay, and the care paid for by the NHS. Once you’re in the home, you should query any fees which may include charges for nursing care that are already being paid for by the NHS.

What do I have to pay?

You may have to pay towards the fees for services not paid for by the NHS, such as accommodation and personal care. What you pay is, based on a set of rules that take into account:

• how much 'capital' you have (including savings, stocks and shares and property you own); and
• your income (how much money you have coming in each week, including benefits).

The rules are complicated and only the main points are set out here. Organisations including Age Concern,  Help the Aged and Counsel and Care can give you more information (see 'Further help' for details).

The council looks only at your own income and savings. They cannot take into account money or income that belongs to your husband or wife or family (but see 'What must my husband or wife do for me?' below).

If you have £19,500 or more in capital, you will have to pay all the fees, whatever your income is (though this figure can change over time) and you will also normally have to find a residential care home yourself. If you can't do this, and there is no-one to do it for you, the council must help you (but you still have to pay the full fee).

If you have less than £19,500 or when your savings drop to this level, the council will look at how much you could afford to pay. All your income (except some items which don't count) will have to go towards paying your care costs, apart from a small amount which you must be left with ('a personal expenses allowance').