Paying for care home fees before CHC is decided
When your relative needs to move into a care home or nursing home, it often happens quite quickly, and the assessment for NHS Continuing Healthcare (CHC) can take much longer. In the meantime, you might get conflicting advice from social workers, care providers or the local authority, and you’ll be expected to provide answers relating to costs and how you plan to fund them.
It’s important to know that paying for care home fees in the short term does not automatically mean you lawfully owe those fees in the long term. If your relative is eligible for NHS CHC, the NHS should fund the full package of care, whether at home or in a care home.
Read our guide on what CHC is and what eligibility looks like.
In this article:
- Who pays for care home fees whilst CHC is being considered?
- Why families are often told to pay care home fees upfront
- How do you pay for care home fees in the short term?
- Can you avoid paying for care home fees while waiting for CHC?
- What happens if CHC funding is awarded later?
- What if CHC funding is refused or delayed?
- Speak to Farley Dwek
Who Pays for Care Home Fees While CHC Is Being Considered?
A common question we hear from families is who pays for care home fees while CHC is being considered, and because the system blends health and social care, it can be confusing. Usually, the care home needs a named payer while the assessment process runs in the background, so it’s common to self-fund by default.
That said, who should pay depends on what stage you are at and whether your relative has been referred for a full assessment. If there is a realistic possibility of a primary health need, the local integrated care board (ICB) must assess NHS CHC properly, rather than treating the need as ‘social care’ and moving straight to local council funding.
While the assessment for NHS continuing healthcare is in progress, it’s common to enter in to one of the following arrangements, depending on the policy in your area:
- You pay temporarily using income, savings, or a combination of both
- The local authority puts interim support in place, often alongside a means test
- The care provider agrees a short-term contract while funding discussions are ongoing
- Funding is split for a period while professionals dispute responsibility
- The NHS or the local authority meets the full cost, under a “Discharge to Assess” agreement (sometimes called “D2A”, “pathway 1” or “pathway 2”)
However, none of these arrangements dictates eligibility – they simply deal with immediate care costs.
Why Families Are Often Told to Pay Care Home Fees Upfront
Families are often told to pay upfront because the current system prioritises placement over correct funding decisions, and unfortunately, delays are common.
The NHS says ICBs will normally make a decision within 28 days of receiving a completed checklist or a request for a full assessment. If the ICB decides your relative is eligible for NHS continuing healthcare at a later date, but takes longer than 28 days without a justifiable reason, it should refund care costs from day 29 until the decision date.
You may also be pushed into paying because the professionals involved make assumptions too early in the process, i.e. describing needs as ‘social’ before they consider the complexity, intensity and unpredictability of the person’s needs or before they gather all the evidence. Care homes may also ask you to sign a self-funder agreement because it gives them certainty, however being told to pay does not equal a final decision.
How Do You Pay for Care Home Fees in the Short Term?
In most cases, people cover care home fees by using pension income, using savings, using temporary help from the local authority or agreeing to staged payments with the care provider. Read more about care home guidance on funding care, as a useful starting point.
If the local council opens a discussion about a financial assessment, find out more here about how savings thresholds work in social care.
Because the process is complex, you should protect yourself by keeping copies of contracts, invoices, bank transfers, care plans, and assessment paperwork. Write down who told you what, and when. That way, if CHC is awarded later, your records can support reimbursement and any reclaim.
Selling a house to pay for care home fees
Selling a house to pay for care home fees can create irreversible loss if the NHS later awards CHC. Before you make any kind of permanent decision, you should aim to get as much clarity as possible and look at temporary options in the short-term.
You can ask the ICB for the next steps and timescales in the assessment process, or speak to the local authority to ask what interim arrangements exist. If your relative is in a nursing home and needs registered nursing care, you should also ask about NHS funded nursing care, which can reduce costs while CHC is being considered.
If you want to delay the sale of a property, you may want to consider a Deferred Payment Agreement (DPA), wherein the local authority pays the fees in the interim, secured against the value of the property. Those fees are repayable upon the eventual sale of the property. Be aware that local authorities are entitled to charge interest and admin fees, although not all do. Always take independent financial advice before making a decision.
The “12-week property disregard” requires local authorities to ignore the value of any property in a financial assessment for the first twelve weeks after someone moves into a care home. Given the cost of care, this can amount to a significant sum, so make sure to take advantage of this.
Can You Avoid Paying for Care Home Fees While Waiting for CHC?
It’s not unusual for people to look ways to avoid paying for care home fees because bills can drain savings fast. The reality is, you may not be able to avoid all payments, but you can often avoid paying on the wrong basis, for longer than is necessary.
Helpful steps you could take include:
- Requesting an urgent assessment where needs justify it
- Checking whether fast-tracked CHC applies when someone is deteriorating rapidly
- Challenging assumptions that needs are social rather than health-related
- Confirming whether NHS-funded nursing care applies in a nursing home.
Waiting is expensive, so it helps to understand expected fees. Our recent guide on Care Home Costs and Fees explains typical costs and what informs them.
You can also read our guide on how to avoid care home fees, which covers practical steps families take to protect themselves.
What Happens If CHC Funding Is Awarded Later?
If the ICB later finds your relative eligible for NHS CHC, the NHS should fund the package of care going forward. You might also be entitled to reimbursement for fees paid that should have been NHS-funded. As mentioned earlier in this article, records matter, so be sure to keep a record of all invoices, bank statements and care documentation, in case you need to refer to them at a later date.
If you believe your relative should have been eligible for NHS continuing in the past, or felt they weren’t assessed properly, you may need a retrospective review. Our Retrospective Reclaims Service supports families in recovering wrongly paid fees.
What If CHC Funding Is Refused or Delayed?
It’s common to see decisions that do not match the evidence, especially where assessors might downplay risks or overlook day-to-day unpredictability – but a refusal isn’t necessarily the end.
If funding is refused, you are within your rights to request the rationale and appeal the decision. If it’s delayed, you can push for timelines and written updates from the ICB. If you want a clear view of what has happened so far and what you should do next, our Case Review service can help.
Speak to Farley Dwek
Our expert team support families every day, from providing early advice, through to supporting with appeals, advocacy and reclaiming fees. If you need support at any stage in the process, we can help you understand where responsibility should sit and what action to take next. Contact us or speak to our friendly team by calling 0161 272 5222.