Can the NHS fund live-in care? Continuing Healthcare, social-care funding, and what families actually get

Most families looking into NHS funding live-in care arrive after one of two shocks. Either the hospital is asking when Dad can go home and nobody is explaining who pays for the carer he now needs, or the first live-in quote has landed and the number is bigger than expected. You want a straight answer about what the state covers and what falls to the family.

There are three funding routes (NHS Continuing Healthcare, local-authority social care, and self-funding), and most families end up using a mix. The rules are knowable, the assessments are free, and the system rewards families who push politely and document everything. Here is what each route actually means.

The three funding paths in one paragraph

NHS Continuing Healthcare (CHC) is fully NHS-funded care for adults whose needs are primarily health-related rather than social: it can pay for a live-in carer in full, including the agency fee. Local-authority social-care funding is means-tested and covers people whose needs are mainly about daily living rather than treatment; the council either arranges care or gives you a direct payment to spend. Self-funded care is what most families do, paying weekly out of savings, pension or property until either a means-test threshold is crossed or eligibility for CHC kicks in. The three are not mutually exclusive. You can be self-funded today and CHC-funded next month if your loved one's condition changes.

NHS Continuing Healthcare (CHC): the route that can fund 100% of live-in care

NHS Continuing Healthcare is the only route that pays the full cost of care, including live-in care, when the assessment goes your way. It is not means-tested. It does not look at savings, the family home or pension income. It looks only at clinical need.

The legal test is whether your loved one has a "primary health need." That phrase comes from the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, which is the rulebook every NHS Integrated Care Board (ICB) must apply. In practice the framework looks at twelve "care domains": things like behaviour, cognition, mobility, nutrition, continence, skin integrity, breathing, drug therapies, psychological needs, communication, altered states of consciousness, and other significant care needs. Each domain is rated from "no needs" up to "priority." If needs come out as either one "priority" rating, or two or more "severe" ratings, eligibility is usually clear-cut. Below that, the picture gets contested.

CHC is most commonly granted in three situations: rapidly deteriorating conditions where end-of-life care is needed (this triggers the Fast Track Pathway), complex long-term conditions like advanced MS or motor neurone disease, and dementias where behaviour and cognition needs sit at the severe end. Families caring for someone with moderate dementia, frailty or post-stroke recovery often qualify for partial support but get refused outright on CHC at the first attempt. We will come back to that.

When CHC is granted, you have a choice in how it is delivered. The ICB can arrange care directly (less common for live-in), or it can issue a Personal Health Budget (PHB), a notional pot of money managed on your loved one's behalf. The PHB is what makes CHC compatible with the kind of carer-of-your-choice arrangement that families want when they look at what live-in care actually involves. You agree a care plan with the ICB, and the budget pays the carer.

The CHC assessment: checklist, DST, recommendation, ratification

The assessment runs in four stages and the timeline can stretch from a few weeks to several months. Here is what to expect.

Stage one: the CHC Checklist. A nurse, social worker or GP completes a short screening tool to decide whether a full assessment is justified. This is meant to be a low bar: it screens people in, not out. You can ask for the checklist to be completed at any time; you do not have to wait for the NHS to offer. Age UK's funding guide explains the trigger points well, and so does Carers UK.

Stage two: the Decision Support Tool (DST). If the checklist clears, a multi-disciplinary team (MDT) of at least two professionals from different disciplines convenes to complete the DST. This is the proper assessment. The family should be invited, can bring an advocate, and should expect a meeting of around two to three hours where each of the twelve care domains is scored with evidence. Bring care logs, GP letters, hospital discharge summaries and medication lists. The more documented evidence you have, the harder it is for the team to underscore a domain.

Stage three: the MDT recommendation. The team writes a recommendation: eligible or not eligible, with reasoning against each domain.

Stage four: ratification by the ICB. The Integrated Care Board signs off (or doesn't). They are meant to follow the MDT recommendation in all but exceptional cases. The framework target is 28 days from positive checklist to ratification; in practice it commonly takes two to four months, and longer if the ICB pushes back on the MDT.

What families actually experience: the first DST is denied more often than people expect, particularly for cognitive-led conditions where behaviour is the lead need. Scoring is subjective, evidence is patchy when nobody has kept detailed care logs, and ICBs are under financial pressure. You have a right to a written rationale and a right to appeal. We cover appeals below.

Local-authority social-care funding: means-tested, but flexible

If your loved one does not qualify for CHC, the next stop is the local authority. Every council in England has a statutory duty under the Care Act 2014 to carry out a care-needs assessment for anyone who appears to need support, free, regardless of income, regardless of whether you eventually pay yourself. Always request this assessment. It is your statutory entry point and it generates a written care plan.

Once needs are agreed, a separate financial assessment decides what the council pays. This is the means-test. England uses two capital thresholds, both set by the Department of Health and Social Care and updated periodically. The current rules are explained on gov.uk's paying for your own care guidance and Age UK's means-test guide.

In broad terms (and you must check the current 2026 figures on gov.uk because they change):

• Above the upper capital threshold (approximately £23,250 in recent years), you are treated as a full self-funder. The council will still arrange care if you ask, but bills you for the full cost.
• Between the lower and upper thresholds (approximately £14,250 to £23,250 in recent years), the council contributes and you contribute from a "tariff income" calculated against your capital.
• Below the lower threshold, capital is disregarded entirely. You contribute only from income, minus a protected personal allowance.

For someone receiving care at home rather than in a residential setting, the value of the home you live in is disregarded. This is a critical point: it is treated differently from the residential-care means-test, where the home counts after a 12-week disregard.

If the council agrees to fund or part-fund your care, you can take the money as a direct payment instead of accepting council-arranged care. Direct payments are paid into a separate account and used to commission your own provider, including a live-in carer found through an introductory agency. Direct payments are what give families the choice and control that council-arranged block contracts often don't.

CHC appeals: what to do when you are turned down

A CHC refusal is not the end of the road. The framework gives families two clear appeal routes.

First, the ICB-level local resolution. You have six months from notification of the eligibility decision to ask for it to be reconsidered. The ICB must reconvene the MDT or look again at the evidence. This is where new evidence matters: fresh GP letters, updated care logs, specialist reports. Many cases turn at this stage.

Second, an Independent Review Panel (IRP) convened by NHS England. If local resolution doesn't change the outcome, the case can be escalated to an IRP, which sits independently of the original ICB. Their decision is non-binding on the ICB but in practice carries significant weight. The NHS England restitution process also allows families to claim back care costs that were wrongly self-funded if eligibility is granted retrospectively, going back to the period the assessment should have agreed cover.

Final route: the Local Government and Social Care Ombudsman. The ombudsman investigates maladministration in how the assessment was carried out, not whether the clinical judgement was right, but whether the process was lawful and fair. Their decisions are binding and they can order recompense.

A practical note: appeals reward documentation. From the day you suspect your loved one's needs are health-led, start keeping a daily diary: medication times, incidents, nights of disrupted sleep, falls, behaviours, the time you spend on each. That evidence is what tips a borderline DST.

Self-funding: when families pay directly

Most live-in care in the UK is paid for privately. If your loved one's capital is above the upper threshold and they have not qualified for CHC, this is where the conversation lands. Self-funding gives you full choice over carer, schedule and standards. The harder part is cash flow. For an overview of weekly prices, see our write-up on how much live-in care costs.

Most self-funders draw from a mix of pension income, ISA and investment drawdowns, and equity in the family home. There is no tax relief on care costs in the UK. The cost is paid from after-tax income or capital.

If property equity is the main resource, there are three common routes. First, selling the home and downsizing, straightforward but emotionally loaded, particularly when the home is where care will be delivered. Second, a council deferred-payment agreement, where the council loans against the value of the home and recovers the loan from the estate later; this is most relevant for residential care. Third, equity release, a regulated mortgage option that gives ongoing income against the home without selling. Talk to a financial adviser who specialises in later-life finance before going down this path.

Non-means-tested benefits help too. Attendance Allowance is for people over State Pension age who need help with personal care, paid weekly, not means-tested. Personal Independence Payment (PIP) covers the same ground for under-State-Pension-age claimants. Neither pays the full cost of live-in care, but both offset a meaningful slice of weekly costs and are worth claiming.

Where MeddyCare fits: both CHC and council funding work with us

We are an introductory agency. Families come to us to find a vetted carer; the family then contracts directly with the carer they choose. That structure matters for funding, because both Personal Health Budgets and council direct payments are designed for this exact arrangement: the family is the commissioner, the carer is the provider, and an introductory agency vets and supports the placement.

In practice this means:

• CHC Personal Health Budgets can pay the weekly carer cost and the MeddyCare service fee where the care plan supports a live-in placement.
• Council direct payments can do the same, subject to your local authority's rules on hourly rates and provider standards.
• Self-funded families are the most common. You pay weekly, no long-term tie-in, with a Care Coordinator supporting you throughout.

What we do: vet every carer with Enhanced DBS, two references, right-to-work checks and an in-person interview, then introduce a shortlist. What we don't do: provide regulated clinical care directly. The carer the family hires provides the care; we support the relationship. For more on how this works in complex cases, see specialist care for complex needs and our guide to live-in care for dementia.

Frequently asked questions

Does CHC cover all care costs?

When CHC is granted, yes. It covers the full assessed package of care, including a live-in carer if that is the agreed plan, plus the agency or service fee. It does not cover non-care living costs like food, utilities or rent. The package is reviewed at least annually, and can change if needs do. The legal basis is the National Framework.

Will the council pay for a live-in carer?

Councils can, but rarely commission live-in care directly. Their block contracts are mostly residential or visiting. The realistic route is to ask for the agreed support to be paid as a direct payment, then commission a live-in carer through an agency like MeddyCare. Some councils set hourly-rate caps that don't match live-in weekly rates. Ask up front and get the answer in writing.

How long does a CHC assessment take?

The framework target is 28 days from a positive checklist to ratification. In practice, expect two to four months for a standard case. The Fast Track Pathway completes in days for end-of-life situations. You can escalate to the ICB's complaints process if a case stalls beyond the target.

We were turned down for CHC. What now?

You have six months from the decision to ask for local reconsideration by the ICB. Add fresh evidence: GP letters, care logs, specialist reports. If that fails, escalate to an Independent Review Panel via NHS England. If process failures are involved, the Local Government and Social Care Ombudsman is the final route. Age UK's funding pages list reputable starting points.

Can we use a direct payment or Personal Health Budget to hire a MeddyCare carer?

Yes. Both are designed to work this way. The family is the commissioner of care; the carer is the provider; we are the introductory agency that vets and matches. We supply your Care Coordinator and the documentation councils and ICBs typically ask for. The contract sits between the family and the carer.

Do Attendance Allowance and PIP help?

Yes. Attendance Allowance (over State Pension age) and PIP (under State Pension age) pay weekly and are not means-tested. They won't cover the full cost of live-in care but they take a useful slice off the weekly bill. Carers UK has step-by-step claim guides.

Does the value of the family home affect home-care funding?

No. For care delivered at home, the value of the home you live in is disregarded from the means-test. This is different from the residential-care rules, where the home counts after a 12-week disregard. It is one of the strongest financial arguments for keeping a loved one at home with live-in care. Check current figures on gov.uk's care funding pages.

Where to start this week

Two phone calls move you forward. First, ask your loved one's GP or local social services for a care-needs assessment, free, statutory, and the gateway to council funding even if you end up self-funding. Second, ask the GP, hospital discharge team or community nurse to complete a CHC Checklist. Neither call commits you to anything, and both create a paper trail you can use later if needs progress.

Funding routes are not as fixed as families fear. People move from self-funding to CHC when conditions change, and from council-arranged care to direct payments when they want more control. Talk to us. We can walk you through which routes are realistic, introduce you to vetted live-in carers if you are ready, and stay alongside you through the assessment if you are not yet.