Publicly funded care, explained

Both branches start from the same place, a needs assessment that finds eligible needs, an NHS Continuing Healthcare decision, or an award of a benefit such as Attendance Allowance. The different types of care funding sets out where that first decision comes from in full: the NHS, the council, and the benefits that are paid whatever your savings. What decides whether the care is arranged for you or handed to you as money is usually your own choice, made once the needs assessment or the Continuing Healthcare decision is through, and it can be changed later in either direction.

Not every family qualifies for any of the three. Savings above the council's threshold with no complex health need and no non-means-tested benefit awarded means paying for care privately, at least for now, and that is a normal position to be in rather than a sign anything has gone wrong. Self-funding your care sets out the options for paying privately and what to check as savings run down towards the threshold, since a fresh needs assessment can bring council funding into reach later even if it is not available today.

Most families who want to keep the same carer, rather than whoever an agency's rota sends, choose the direct payment or personal health budget route. On that route, the same weekly budget usually stretches further too: carers on PrimeCarers charge £18 to £25 an hour, typically about £20, with our fee included, against £28 to £35 an hour through an agency, so a fixed personal budget buys more hours of care. See carers near you to check what that looks like for your postcode before you decide.

1. 1

   A dedicated account

   Most councils ask for a separate bank account or a prepaid card used only for the direct payment, so the money is never mixed with your own. The same applies to an NHS direct payment for a personal health budget.
2. 2

   Spend it on the plan, not around it

   The money is for the needs written into the care and support plan or the personalised care and support plan: personal care, a personal assistant's wages, respite, or equipment agreed in advance. It is not for rent, food shopping for the whole household, or anything unrelated to the assessed needs.
3. 3

   Keep every record as you go

   Invoices from a carer or agency, timesheets, bank statements and, if you employ someone, payslips and payroll records. Councils typically ask to see three months to a year of these at a time, and it is far easier to keep a folder from the start than to reconstruct one later.
4. 4

   Expect a review, usually annual

   The council or NHS checks the account against the plan, commonly once every 12 months, sometimes more often in the first year. It is a check that the money matched the need, not an audit to catch you out, and a tidy folder makes it short.
5. 5

   Tell them if the underspend or overspend is large

   A little left over most weeks is normal and can usually be carried forward for something like extra cover while you are away. A large, unexplained underspend can mean the council reduces the payment or asks for money back, so flag it rather than let it build up unreported.

Carers on PrimeCarers are self-employed, and PrimeCarers is an introductory service rather than an employer or a care provider: it is not CQC-registered and does not manage or deliver the care itself. Before a carer is introduced to you, their identity, right to work in the UK and an accepted criminal-record check (Enhanced DBS issued within the last 18 months, DBS Update Service, Scottish PVG or Access NI) are checked, and they are interviewed online; they are insured while they work. Their invoices are what you show the council or NHS at review time. How we vet every carer sets out exactly what is and is not checked.

For comparison, a typical care home place on this site's own cost figures runs about £1,100 to £1,600 a week, with nursing care nearer £1,410, though the council's own usual cost for your relative's area may sit below that. Care at home or a care home sets the two settings side by side, including how live-in care compares with a care home place once someone is assessed as needing residential care.

A direct payment can pay a relative who lives elsewhere to provide care, agreed as part of the plan. It cannot normally pay a close family member living in the same house, unless the council decides that is the only practical way to meet the needs, which does happen in some cases. Either way the arrangement is between your relative and the family member being paid, at a fair rate for the hours worked, and it has its own tax and benefit consequences. Can my mum pay me to care for her? goes through the tax, Carer's Allowance and power of attorney questions that come with it.

Carer's Allowance itself is a different payment again: money to the family member doing the caring, rather than money to spend on a carer. It is claimed separately from any of the routes on this page, and getting it can affect a severe disability addition your relative was getting for living alone, so it is worth checking both ways round before either claim goes in. Carer's Allowance explained covers who qualifies and how to claim.

1. 1

   Tell the council or NHS team as soon as something changes

   As it happens

   A fall, a hospital stay, needing more help at night, or savings moving towards a threshold. Reporting a change promptly is far easier than an overpayment or a gap in care being sorted out later.
2. 2

   Ask for a reassessment rather than waiting for the scheduled one

   Any time

   Care and support plans and personal health budgets are reviewed at least once a year, but you do not have to wait for that date if needs have clearly grown or shrunk. Ask for the assessment to be brought forward.
3. 3

   If a decision seems wrong, ask for it in writing and challenge it

   Time-limited

   A refusal, a reduced contribution, or a rejected top-up can usually be challenged. Local authority funding and NHS Continuing Healthcare cover the reconsideration and appeal routes and their deadlines in full.
4. 4

   Get free advice before you write anything

   Free

   Age UK, Citizens Advice, Carers UK and the council's own welfare rights team all help with reassessments, disputes and the paperwork behind a direct payment, and none of them charge for it.