The short answer
- Dementia alone does not decide itEligibility rests on the needs the care involves day to day, not the diagnosis. Many families with dementia are told nothing will be free before anyone has looked at the needs in detail.
- The NHS route pays for everything, savings includedNHS Continuing Healthcare is not means-tested. It usually needs severe needs across more than one area, such as behaviour, nutrition and mobility together, not dementia by itself.
- Below £23,250 in savings, the council pays a shareThe council must assess anyone who appears to need care. What it pays towards depends on a separate means test, and live-in care specifically can take an extra conversation.
- A direct payment lets you choose the carerWhichever route pays, ask for the money as a direct payment or personal health budget so you can pick who moves in, rather than take whoever is offered.
Rules are for England. Figures are 2026/27, from gov.uk, nhs.uk and the National Framework for NHS Continuing Healthcare, checked 4 September 2026.
The short answer
Two questions decide which route fits your relative
Nobody is entitled to free live-in care simply because they have dementia. What decides it is the kind of needs the care involves, and how much your relative has in savings. Answer the two questions below in order.
Question 1
Is the care your relative needs mainly about their health, not just their day-to-day care?
This is not about the diagnosis. It is about whether the needs, taken together, are intense, complex or unpredictable enough that a council could not reasonably be expected to meet them.
Likely yes
Ask for an NHS Continuing Healthcare checklist
If it is agreed, the NHS pays the whole cost of the care, including live-in care at home, whatever your relative has in savings.
How Continuing Healthcare works →
Not yet, or unclear
Most families with dementia start here. Go to the next question, and ask for the checklist anyway if needs are severe: it costs nothing to ask.
Continue to the next question below
Question 2
Does your relative have less than £23,250 in savings, not counting the home they live in?
The council must assess anyone who appears to need care whatever their savings. This question only decides whether it also pays towards it.
Below the limit
Ask the council for a care needs assessment
If the needs are found eligible, the council pays a share, sometimes all of it, worked out in a separate means test. Ask for the council’s contribution as a direct payment if you want to choose the carer.
The eligibility test and the means test →
Above the limit
Your relative pays for the care itself
The council will still carry out a free needs assessment on request, and Attendance Allowance is worth claiming regardless of savings. Ask again once savings fall towards the threshold.
Paying for care yourself →
Both routes start with an assessment, and both assessments are free, whatever the outcome is likely to be. It is worth asking for both if there is any doubt: the Continuing Healthcare checklist and the council's care needs assessment can run alongside each other, and one does not have to finish before the other starts. What does fully funded care mean? sets the two routes side by side in more depth, including what "fully funded" does and does not cover.
NHS Continuing Healthcare
When the NHS pays for all of it, dementia included
Continuing Healthcare is assessed against twelve areas of need, not against a diagnosis. Dementia on its own, however advanced the label sounds, usually does not meet the test. The combination and intensity of the needs is what does.
Needs that often meet the test
- Behaviour that puts your relative or somebody else at risk, such as leaving the gas on, walking into traffic or repeated falls from wandering
- Eating or drinking problems severe enough to threaten weight or hydration, including refusing food or forgetting to swallow safely
- Needing skilled intervention for distress or aggression that ordinary reassurance does not settle
- Two or more of these together, especially alongside a physical illness such as heart failure or advanced Parkinson’s
What does not decide it on its own
- A dementia diagnosis on its own, however advanced the stage
- Needing reminding, prompting or company for most of the day
- Needing help with washing, dressing and meals that a carer can plan for
- Confusion that is manageable with a familiar routine and a consistent carer
Ask the GP, a memory clinic nurse, a hospital discharge team or a social worker for the Continuing Healthcare checklist, by name, and do it as soon as the pattern above sounds familiar rather than waiting for a crisis. A full assessment follows if the checklist score is high enough, done by a team of at least 2 professionals, and a decision should usually reach you within 28 days. If it is agreed, the NHS can fund live-in care at home through a personal health budget, so you still choose the carer. NHS Continuing Healthcare covers the twelve domains, the assessment day and how to challenge a refusal in full, and the seven stages of dementia sets out roughly where in the illness this combination of needs tends to appear.
Council funding
What the council will pay towards, and why live-in care needs its own conversation
If the needs are mainly personal care and supervision rather than a primary health need, the route is the council, and what it pays depends on your relative's savings. Getting a live-in carer funded, rather than a cheaper alternative, is often a second conversation on top of the first.
What tends to work
- Ask for the eligible needs to be written down in full, including night-time risk and behaviour, not only personal care tasks
- Say plainly that your relative wants to stay at home, and why: the council’s duty is to promote wellbeing and independence, not to pick the cheapest option automatically
- Ask for the council’s share as a direct payment, then add your own money to it if the personal budget alone does not cover a live-in carer
- Get the eligible needs and the personal budget in writing before agreeing anything
What can go wrong
- Assume a live-in carer is a legal right the way a care home top-up is: that formal right only applies to specified accommodation, not home care
- Accept a lower personal budget without asking how it was calculated against the written needs
- Wait for the council to suggest live-in care itself, since a residential place is often what gets offered first because it is simpler for the council to cost
- Give up after one refusal: ask for the reasons in writing and challenge them through the complaints procedure if the needs assessment looks incomplete
A council must assess anyone who appears to need care, and below £23,250 in savings it must pay a share, worked out in a financial assessment that leaves your relative with a protected weekly income (the Minimum Income Guarantee, £241 a week for a single pensioner in 2026/27). The right to choose a more expensive setting and add a top-up is written into law for care homes, but that specific right does not extend to home care in the same way: for a live-in carer, the case is made through the care and support plan itself, on the strength of the eligible needs recorded and the council's duty to promote wellbeing and independence, not through a standard top-up form. A direct payment is the practical route through this: the council's contribution is paid to you, and you can add your own money to reach the cost of a live-in carer if the personal budget alone falls short. Local authority funding for care at home explains the eligibility test, the means test and direct payments in full, and is live-in care cheaper than a care home? sets the two costs against each other, which is often the argument that persuades a council either way.
Money that helps without being free
Attendance Allowance and the other benefits worth claiming
Neither of the two routes above pays for everyone. Two benefits exist alongside them, not means-tested, that reduce what a family pays without needing an assessment of needs first.
Both are worth claiming whatever else is happening with the council or the NHS: Attendance Allowance is not affected by savings, and it continues if council funding starts, though it usually stops if NHS Continuing Healthcare later funds a place in a nursing home. Can my mum pay me to care for her? covers the related question of being paid by your own relative rather than the state.
While you wait
What live-in care costs if you are paying some or all of it yourself
Assessments take weeks, and most families end up funding some of the care themselves while they wait, or for good, if savings sit above the council's threshold. This is what a live-in carer costs for dementia care today, set against a care home.
A week of live-in care against a residential dementia care home
| A week | Notes | |
|---|---|---|
| Live-in care on PrimeCarers | £1,050 to £1,400 | Carer’s rate with our fee included |
| Live-in care for more complex dementia needs | £1,260 to £1,750 | Where behaviour or health needs mean an experienced carer |
| Live-in care through an agency | £1,120 to £1,750 | For comparison, not a PrimeCarers price |
| A residential dementia care home | £1,100 to £1,600 | Fees only; excludes personal spending |
Live-in care on PrimeCarers
- A week
- £1,050 to £1,400
- Notes
- Carer’s rate with our fee included
Live-in care for more complex dementia needs
- A week
- £1,260 to £1,750
- Notes
- Where behaviour or health needs mean an experienced carer
Live-in care through an agency
- A week
- £1,120 to £1,750
- Notes
- For comparison, not a PrimeCarers price
A residential dementia care home
- A week
- £1,100 to £1,600
- Notes
- Fees only; excludes personal spending
PrimeCarers rates, 2026/27, with our fee included. There is no deferred payment agreement for care at home, the arrangement some families use to defer a care home's fees against the value of the house; that route exists for care homes only.
Paying for some of it yourself is not a reason to skip the assessments. A needs assessment is free and does not depend on being able to afford the care, and once it is done, the council can act quickly if savings later fall towards the threshold rather than starting from nothing. Self-funding care covers the options for paying privately without selling the house, and the cost of live-in care breaks down what is included in a live-in week.
How to start
The calls to make this week, and who should make them
If your relative can no longer manage their own affairs, somebody has to make these calls for them. That is usually whoever holds Lasting Power of Attorney, or, if none was set up before the diagnosis progressed, a step the family may need to take through the Court of Protection first.
- 1
Write down a bad week, not a good one
TodayWhat happens overnight, how often somebody has to intervene, what your relative can no longer do safely alone. Both assessments below are won or lost on this evidence. - 2
Ask for both assessments
This weekRing the GP, memory clinic or hospital discharge team and ask for a Continuing Healthcare checklist by name. Separately, ring adult social care at the council and ask for a care needs assessment. Neither has to wait for the other. - 3
Check the paperwork is in place
If not already doneIf your relative can no longer make decisions, whoever holds Lasting Power of Attorney for finances can deal with the council and DWP on their behalf. Without one, the family may need to apply to the Court of Protection, which takes months, so start it in parallel rather than waiting. Mental capacity and MCA explained goes through what this involves. - 4
Look at live-in carers while you wait
Free to searchSearch by postcode to see who is available and what they charge. Every carer has an online interview, and an ID check, a right to work check and an enhanced DBS on the Update Service before they appear, and they are insured while they work. You are not committing to anything by looking. - 5
Bring the funding decision to the carer, not the other way round
Once agreedWhichever route pays, tell your chosen carer what the personal budget or health budget covers so the arrangement is clear from day one.
Questions
Questions families ask about funding live-in care for dementia
No. Eligibility depends on the needs the care involves, not the diagnosis. A person with dementia whose needs are mainly reminding, supervision and personal care usually pays for their own care, or gets a means-tested share from the council. Free, fully funded care through the NHS is reserved for needs that are intense, complex or unpredictable enough to count as a primary health need.
Yes, and it is worth asking for a checklist rather than assuming the answer is no. It is most often agreed at a later stage, when behaviour, nutrition, mobility and other needs combine and become severe, rather than for dementia alone. If it is agreed, the NHS pays the whole cost of care at home, including a live-in carer, with no means test. NHS Continuing Healthcare explains the assessment.
The council must meet eligible needs, but it does not have to choose the most expensive way of meeting them, and a care home is often what gets offered first because it is simpler to cost. Live-in care can still be agreed, usually through a direct payment, by making the case on the strength of your relative’s written needs and their wish to stay at home. There is no automatic right to a live-in carer the way there is a right to top up a care home place.
In England, below £23,250 the council pays towards the cost, on a sliding scale that increases as savings fall. Below £14,250 savings are ignored entirely. The value of the home is not counted for care at home, only for a permanent move into a care home. Local authority funding for care at home works through the means test in full.
Not on its own, but it helps. It is a cash benefit for the person with dementia, not means-tested, and it is paid whether or not a hands-on physical need exists: needing supervision because of confusion or the risk of wandering is enough on its own. It goes some way towards a live-in carer’s cost rather than covering it in full. Attendance Allowance covers the rates and how to claim.
Whoever holds Lasting Power of Attorney for property and financial affairs can deal with the council and the Department for Work and Pensions on their behalf. If no LPA was set up before capacity was lost, the family usually needs to apply to the Court of Protection to be appointed deputy, which takes several months, so it is worth starting alongside the care assessments rather than waiting for it to finish first.
Most families pay for care themselves in the meantime. A live-in carer on PrimeCarers runs from £1,050 to £1,400 a week, more where dementia needs are complex. Money paid before Continuing Healthcare is agreed can sometimes be reclaimed if the NHS should have assessed sooner; ask about this once a decision is made rather than assuming it is lost.