The news that many care home residents are being warned that they will not qualify for Winter Fuel Payment shines a spotlight on the wider issue at hand: the costs associated with getting older and the increasing burden of care.

Across England and Wales, families are struggling with the rising cost of care homes. Fees have far outpaced inflation, leaving many older people and their loved ones wondering how they can possibly afford long-term care.

The average weekly cost of residential care now exceeds £1,100, with nursing care often far higher. For those with complex or long-term health needs, annual fees can easily surpass £70,000, rapidly draining a lifetime’s savings.

Yet there is a crucial source of free NHS funding that many people don’t know about: NHS Continuing Healthcare (CHC). For those who qualify, CHC covers the entire cost of care including medical support, accommodation, personal care, and meals, completely free, regardless of income or savings.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS for adults with serious and ongoing health needs.

Unlike social care, which is means-tested, CHC is based solely on health needs, not financial circumstances. It can be provided in a care or nursing home, a residential facility, or in your own home.

If eligible, the NHS pays 100% of care costs with no means test, contributions, or top-up fees. Despite this, many people remain unaware of CHC until they have already spent large sums on care.

Why CHC matters more than ever

With care costs soaring, awareness of CHC funding has never been more vital. Many families face financial hardship, home sales, or depleted savings that were meant to support future generations.

If your needs are primarily health-related rather than social, you may not have to pay at all. CHC exists to ensure healthcare remains free at the point of need, whether at home or in a care facility.

Sadly, the scheme remains underused. Thousands who might qualify are never assessed or are wrongly told they do not meet the criteria. Understanding your rights can make all the difference.

Who can get NHS continuing healthcare?

To qualify, your health needs must be significant, complex, or unpredictable. A local NHS assessment team, usually including nurses, doctors, and social workers, will determine whether your needs are primarily health-based.

CHC is not limited to care homes. Many people receive funding at home, allowing them to stay in familiar surroundings while the NHS covers carers, nurses, and equipment.

How the NHS CHC assessment works

• Checklist assessment: A brief screening carried out by a health or social care professional.
• Full assessment (Decision Support Tool): If the checklist suggests a higher level of need, a detailed review is completed by a multidisciplinary team (MDT).
• Decision by the Integrated Care Board (ICB): The local NHS body makes the final eligibility decision.

If approved, the NHS pays for your full care package. If refused, you can appeal, and many families successfully overturn initial decisions with proper evidence and legal guidance.

The truth about top-up fees

If you are not eligible for CHC, care funding becomes the responsibility of the local authority, which will assess your finances.

In England, individuals with over £23,250 in capital (or £50,000 in Wales) must pay the full cost of care. As fees rise, people’s savings are depleted faster than ever, making top-up fees a growing concern.

Top-up fees are additional payments when a care home’s fees exceed the local authority’s usual rate. However, they should only be requested in limited, lawful situations: when no suitable care home is available at the standard rate, and when the family voluntarily chooses a more expensive option.

Top-ups should be for lifestyle choices, not a condition of receiving care. Unfortunately, many families are wrongly told they must pay even when no alternative is available. These requests can and should be challenged.

If your relative qualifies for CHC, no top-up fees should ever be charged. The NHS is legally responsible for paying all reasonable care costs, including accommodation, food, and nursing support.

Why families rarely hear about CHC

A major issue is lack of awareness. Families are often not informed about CHC until they have already spent months or even years paying for care.

If your loved one’s needs are significant, request a CHC assessment as early as possible. Even if the person has been in care for some time, retrospective reviews are available. In England, you can ask for a review of unassessed care periods dating back to April 2012, even if the individual has since passed away.

Don’t pay until you know your rights

The cost of care has reached crisis levels. Families should not have to sell homes or drain savings when their loved one’s needs are primarily medical.

NHS Continuing Healthcare exists to prevent exactly that, ensuring that care remains free when it is, in essence, healthcare. Yet far too few know it exists, and even fewer understand how to access it.

If you or someone you care for needs long-term care, always ask about CHC before paying privately. The difference could be life changing.

Rising care fees may be inevitable, but with the right information and, if needed, specialist legal help, you don’t have to face them alone.

Lisa Morgan is a partner and the head of the nursing care fee recovery team at Hugh James Solicitors.