Home care in London is usually paid for in one of three ways: by the person receiving care, by their borough council, or by the NHS. Council support follows a care needs assessment and then a financial assessment, while NHS Continuing Healthcare can fund the whole package where someone’s needs amount to a primary health need. Direct payments are a way of managing council or NHS money rather than a separate payer, and benefits such as Attendance Allowance ease the household budget without paying an agency invoice by themselves. The familiar £23,250 capital threshold is only a national benchmark; individual London authorities can run more generous non-residential charging policies. The safest first step is to ask the borough for a needs assessment, then weigh any public funding against the private care that keeps the person safe at home.
Who pays for home care: the three funding routes
There is no single payer for home care. Most packages are funded through one of three routes: private payment, local authority social care funding, or NHS Continuing Healthcare. Short-term reablement may also be free after a hospital stay, fall or illness. Benefits can help with household costs, while personal budgets and direct payments give an eligible person more control over public money.
The route depends on two separate questions. First, what support does the person need to remain safe and independent? Second, who is responsible for paying for those assessed needs? A person can also have a mixed package, such as council-funded morning visits with privately funded companionship or overnight support.
| Funding route | Who may qualify | What it can cover |
| Self-funding | People paying privately, often because of capital, income, choice or speed | Hourly, live-in, overnight, respite and specialist home care |
| Council funding | People with eligible social care needs after a needs and financial assessment | All or part of an agreed care and support plan |
| NHS CHC | Adults assessed as having a primary health need | The full assessed health and social care package, including care at home |
| Reablement | People recovering after hospital, illness, injury or a fall | Short-term support, usually for no more than six weeks |
| Benefits | People meeting the rules for Attendance Allowance, PIP or carer benefits | Extra income that may help with costs, rather than a commissioned care package |
Sources: NHS care and support you can get for free
When will a London council help with home care costs?
Your borough must first decide whether your needs are eligible under the Care Act. A care needs assessment looks at daily activities, safety, wellbeing and the outcomes you want to achieve. It should consider needs arising from dementia, frailty, disability or illness, as well as the effect on an unpaid family carer. The assessment is about need, not money.
If the council finds eligible needs, it will normally complete a financial assessment. This reviews income, savings, investments and certain disability-related expenses. The result may be full council funding, a shared contribution, or a decision that you must pay the full cost. You can ask for the calculation in writing and challenge information you believe is wrong.
What happens during the needs and financial assessments?
Prepare for the assessment by describing what happens on a difficult day, not only what is manageable when family members are present. Keep notes about missed medication, falls, night-time waking, personal care, nutrition, wandering, distress and carer exhaustion. Specific examples help the assessor understand the frequency, intensity and risk attached to each need.
1. Contact your borough’s adult social care team and request a care needs assessment.
2. Ask for a carer’s assessment if a relative or friend provides regular unpaid support.
3. Gather bank statements, benefit letters, pension information and evidence of disability-related expenditure.
4. Request the written eligibility decision, care plan, personal budget and financial contribution calculation.
Is your home included in the means test?
If care is delivered in your own home, the value of that home is normally disregarded in the financial assessment. This is different from some care home charging rules. Other property, savings, investments and income may still be considered, subject to the Care Act regulations and your council’s policy.
The widely quoted £23,250 figure is a useful benchmark, but London policies are not identical. The City of London currently publishes an upper capital limit of £34,875 for care outside a care home and a lower limit of £14,250. Check your own borough before assuming that a national headline figure settles your eligibility.
How do personal budgets and direct payments work?
A personal budget is the amount the council agrees is available to meet eligible needs. The council can manage it, pay a provider, make a direct payment to you or combine those approaches. Direct payments can give a family greater choice over the agency, care worker, schedule and language or cultural fit, as long as the spending follows the agreed care plan.
Choice comes with responsibility. If you employ a personal assistant directly, you may need to manage payroll, tax, National Insurance, pension duties, insurance and safer recruitment. A managed home care agency takes on employment, supervision and cover responsibilities, which is one reason its hourly rate is usually higher than an introductory platform.
When does the NHS pay for care at home?
The NHS can fund care at home when a person qualifies for NHS Continuing Healthcare, often called CHC. Eligibility is based on the nature, intensity, complexity and unpredictability of the person’s needs, not on a diagnosis, income or savings alone. Dementia can form part of a qualifying picture, but it does not create automatic entitlement.
Ask a GP, social worker, district nurse or other health professional for a CHC Checklist if needs are complex or deteriorating. A positive checklist leads to a full multidisciplinary assessment. If the person is rapidly deteriorating and may be approaching the end of life, ask whether the Fast Track Pathway is appropriate.
What can NHS Continuing Healthcare cover at home?
When CHC is awarded, the NHS funds the full assessed package of health and associated social care. At home, this may include personal care, clinical support, supervision, specialist equipment and paid carers. The package must meet assessed needs, although the local Integrated Care Board can consider cost, suitability and value when agreeing how it will be delivered.
People receiving CHC at home should usually be offered a personal health budget. This can be managed as a notional budget, by a third party, or in some cases as a direct payment for healthcare. It provides more involvement in planning, but it must still be used for agreed health and wellbeing outcomes.
Is reablement after hospital free?
Intermediate care or reablement is short-term support designed to help someone recover independence after hospital, illness, injury or a fall. NHS guidance says it may be free for up to six weeks, although it lasts only as long as the person needs it and services vary locally. Hospital staff may arrange it before discharge, or a GP, paramedic or adult social care team may refer.
Reablement is goal-focused, not an open-ended home care package. If the person still needs help when it ends, ask for a social care assessment and, where needs are primarily health-related, consider CHC screening. Families can also arrange private support to fill gaps or maintain continuity.
Does NHS-funded Nursing Care pay for care at home?
No. NHS-funded Nursing Care is a contribution towards registered nursing care for someone living in a nursing home. It should not be presented as a funding route for ordinary care delivered in a person’s own home. For care at home, the relevant NHS routes are CHC, a personal health budget linked to CHC, and short-term intermediate care or reablement.
When do you need to self-fund home care?
You may need to pay privately because the financial assessment finds you responsible for the full cost, because the council funds fewer hours than the family wants, or because you prefer to choose and start a service without waiting for public arrangements. Self-funding can also sit alongside a council or NHS package.
Current London pricing varies by service model and complexity. Tidal Living’s hourly home care guide places introductory platforms at roughly £19 to £25 per hour, fully managed agencies at about £30 to £40, and specialist or complex support at about £35 to £60 or more. Ask whether the quote includes travel, minimum visit lengths, evenings, weekends, supervision, holiday cover and emergency replacement care.
Which benefits can help with home care costs?
Benefits are not the same as a commissioned care package, but they can improve the household budget. Attendance Allowance is not means-tested and is available to people over State Pension age who need personal care or supervision because of illness or disability. For 2026/27, the weekly rates are £76.70 and £114.60, depending on the level of help needed.
People under State Pension age may qualify for Personal Independence Payment. An unpaid family carer may be eligible for Carer’s Allowance, which is £86.45 a week in 2026/27, subject to care hours, earnings and other benefit rules. Carer’s Allowance belongs to the carer and should not be described as payment for the older person’s agency care.
How should a London family start?
Start the public funding process even if you expect to self-fund. A council assessment can clarify needs, identify equipment or reablement, support an unpaid carer and create a useful record if circumstances worsen. At the same time, compare providers so the family understands what safe support would cost and how quickly it could begin.
The below list is a summary of the steps you should take in order to evaluate opportunities for public funding:
- Request a care needs assessment from the adult social care team in the person’s borough.
- Ask for a financial assessment and a written explanation of the borough’s current capital policy.
- Request a CHC Checklist if the needs appear primarily health-related, complex or rapidly changing.
- Check Attendance Allowance, PIP and carer benefits using current GOV.UK guidance.
- Compare council-arranged care, direct payments and a CQC-registered managed agency on continuity, risk and total cost.
Next steps to take
Funding decisions can take time, but urgent care needs should not be ignored. If someone is unsafe at home, approaching hospital discharge or exhausting an unpaid carer, arrange an immediate conversation about risk and the minimum safe level of support. Public assessments and private planning can proceed at the same time.
Tidal Living provides psychotherapist-led, CQC-registered domiciliary care in London, including hourly care, live-in care and respite support. To discuss the care you or your loved ones need and receive a clear private estimate, book a free assessment or call 0203 576 1970.
Frequently Asked Questions
Do I have to sell my home to pay for home care?
Normally, no. When care is provided in your own home, the value of that home is generally disregarded in the social care financial assessment. Savings, investments, income and other property may still be considered. Ask your borough for its written non-residential charging policy if the calculation is unclear.
Can the council pay a private home care agency?
Potentially. The council may arrange an approved provider, pay another organisation, or offer a direct payment that you use for care meeting the agreed plan. If the preferred service costs more than the personal budget, ask whether a lawful personal contribution or additional private hours can create a mixed package.
Does dementia automatically qualify for NHS Continuing Healthcare?
No. CHC is based on the total pattern of needs rather than the diagnosis. Advanced dementia may involve severe cognition, behaviour, nutrition, medication, mobility or supervision needs, but a multidisciplinary team must still assess their nature, intensity, complexity and unpredictability.
Who pays for care after hospital discharge?
Short-term intermediate care or reablement may be free for up to six weeks when it helps someone recover or prevents admission. If ongoing support is still required, responsibility may move to the council, the NHS through CHC, the individual, or a combination. Ask about the plan before the temporary service ends.
References
- NHS: Care and support you can get for free
- NHS: NHS Continuing Healthcare
- NHS: Personal budgets and direct payments
- NHS: Care to support recovery after hospital or illness
- GOV.UK: Benefit and pension rates 2026 to 2027
- City of London: Adult social care financial assessments
- Tidal Living: Who pays for respite care?
- Tidal Living: Home care in London
