When someone you love is diagnosed with dementia, one of the first big worries that creeps into your mind is money — specifically, whether they’ll need to pay for a care home. It’s a question thousands of families ask every year: do dementia sufferers have to pay care home fees, or is help available? The truth is, the answer isn’t straightforward. It depends on the level of care needed, financial circumstances, and what type of funding your loved one may qualify for.

In this guide, I’ll walk you through the whole system in a friendly, conversational way — helping you understand how care fees work in the UK, what support options exist, and how to make confident, informed decisions.

What actually decides whether you have to pay care home fees?

Is a dementia diagnosis enough to get free care?

It’s a really common belief that dementia automatically qualifies someone for free care home funding. Sadly, it doesn’t. A dementia diagnosis alone does not guarantee free care. The system looks at two things:

1. What kind of care is needed

2. Your financial situation

To understand this properly, you need to know the difference between health needs and social care needs.

What’s the difference between a health need and a social care need?

Type of Need	What It Means	Examples in Dementia Care	Who Is Responsible for Funding?
Health Need	Ongoing medical or nursing requirements that relate to a person’s health condition	Unpredictable behaviour, complex mobility issues, severe confusion requiring clinical oversight, regular nursing intervention	NHS (may include CHC or FNC)
Social Care Need	Help with everyday activities needed to stay safe, clean, and supported	Washing, dressing, eating, toileting, supervision to prevent wandering	Local Council (means-tested)

What is a care needs assessment, and why does it matter?

Your local council starts by carrying out a care needs assessment. This looks at:

• Cognitive challenges (memory, confusion, decision-making)

• Behavioural symptoms (agitation, wandering, aggression)

• Safety risks

• Mobility needs

• Whether residential or nursing care is required

This determines the type of care your loved one needs — which is essential for working out what they might have to pay.

What is the financial assessment (means test), and what does it look at?

If the council may need to contribute financially, they’ll perform a means test. This looks at savings, pensions, income and sometimes property. The results of this assessment determine who pays and how much. In England, the thresholds are clear:

Here’s a simple breakdown for England:

When can care home fees be fully or partly covered?

Can you get free care through NHS Continuing Healthcare (CHC)?

NHS Continuing Healthcare is the only way to get all care home fees paid in full — including accommodation. To qualify, your loved one must have:

• Severe, unpredictable or complex health needs

• A primary need for healthcare rather than social care

Dementia alone doesn’t guarantee CHC, but advanced dementia or significant behavioural difficulties can make someone eligible.

What happens if CHC is denied — can you appeal?

This is one of the biggest knowledge gaps online.

Yes — you can absolutely appeal.

You can request:

• A review of the decision

• A full reconsideration

• Support with gathering evidence (care records, risk assessments, medical notes)

CHC is often refused the first time, so don’t be discouraged.

What is NHS-funded Nursing Care (FNC), and who gets it?

If your loved one needs nursing care but not enough to qualify for CHC, the NHS may provide a weekly contribution towards their nursing costs. It won’t cover everything, but it does reduce the overall fees.

Can the council help pay for care?

Yes — if your loved one’s savings fall below the national thresholds.
But remember:

• The council pays for social care, not nursing care.

• You may still need to pay towards accommodation and extras.

Do you have to pay if you own a home or have savings?

Many families worry about whether a home must be sold to pay for care. In some cases, the property is included in the assessment, but several important exceptions apply. The home is not counted if:

• A spouse or partner still lives there

• A disabled or dependent relative lives there

• You’re within the 12-week property disregard period

If you don’t want to sell the home straight away, a deferred payment scheme may help keep your options open.

What are deferred payment schemes, and should you consider one?

A deferred payment scheme lets you delay paying care home fees until after the home is eventually sold. It can be helpful if:

• You want to keep the home in the short term

• You need time to plan financially

• You don’t want to disrupt family living arrangements

Interest and admin fees do apply, so it’s not right for everyone.

What does self-funding actually mean for you?

What costs will you pay as a self-funder?

If you’re self-funding, you’ll typically cover:

• Accommodation

• Meals

• Personal care

• Nursing care (unless CHC or FNC applies)

• Extras like hairdressing, trips, podiatry

How much do dementia care homes typically cost in the UK?

Residential dementia care in the UK often ranges between £800–£1,500 per week, depending on the region, type of care, and level of specialisation. Specialist dementia nursing units tend to cost more.

What funding options exist for self-funders?

This is rarely explained well elsewhere. Options include:

• Attendance Allowance

• Pension income

• Equity release

• Deferred payment schemes

• Care fee annuities

• Personal budgets

What if the council pays but your chosen home is more expensive?

Do you need to pay top-up fees?

If the home you choose costs more than what the council is willing to fund, a top-up fee may be required.

Important notes:

• You generally cannot pay your own top-up fee — it must come from a third party.

• If the top-up payer can no longer afford it, you may need to move to a different home.

What are the new rules for care home payments?

The new rules for care home payments are designed to make care more affordable and to protect people from very high lifetime costs. Under these changes, there will eventually be a cap on how much you personally pay for care, meaning once you reach that limit, the state steps in. The savings thresholds for means-tested support are also set to rise, allowing more people to receive help from their local council instead of paying privately.

While not all reforms are fully in place yet, the aim is simple: to give families clearer financial protection and reduce the risk of someone losing most of their assets because they need long-term care.

Real examples — When do people with dementia pay or not pay?

Example 1 — Early-stage dementia

Someone with early-stage dementia typically has social care needs rather than medical ones, meaning they are usually self-funding unless their finances fall below the local authority thresholds.

Example 2 — Mid-stage dementia with nursing needs

A person who requires regular nursing oversight may receive NHS-funded Nursing Care and may receive partial help from the council depending on their financial assessment.

Example 3 — Advanced dementia with complex behaviours

In advanced cases, where behavioural or medical needs are severe and unpredictable, there is a stronger chance of receiving full NHS Continuing Healthcare funding.

What should you do next if you’re arranging care?

Practical steps to take right now

Here’s a simple checklist to help you move forward:

• Request a care needs assessment from your local council

• Ask for a financial assessment if funding may be needed

• Check for CHC eligibility

• Gather medical notes and care records

• Compare local care homes and check what’s included in their fees

• Seek independent financial advice

• Keep written notes for appeals

What mistakes should you avoid?

• Assuming dementia automatically qualifies for free care

• Selling a home before understanding exemptions

• Forgetting to check what is included in care home fees

• Ignoring CHC appeals — many people succeed the second time

How do rules differ across the UK nations?

Here’s a simple comparison:

Conclusion

So, do dementia sufferers have to pay care home fees?

Sometimes yes — sometimes no. It all depends on health needs, financial circumstances, and what support the NHS or local council can offer. The system can feel overwhelming at first, but once you break it down, it becomes much more manageable. By understanding the assessments, knowing your rights, and planning early, you can help your loved one receive the right care without unnecessary stress.

FAQs

1. What is the life expectancy of a person with vascular dementia over 80?

Usually around 3 to 5 years, though it can vary depending on overall health and how quickly the condition progresses.

2. Can I refuse to pay care home fees?

You can refuse only if you are not legally responsible, but the person needing care is still expected to pay based on their financial assessment.

3. How much does a dementia care home cost per week?

Dementia care typically costs £800 to £1,500 per week in the UK, depending on location and level of care.

4. Who pays for a care home if you have no money?

If someone has no savings or assets, the local council usually pays for their care after a financial assessment.

5. Are next of kin responsible for care home fees?

No, next of kin are not legally responsible for paying care home fees unless they voluntarily agree to a top-up payment.