By the Big on Health editorial team, Ideas in Medicine Ltd.

This is not medical, legal or financial advice. Big on Health is a UK review site. For health worries, speak to the GP, pharmacist or NHS 111. If someone is seriously ill, injured or in immediate danger, call 999. For money questions, speak to the council, a benefits adviser or a regulated financial adviser.

Working out who pays for care at home is often the hardest part of arranging it. The short answer is that it can be the NHS, the council, the person themselves, or a mix, and the rules differ in England, Scotland, Wales and Northern Ireland. This guide sets out the routes in plain English: what is free, how the council means test works, direct payments, benefits that can help, what private care really costs, and the honest difference between agency and self-employed rates. We do not give benefit rates here, because they change; we link to the official pages instead. We checked every source on 26 Oct 2026.

The three main payers

• The NHS pays for health care, and in some cases for all of someone’s care at home.
• The council (or Health and Social Care Trust in Northern Ireland) may pay towards social care, after a needs assessment and, usually, a financial assessment.
• The person pays the rest, or all of it, from income, savings and benefits. This is called self-funding.

Many families end up with a mix: the council funds some visits, the person tops up with private hours, and benefits help with the gap.

What the NHS may pay for

NHS continuing healthcare

The NHS says some people with long-term complex health needs qualify for free health and social care arranged and funded solely by the NHS, called NHS continuing healthcare. It can be provided in your own home. Eligibility depends on assessed needs, not a particular diagnosis. Most people first have an initial checklist assessment, which can be completed by a nurse, doctor, other health professional or social worker, and this decides whether a full assessment is needed. The NHS says a decision should usually be made within 28 days. If someone’s health is deteriorating quickly and they are nearing the end of life, it says they should be considered for the fast-track pathway, usually within 48 hours.

If you think this might apply, ask the GP, social worker or district nurse for the checklist. If someone is not eligible, the NHS says the NHS may still pay for part of a package of support, sometimes called a joint package. The NHS pages on continuing healthcare describe the system in England; ask the council, health board or Trust how it works where you live.

Free help after hospital and small equipment

The NHS says that in England you may be eligible for free care and support for up to six weeks after a hospital stay, or to prevent a hospital stay, called intermediate care or reablement. It is not available in all areas. mygov.scot says that in Scotland you might get free home care from the council for up to 28 days after leaving hospital. The NHS also says equipment and home adaptations that each cost less than £1,000 must be provided free if the council’s assessment says you need them. See Care after a hospital stay and Disabled Facilities Grant.

What the council may pay for

Step 1: the needs assessment

The NHS says the needs assessment is free and anyone can ask for one. It works out what help is needed, for example a paid carer for two hours a day or two hours a week, and what they should do. Even if you plan to pay yourself, it is worth having: the NHS says it helps you explain to an agency or carer what is needed. If a relative does a lot of the caring, they can ask for a carer’s assessment too.

Step 2: the financial assessment (means test)

If the person is eligible for care, the council works out how much they pay. The NHS says that in England:

• the council generally helps to pay for care if savings are under £23,250;
• the assessment looks at earnings, pensions, benefits (including Attendance Allowance or PIP), savings and property;
• for care at home, the value of the person’s house is not included;
• it does not ask about the value of possessions or life insurance;
• giving money or property away to avoid paying will not work, and could stop any financial help;
• the council must usually reassess finances once a year.

The NHS adds that you can choose not to have a financial assessment and pay for care yourself. If savings are falling, it suggests contacting the council about three months before they drop below the limit, because councils fund from the date you contact them, not before.

The NHS also says you will not have to sell your home to pay for help in your own home. Care homes are different; see the NHS page on paying for your own care.

Rules and figures change, so check with the council or Trust before making plans. The £23,250 figure is the NHS England page’s figure and applies in England.

Personal budgets and direct payments

If the council is paying towards care, the NHS says it must give a care and support plan, and a personal budget: the amount it thinks the care should cost. In England the NHS says you can take the personal budget in three ways, or a mix:

• as a direct payment into a bank account, for you to arrange care yourself, usually with receipts;
• the council arranges and pays for the care;
• an organisation you choose, such as an individual service fund, manages it.

GOV.UK says direct payments let you choose and buy the services you need instead of getting them from the council, and are available in England, Scotland and Wales. In Scotland, mygov.scot calls this Self-directed Support, with four options: a direct payment, an Individual Service Fund, the council arranges support, or a mix. In Northern Ireland, nidirect says you can apply for direct payments from the Trust once you have been assessed as needing social services support, and that they can be topped up if you want a more expensive service or extra hours.

What direct payments mean in practice

• You may become an employer. The NHS says that if you use a direct payment to employ someone you know, rather than an agency, you will have responsibilities as an employer. It lists background checks or references, tax, National Insurance and pension contributions.
• You must stick to the plan. The NHS says the council may ask you to sign a direct payment agreement, and if money is spent on something not agreed in the care plan, it could take the money back or end the payments.
• Someone else can manage it. The NHS says the money can be paid to a carer, friend, family member or advocate who spends it for you.
• Agencies are an option. The NHS says using an agency removes the legal obligations of being an employer, but could cost more and mean not having the same person each time.

Benefits that can help

Some disability benefits are not means-tested and can be put towards care. The NHS says Attendance Allowance and Personal Independence Payment (PIP) are not means-tested and can help with the cost of homecare.

• Attendance Allowance is for people over State Pension age who need help because of a disability or health condition. In Scotland, GOV.UK says to apply for Pension Age Disability Payment instead. See our guide Attendance Allowance and the GOV.UK page for current rates.
• PIP can help with extra living costs for someone with a long-term health condition or disability who has difficulty with everyday tasks or getting around. GOV.UK says you can get it even if you are working or have savings. It is usually claimed by people under State Pension age; see GOV.UK: PIP for who can claim.
• Carer’s Allowance may be paid to someone caring at least 35 hours a week for a person getting certain benefits. In Scotland it is Carer Support Payment. GOV.UK warns it can affect other benefits for both of you. See our guide Carer’s Allowance and the GOV.UK page.

Benefits rules and rates change every year, so always check the official page before relying on a figure.

What private care costs

The NHS gives these broad figures for England:

• Visiting care: £15 to £30 an hour, varying by area, with a typical hourly rate of around £20.
• Live-in care: from around £800 a week, and as much as £1,600 a week if a lot of care is needed.

Evenings, weekends, bank holidays, short visits and complex needs often cost more. Our guide Home care costs in the UK in 2026 goes into detail, and Live-in care in the UK and Overnight care at home cover those options.

Agency, self-employed or direct hire: an honest look at rates

Hourly rates are not like for like, so compare what is included as well as the headline figure.

Agency carers

The agency employs the carer. Its rate usually covers the carer’s pay and employment costs, holiday, training, management, insurance, out-of-hours cover and regulation. The NHS says agencies should give self-funders a clear price list and a monthly bill. You are not the employer. It is often the most expensive per hour, but cover for sickness and holidays is the agency’s problem.

Self-employed carers, often through a platform

A self-employed carer sets their own rate and pays their own tax and National Insurance. A platform may add a fee. The hourly cost can be lower than an agency, and you may get more say over who comes. But you usually arrange cover yourself if they are ill or away. GOV.UK says someone is probably self-employed if they quote for work, are not directly supervised, invoice, pay their own tax and National Insurance, and do not get holiday or sick pay. It warns that if status is wrong, people may face unpaid tax and penalties. If you control when, where and how they work like an employee, take advice.

Employing a carer directly

The NHS says that if you employ a paid carer, you have the legal responsibilities of an employer, including arranging cover for illness and holidays. GOV.UK’s step-by-step guide covers National Minimum Wage, PAYE and National Insurance, sick pay, workplace pensions and Employers’ Liability insurance, which GOV.UK says you must have unless you only employ a close family member. Most workers are entitled to 5.6 weeks’ paid holiday a year. So the true cost is more than the hourly wage.

Our guide Care agency vs private carer in the UK compares the routes in more detail.

A simple budget checklist

• Have we asked for a needs assessment, and a carer’s assessment for the family carer?
• Is NHS continuing healthcare worth asking about?
• Have we claimed every benefit the person may be entitled to?
• Do we have the rate in writing, including evenings, weekends, travel and cancelled visits?
• If we hire a carer directly, who handles pay, tax, National Insurance, pension and holiday?
• If we use an agency or platform, what fee is included?
• When will we review the cost, and what will we do if savings fall?

For an interview list, see Questions to ask before hiring a carer. For checks, see DBS checks when hiring a private carer.

Getting independent advice

The NHS points to free sources of advice on paying for care, including MoneyHelper, Age UK and Independent Age, and to specialist care fees advisers for unbiased financial advice. If you disagree with a council’s financial assessment, the NHS says to complain first to the council, and then to the Local Government and Social Care Ombudsman if needed.

When to get urgent help

• Call 999 if someone is seriously ill or injured, or their life is at risk.
• NHS 111 if you are worried about someone’s health and it is not an emergency.
• The local council or Trust if care at home breaks down and you need social care help quickly.

Related guides

Sources

All checked on 26 Oct 2026.

• NHS: Paying for your own care (self-funding)
• NHS: Financial assessment (means test) for social care
• NHS: When the council might pay for your care
• NHS: Personal budgets and direct payments
• NHS: NHS continuing healthcare
• NHS: Care and support you can get for free
• NHS: Help at home from a paid carer
• NHS: Getting a care needs assessment
• GOV.UK: Apply for direct payments
• GOV.UK: Attendance Allowance
• GOV.UK: Personal Independence Payment
• GOV.UK: Carer’s Allowance
• GOV.UK: Employment status: self-employed and contractor
• GOV.UK: Get ready to employ someone for the first time
• GOV.UK: Employers’ liability insurance
• GOV.UK: Holiday entitlement
• mygov.scot: Care at home
• mygov.scot: Costs of personal and nursing care
• mygov.scot: Self-directed Support
• GOV.WALES: Charging for social care
• nidirect: Direct payments for care
• nidirect: Support to stay in your own home
• nidirect: Employing a paid carer or personal assistant

This page is general information, not medical, legal or financial advice. Check care, benefit and funding rules with the local council, Health and Social Care Trust or GOV.UK before making plans.

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