Dementia and care funding

Why dementia care is usually means tested

NHS care is free. Social care is means tested. Dementia care is generally assessed as social care, because much of what it involves is help with daily living rather than treatment of a medical condition.

Families find this genuinely unfair, and the argument that a diagnosed neurological illness should be treated like any other illness is a reasonable one. But it is the system as it currently stands, and understanding it is the first step to working within it.

That said, some people with dementia do qualify for full NHS funding, and the number who should but do not is not small. If the first decision looks wrong, it is worth challenging.

NHS Continuing Healthcare

NHS Continuing Healthcare is a package of care funded entirely by the NHS, outside the home, for people whose needs are primarily health needs. It is not means tested and it covers the full cost including accommodation.

Assessment normally runs in two stages. A checklist screens whether a full assessment is warranted. If it is, a multidisciplinary team completes a Decision Support Tool covering twelve care domains, including behaviour, cognition, communication, mobility, nutrition, continence, skin, breathing, drug therapies, altered states of consciousness and others.

Each domain is rated, and what matters is the overall picture: the nature, intensity, complexity and unpredictability of the needs. A single severe rating in certain domains, or a combination of high ratings, can indicate a primary health need.

Where dementia cases are often underrated

• Behaviour. Risk to self or others, resistance to essential care, and how often intervention is required. This is frequently the strongest domain in a dementia case and is often understated.
• Cognition. Memory, and also whether the person can recognise risk and make decisions about their own safety.
• Unpredictability. Needs that fluctuate and cannot be planned for carry real weight and are easy to miss in a snapshot assessment.

Keep a diary. Contemporaneous records of incidents, interventions and night-time needs are the most useful evidence a family can bring, and far more persuasive than a general description months later.

NHS-funded Nursing Care

Where someone in a nursing home needs nursing care but does not meet the continuing healthcare threshold, the NHS pays a flat weekly contribution towards the nursing element. It is considerably less than full funding but it is not means tested, and it should be considered automatically for anyone in a nursing home.

Challenging a decision

You can ask for a review of a continuing healthcare decision. There is a local resolution stage and then an independent review process. Deadlines apply, so act promptly.

Grounds worth examining: whether the process was followed properly, whether the family was involved as it should have been, whether the domain ratings reflect the evidence, and whether the decision addressed nature, complexity, intensity and unpredictability rather than simply totalling scores.

A significant proportion of challenges succeed, which tells you something about how often the first assessment is wrong.

Planning while capacity remains

This is the practical point that matters most, and it is time limited.

A lasting power of attorney can only be made while the person still has capacity to make it. Once capacity is lost, the alternative is a deputyship application to the Court of Protection, which is slower, more expensive and more restrictive. Both a property and financial affairs LPA and a health and welfare LPA are worth having.

If a diagnosis has just been made and there is no LPA in place, this is the single most urgent thing on the list. It is more important than any funding question, because without it nobody can act on the person's behalf at all.

This page is general information about the rules and does not constitute advice.

Last reviewed: 17 September 2026. Next review: Annually.