Understanding Care Home Fees in Northern Ireland

When a loved one needs to move into a residential care home or nursing home in Northern Ireland, one of the most immediate concerns is the cost of care. The system for charging for residential accommodation is governed by a set of rules designed to be fair and consistent, ensuring that those who can afford to contribute to their care do so, while protecting those with limited means. This guide provides a clear breakdown of how care home fees are calculated, based on the official Charging for Residential Accommodation Guide (CRAG) 2015 [1] and the latest annual updates, including the 2025/26 Circular (HSC (CHU) 1/2025). While the core framework remains consistent, key figures are reviewed annually.

What Are Care Home Fees?

Care home fees cover the cost of accommodation, meals, and personal care. In Northern Ireland, the amount a person is expected to pay is determined through a financial assessment, often referred to as a "means test." This assessment is carried out by the local Health and Social Care (HSC) Trust.

The Standard Rate

The "standard rate" represents the full cost of the care home placement. For homes managed directly by the HSC Trust, this rate is set by the Trust itself. For independent or private care homes, the standard rate is the fee that the Trust has agreed to pay for the placement under its contract with the home. If a resident's financial assessment shows they have the resources to pay the full cost, they will be expected to do so.

Assessment of Ability to Pay

If a resident is unable to pay the standard rate, the HSC Trust is required to assess their ability to contribute. This comprehensive financial assessment looks at the resident's income and capital to determine a lower, more affordable contribution. The legal framework for this assessment is laid out in the Health and Personal Social Services (Assessment of Resources) Regulations (Northern Ireland) 1993 [2].

Types of Care Homes

It is important to distinguish between the two main types of care homes in Northern Ireland, as the contractual arrangements differ slightly:

In both cases, the financial assessment process is the same. The key difference lies in how the fees are paid. For Trust-managed homes, the resident pays their assessed contribution directly to the Trust. For independent homes, the Trust pays the full contractual rate to the home, and the resident then refunds the Trust based on their assessed ability to pay.

The Personal Expenses Allowance (PEA)

To ensure that residents have money for personal items and small luxuries, the assessment rules allow for a Personal Expenses Allowance (PEA). This is a set amount that a resident is allowed to keep each week from their income before their contribution to care fees is calculated. The Personal Expenses Allowance (PEA) is adjusted annually to reflect inflation. As of the 2025/26 updates, this amount is reviewed to ensure residents retain a fair amount for personal use (historically around £24-£30 per week). This amount is intended to cover day-to-day expenses such as toiletries, newspapers, and small gifts, and is not to be used to contribute towards the main care home fees.

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References

[1] Department of Health, Social Services and Public Safety. (2015). Charging for Residential Accommodation Guide (CRAG) 2015. https://www.health-ni.gov.uk/publications/guidance-charging-residential-accommodation

[2] The Health and Personal Social Services (Assessment of Resources) Regulations (Northern Ireland) 1993. https://www.legislation.gov.uk/nisr/1993/127/contents/made