Is dementia care free? NHS Continuing Healthcare and dementia

Dementia care is not automatically free in England. Most day-to-day dementia care is classed as social care, which the council means-tests. It becomes free only if the person qualifies for NHS Continuing Healthcare (CHC), which depends on the complexity, intensity and unpredictability of their needs, not on the dementia diagnosis. Some help, such as diagnosis, memory clinic care, reablement and certain equipment, is free for everyone.

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At a glance

• A dementia diagnosis alone does not qualify someone for CHC (NHS.uk).
• CHC pays for the whole care package, at home or in a care home, if there is a “primary health need”.
• The assessment uses a Decision Support Tool with 12 care domains, including cognition and behaviour.
• The Integrated Care Board should usually decide within 28 days of a positive checklist.
• If CHC is refused, the council may still help if savings are under £23,250 (2026/27).

For an overview of the support available, see our guide to dementia care at home: costs and support.

What dementia care is free on the NHS?

Whatever someone’s income or savings, these are free:

• GP care, memory clinic assessment and diagnosis, and follow-up from specialist teams;
• district nursing and community health services;
• reablement and intermediate care for up to 6 weeks, often after a hospital stay;
• community equipment and minor adaptations costing £1,000 or less, when assessed as needed;
• a Care Act needs assessment and a carer’s assessment from the council.

Help from charities such as the Alzheimer’s Society Dementia Support Line (0333 150 3456) and Dementia UK’s Admiral Nurse Dementia Helpline (0800 888 6678) is also free.

Who pays for everyday dementia care?

The NHS says “a diagnosis of dementia doesn’t necessarily mean you will qualify for NHS continuing healthcare. This depends on how complex and severe your needs are” (NHS.uk). The Alzheimer’s Society adds that “most people requiring care and support are classed as primarily having social care needs”.

That means most help with washing, dressing, meals and supervision is arranged through the council or paid for privately. You contact the adult social care team at your relative’s local council. Their financial assessment uses these limits for 2026/27 (DHSC):

• Over £23,250 in savings: you pay the full cost.
• £14,250 to £23,250: you contribute from income and part of your savings.
• Under £14,250: savings are ignored; you contribute from income only.

For care at home, the value of the person’s home is always ignored. See council funding for home care: the means test explained.

What is NHS Continuing Healthcare?

CHC is a package of care arranged and funded entirely by the NHS for adults whose main need is a health need. It can pay for care at home, including live-in care, or for care home fees. There is no means test.

CHC is managed by the Integrated Care Board (ICB) for the area where your relative is registered with a GP. Several ICBs merged in April 2026, so check which one now covers them; the GP surgery can tell you. The process follows the National Framework for NHS Continuing Healthcare (July 2022, revised).

Our main guide covers the rules for all conditions: NHS Continuing Healthcare at home.

How is CHC assessed for someone with dementia?

There are three stages.

1. The Checklist

A nurse, doctor, social worker or other professional completes a short screening tool. The threshold is set low on purpose, so many people who are screened in will not ultimately qualify. You can ask for a Checklist at any time, for example at a hospital discharge meeting or care review.

2. The full assessment

A multidisciplinary team of at least two professionals uses the Decision Support Tool (DST). It rates need across 12 care domains:

Each domain is rated from no need up to severe, and four domains, including behaviour, can be rated “priority”. As a rule of thumb, one priority need or two severe needs usually indicates eligibility, but the decision is based on the whole picture (DHSC Decision Support Tool guidance, 2022).

3. The decision

The team considers four key characteristics: the nature, intensity, complexity and unpredictability of the person’s needs. The ICB makes the final decision. It should usually do so within 28 days of receiving the positive Checklist. If it is late without good reason, it should refund care costs from day 29.

Which dementia needs make CHC more likely?

No single symptom guarantees eligibility. The following may point towards CHC, especially in combination:

• behaviour that puts the person or others at serious risk and needs skilled, planned intervention;
• distress or agitation that is severe and unpredictable, day and night;
• swallowing problems needing specialist support to eat and drink safely;
• complex medication that needs regular monitoring and adjustment;
• frequent falls, pressure sores or infections alongside cognitive decline.

The DST guidance says “Well managed needs are still needs.” If a skilled carer is preventing incidents, that does not mean the need has gone. Make sure assessors know what the carers actually do to keep your relative safe.

How can you prepare for a CHC assessment?

The Alzheimer’s Society suggests families:

• write a one-page medical history and keep it updated;
• keep records of conversations with professionals;
• request relevant medical and care records;
• read the National Framework and consider each of the 12 domains;
• attend every assessment;
• gather evidence from professionals who know your relative.

A diary of incidents, falls, night waking, refusals of care and time spent supporting your relative is especially useful. Care agency daily notes and medicines charts are good evidence too.

You do not need a solicitor or paid representative to apply.

How is CHC different from council funding?

What happens if CHC is agreed for care at home?

The ICB becomes responsible for arranging and funding care that meets the person’s assessed needs. It may commission an agency, or you can ask for a personal health budget, which people eligible for CHC have a legal right to have. A personal health budget can be managed by the NHS on your behalf, by a third party, or as a direct payment you manage yourself, following a care plan agreed with the ICB.

Families sometimes want more care than the ICB agrees to fund. Talk to the ICB about how any extra, privately paid care can be arranged alongside the CHC package.

What if CHC is refused?

1. Ask for the written reasons and the completed DST.
2. Request local resolution with the ICB. Explain which domains you think were under-scored and why.
3. Ask NHS England for an Independent Review Panel if you are still unhappy.
4. Complain to the Parliamentary and Health Service Ombudsman about maladministration if needed.

Even if refused, CHC must be reviewed if needs change. Eligible people are reviewed after 3 months, then at least yearly.

If your relative lives in a nursing home and is not eligible for CHC, the NHS may pay NHS-funded Nursing Care of £267.68 a week towards nursing costs (from April 2026). This does not apply to care at home. See NHS-funded nursing care vs Continuing Healthcare.

Is Fast Track CHC available for dementia?

Yes. If someone with dementia has a rapidly deteriorating condition and may be entering a terminal phase, a clinician can complete the Fast Track Pathway Tool. The ICB should accept it and arrange care urgently, usually within 48 hours. See Fast Track Continuing Healthcare.

What other help reduces the cost of dementia care?

• Attendance Allowance: £76.70 or £114.60 a week in 2026/27, not means-tested.
• Council Tax disregard for severe mental impairment, which can reduce the bill to nothing if the person lives alone.
• Carer’s Allowance: £86.45 a week for eligible family carers.
• VAT exemption on care from a CQC-registered provider.

See dementia care at home: costs and funding for the full list.

Frequently asked questions

Is dementia care free in the UK?

Not usually. In England, most dementia care is social care, which the council means-tests. It is fully free only if the person qualifies for NHS Continuing Healthcare, based on the severity and complexity of their needs. Diagnosis, memory clinic care, up to 6 weeks of reablement and small equipment are free for everyone.

Does dementia qualify for NHS Continuing Healthcare?

Dementia alone does not qualify. Eligibility depends on whether the person has a “primary health need”, assessed across 12 care domains. People with advanced dementia who have severe or unpredictable behaviour, swallowing difficulties or other complex health needs may qualify. Ask for a CHC Checklist if you think your relative’s needs are complex.

How long does a CHC decision take?

The Integrated Care Board should usually make a decision within 28 days of receiving a positive Checklist. If there is an unjustified delay beyond that, it should refund care costs from day 29. The Fast Track route for people nearing the end of life is much quicker, usually within 48 hours.

Can CHC funding be withdrawn for someone with dementia?

Yes. CHC is reviewed after 3 months and then at least once a year. If needs are judged to have reduced, funding can stop, and care may move to council or self-funding. You can challenge a decision through local resolution with the ICB and then an NHS England Independent Review Panel.

Who do I contact about CHC?

Ask your relative’s GP, hospital discharge team, district nurse or council social worker to complete a CHC Checklist. The Checklist is then sent to the Integrated Care Board for their area. The GP surgery can tell you which ICB covers your relative.

Can someone with dementia in a care home get CHC?

Yes. CHC can pay for care in a care home as well as at home, including the full care home fees. The same assessment applies: eligibility depends on the nature, intensity, complexity and unpredictability of needs, not the diagnosis or the setting. If someone in a nursing home is not eligible, they may get NHS-funded Nursing Care instead.

Sources

• NHS.uk: dementia, social services and the NHS
• NHS.uk: NHS Continuing Healthcare
• Alzheimer’s Society: what is NHS continuing healthcare?
• Alzheimer’s Society: tips on preparing your case for NHS continuing healthcare
• DHSC: National Framework for NHS Continuing Healthcare (July 2022, revised)
• DHSC: NHS Continuing Healthcare Decision Support Tool guidance
• DHSC: Fast Track Pathway Tool guidance
• GOV.UK: NHS-funded nursing care rate 2026
• DHSC: social care charging for local authorities 2026 to 2027
• DWP: benefit and pension rates 2026 to 2027
• Alzheimer’s Society: Dementia Support Line
• Dementia UK: Admiral Nurse Dementia Helpline
• NHS England Digital: ICB mergers from April 2026

This guide is general information, not financial, legal or medical advice. Last reviewed September 2026.

Reviewed by The Care Panel team on 15 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.