Residential or Nursing Home Fees: What the Difference Is

In short: Residential or nursing home fees differ mainly because a nursing home always has a qualified nurse on duty, and in England the NHS pays £267.68 a week (2026/27, from 1 April 2026) towards that nursing care for eligible residents who do not qualify for NHS continuing healthcare. This guide explains what each type of home provides, what the weekly fee covers and how to work out which type of care is needed.

What is the difference between residential or nursing home fees?

A residential home provides accommodation and personal care, while a nursing home provides the same plus nursing from at least one qualified nurse who is always on duty. That staffing difference is the main reason residential or nursing home fees are not the same.

The NHS describes two main types of care home. Residential homes provide accommodation and personal care, such as help with washing, dressing, taking medicines and going to the toilet. Nursing homes, sometimes called care homes with nursing, also provide personal care, but one or more qualified nurses will always be on duty to provide nursing care. Some homes offer both residential and nursing places, so it is worth checking which type of place a quoted fee relates to.

The NHS says nursing homes usually cost more than residential homes because they provide nursing care, so residential or nursing home fees can differ noticeably for the same area. It does not publish a single standard figure, because fees depend on the area, the home and the level of care needed. For typical weekly ranges from independent sources, see our guide to average care home fees in the UK.

What residential or nursing home fees usually cover

The weekly fee covers whatever the home’s contract says it covers, so ask for the list of inclusions and extras in writing before agreeing a place. Residential or nursing home fees are not standardised, which is why the written detail matters. The Competition and Markets Authority (CMA) has published a guide to consumer rights for residents and families which says a care home should be open about what you will pay.

According to that guide, a home should tell you, at the start of your enquiry:

• An indication of the weekly fee if you are paying for your own care, noting that the exact amount depends on an assessment of care needs and the type of room chosen.
• Any other payments due upfront, such as deposits.
• Which services are included in the weekly fee.
• Any additional fees, for example for being accompanied by staff to a hospital appointment, and optional extras such as hairdressing.

Once the home has assessed the person’s needs, it must confirm the final amount, including the final weekly rate, and you should be given enough time to consider that offer before accepting it. In a nursing home, the weekly fee also pays for nursing care, part of which may be met by the NHS, as explained below.

If the fee later rises, the contract should explain how. Our guide to care home fee increases and your rights sets out what the CMA says is fair.

NHS-funded nursing care: the weekly rate for 2026/27

From 1 April 2026 the standard weekly rate of NHS-funded nursing care in England is £267.68, up from £254.06. GOV.UK announced the increase of about 5.4% for 2026/27, and the NHS website gives the same standard rate.

There is also a higher rate of £368.24 a week (previously £349.50). The NHS says this applies only to people who moved into a care home before 1 October 2007 and were on the previous high band. They stay on it unless their needs change, they stop living in a nursing home or they become eligible for NHS continuing healthcare. Rates are the same across England (as at November 2026).

You may be eligible if you live in a nursing home, you are not eligible for NHS continuing healthcare, and you have been assessed as needing care from a registered nurse. The NHS pays the flat weekly amount directly to the care home, so you do not receive the money yourself. Most people do not need a separate assessment, but if one is needed your integrated care board (ICB) can arrange it. If you are refused and disagree, you can ask the ICB to review the decision.

Our guide to NHS-funded nursing care covers eligibility and reviews in more detail.

How the NHS contribution fits into the weekly bill

The NHS contribution covers only the nursing element of a nursing home fee, and you pay the balance unless NHS continuing healthcare applies. Understanding this split makes residential or nursing home fees easier to compare. The CMA’s advice to care homes, re-issued on 8 December 2021, says NHS-funded nursing care does not cover the wider non-nursing care or the accommodation, and that a resident should not be asked to pay for the portion the NHS already funds.

The same advice describes the arrangement in England like this: the home sets an overall fee for care and accommodation that includes any registered nursing it provides, the NHS pays its national rate straight to the home, and the individual or their representative pays the rest, unless a different contracting arrangement has been agreed. The CMA also says a home’s terms should explain how the NHS payment relates to your own contribution, and what happens to your share if the NHS payment goes up, goes down or stops.

That is worth checking after the April 2026 uplift. Ask the home to show, in writing, how the new NHS rate affects the bill. The CMA also takes the view that contract terms making a resident pay the nursing contribution after the NHS has stopped it, for example following a death, are unfair.

If someone qualifies for NHS continuing healthcare, the NHS arranges and pays for the care home placement in full, according to Age UK. Eligibility for that is considered first, so see our CHC checklist guide if the person has complex health needs.

How to tell whether residential or nursing care is needed

The first step is a care needs assessment from the local council, which looks at what support the person needs and where it can best be provided. Getting this right matters because it decides which of the residential or nursing home fees apply. Age UK and the NHS both give this as the starting point, whether the person will later pay their own fees or ask the council for help.

The NHS says a nursing home may be the right choice where someone needs help from a qualified nurse, for example people who:

• have a colostomy or are fed through a tube;
• have severe learning disabilities, severe physical disabilities or both;
• have had a serious illness or surgery and need care and treatment to recover.

A residential home is designed for people who need help with daily personal care but do not need a nurse on duty. The type of home is not something a family chooses alone, because the decision rests on assessed need. The social worker carrying out the assessment is the person to ask, and it can help to bring information from the GP or hospital team who know the medical picture.

When you visit, ask whether a registered nurse is on duty at night, how the home responds if needs rise, and whether it can keep someone whose needs increase.

If care needs change after moving in

A home can raise or lower fees when care needs change significantly, but it should be able to justify the change and give you proper notice. The CMA’s advice says an increase for changing needs must be reasonable and proportionate, evidenced for example by a recognised dependency tool, and that the home should consult the resident and their representatives first.

It adds that the home should normally give advance written notice, for example 28 days, and that fees should also come down when needs reduce. If the resident or family disputes the assessment, the CMA says the home should involve independent professionals and should not backdate the new rate. Where someone declines suddenly and needs extra care at short notice, the CMA suggests reasonable notice such as seven days, with the chance to leave without penalty.

A home can ask a resident to leave only for valid reasons set out in the contract, such as being unable to meet needs even after reasonable adjustments, and the CMA says it should consult first and give at least 28 days’ written notice. If a move between a residential and a nursing home is being suggested, ask for the reasons in writing.

Who pays: the council, the NHS or the resident

Who pays depends on needs and savings: the NHS pays in full for continuing healthcare, the council helps if capital is below £23,250, and otherwise the resident pays. These England limits are as shown by Age UK, page updated April 2026.

If the council carries out a financial assessment, it looks at income and capital, which decides who pays residential or nursing home fees. Over £23,250, the person pays their own fees as a self-funder. Between £14,250 and £23,250, the council provides support and the person pays a contribution from income plus a tariff income. Under £14,250, the council provides support and the person pays a contribution from income with no tariff income. The council must make sure the personal budget is enough to pay for at least one suitable care home. If someone wants a more expensive home and a relative can pay the difference, that is a top-up fee, which is covered in our third party top up fees guide.

NHS-funded nursing care is paid whichever of these routes applies, as long as the person is eligible and not receiving continuing healthcare. For the wider picture, see paying for care in England.

Scotland, Wales and Northern Ireland

The NHS-funded nursing care rate quoted above applies in England only, and each other nation has its own arrangements. The NHS page on this topic covers England and does not describe the other nations.

The CMA’s 2021 advice summarises them as follows. In Wales, the NHS, through Local Health Boards, is responsible for paying for nursing care by a registered nurse for eligible residents. In Scotland, councils make flat rate payments to care homes for the personal and nursing care of residents assessed as eligible, called Free Personal and Nursing Care payments. In Northern Ireland, similar payments are called HPSS Payments for Nursing Care. Rates and rules change, so check the current position with the relevant NHS body, council or Health and Social Care Trust.

Frequently asked questions

Is a nursing home more expensive than a residential home?

Usually, yes. The NHS says nursing homes typically cost more because they provide nursing care and always have a qualified nurse on duty. Actual fees vary by area, by home and by the level of care needed, so ask each home for a written quote.

How much does the NHS pay towards nursing home fees in 2026/27?

In England, the standard NHS-funded nursing care rate is £267.68 a week from 1 April 2026, paid straight to the home. A higher rate of £368.24 applies only to people who moved in before 1 October 2007 and were on the previous high band.

Does NHS-funded nursing care pay the whole nursing home fee?

No. It is a flat weekly contribution towards the nursing element only. The CMA says it does not cover the wider non-nursing care or the accommodation, so the resident or the council normally pays the balance unless NHS continuing healthcare applies.

Who decides whether someone needs a residential or nursing home?

The decision follows a care needs assessment, usually arranged through the local council. Nursing care is considered where the person needs help from a registered nurse. If NHS funding may apply, the NHS also looks at eligibility for continuing healthcare first.

Can a residential home keep someone whose needs increase?

It depends on the home and its registration. The CMA says a home may ask a resident to leave for valid reasons, such as being unable to meet needs after reasonable adjustments, after consulting them, and with at least 28 days’ written notice.

Is the NHS nursing contribution paid to me or to the care home?

It is paid directly to the care home, not to you. The NHS says it pays the flat weekly rate to the home, which should then show clearly how it affects the fee you or the council pay.

Do these figures apply in Scotland, Wales and Northern Ireland?

No. The 2026/27 rate here is for England. Wales, Scotland and Northern Ireland have separate arrangements for nursing care payments, so check current rates with the relevant NHS body, council or Health and Social Care Trust.

Official sources

• GOV.UK: Better community care thanks to nursing funding boost (2026/27 rates)
• NHS: NHS-funded nursing care
• NHS: Care homes
• Age UK: Paying for residential care
• GOV.UK (CMA): Care homes, consumer rights for residents and their families
• GOV.UK (CMA): Care homes consumer protection case, advice re-issued 8 December 2021

This page is general information, not legal, medical or financial advice. The Care Panel is an independent guide and is not part of any government body or care provider. Last checked 9 November 2026.

Related: NHS-funded nursing care explained · Average care home fees in the UK · Paying for care in England

Reviewed by The Care Panel team on 9 November 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.