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Domiciliary Care Eligibility: Who Qualifies in the UK

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There is no single test that says “you qualify” or “you don’t”. In England, council-arranged home care depends on an assessment of your needs and then a separate check of your finances. Private home care, NHS Continuing Healthcare and support for disabled children each follow their own routes. Age and diagnosis do not decide any of them on their own. This guide explains each route in plain terms, with a focus on London.

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TL;DR

  • Council help in England is based on assessed needs, not on age or a diagnosis. You must have needs linked to a physical or mental impairment or illness, be unable to achieve two or more set daily outcomes, and face a likely significant impact on wellbeing.
  • Meeting the needs test does not mean the council pays. A financial assessment decides whether you contribute or pay in full.
  • NHS Continuing Healthcare is a separate, NHS-funded route for people with a primary health need.
  • You do not have to qualify for anything to get home care. Anyone can arrange it privately, including live-in care and hourly visits.
  • Children and young people with disabilities are assessed under different rules from adults, and short breaks can take place in their own home.

Table of Contents

Does age or diagnosis decide who qualifies?

No. The Care Act 2014 says that decisions about an adult must not be based only on their age or on any condition they have. You can be 55 with a physical disability and qualify, or 90 and not qualify, because what counts is what you can and cannot do day to day.

You also do not need a formal diagnosis to be assessed. SCIE guidance for practitioners says the assessor looks at whether your difficulties are linked to a physical, mental, sensory, learning or cognitive disability or illness. If someone is struggling to cope and has no diagnosis yet, ask for an assessment anyway. Waiting for a label can delay help.

The three tests for council-arranged care

A London council, such as Barking and Dagenham, looks at your needs and the outcomes you want from daily life. It then applies three conditions:

  1. Your needs arise from a physical or mental impairment or illness.
  2. As a result, you cannot achieve two or more of the listed outcomes.
  3. This is likely to have a significant impact on your wellbeing.

All three must be met. If one is not, you do not meet the national eligibility threshold.

The daily outcomes the council looks at

Mind’s guide to eligibility lists the ten outcomes. They include:

  • managing and preparing meals
  • maintaining personal hygiene
  • managing toilet needs
  • dressing appropriately
  • keeping the home habitable
  • using the home safely
  • maintaining personal relationships

The full list also covers things like work, training and community activities, and caring responsibilities.

What “unable to achieve” means

This is wider than many families expect. According to the same Mind guide, you count as unable to achieve an outcome if you need physical help or prompting, if doing it causes significant pain, distress or anxiety, or if doing it puts your health and safety, or other people’s, at risk.

That matters most for people with dementia, learning disabilities or mental health conditions. Someone may be physically able to make a meal but forget to eat, or leave the cooker on. Needing a reminder or prompting counts. SCIE tells practitioners to link each daily difficulty to the underlying impairment, so it helps to describe the difficulty in specific terms: what happens, how often, and what the risk is.

How the assessment works in practice

You start by contacting the adult social care team at the council where you live. Councils are responsible for people who are ordinarily resident in their area, so in London that is usually your home borough, not where a relative works or where your care provider is based. Southwark’s assessment and eligibility policy sets this out.

The assessment is a conversation, usually at home. Councils are expected to take a strengths-based approach, as Salford City Council explains. That means the assessor asks what you can do, what you want to keep doing, and what support would help, not only what you cannot do. Care planning must be person-centred and use the least restrictive way of meeting your outcomes.

A few practical tips:

  • Ask a family member or friend to be there, or to speak up for you if you find it hard.
  • Describe your worst days as well as your best. Assessors often see someone at their most capable.
  • Keep a short diary for a week: falls, missed meals, night-time waking, medication problems.
  • Mention what you want to keep doing. Staying steady on your feet is part of staying independent, and resources such as balance training for seniors show how exercise can reduce fall risk while care support is put in place.

An occupational therapy visit can be part of this, particularly for equipment and home adaptations. We explain it in our occupational therapy home assessment guide.

If you are found not eligible

That is not the end of the road. The council will still give you advice about who can support you and how to stay well, as Barking and Dagenham notes. If you disagree with the outcome, you can ask for it to be reviewed or use the council’s complaints process.

Qualifying does not mean the council pays

This is the point that surprises most families. Meeting the needs test only means the council has a duty to meet your eligible needs. A separate financial assessment then decides whether you pay something, or everything.

The NHS Continuing Healthcare leaflet states that local-authority support may involve a contribution depending on income and savings. The Nuffield Trust reports, for home care in England in 2021/22, that people with assets above £23,250 receive no state support, while those between £14,250 and £23,250 may receive some funding depending on need. Thresholds are reviewed, so check your council’s current figures before you rely on them.

The Nuffield Trust also notes that, in practice, access to state-funded support is shaped by both need and means, and that means is often the deciding factor. If you are close to a threshold, ask the council to explain exactly how your capital and income were counted.

If the council is paying part or all of the cost, the support plan sets the time and tasks. Salford’s guidance gives an idea: council visit times typically start at 15 minutes and go up in 5-minute steps according to assessed need. Short visits suit a quick check or medication prompt, but not someone who needs unhurried help with washing and dressing.

We cover how funding choices interact with live-in arrangements in our guide to protecting council funding for live-in care.

Qualifying does not mean the council pays — overview diagram

NHS Continuing Healthcare: a different route

NHS Continuing Healthcare (CHC) is free care arranged and funded by the NHS. According to the NHS public information leaflet, it is for people aged 18 or over who are assessed as having a primary health need. Eligibility does not depend on a particular diagnosis or condition.

The primary health need is judged by the nature, complexity, intensity and unpredictability of your needs. Two people with the same condition can get different outcomes, because what matters is how much healthcare your needs involve. CHC can be provided at home, and it is not means-tested.

It is a demanding process and families often find it hard. Our guide to NHS continuing healthcare eligibility and how to apply walks through the steps.

Arranging home care privately

You do not have to qualify for anything to have care at home. The NHS confirms that people can arrange their own homecare, either through an agency or by employing their own carer. This applies if you are not eligible for council support, or if your savings are above the financial limit.

Many London families choose a private agency for reasons that have nothing to do with funding:

  • Waiting times for assessment and care packages can be long.
  • Council visit lengths may be shorter than you want.
  • You can choose the days, times and continuity of carers.
  • You can start quickly after a hospital stay or a fall.

If you use an agency, check that it is registered with the Care Quality Commission and read its latest inspection report. Employing a carer yourself makes you the employer, with responsibilities for things like pay, insurance and cover for sickness, which an agency handles for you.

What supervision means in domiciliary care

Families often ask whether a carer can “keep an eye on” someone. In home care, supervision means different things, and it should be written into the care plan.

The NICE guideline on home care says the plan follows a local-authority assessment and should address safety and wellbeing. A risk plan can include verbal prompts, for example reminding someone to drink, take medication or use their walking frame. NICE also says home care workers should be trained to recognise and respond to common conditions, including dementia, mental health conditions, and physical or learning disabilities.

In practice, supervision can look like:

  • Prompting: reminding the person to eat, drink, wash or take medication.
  • Presence during a task: staying nearby while the person showers or uses stairs.
  • Companionship and checking in: regular visits to see that the person is safe and well.
  • Continuous cover: live-in care, or waking or sleeping night support, when someone should not be alone.

A visiting carer is not there all day. If someone is at risk when alone, such as wandering with dementia, say so clearly at assessment, because it affects whether hourly visits are enough or longer cover is needed.

Children and young people with learning disabilities, autism or mental health needs

The adult Care Act tests above do not apply to children. Disabled children are supported through children’s services, and parents can ask their council for an assessment of the child’s needs and the family’s. Statutory guidance on short breaks for disabled children explains that short breaks can take place in the child’s own home, in an approved carer’s home, or in a community or residential setting.

Start by contacting your borough’s children with disabilities team or the school’s special educational needs coordinator. Many boroughs also run a Local Offer page that lists services. Young people moving towards 18 will usually be assessed under the adult rules, so ask about transition planning early.

Families who pay privately can also arrange support at home. For background, see our guides to learning disabilities for UK families and autism support.

Our perspective on eligibility

We have been supporting people in their own homes across London for over 30 years. The most common thing we see is families waiting until a crisis before asking about help. Eligibility rules can feel like a barrier, but they are better used as a starting point for a conversation.

Our view is simple. Ask for the council assessment, because it gives you a record of needs and may open funding. At the same time, do not wait for a decision if your relative is struggling now. Private care can begin quickly and can be adjusted as the picture becomes clearer.

The best care plans we see are built around what the person wants to keep doing. Independence, dignity and freedom of choice are not extras. They shape how visits are timed, who attends, and how a carer prompts rather than takes over. Our guide to promoting independence at home explains how.

— Dan

How Kells can help while you sort out eligibility

Kells Domiciliary Care is regulated by the Care Quality Commission, and our carers are qualified and DBS checked. We provide call-in visits, live-in care, dementia care, respite cover, personal care and support for children and adults with disabilities across London. If you are waiting for a council decision, or have been told you do not qualify, we can talk through what level of support would suit and start with a personal care assessment. You can also download our free home care guide or contact us to talk it through.

A simple route to follow

  1. Write down what your relative struggles with, how often, and what the risks are.
  2. Contact the adult social care team in their home borough and ask for a needs assessment.
  3. If the person has significant, complex health needs, ask whether a CHC checklist should be completed.
  4. Expect a financial assessment if the council is to contribute to costs.
  5. If you cannot wait, or are not eligible, arrange care privately and review it regularly.

FAQ

Who qualifies for domiciliary care?

For council-arranged care in England, you qualify if your needs come from a physical or mental impairment or illness, you cannot achieve two or more set daily outcomes, and this is likely to significantly affect your wellbeing. Age and diagnosis alone do not decide it. Anyone can pay for private care without meeting these tests.

Do I need a diagnosis to get a care assessment?

No. SCIE guidance says a formal diagnosis is not required. The assessor looks at whether your difficulties are connected to an impairment or illness, so you can ask for an assessment while tests are still under way.

If I qualify, will the council pay for my home care?

Not necessarily. A financial assessment looks at your income and savings, and you may pay a contribution or the full cost. Check your council’s current thresholds, as the Nuffield Trust figures for 2021/22 were £14,250 and £23,250.

Can a carer supervise someone who should not be left alone?

A carer can prompt, stay with someone during tasks and check in on them, and this should be set out in the care plan. If a person is at risk when alone for long periods, tell the assessor, because longer visits or live-in care may suit better than short calls.

What if I am not eligible for council help?

The council should still give advice on other support. You can arrange care privately through an agency or by employing a carer, as the NHS explains.

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