How care homes get paid in Kent, including funded nursing care

A council funded nursing resident in Kent brings the home about £1,645.68 a week: £1,378.00 from Kent County Council and £267.68 of NHS Funded Nursing Care. The two arrive separately, on different timetables, and the resident's own contribution goes to the council, not the home. Add NHS Continuing Healthcare, family top ups and self funders, and a single home can be paid from four sources on three timetables. That is the short answer to how care homes are funded.

Headline fee rates tell you what a home earns. They do not tell you when the money arrives, who owes it if it is late, or what happens when a resident's funding changes. Those are the questions that decide cash flow, and they are the ones a buyer or lender should ask first. Kent is a useful example: it has 487 care homes and 14,824 beds, 127 of them nursing homes with 7,195 beds, and the council funds only about 35% of its beds.

Who pays for care home fees? The four sources

Kent County Council pays the care and accommodation fee for people it funds. The price sits between the council's guide price and the ceiling price the home sets on the council framework, which it can review on 1 April and 1 October. In 2025/26 Kent's average rates were £1,186.81 a week for residential care and £1,378.00 for nursing, up 11.6% and 11.2% on the year before. The council pays every four weeks by BACS, two weeks in advance and two in arrears, once it has issued a Financial Activation Notice for the placement. Existing placements rise each April by CPI for the twelve months to the previous December, subject to the council's budget.

The NHS pays Funded Nursing Care for every resident assessed as needing registered nursing, including self funders. From 1 April 2026 the standard rate is £267.68 a week, up 5.4% from £254.06; the higher band, for residents on it since before October 2007, is £368.24. It goes straight to the home from NHS Kent and Medway through NHS Shared Business Services, not through the council. Kent's nursing rates exclude it, so homes quote the council a nursing price without FNC. Over a year, FNC is worth £13,919 per eligible resident.

NHS Continuing Healthcare pays the full fee for residents whose needs are primarily health needs. In Kent it is arranged by the All Age Continuing Care service, now run by Kent Community Health NHS Foundation Trust, and paid through NHS Shared Business Services.

Residents and families pay in three ways. A council funded resident pays their assessed contribution to the council every four weeks on a Kentcare invoice, keeping a personal expenses allowance of £31.80 a week in 2026/27. A family can top up the difference where the home charges more than the council pays, agreed with the council at placement. Self funders pay the home's own fee on its own terms, usually monthly in advance.

What is NHS funded nursing care?

NHS funded nursing care, usually shortened to FNC, is a weekly payment from the NHS to a care home with nursing. In the words of the national framework, it is “the funding provided by the NHS to care homes with nursing to support the provision of nursing care by a registered nurse”. Councils are not allowed to provide registered nursing care, except in very limited circumstances (section 22 of the Care Act 2014), which is why the NHS pays this part of the fee wherever the resident's other funding comes from.

A resident qualifies when they need care from a registered nurse and their overall needs are best met in a care home with nursing. The framework says the NHS must always consider NHS Continuing Healthcare first, and only then decide on funded nursing care. FNC is not means tested: the NHS website says it is paid irrespective of who funds the rest of the care home fees, so self funders get it too.

It pays for the registered nurse's time, including time spent supervising care delegated to others. It does not cover care assistants, the wider personal care or the accommodation. The home sets one overall fee for care and accommodation, including its nursing, and the integrated care board pays FNC at the national rate direct to the home. The council, the resident or the family pays the balance.

The funded nursing care rate for 2026/27 is £267.68 a week from 1 April 2026, set by DHSC on 9 March 2026, a rise of 5.4%. DHSC says it supports around 80,000 people. The higher rate of £368.24 applies only to residents who were on the high band of the old three band system before it ended on 30 September 2007. In Kent, NHS Kent and Medway pays it.

A worked week

Take one council funded nursing resident at Kent's average rate. The council pays £1,378.00 a week and the NHS adds £267.68, a total of £1,645.68. Over a four week council cycle that is £6,582.72. FNC makes up 16% of the income, so a delay in NHS payments matters even when the council pays on time.

The resident's contribution does not appear in this sum. Kent pays the home gross, the full price, and collects the resident's share itself. If a resident's contribution goes unpaid, that is the council's debt to chase, not the home's. Councils that pay net leave the home to collect the resident's share itself.

Three timetables over eight weeks

Kent pays every four weeks, two weeks in advance and two in arrears. As we read the schedule, a payment made at the end of week two covers weeks one to four. Once a placement is running, the home is never more than two weeks behind. The gap comes at the start: payment follows the Financial Activation Notice, so a new placement can wait for its first money.

Self funders usually pay a month in advance, which is the best cash position a home can have. FNC follows its own NHS cycle, which NHS Kent and Medway does not publish. NHS Shared Business Services, which processes the payments, reported paying invoices in 23 days on average between July and December 2025, against terms of 30 days.

Former self funders and price reversion

With the council funding about 35% of Kent's beds, many residents pay for themselves. When a self funder's capital falls to the upper limit of £23,250, the council steps in. Kent's contract says the price then temporarily reverts to the home's ceiling price on the framework. The council may negotiate it down, and reserves the right to move the resident.

For a home whose private fee is well above Kent's rate, that is a major risk to income. A family may top up the difference, but only where someone is willing and able to pay it, and the resident can only top up their own fee in limited cases, such as during the 12 week property disregard or under a deferred payment agreement.

Care home top up fees: who pays the difference?

A top up covers the gap between what the council pays and what the home charges for a room the resident has chosen. It is agreed with the council at placement. Under the national statutory guidance the council should make sure the person paying is willing and able to keep paying. If the top up stops, the placement has to be reviewed, so a home that relies on top ups should know which residents have them and who pays.

What is NHS continuing healthcare, and what does it pay?

NHS continuing healthcare, or CHC, is a package of ongoing care “arranged and funded solely by the National Health Service” for an adult found to have a primary health need. When that happens, the NHS pays for all of the person's assessed health and associated social care needs, including accommodation where that is part of the need. In a care home, that means the whole fee. It is not means tested: NHS care is free at the point of delivery, and the framework says the person cannot be asked to pay towards their assessed needs, so there is no top up. They can still buy extra private services delivered separately.

A primary health need is about the level and type of day to day care a person needs, taken as a whole, and not about their diagnosis. The test is whether most of their care is focused on health needs. The process has set steps:

• Checklist. A short screening tool, completed by a nurse, doctor, other health professional or social worker, decides whether a full assessment is needed.
• Full assessment. A multidisciplinary team of at least two professionals uses the national Decision Support Tool, which scores 12 areas of need, and makes a recommendation to the integrated care board.
• Decision. In most cases within 28 calendar days of the board receiving a positive Checklist.
• Fast Track. For people whose condition is deteriorating rapidly and may be entering a terminal phase, care can start without the full process.
• Reviews. Within three months of the decision, then at least once a year. Eligibility can end if needs change.

A resident who becomes eligible for Continuing Healthcare moves from council and private funding to the NHS. The home's contract and its payer change, and so can its price. Eligibility is reviewed, so the reverse can also happen, and the home may move back to council or private fees with FNC on top. Homes with many CHC residents depend on one NHS commissioner for a large part of their income.

How Kent compares

Kent is generous by national standards. Its nursing rate is the 5th highest of 152 councils and the highest in the South East; its residential rate is 19th. Both rose about twice as fast as the national median in 2025/26: 11.2% for nursing against 5.3%. Next door, Medway pays £1,125.89 for nursing and £875.07 for residential care. A home near the boundary that takes residents from both councils has two prices, two contracts and two payment cycles.

How we worked this out

Payment and pricing rules come from Kent County Council's published care home contract schedule and its charging guide for residential care. The FNC rates are from DHSC's announcement of 9 March 2026. The explanations of FNC and CHC follow DHSC's National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022, revised July 2023) and the NHS website's guide to NHS continuing healthcare. The personal expenses allowance and capital limit are from DHSC's local authority circular on charging for 2026/27. Council fee rates and ranks are the 2025/26 rates every council reported to DHSC for the Market Sustainability and Improvement Fund. The worked week adds the 2026/27 FNC rate to the 2025/26 council rate, because Kent's 2026/27 average is not yet published. The council funded share is people Kent funds in care homes in an average week in 2024/25 (NHS England, ASC-FR) divided by CQC beds at 1 October 2026.