Your local council's social work team are obliged to perform an assessment of your care needs if you request it. If they agree that you need care, they will then undertake a financial assessment. Taking your income and savings - but not the value of your home - into account, the financial assessment will establish whether you qualify for financial assistance from the state. In Scotland there is no financial assessment for people aged 65 and over as the majority of personal and nursing care is provided free of charge.
There are several ways that care can be funded. In some cases local councils, general practitioners (GPs) or Clinical Commissioning Groups will pay all or part of the costs of care. In England and Wales people may be required to make a financial contribution to their package of care.
Once the council has decided that you have eligible needs for care, they will discuss with you how these can be met.
What happens next depends on where you are in the UK and on your local council. The council may provide your care itself, or ask an approved agency to provide it on their behalf. Or the council may offer you a personal budget - a notional amount to spend - which would give you more choice and control over your care. This could also be spent using a direct payment - cash given to you by the council to arrange your own care.
You can either buy services from a regulated homecare agency or take on the responsibility of employing your own personal assisant (PA). Regulated agencies carry out careful checks on staff they recruit, consider health and safety risks, and account to the Revenue for tax and national insurance. They are inspected by a care regulator and must carry out staff training. In contrast, PAs are not regulated and you would need to arrange checks, training and PAYE, as well as comply with the law as an employer - a burden some would prefer to avoid.
Instead of a direct payment, you could ask the council to buy council services or services from a homecare provider for you, using your personal budget.
Finally, you or your family can fund your own care, without state assistance, and use a local homecare agency privately to provide care, or add to the care the council provides.
VAT is not usually charged on homecare services so it is important to check if fees quoted by providers include VAT or not.