Written and reviewed by the Oath Healthcare care team · CQC-regulated provider · Last reviewed: 11 June 2026
“The consultant said your husband can come home — but he’ll need complex care.” If that sentence has just landed in your week, you’re likely sitting somewhere between exhausted and overwhelmed. PEG feeds. Tracheostomy suction. Catheter changes. The discharge team uses the words like everyone knows what they mean, and you nod because there isn’t time to ask.
This guide is the one we wish every family was handed before they made the decision. Plain English. What complex care actually involves. What it costs. Who pays. How to choose a provider you can trust your husband, wife, mum or dad’s life to — because that’s what we’re really talking about.
Quick answer: Complex care is specialist, nurse-led care at home for people with high-acuity needs — PEG feeding, tracheostomy, ventilator support, spinal injury, motor neurone disease, brain injury, or end-stage conditions. UK costs typically run £1,300–£2,000+/week for live-in complex care. Often funded by NHS Continuing Healthcare. Oath Healthcare delivers CQC-regulated complex care — call 01223 755887 for a free assessment.
What is complex care?
Complex care (also called “continuing care,” “long-term care” or “specialist care at home”) is care for people whose needs go beyond what a standard carer can safely handle. It’s clinical care, delivered at home, by trained carers — often under the supervision of registered nurses.
The defining feature is clinical complexity. A standard domiciliary care visit might involve helping someone get washed, prepare a meal, take their medication. Complex care involves things like:
- PEG (percutaneous endoscopic gastrostomy) feeding and flushing
- Tracheostomy care and suctioning
- Ventilator management (invasive or non-invasive)
- Stoma and catheter care
- Wound care including pressure ulcers
- Bowel management programmes (especially for spinal injury)
- Seizure management for severe epilepsy
- Medication administration for complex regimes (often 15+ medications/day)
- Postural care and manual handling for people who can’t reposition themselves
- End-of-life care with symptom management
What it isn’t: it isn’t a nurse sitting in the house 24/7 with nothing else to do. It’s trained, specialist carers — often with a supervising nurse — delivering care that’s safe, dignified, and lets the person stay in their own home rather than living in a hospital bed for months on end.
Who needs complex care?
The route into complex care usually starts with one of these:
- Spinal cord injury — particularly C4 and above, where bowel, bladder and respiratory function are affected
- Acquired brain injury — stroke, traumatic brain injury, hypoxic injury
- Motor neurone disease (MND/ALS) — particularly as bulbar symptoms progress and ventilator support is needed
- Multiple sclerosis (advanced) — complex spasticity, swallowing, mobility
- Cerebral palsy with high support needs — particularly in adulthood
- Huntington’s disease in mid-to-late stages
- Late-stage Parkinson’s, MSA, PSP with feeding and mobility complications
- Severe respiratory disease requiring ventilation
- Post-major surgery with prolonged recovery — for example, cardiac, transplant, or extensive cancer surgery
- End-of-life care with complex symptom management — often via Fast-Track NHS CHC
Around 1.7 million people in the UK live with a condition complex enough that complex care could be appropriate, and yet only a small fraction receive it at home. Most are still in long-stay hospital beds or residential nursing homes because families don’t know home-based complex care is an option.
Complex care at home vs in a nursing home vs in hospital
| Complex care at home | Nursing home | Long-stay hospital bed | |
|---|---|---|---|
| Familiar surroundings | ✓ Own home | ✗ Shared facility | ✗ Ward |
| 1-to-1 attention | ✓ Always | ~ 1 staff : 6–8 residents typical | ~ 1 nurse : 8+ patients |
| Family access | Unlimited | Visiting hours | Visiting hours |
| Personalised routine | ✓ | Limited | Hospital routine |
| Typical UK cost | £1,300–£2,500/week | £1,400–£2,000/week | NHS-funded (~£3,500/wk equivalent) |
| NHS CHC eligible | Yes — at home | Yes — in nursing home | N/A |
| Infection risk | Low | Higher (shared environment) | Highest |
For most families, the math is similar — costs are comparable, but the quality of life and infection-risk profile favour home. The barrier is usually awareness, not money.
How complex care actually works at home
There are three common delivery models:
1. Complex live-in care
One trained complex-care worker lives in the home for typically 1–2 weeks at a time, with a rotational second carer for cover. Suitable when the person needs continuous monitoring or support throughout the day but their nights are largely settled. Typical cost: from £1,300/week.
2. 24-hour care (two-carer split-shift or live-in + waking night)
Used when the person needs active care at night too — for example, ventilator monitoring, frequent repositioning to prevent pressure damage, or seizure management. Either two day-and-night carers on rotation, or a live-in carer with a separate waking-night carer. See our full guide on 24-hour care at home. Typical cost: £1,800–£2,500/week.
3. Visiting complex care
For people whose needs are intense but time-limited — a tracheostomy check three times a day, a PEG feed at set times, a ventilator wean. The carer comes in for the procedure, then leaves. Typical cost: £25–£40/hour, with higher rates for nurse-led visits.
What complex care costs — and who pays
The UK ballpark for 2026:
- Visiting complex care: £25–£40/hour (higher with nurse-led element)
- Complex live-in care: £1,300–£1,800/week typical, £2,000+/week for high-acuity
- 24-hour two-carer complex care: £1,800–£2,500/week
- Palliative live-in (end-of-life): £1,350/week typical, often Fast-Track CHC funded
The big question every family asks: who pays for this? In England, three routes:
1. NHS Continuing Healthcare (CHC) — the underused one
If the person’s primary need is healthcare (not social care), the NHS pays 100% — regardless of savings. Complex care patients very often qualify, because by definition their needs are clinical. Yet only a small fraction of eligible families apply.
The process: a checklist screening, then a full assessment using the Decision Support Tool (DST), which scores 12 care domains (behaviour, cognition, breathing, drug therapies, etc). If the person scores at least one “Priority” or two “Severe” ratings, they’re likely eligible. Use our free 60-second CHC eligibility checker to see if it’s worth pursuing, and read the full NHS CHC checklist to understand the process.
For end-of-life situations, there’s Fast-Track CHC — designed to put NHS funding in place within 48 hours. If you’re hearing words like “days to weeks” from a clinician, ask the discharge team specifically about Fast-Track.
2. Local authority funding
If CHC isn’t awarded but the person has savings/assets below £23,250 (England 2026 threshold), the local council contributes on a sliding scale after a needs assessment. The local authority can also fund care for those just above the threshold via “self-funded care arranged by the council” routes.
3. Self-funded
If CHC is declined and savings are above the threshold, the family funds the care. This is common — particularly for people in the £25,000–£100,000 savings band where neither route fully helps. The good news: most families in this position who choose complex care at home find it costs roughly the same as a nursing home, but with vastly more 1-to-1 attention.
How to choose a complex care provider
Complex care providers are not the same as standard home care providers. The training is different, the supervision is different, the carer-to-client ratios are different. Here’s the 8-point checklist that separates serious complex care providers from agencies that just say they “do” complex care.
- CQC rating — Good or Outstanding only. Anything less, walk away. Check live ratings on the CQC website.
- DBS-checked carers with complex-care training — generic care training isn’t enough. Ask specifically about clinical competency frameworks.
- Same-carer continuity — a different carer every day is dangerous in complex care. Routines, equipment, medication regimes — they all need familiarity.
- Written, condition-specific care plan — not a template. The plan should name the equipment, the procedures, and the escalation pathway for each scenario.
- Registered nurse oversight — a named clinical lead supervising the care, signing off competencies, and available for escalation.
- Out-of-hours support — 24/7 phone line staffed by people who can actually help, not just take a message.
- Local presence with named manager — a complex care patient should not be handled by a head office two hours away.
- Pricing transparency — published rates, written quotes, no surprise charges. If a provider says “we’ll discuss pricing once we know more,” that’s a flag.
For a wider perspective, see our 27 questions to ask before signing up — the complex-care version of that conversation should always include the points above.
What’s it like, day-to-day?
One of our Cambridgeshire clients is a 52-year-old woman with motor neurone disease. Her care started as visiting care twice a day. Now, eighteen months on, she has 24-hour complex care at home: a live-in carer trained in non-invasive ventilation, with a second carer covering nights when her breathing needs more support. She uses an eye-gaze computer to communicate. She still hosts her book club on the second Tuesday of every month.
That’s the bet of complex care at home: the medical needs are met, but the person is still living their life. They’re not a patient in a bed. They’re someone whose grandchildren still visit on Sunday afternoons.
Frequently asked questions
What is complex care?
Complex care is specialist, nurse-supervised care for people with high-acuity clinical needs — PEG feeding, tracheostomy, ventilator support, spinal cord injury, motor neurone disease, brain injury, or end-of-life conditions. It’s delivered at home by trained complex-care workers, allowing people to avoid long-stay hospital beds or residential nursing homes.
How much does complex care at home cost?
UK 2026 prices: complex live-in care from £1,300/week, 24-hour two-carer complex care £1,800–£2,500/week, visiting complex care £25–£40/hour. Often funded fully by NHS Continuing Healthcare if the person has a primary health need.
Does the NHS pay for complex care?
Yes, through NHS Continuing Healthcare (CHC) — when the person’s care needs are primarily about healthcare rather than social care. Complex care patients very often qualify by definition. The fast-track route can put NHS funding in place within 48 hours for end-of-life situations.
What’s the difference between complex care and standard home care?
Standard home care covers personal care (washing, dressing, meals, medication prompting). Complex care covers clinical procedures — PEG feeds, tracheostomy suction, ventilator management, catheter care, wound care, seizure management — delivered by carers with specialist training and registered nurse oversight.
Can complex care be delivered at home instead of in a nursing home?
Yes, and increasingly families choose it. Home-based complex care typically costs the same as a nursing home (£1,300–£2,500/week) but provides 1-to-1 attention, familiar surroundings, unlimited family access, and lower infection risk. The barrier is usually awareness, not cost — many families simply don’t know it’s an option.
Who needs complex care?
People living with spinal cord injury, acquired brain injury, motor neurone disease, advanced multiple sclerosis, severe cerebral palsy, Huntington’s, late-stage Parkinson’s, severe respiratory disease requiring ventilation, post-major surgery recovery, and end-of-life conditions. Around 1.7 million people in the UK have conditions complex enough that complex care could be appropriate.
How do I find a good complex care provider?
The 8-point checklist: CQC Rated Good or Outstanding, DBS-checked carers with complex-care training, same-carer continuity, written condition-specific care plans, registered nurse clinical oversight, 24/7 out-of-hours support, local presence with a named manager, and pricing transparency. Generic home care agencies should be avoided for complex care.
Speak to the Oath Healthcare complex care team
Complex care is what Oath Healthcare specialises in. CQC Rated Good. Registered nurse clinical oversight. Carers trained in PEG, tracheostomy, ventilator, spinal injury and end-of-life care. We work with NHS discharge teams and CHC commissioners across England.
If you’re working out the right complex care for a family member — whether they’re in hospital now or already at home struggling with standard care — we’d be glad to help. The first call is free, takes 15 minutes, and there’s no obligation. Speak to a local care advisor:
- Cambridge: 01223 755887 — covering Cambridgeshire, Ely, Huntingdon, Newmarket, St Neots
- Suffolk: 01223 755887 — covering Bury St Edmunds, Ipswich, Sudbury, Mildenhall
- Redbridge & East London: 020 3949 4333 — covering Ilford, Wanstead, Woodford, Romford
- South Essex: 01268 206550 — covering Basildon, Southend, Canvey Island, Brentwood
- Nottingham: 0115 865 6333 — covering West Bridgford, Beeston, Mansfield, Hucknall