Finding the money to pay for care home fees is one of the biggest sources of anguish for older people. Those with savings or a house worth £22,250 have to pay the full amount themselves. The sharp increases in property prices in the past decade mean virtually anyone who owns his or her home is now liable for the full amount, although the house is not counted if a spouse, partner or dependent child still lives there. Average care home fees are now £450 a week, the Government estimates.

A second entirely different “rationing” system applies for those who are still living in their own home, but need assistance. What you get depends on where you live because that system is run by local authorities.

Under the rules there are four bands of need and in the past few years most local authorities have tightened their criteria so fewer and fewer people qualify. In seven out of ten local authorities only those judged to have “critical” or “substantial” need are eligible.

West Berkshire, Wokingham and Northumberland have the tightest restrictions, offering help only in “critical” cases. Many others are planning to follow suit, but are waiting for the result of a legal challenge against Harrow council, which tried to toughen its criteria to “critical” last year.

Sunderland and Calderdale in West Yorkshire are the only councils that still offer help with care in cases judged to be low-level. Anyone who lives elsewhere judged to have only low-level need has to pay for care, with carers costing in the region of £10 an hour.

In Scotland “personal care” in a person’s own home is free to all and 50,000 Scots have received it, at a cost of £256 million a year, since 2002 when it was introduced.

— The following examples are based on real cases. John, 52, is in a wheel-chair after a motorcycle crash, with his wife his main carer. He has been judged to be in “substantial” need, so used to get 15 hours of care a week from the local authority to help him get up and dressed in the morning. Last year he lost his entitlement after the council announced that it would fund only people with “critical need”. His annual bill is £7,800.

— Eileen, 80, is in good health but is increasingly frail and needs help with shopping and housework. But she is judged to have only “moderate” need by her local authority so does not qualify for any help. Her annual bill is £3,120 for home help six hours a week.

— Dorothy, an 86-year-old widow, suffers dementia and moved to a residential care home a year ago when her family felt they could no longer provide proper care for her. The NHS said her needs were for “personal” care not medical care so refused to pay. Social services said that because she owns a house worth £100,000, more than the £22,250 upper threshold, she would have to “self-fund”. For the first year she used her savings to meet the gap between her pension and the £2,000-a-month care home fees. But now the savings have run out she has to sell her home. Her annual bill is £24,000.

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