Imagine moving a loved one into a care home. You’ve ticked the boxes for medical needs, social support, meals, safety. You assume—because this is the UK—that their healthcare will be covered by the NHS. Then comes the surprise: foot care, something so basic and essential to mobility, comfort and dignity, is not routinely included. Families are asked to pay privately, residents sometimes go without, and the NHS will only step in if someone is judged to be “at risk.”
This raises a difficult but vital question: who should pay for foot care in care homes?
It’s easy to think of this as a financial issue, a question of budgets and contracts. But it’s much more than that. The way foot care is funded carries moral weight, ethical implications, and serious clinical consequences. It also touches something cultural: in the UK we expect healthcare to be there for us “from cradle to grave.” When families discover that foot care in care homes often falls outside that promise, the shock is real.
In this article we’ll look at how things stand today, what the consequences are, and—crucially—who should be responsible for making sure every resident has access to proper foot care.
The current reality – who Pays for Foot Care in Care Homes?
So, who actually pays for foot care in care homes today? The short answer: it depends where you live, your medical risk status, and what your care home decides to provide. In other words, there is no clear, consistent system.
For most residents, routine podiatry—things like nail care, corns, callus, and general foot health—is not provided by the NHS. Unlike dentistry, where NHS funding can be contracted to external providers, podiatry is only delivered through NHS teams directly. These teams are commissioned locally by Integrated Care Boards (ICBs) or GP-led structures, and their contracts vary widely across the country.
What they usually cover is the “at risk” population: people with diabetes, rheumatoid arthritis, poor circulation, or other conditions that put their feet at higher risk of ulceration and infection. Even then, the threshold for accessing NHS podiatry is high, and it differs from one area to another. The result is that many residents in care homes, who may have painful but non-“at risk” foot problems, simply fall through the gaps.
That leaves three main funding routes:
- Private payment: the most common. Residents or their families arrange and pay for podiatry themselves.
- Care home provision: a minority of homes do include foot care in their fees. Care Home Podiatry Ltd currently works with several groups, such as Ideal, Danforth and Borough Care, where podiatry is arranged for every resident. In those homes, no one misses out.
- Local authority support: extremely rare. Leeds is one of the few councils known to help towards residents’ private podiatry bills, though this is the exception rather than the rule.
For the majority of care home residents across the UK, therefore, foot care is a private expense—not a given part of healthcare.
The result is that many residents in care homes, who may have painful but non-“at risk” foot problems, simply fall through the gaps.
Consequences of the Current Funding Model
When foot care is left to chance, the results are sadly predictable. Many residents simply go without. Some decline treatment because of cost, others because their families don’t realise it isn’t automatically included, and some care homes don’t see it as their responsibility to organise.
The clinical consequences are serious:
- Pain and discomfort – Overgrown nails, corns, and callus can make even short walks painful. For residents already frail or unsteady, that discomfort quickly translates into reduced mobility.
- Increased falls risk – Poor foot health affects balance and gait. Falls are one of the leading causes of injury and hospital admission for older people; untreated foot problems add to that risk.
- Loss of independence – When walking becomes too uncomfortable, residents rely more heavily on carers for even simple daily activities, eroding confidence and dignity.
- Infections and complications – While NHS teams will usually step in once a problem becomes high-risk, this reactive model means issues are only treated after they escalate. By then, complications can be harder and more costly to manage.
And these aren’t just theoretical risks. National headlines have shown the reality when podiatry is neglected. In Norfolk, inspectors found residents left with “long and dirty toenails” that were causing pain and restricting mobility (BBC News, 2021). In Darlington, an “inadequate” care home was reported to have residents with toenails so overgrown that walking became difficult, undermining both independence and dignity (MSN News, 2023).
These cases highlight not just isolated poor practice, but a systemic problem. When foot care isn’t funded properly, it slips through the cracks. The result is avoidable harm to some of the most vulnerable people in our society.
Moral and Ethical Dimensions
Foot care in care homes isn’t just a clinical issue, it’s a question of values. Right now, the way things are set up forces many residents to treat podiatry as if it were a luxury — something they buy only if there’s enough money left over.
In practice, foot care often comes out of a resident’s petty cash fund — the small allowance meant for life’s little extras. That same pot is used for haircuts, newspapers, birthday presents for grandchildren, or the occasional bar of chocolate. Residents are sometimes asked, in effect: do you want your nails cut this month, or would you rather have the things that bring you joy?
That choice is deeply unfair. Foot care should not be competing with small pleasures; it is not an optional extra. Good foot health is a basic part of living comfortably and with dignity. When we allow it to slip into the “nice to have” category, we send the message that older people’s pain and mobility simply matter less.
There is also a wider justice question. We live in a country where people expect healthcare to be provided by the NHS. Families are understandably shocked to discover that something as fundamental as foot care is, more often than not, excluded. Why should access depend on whether a resident has savings, or whether their care home happens to budget for it, when the consequences of neglect are so profound?
At its core, this is about fairness, dignity, and respect. The feet that once walked children to school, earned a living, and kept households running deserve better than to be sidelined in later life.
Who Should Pay?
If we accept that foot care is essential, the next question is obvious: who should pay for it?
In principle, the answer feels simple. Healthcare in the UK is meant to be universal, and foot care is healthcare. The NHS should fund it. That would be the fairest solution, and it would prevent the postcode lottery we see now. But with NHS budgets already stretched to breaking point, a national expansion of podiatry services to cover every care home resident looks unlikely any time soon.
So if not the NHS, then who? At present the burden falls largely on residents and their families, but this model is patchy, inequitable, and at times degrading. We wouldn’t dream of telling someone they have to pay privately for wound dressings or pain relief in a care home — why should foot care be treated differently?
The most realistic answer, and one we already see working well in some groups, is for care homes to include podiatry as part of the room fee. Just as meals, cleaning, and hairdressing are factored into daily life, so too should foot care. This approach means no one misses out, residents aren’t forced to choose between comfort and small pleasures, and the risks of neglect are dramatically reduced.
Care Home Podiatry Ltd already supports several providers who take this route, including Ideal, Danforth and Borough Care. The results are clear: residents get regular care, no one slips through the cracks, and problems are dealt with before they escalate. It is a preventative model that works.
Other options — such as local authority contributions (as seen in Leeds), or families continuing to pay out-of-pocket — may have a role, but they are either too rare or too inconsistent to build a fair system around.
If we are serious about protecting older people’s dignity and health, the cost of foot care should not sit in the “luxury” column. It should be part and parcel of what it means to live in a care home.
Conclusion
The way foot care is funded in care homes matters. At present, most residents are left to pay privately, NHS provision is reserved for those deemed “at risk,” and only a handful of care homes choose to include podiatry as standard. The result is patchy, inequitable, and too often leaves older people in pain or at risk of falls.
These problems are not just theoretical or buried in academic reports — they come up repeatedly in inspector reports and national news. In Norfolk, residents were found to have “long and dirty toenails” that restricted mobility and caused pain. In Darlington, similar overgrowth was reported, limiting walking and undermining dignity. These are not isolated anecdotes; they are symptoms of a broken system.
This is more than a budgeting question. It is a matter of fairness and dignity. Healthcare in the UK is expected to be universal — families are rightly shocked to learn that basic foot care is excluded. We would not accept a system where wound dressings or pain relief were left to petty cash; we should not accept it for podiatry either.
The most realistic and humane solution is for care homes to take responsibility and build foot care into their fees. Where this is done, the benefits are obvious: residents are comfortable, mobile, and able to live with more independence. Problems are dealt with before they escalate. Everyone wins.
We can — and must — do better. The headlines aren’t just stories; they are warnings. Foot care is not a luxury. It is a basic part of living well in later life. The question is not whether residents deserve it, but whether we are willing to fund it fairly.
Interested in learning more about foot health in care homes? Make sure to read our previous series
