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Archive for the ‘A Guide to Selecting Care’ Category

Perhaps you are considering home care for your relative, taking care of them in your home. Or, perhaps you may move your relative to a care home.

In any of these situations, you must make a decision about the care of your relative. This is not an easy decision. Change is very difficult. You must consider your relatives physical and medical requirements and how much care he or she needs.

You must also assess the effects of care giving on your time and your needs. Because there are so many things to consider when making this decision, we’ve developed a checklist. The first part of the checklist is designed to help you assess your relatives needs. From there, you’ll be guided through assessing your needs and your family’s needs.

If you are considering a service that you expect to be funded by the local authority you must ring the local authority team and ask about an assessment. Social Services staff will help to see if they can assist you directly or provide information including “signposting to other sources of help, information and advice.

The choices you make will affect your loved one, as well as you and your family.

Printing and reading this checklist will help guide you through the decision-making process. Keep it with you as you tour Homes or discuss options with your relative. The checklist will help you determine which environment best fits your relatives needs. Because this can be a complex decision, you may want to obtain guidance from outside resources, such as:

• A Social Worker – to help you through the emotional difficulties and to co-ordinate the multi-disciplinary assessment that will help shape your or your relatives decision.
• A Doctor – to help you understand diseases or illnesses, what treatment is required, and how it may progress.
• A Financial Planner – to assist with understanding your relatives finances and to see what arrangements can be made to meet the cost of care.
• A Solicitor – to help with any legal issues, including buying or selling your relatives home And, once you’ve made your decisions, remember to allow time for you, your family and your relative to adjust to the changes.

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Specialist Care Services

There may be occasions when an individual’s care need is so specific or acute that specialist care is required.

This may take the form of intensive nursing care, care for particular illnesses/disease or palliative care.

PAYING FOR SPECIALIST CAREIn paying for acute or specialist care, it is vitally important to first of all determine the extent of any state funding entitlement as in some cases this will meet the full cost of care.

In circumstances where there is a requirement for some or all of the cost to be met by the individual, specialist advise should be sought.

In some circumstances, charitable or voluntary services may be available to assist with a specialist care need without charge to the individual. This might typically include MacMillan Nurses and hospice accommodation.

BENEFITS FOR SPECIALIST CAREThe type and level of benefits available for individuals with an acute or specialist care need will be dependent upon the extent of their problem and the type of care they require as well as their own financial circumstances.

The following benefits are care or age specific.  Those receiving care at home or in a residential setting should also visit the relevant sections.

Attendance AllowanceThis is a non means tested benefit payable irrespective of capital or income to those needing help with basic tasks. It has two levels, a lower or daytime rate and a night time or higher rate.

More Details

Pension CreditThis is the restructured alternative to Income support and offers two basic types of benefit, one which is designed to ensure a minimum guaranteed income and the other which to a degree is designed to assist those who have savings or additional private income.

More Details

Continuing Care BenefitTotally funded care for those with an acute care need.

More Detail

Registered Nursing Care Contribution (RNCC)A non means tested payment specifically for those with a nursing care need. More details are available at WPIC Continuing Care Benefit.

Benefit Details gratefully provided by http://www.careaware.co.uk/

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Care Home – Residential and Nursing Homes

There will be occasions, when the level of care which is needed cannot practically or cost-effectively be provided in your own home on a permanent basis. Therefore consideration will need to be given to the facilities provided by residential and nursing homes as a longer term arrangement. Coming to terms with this situation can be extremely traumatic for everyone concerned. Many of our preconceptions about care homes are very often far removed from reality. There are a range and variety of care homes to suit every taste and preference. When people actually visit a home for the first time, a reaction of ‘I had no idea it would be like this’ is commonplace.

The decision to enter care may mean giving up your own home, and this is understandably a step which may be taken with a degree of reluctance. However, residential care does provide the benefit of security, companionship and 24 hour care and overall can offer a positive alternative.

Types of care home

There are different types of care homes. Some offer full-time nursing care, others support people with a specific disability or medical need.

If you are currently receiving treatment on a regular basis from a qualified nurse then you may need a care home with nursing. Your district nurse or hospital staff will be able to help you decide.

Care homes

You may choose to go into a care home (sometimes called residential home) if you can no longer manage in your own home. Services you should expect at a care home include:

What is meant by Respite Care?

Respite care describes separate periods of care if you, or your carer, need to have a short-term break. Respite care can be provided either in residential care or at home, at the time of your choice. The breaks are only short-term and do not usually last for longer than three months of continuous care. This can be also provided in a emergency such as illness.

You can get some respite from your caring role in a number of different ways:

1. Residential respite: The Person you care for goes away to be looked after by someone else for a while – residential or nursing care or on holiday.
2. Domiciliary care: Someone comes into your home and takes over care for a while (a few hours or sometimes overnight) so you can go out or have some time to yourself.
3. You can sometimes get a break when the person you care for is involved in other activities – for instance at school, at a Day Centre.

Assessment of needs by the Local Authority

The first step is usually to approach the local authority to ask for an assessment for the person you care for – and for you as his/her carer. The Local Authority social worker doing the assessments will consider the needs of the person you care for, and your needs as their carer, and consider what services they may be able to provide (bearing in mind local priorities and availability of services). They will also do a Financial assessment under their Charging Policy which means that you (or – more usually – the person you care for) may be charged for the services according to means.

Direct Payments

In this case, the Local Authority works out what services they think you may need and then, instead of arranging the services, gives you (or the person you care for) the money to buy the service directly from an appropriate agency or person. You could then use the money to employ somebody directly yourself if you wish. See the Department of Health website for more details.

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QUESTIONS

1) I have been told that I should have an assessment of my needs carried out by my local social services Department. Why is this and what will happen?

Why it is important for the council to assess your needs.
Who will my assessment involve?
How it is decided what my needs are?
How will I pay for my care?
Where do Direct Payments fit into this?

2) I have been told to look for a care home for my relative. What do I need to know to help me to do this?

3) I live in England. How do I pay for my care home fees?

4) My relative has been asked to pay a ‘third party top-up’ toward the cost of my care home fees. Is this correct?

5) Can my relative be forced to go into a care home against their wishes?

ANSWERS

1) I have been told that I should have an assessment of my needs carried out by my local social services Department. Why is this and what will happen?

Why it is important for the council to assess your needs.
It is important that you receive an assessment of your needs, as without this you will be unable to access the services which are available to you. All local council Social Services departments in England have a duty in accordance with the National Health Service and Community Care Act 1990 (NHSCCA (1990) ) to undertake an assessment of your needs if it ‘appears’ to them that you may need the services that they provide. If, during this assessment, it appears to them that you have a disability, the council have a duty to assess your needs regardless of whether they are able to provide the services that you require. If you are assessed as having a need for services, and you meet the council’s eligibility criteria, the council will arrange for you to begin receiving these services.

Who will my assessment involve?
Your assessment will involve the professionals who have been allocated to help you asking you a series of questions about your care needs. People from both health and social services will be at the assessment, in what is called the Single Assessment Process (SAP). This means you will only need one assessment which will ascertain all of your health and social care needs. 

To request an assessment call 01926 410410, you will initially speak to a Customer Service Advisor based in the Customer Service Centre in Warwick, who will be able to advise you of your eligibility for further assessment for services
or visit http://www.warwickshire.gov.uk/adultsocialcare

How it is decided what my needs are?
When you are assessed you will be asked about how you cope with all aspects of your life. The Single Assessment Process (SAP) sets out several areas known as ‘domains’ that should be covered during the assessment, and will include such things as: your health; housing; living environment; whether you have enough money to live on; how you cope with daily living tasks such as washing and bathing; the preparation of meals; and the support networks (people who can help) available to you. The assessment should not only focus on practical issues but should also take into consideration what you think and feel. You may hear these kind of needs referred to as ‘psychological’ needs. It may be that the social worker will, with your permission, seek the opinions of other professionals, such as your doctor, before he or she is able to establish your needs in full. You may wish to start to make a list of questions or keep a diary of your difficulties so that you have all the information to hand when they visit. A friend or relative can also be present at the assessment.

If it is decided that you do not require support from your local council, the social worker should give you a copy of your Needs Assessment. If, however, it is decided that you do require support from your local council Social Services, then the social worker should put these needs in writing on a form, known as a Care Plan. This Care Plan should state each of your individual needs, how they are to be met, details of when and who will be meeting them, and why they need to be met. The Care Plan should be signed and dated by whoever completes it and should also be signed by you to confirm that you agree with it. Your Care Plan is like a contract with your local council social services for your care. If you do not feel that all of your needs have been included or the way they are to be met is not appropriate, you can request a review of the Care Plan. If there are needs that cannot be met for any reason, they should be recorded in this document.

How will I pay for my care?
If it is agreed that your needs can be met by Social Services you will be asked to fill in a form about your finances to find out how much you can afford to pay towards the care that they propose to provide. (You should not have been asked to do this before this point). Services provided by local council Social Services are not free of charge except to those on the lowest incomes and you may need to make some payment towards their cost. Council Social Services departments set their own charging procedures and rates for care provided to you. However, they must follow government guidance called ‘Fairer Charging Policies for Home Care’, so that whatever you are charged is a fair rate and does not leave you in poverty. If you feel that you are being charged too much you may wish to make a complaint to the council Social Services’ charging department. If it is decided that your needs can only be met in a care home, the council Social Services have to follow government guidance called ‘Charging for Residential Accommodation Guidance’ (CRAG). (Please see below for Frequently Asked Questions on this topic). Warwickshire Country Council knows that Direct Payments are an effective where people can access information and support.  To ensure this is available we can fund Direct Payments contact the Support Services -  01926 410 410 

Where do Direct Payments fit into this?
If you need care or support provided to you at home, but wish to arrange this yourself, you can apply to the council for Direct Payments. This is a system where once the council Social Services have assessed you as needing support, they offer you the option of taking the money they estimate will be required for you to purchase the services yourself. If you choose to take up the option of Direct Payments, you may feel more in control, but you will also hold the responsibilities of an employer such as paying National Insurance. However, the government is keen for older people to take up Direct Payments, and many areas have local Independent Living Teams or other voluntary sector organisations that can help you arrange this. Some are able to provide a vetted list of employees. If you would like to take up this option, you should ask your social worker for more information. Please see WPIC Direct Payments for more details.

2) I have been told to look for a care home for my relative. What do I need to know to help me to do this?
First of all you need to make sure that your relative’s needs have been fully assessed by all of the appropriate professionals and that these needs have been put in writing. You will need to see a copy of this assessment, or Care Plan, so that you know which kind of care home to look for (see question 1). This assessment should take place regardless of your relative’s financial situation. If your local council Social Services have agreed they should be paying the care home fees, they should also provide you or your relative with a written Care Plan.

There are several ways to find information about care homes in your area:

1) WPIC provides an independant Care Home & Domiciliary Care Search available from the homepage.
2) Your local council Social Services should be able to provide you with a list and tell you which ones accept their ‘usual cost’ or ‘standard rate’. It is important to ask for this figure, because if you choose a care home that is more expensive than this ‘standard rate’, they will ask you to find someone to pay a ‘third party top-up’ towards your care home fees. (See Question 3 for more information about the council’s right to do this) .
3) The other body that will be able to give you details is the Commission for Care Quality Commission (CQC) (http://www.cqc.org.uk), which is responsible for inspecting and registering care homes in England. Once you have found a suitable care home CQC can also provide you with a report of their last inspection of the care home.

3) I live in England. How do I pay for my care home fees?
Choose which option is most relevant for your situation:

I have more than £23,000 in capital savings.
If you have more than £23,000 capital savings (including capital such as premium bonds and stocks and shares) you will be expected to pay all of your full weekly care home fees until your capital savings reduce to £23,000. You should also be entitled to Disability Living Allowance or Attendance Allowance (both non means-tested benefits claimed from the Department of Work and Pensions and paid to people with disabilities) to pay toward the fees. At a minimum of three months before your savings approach this figure (or whatever the revised threshold is for the year that this occurs) you should contact your local council Social Services to ask them to assess your needs. If they agree your needs should (still) be met in a care home, they should accept responsibility for paying for your care home fees. They should pay the care home fees in full and assess how much you can afford to pay towards them and then invoice you or whoever is taking responsibility for your finances for your assessed financial contribution.

I have less than £23,000 capital savings at the time I move into a care home, but I own land or a property worth over £23,000.
There are several possibilities:

Postpone when you pay your care home fees.
If your local Social Services assess your needs as appropropriately met through care in a care home (see question 1 about assessments) you can apply to your local council Social Services department to be considered for a ‘Deferred Payment Scheme’. This can be used if you do not want to sell your property in your lifetime, or you need funding until the property can be sold. This is effectively a loan to pay the care home fees based on the value of the property. The agreement lasts until the property is sold or for 56 days after the property owner dies. The council will generally put a legal charge on the property to ensure that the owed amount is recoverable by the council if the property is sold. No interest can be charged on the amount owed whilst the agreement is in place.

A local authority does not have to enter into a Deferred Payment scheme with you, but if they refuse they should put their reasons in writing. Local councils should not refuse your request for a Deferred Payments agreement purely because your other capital is below the £23,000 limit.
Could this choice affect your entitlement to state benefits?
 If you opt for the Deferred Payments scheme because you choose not to sell your property, your entitlement to benefits will be affected and you are unlikely to be able to claim Pension Credit. You will remain eligible for Attendance Allowance and the Mobility element of the Disability Living Allowance, as in effect you are a retrospective ‘self-funder’ (you intend to pay back the money to the council).
Asking for a loan to pay your care home fees while your property is on the market.
You can ask the council Social Services for a Deferred Payments arrangement as an ‘interim loan’ whilst your property is being sold. This is an interest-free loan in which the council will fund the cost of the care home placement until the sale of the property has taken place. This may be useful if the property is taking a long time to sell, or is more complicated than usual. If you are provided with a Deferred Payment scheme in these circumstances, you should still be able to claim Pension Credit as you are not considered to be ‘depriving’ yourself of the capital in your property.

It is not advisable to use your £23,000 capital to pay for your care home fees whilst you sell your property. This is because once your capital reduces to below £23,000, the council Social Services have a duty to provide your care if they agree it needs to be met in a care home. You also run the risk that you may not sell your property before your capital is used up, putting your place in the care home at risk.
Do you have to start paying care home fees as soon as you move into the care home?
 No – the council Social Services should ignore the value of your property in their financial assessment for up to 12 weeks after you have become a permanent resident in the care home and will pay the fees. But they will invoice you for an assessed contribution (consisting of your state pension and any other income less an allowance of £21.90 per week). This right is called ‘the 12-week disregard’. If your property is sold before you have been in the home for 12 weeks you will have to start using the capital from the sale to pay the fees in full.

Once your property is sold the value of the sale (less 10% sales costs and any outstanding mortgage payments) will be assessed as your capital savings and you will be required to use this to pay your care home fees.

I have less than £23,000 capital savings and no beneficial interest in land or property.
Following an assessment of your needs by a social worker, if it is agreed that your needs should be met in a care home, the council Social Services is responsible for paying the full cost of your care home fees. They will still need to carry out a financial assessment to see how much you are able to pay towards these fees. They will ask you (or a relative) to complete a form about your weekly income and capital savings and any land or property you have a beneficial interest in. You should only be asked for your own financial details, but sometimes the form will ask for details of your partner. Your partner does not have to give this information and should consider carefully before they do (see below, ‘Liable Relative’.)

If you have over £14,000 you will be assessed as if you earn £1 for every £250 (or part of £250) per week on your capital between £14,000 up to £23,000. You will be expected to take this from your capital to pay toward your fees and this will gradually reduce your capital savings down to £14,000.

If you have under £14,000 they will only take into account your current weekly income, for example, your state pension and occupational pension. You are able to give half of your occupational pension to your spouse and the council Social Services should ignore this in their assessment of what you can afford to pay.

Each week Social Services will allow you to be left with a personal allowance of £21.90. If you are over 65 and have savings you may also be entitled to up to £5.65 per week Savings Disregard in addition to this.

What about moving to a nursing registered care home?
If you move into a nursing registered care home, the nursing part of your care should be paid for by the National Health Service (NHS). You should be assessed by a Registered Nursing Care Contribution nurse (RNCC), either in the hospital or the care home. This is currently paid at £106.30 per week.

If you are paying your own care home fees (often known as a ‘self-funder’) this contribution should be taken off the amount you pay to the care home for your fees. If your fees are being paid by your local council, then what they pay for your care will be reduced by the amount of the RNCC contribution. You will not receive this money, as it is paid directly to the care home.
My husband/wife has been told by our local council Social Services that he/she has to pay toward my care home fees. Is this correct?
In accordance with the National Assistance Act 1948 a husband or wife is ‘liable’ to financially support their spouse. Local councils can request a husband or wife to contribute toward the cost of their spouse’s care if they feel he/she can afford to do so. However, they cannot force the husband or wife to disclose details of their finances. If the husband or wife refuses to pay toward the cost of the care, the council Social Services can apply to the court for a decision about whether they are liable. The government is currently reviewing this piece of legislation with a view to withdrawing it.

The procedures relating to paying care home fees in the devolved regions is different to England.

Age Concern England
Tel.:   0800 00 99 66  
www.ageconcern.org.uk

Age Concern Scotland
Tel.: 0131 220 33445
www.ageconcernscotland.org.uk
 
Age Concern Cymru
Tel.:   02920 371 566  
www.accymru.org.uk

Age Concern Northern Ireland
Tel.:   02890 245729  
www.ageconcernni.org
 
4) My relative has been asked to pay a ‘third party top-up’ toward the cost of my care home fees. Is this correct?
All council Social Services departments in England have a duty to allow an older person to choose which care home they would like to live in, provided this can meet their needs and provided they meet the appropriate standards of care set by the government. This duty is provided in accordance with The National Assistance Act 1948 (Choice of Accommodation) Directions 1992.

If you prefer a care home which is more expensive than the one that your local council Social Services has found for you, or which is more expensive than their standard rate, but which has a vacancy and can meet your individual assessed needs in full, you will be asked to find a ‘third party top up’ to pay the difference in cost. This means that a relative or friend will need to sign an agreement stating that they will pay the difference between what the care home charges and the council agree to pay. It is important that the person who agrees to make this regular payment understands their commitment, and is able to afford the payment without causing financial problems for themselves. They should also know that if the care home increases their fee, the council may not necessarily increase their payment.

It may be that the council Social Services tell you or your relatives that they will only pay for a care home which comes within their standard rate, even though there are no other care homes with vacancies available. In addition to this, it may be that these particular care homes cannot meet all of your needs, especially your psychological needs (see question 1), such as the importance of being near to friends and family. If either of these situations are the case when the council Social Services have agreed you need to move into a care home, they should use their discretion to pay more to meet your care needs in a more expensive care home. This will mean that a third party does not need to meet the extra costs on your behalf and the choice of home has been based on need and not preference.

There are some circumstances in which it is appropriate to make a complaint to your local council Social Services, for instance: if you feel that the care home that the council Social Services has chosen for you will not meet your needs; you have not been given enough support in order to find a care home at the council’s standard rate; or you are not able to find a vacancy in a care home that can meet all of your individual assessed needs as stated in your care plan. This can be done initially to the social work team manager in writing (it would be advisable to keep a copy of the letter). If you do not feel that your complaint has been responded to appropriately you may wish to send your complaint to the council Social Services Complaints Department for the complaint to be investigated formally and independently.

5) Can my relative be forced to go into a care home against their wishes?
If your relative has the mental capacity to be fully involved with all decisions they cannot be forced to go into a care home. However, if their needs are assessed as needing to be met in a care home but your relative still wishes to return home, the council Social Services may ask them to sign a disclaimer to say that the risks involved in this decision have been explained and accepted. The council Social Services may agree to provide a package of care up to cost of the level of the care home fees they usually pay. If they do not agree to this, it should be made quite clear in writing why they were unable to provide these services.

If your relative has difficulties with mental capacity and is unable to make an informed choice about their living arrangements, the council Social Services could apply for a Guardianship Order in accordance with the Mental Health Act 1983. This would mean that the older person would need to remain in a place of safety, such as a suitable care home whilst the order was in place. The council Social Services would have to reapply for the Guardianship Order to be renewed after 6 months if it was assessed that your relative should stay there longer.

If your relative has dementia and it is unclear how much they understand it may be difficult for the council Social Services and the relatives to come to the right decision about the older person’s care needs. As with all Needs Assessments, it is particularly important to ensure that everyone involved in planning the care is consulted for their view or professional opinion. This must be continually reviewed and monitored. If this is undertaken regularly and appropriately, the care needed can be adjusted and altered according to the changing needs. The older person could only be made to remain in a place of safety if the council Social Services were to take steps under the Mental Health Act 1983. This option should only be followed when all other possibilities to meet the care needs have been explored.

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 THE CARE SYSTEM

The care system is extremely complex and CareAware have provide a guide designed to help you negotiate your way through the care maze by providing the information and assistance you need.

Thanks to advances in medical science and improved standards of living, we can all look forward to a longer and healthier life. However, it is also more likely that we will need some form of help and assistance during older age. The uncertainty of how this help might be provided is understandably of concern to us all.

• What type of care might be available?
• Who will pay for it?
• What choices and rights do I have?
• How does the care system work?
• Will I have to sell my home?
• Will I still be able to leave an inheritance to my family?

These are just a few of the questions which spring to mind.

The current care system is complex and confusing. It is therefore vitally important to be aware of the problems and issues and to identify the potential solutions which may be available. This section of the website will give a brief introduction to the issues involved and will invite you to explore specific aspects in more detail if you require.

THE POLITICS OF CARE

The basis of our current system and the problems it presents to the public

During the 1980s, there was an explosion in the number of care homes and residents in the UK, fuelled by an ageing population, increasing care demands and a decline in the availability of informal carers.

With funding provided through the Department of Health and Social Security, the cost to the government of care provision had begun to spiral and the authorities were aware that this was an unsustainable position.

The response was the National Health and Community Care Act 1990 which was introduced in 1993 and transferred funding responsibility to local authority Social Services and effectively placed a budget constraint on care fee funding.

The result of these changes is a system which effectively rations care funding and has reduced the number of care beds available.

Despite a Royal Commission into the issues and the introduction of additional funding support through the government’s nursing care contribution, care provision in England remains subject to a means testing procedure which many feel penalises those who have been prudent during their working life and betrays the country’s promise of cradle to grave care.

THE ORGANISATIONS INVOLVED

The National Health Service

Over the last ten years, the role of the NHS in providing long term care for older people has declined significantly with the closure of many long stay geriatric wards and the redirection of resources to reduce waiting lists and fund ever more sophisticated and expensive treatment. Once the medical input to a patient’s needs has been completed the NHS’s responsibility passes to the local authority. In cases where there is an ongoing need for nursing input but which can be provided in a setting other than hospital, the NHS will continue to offer some funding support through the Registered Nursing Care Contribution or RNCC.

Local Authority Social Services

As a result of the National Health and Community Care Act, primary responsibility for care provision now rests with the Social Services department of the local authority. They are required to provide an assessment of need to determine the most appropriate care package for an individual and also to undertake the financial means testing in accordance with CRAG, the Charging for Residential Accommodation Guide. Whilst some local authorities continue to own and operate their own care homes, this practice has tended to decline over recent years.

The Department for Work and Pensions

The DWP was formerly known as the Benefits Agency and its main role is to administer the benefits system including Pension Credit and Attendance Allowance.

The Independent Care Sector

The largest group of care providers is the independent sector incorporating charitable and voluntary homes. The majority are owner/operator homes although there has been an increase in the number of multiple operator groups and plc.

CARE REGULATIONS

There can be no definition of a good care home since the selection criteria will largely be one of personal preference. However, every care home must be regulated and must meet the minimum standards as laid down by the The Care Quality Commission (CQC). To ensure compliance with the standards all homes are visited regularly through both planned and unannounced inspections and any change of ownership is closely regulated. Copies of the annual inspection report for homes are available from the CQC on request and CQC Website.

In terms of care assessments, Social Services departments undertake this function through their team of social workers and no placement or contract for care should be entered into, where State funding is required until the funding arrangements have been finalised. For those who are self funding there is no obligation to involve Social Services at all and a claim for benefits can be made directly to DWP.

GETTING THE RIGHT HELP

The expectation is that the various agencies and departments involved in care will work in unison to provide a co-ordinated and streamlined service to the end user. Unfortunately, the reality can be removed from this ideal.

The sheer complexity of the system, the fact that each department operates to different schedules, budgets and masters can leave the patient caught in the middle, particularly when state funding is required.

Negotiating this care maze can be extremely difficult and although each department or professional may be aware of their own duties and services, they may have limited or indeed no knowledge about other options, services and issues.
The key to getting the right help is to obtain advice which encompasses all aspects of care and which as well as addressing the primary issue also gives proper consideration to the many associated issues about which the enquirer may not initially be aware.

FINDING THE RIGHT CARE

An introduction to the types of care available, how to get help and support at home, how to choose a suitable care home, finding help and assistance in your area together with contact details of support agencies.

There is no simple definition of long term care. The help and support we may require in older age can range from the installation of a stair lift to assist us getting upstairs in our own home, to permanent residence in a high dependency nursing home. There are, of course, a whole series of intermediary requirements which may arise. Our care need may vary over relatively short periods, for example after a stay in hospital and our requirements may only be on a temporary basis whilst our normal carer is away on holiday.

Whatever our individual needs, there are a huge range of care services, support organisations and voluntary groups to help us. Very often, the problem may be that we are not aware of just what is available and how we might access it.  Getting the right help will initially depend on the particular type of care which is required.

• Domiciliary care – Care in your own home >>more
• Sheltered housing – Specialised accommodation with a warden in attendance >>more
• Respite care – Temporary residential care or attendance at a day centre >>more
• Residential and nursing care – Full time professional care other than in your own home >>more
• Specialist care services – Dedicated services for specialised or acute needs >>more

FUNDING YOUR CARE

Who Pays for What?

When moving a loved one into a care home, fully understanding what the State provides and being certain about costs and affordability is essential for all involved. Seeking independent advice is important, however, here we seek to answer some of the most commonly asked questions.

State Funding

Who qualifies for local authority financial assistance?
If the State is paying do I have a choice of care home?
What if the home costs more than the local authority is prepared to pay for?
My partner needs care, how does this financially affect me?

Self-Funding

Will the Social Services pay my fees whilst I am selling my former home?
Do I have to sell my property?
Do I have to pay council tax on an empty property?
Is there any financial help that is not means tested?
What happens I move into a care home independently and run out of money?
What can I do to avoid this situation?

State Funding

Who qualifies for local authority financial assistance?
If you have been assessed as needing a care home place and your capital is below £23,000 you should be entitled to financial support from your local authority. If you have capital below £14,000 you will be entitled to maximum support contributing your income less £21.90 retained for personal expenses. If you have capital between £14,000 and £23,000 you will also pay a capital tariff of £1per week for each £250 between these two figures.  Capital includes the value of your former home unless it’s occupied by your partner, a relative who is aged over 60 years or incapacitated, a child under 16 years who you maintain or a separated partner who is a lone parent.

If the State is paying do I have a choice of care home?
Yes and it can even be in a different county. The home you choose must be suitable for your assessed needs, comply with any terms and conditions set by the authority and, not cost any more than they would usually pay for someone with your needs.

What if the home costs more than the local authority is prepared to pay for?
The local authority will allow a third party to top-up who is able to do so over the long term. You are not allowed to top up the fees yourself from capital below £23,000.

My partner needs care, how does this financially affect me?
Only the partner requiring care should be means tested. Property occupied by a partner is disregarded and only fifty percent of any private pension should be taken into account. From April 2006 local authorities have been allocated extra funds so that they do not have to ask married couples to contribute what was known as ‘liable relatives contributions’ towards their spouse’s care however, they will take into account 50% of any joint savings therefore, to accelerate financial help it is better to have separate single accounts meeting care costs paid from the account of the person in the care home.

Self Funding
If you are self funding your care because you are not eligible for local authority funding there are other forms of financial assistance you may be entitled to:

Will the Social Services pay my fees whilst I am selling my former home?
If, apart from your property, your other capital is below £23,000 the local authority will help as above with the costs during the first twelve weeks of permanent care. Beyond that period any financial help will be charged against the value of your former home and recovered from the eventual sale proceeds.

Do I have to sell my property?
No, the Social Services can lend you the money to pay for your care charged against your property value. However, they may limit how much they will pay and it could adversely effect your welfare benefit entitlements.

Do I have to pay council tax on an empty property?
If you move into a care home and your property is left empty then you should receive full exemption from Council Tax until it’s sold.

Is there any financial help that is not means tested?
If you are self funding, Attendance Allowance is a non-means tested, non-taxable allowance paid at the lower rate of £47.10 for those needing care by day or night and, at a higher rate of £70.35 for those needing care by day and night. Also, whether your stay is temporary or permanent if you receive nursing care in a care home you may be entitled to an NHS Registered Nursing Care Contribution (RNCC) towards the cost of your nursing care, paid directly to the home at £106.30 per week.  If your needs are primarily health care needs, you may be entitled to full funding from your local PCT following an assessment under their continuing care eligibility criteria. The RNCC will change to two bands on 1st October. The above applies to England only. Wales, Northern Ireland and Scotland pay different amounts.

What happens I move into a care home independently and run out of money?
Once your capital reduces to £23,000 you can seek local authority assistance. However, if the home costs more than the local authority usually pays and won’t reduce its fees you could be in the difficult situation of either finding a source of top-up or seeking less expensive accommodation the move to which could be detrimental to health and well being. If there is a likelihood of running out of money it’s important that for you to arrange an assessment of your care needs with the local social services department to ensure they will step into help. Also check if the care home owner can continue to accommodate you at social services funding rates or will require a third party top-up.

What can I do to avoid this situation?
They are a way of meeting care costs for as long as you need care whilst using up only part of your capital. For example the use of Immediate Need Care Fee Payment Plans can contribute towards capping the cost and, as so many older people wish enabling an inheritance to be left for the family. The important thing is not to try to do it alone, seek advice. NHFA specialise in this and through their local advisers will ensure you fully understand your entitlements from the State and the options available to you for meeting your care costs whilst also preserving capital and savings.

Flow chart guide to Funding

Maximum Fee Rates 2009/2010 (Effective from 6th April 2009)

Nursing Band Rates 2009/2010

Applicable only to those cases assessed at High band prior to 1st October 2007 pending future

  The Funding information has been kindly provided by NHFA.

Looking for Care? Confused about Care?
We’ve Unlocked the Care System

The care system is extremely complex, so we have provided a guide to negotiate your way through the care maze by providing the information and facts you’ll need.  Let WPIC unlock and simplify the care system.  >> More

Personalisation

Across Government, the shared ambition is to put people first through a radical reform of public services.  It will mean that people are able to live their own lives as they wish; confident that services are of high quality, are safe and promote their own individual needs for independence, well-being, and dignity.  >> More

Sheltered Housing

Sheltered or retirement housing is suitable for people who like independence but want assistance on hand in an emergency, but don’t need to move into a care home. There are different types of schemes available to rent and to buy. The majority of schemes have a scheme manager/warden and community alarm service. >> More

Very Sheltered Housing

 Very sheltered housing is a purpose built complex that allows older people (aged 60+) to live independently in their own flat in a safe and secure trouble free environment.  >> More

Virtual Care

A team of home carers operate between the hours of 10 pm to 7 am to provide intensive support to vulnerable people otherwise imminent risk of admission to residential or nursing home care or may be especially vulnerable after hospital discharge.  >> More

Close Care

Close Care schemes are a relatively new concept and consist of independent flats or bungalows built on the same site as a care home.  >> More

Extra Care

Extra Care Housing is housing designed with the needs of frailer older people in mind and with varying levels of care and support available on site. People who live in Extra Care Housing have their own self contained homes, their own front doors and a legal right to occupy the property.  >> More

Supported Living

 Supported Living is part of the government valuing people plan for making the lives of people with learning difficulties, their families, and carers better. >> More

Direct Payments

Direct Payments are sums of money that we give you instead of providing you with a service, such as home care; short-term breaks; day care; equipment and small adaptations. With Direct Payments you can arrange your own assistance so that you may have more choice and control over the way you live your life. If we give you Direct Payments you must use it to meet the needs that we have agreed with you during your assessment. >> More

Indivdual Budgets

Individual Budgets are designed to bring about independence and choice for people receiving care or support. It gives them a full understanding of the finance that is available, in order to empower them to take control and make decisions about the care that they receive. >> More

The Care Quality Commission (CQC) is the new health and social care regulator for England. We look at the joined up picture of health and social care. Our aim is to ensure better care for everyone in hospital, in a care home and at home.

The ratings are based on an inspection by CQC.  It includes a review of all facilities and systems of control, interviews with residents their families and staff, surveys completed by residents and families and information provided by the home in its Annual Quality Assurance Assessment (AQAA) and the Inspector’s own observations. To ensure that ratings are as consistent as possible, CQC Inspectors adhere to the Key Lines of Regulatory Assessment (KLORA).

 CQC addresses seven categories or ‘outcome groups’, regarding the National Minimum Care Standards for care. These are: choice of home; health and personal care; daily life and social activities; complaints and protection; environment; staffing and management and administration. The more of these that are graded ‘excellent’, the more likely a home is to be graded as ‘3 stars’.

More details are available from Regulation of Care Services

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What’s Right For Your Loved One

It is important to take the time to understand your relatives needs and desires. Remember, it’s very difficult for people to come to terms with the fact that they are no longer capable of caring for themselves. In many cases, your relatives need to feel self-sufficient will conflict with your concern for his or her safety and welfare.

An open line of communication between you and your relative on is essential. Try to put yourself in your relatives shoes. Above all, be patient.

Here are some hints to help you through this difficult time:

Considerations For Your Loved One

Be kind . . . your relative may fear losing control, becoming dependent or a burden.

Be positive . . . your relative may not understand or believe that you have his or her best interest in mind. Remember . . . accepting help is difficult for many people.

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What’s Right For You

Instinctively, we tend to put the needs of our relativies ahead of our own. And, you’re probably doing just that. However, your needs are important, too. For the sake of both you and your relations, it is essential to strike an appropriate balance.

Perhaps you’re feeling overwhelmed, tired, scared, sad, alone, discouraged, or depressed. These feelings are all perfectly natural.

Here are some tips to help you through this difficult time:

• Care for yourself! Otherwise, you will exhaust your own emotional and physical resources.
• Call relatives, sitters, home-helpers, or respite care professionals when you need a break.
• Don’t be afraid to communicate your needs to your relatives.
• Find outlets. Exercising, walking or talking to others will help deal with stress.
• Keep your options open.
• Do your own research.
• Learn as much as you can about the disease or illness.
• Work with your relativies doctor.
• Communicate with your relativies.
• Stay focused on the immediate need. Do one thing at a time.
• Join support groups. They can validate your experiences.

Support groups offer a forum to discuss your feelings. Through support groups, you’ll find out you’re not alone. You’ll discover that many of the feelings you’re experiencing are shared by other members of the group. Typically these feelings include:

Feeling guilty because . . .

• you cannot respond to your relativies every need.
• you spent time away from your relation.
• you mistreated your relation in the past.

Feeling angry because . . .

• family members don’t help out.
• you feel trapped in the situation.

Feeling . . .

• Powerless?
• Embarrassed by your relatives behaviour?
• Stressed?

And, finally, some words of wisdom . . .

• Your relations well being depends on your well being.
• If you’re tired and under stress, your risk of illness or accident increases.
• There is no “right” way to feel.
• Your feelings affect your judgement.
• Difficult and uncontrollable episodes can wear out even the most patient person.
• It is only human to be angry when faced with burdens or losses.
• Focus your attention on the present, not the past.
• Respect your relation.
• The more informed you are, the better equipped you are to handle a situation.
• Asking for help doesn’t mean you’re a failure.
• If you can no longer cope with caring for your loved one and feel you might not be able to avoid causing them harm by leaving them at risk or harm them. Then you need to contact your local Social Services adult team who will be able to help you.

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