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Frequently Asked Questions

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).

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 £23,250 in capital savings.
If you have more than £23,250 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 £23,250. 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 £23,250.
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 £23,250 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 £23,250 capital to pay for your care home fees whilst you sell your property. This is because once your capital reduces to below £23,250, 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 £23.90 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 £23,250 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 £14,250 you will be assessed as if you earn £1 for every £250 (or part of £250) per week on your capital between £14,250 up to £23,250 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 £14,250.

If you have under £14,250 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 £23.90. If you are over 65 and have savings you may also be entitled to up to £5.75 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 £109.79 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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