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 Commission for Social Care Inspection (CSCI). 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 CSCI on request.
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
This refers to care which is provided in your home, and is usually suited to those individuals with a less acute need. It may involve short term visits from the district nurse during convalescence or Meals On Wheels for those who have difficulty preparing food. In general terms, the care is targeted to provide help with a specific task, for example getting up in the morning or bathing. Help may also be provided by the installation of specialised equipment such as grab rails or adapted sanitary ware.
Traditionally, domiciliary care has been provided by partners, family and friends. However, there is an increasing need for professional help and support.
There are a growing number of private nursing and care agencies who specialise in providing tailor made care packages to suit individual circumstances. In addition, voluntary organisations and charities play a major role in this area, providing both physical and social care and also offering support to carers.
SHELTERED HOUSING
Sheltered Housing schemes are ideal for active retired people who wish to lead independent lives, but also require the security of a Warden who is on hand in case of emergencies. It should be noted that such Wardens only offer a watchful eye and it is likely that any care requirement will need to be met independently as detailed under the domiciliary care section.
RESPITE AND DAY CARE
Circumstances may arise in which an individual requires a period of professional care. This may be following a period of sickness or perhaps because of the absence of the usual family carer as a result of holidays.
In such situations, respite care in a residential establishment may provide the solution. Many care homes, particularly those in the independent sector are able to provide extremely flexible respite care packages. These can range from a two week visit, to day care or even an overnight stay.
For some, attendance of a day centre can be an integral part of the care package offering the carer with a degree of respite whilst also providing stimulation, company and a change of environment for the individual in need of care.
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.
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 and diseases or palliative care.
INFORMATION PROVIDED BY CAREAWARE
PO BOX 8 MANCHESTER
M30 9NY
08705 134925
www.careaware.co.uk
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.
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?
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 £22,250 you should be entitled to financial support from your local authority. If you have capital below £13,500 you will be entitled to maximum support contributing your income less £21.15 retained for personal expenses. If you have capital between £13,500 and £22,250 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.
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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.
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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 £22,250.
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.
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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:
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Will the Social Services pay my fees whilst I am selling my former home?
If, apart from your property, your other capital is below £22,250 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.
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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.
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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.
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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 £44.85 for those needing care by day or night and, at a higher rate of £67 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 £101 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.
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What happens I move into a care home independently and run out of money?
Once your capital reduces to £22,250 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.
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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.
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Flow chart guide to Funding
The above information has been provided by NHFA Care Fees Advice who are responsible for its content. Further advice, information or an appointment with your local NHFA Care Fees Adviser can be obtained by calling the NHFA Care Advice Line 0800 99 88 33 or visiting their Website www.nhfa.co.uk
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