FUNDING FOR CARE
Funding from local government in England is already strictly means-tested. And, on top of that, Councils have discretion to decide who gets funding – depending on physical needs. They are under pressure financially and, if possible, would much rather someone else paid – you, the national Government, the NHS.
But it is still just about possible to get some financial help for care - but only if you have very few resources and social workers assess you as meeting their needs threshold. This can be set at critical, severe or considerable. But you really have to be in imminent danger to qualify - and very poor. You can appeal against any decision - on the basis of need.
FUNDED CARE AT HOME
Currently, if you have severe needs and less than £23,250 in assets and savings (not including your home), you could be entitled to some funding to pay for home care. But you need to have assets of less than £15,000 to qualify for totally free home care.
Even if you have savings above the threshold, you are entitled to ask for an assessment of your needs and help with finding care – although some Local Authorities will expect you to pay for such advice and assistance. But to qualify for assistance, you will probably need to be in severe need (and poor).
What is severe need? If you have considerable difficulty with two or more of the following:
Keeping a clean and tidy home
Being safe at home
And this must have a significant impact on your wellbeing:
Physical and mental health
Protection from neglect and abuse
Control over day to day life
Social and financial wellbeing
Suitability of accommodation
Contribution to society
If you are eligible – and have very little money – efforts will still be made to avoid giving you any help. A social worker will calculate if any 'non-paying services' could be used to meet your needs – that means getting your family, friends or anyone else to help. If there is no other option, they will assess your needs. Once this is agreed - for instance, that you need help with dressing and personal hygiene - then a ‘personal budget’ will be calculated. This is the funding needed to pay for meeting your needs.
How much this personal budget is, will depend on your 'needs'. It will also depend on the Local Authority. But a plan will be drawn up – with the family’s input - showing what help is needed and how it is going to be paid for. This will then be agreed with the social worker. The plan may include funding for respite stays in a care home or a sitting service or personal care from an agency carer or a personal carer whom you employ directly. It can also be used for transport.
The money needed to pay for the care plan is the agreed ‘personal budget’. This can be paid directly to the individual or to a family member or a representative or it can be managed by the Local Authority, if no one else is able to manage it. But there may be a charge - of course.
If you become a ‘fund holder’ for an older person, you will need to account for every penny given to you by the Local Authority. It must be spent on care and paid to legitimate organisations. You cannot pay anyone in a black market-style arrangement or pay a member of the family and nor can you spend the money on holidays, fast cars or high living. You will need to open a separate bank account and keep careful records. If you do not spend all the money, they can take it out of the bank account.
Care at home from an agency costs between £16 and £30 per visit. You will probably pay less with a directly-employed personal assistant. But, if you employ an individual directly, then you will be an employer and may be liable for a lot of paperwork as well as to pay their tax, national insurance and pensions as well as holiday and sick pay.
A live-in carer costs around £600-£1,500 a week. Some Local Authorities will allow a budget to spent on this under their funded care at home rules. At present, these ignore the value of your home and only take account of your personal savings (not the savings of a partner). But not all LAs will allow you pay for live-in care out of the budget.
FUNDING FOR RESIDENTIAL CARE
In many parts of the UK, a majority of people living in care homes meet the costs themselves but a sizeable minority – and in some parts a majority – receive Local Authority funding. Often, the person will have tried to live at home with carers providing support but this has not proved acceptable or possible. In other cases, the individual simply needs round-the-clock care and cannot rely on occasional short visits from flying carers.
If you are looking for funding, a financial assessment will need to be completed by social services ( this time it will include your home). If you have savings of more than £23,250, you will be expected to pay the full amount of residential care.
The value of your property will not be taken into account if you are living with a partner or an older relative or a child, who is dependent on you.
They may also ignore the value of a home if a friend or relative has given up their home to live with you and care for you - although some Local Authorities are getting tough on such arrangements and there are instances in which adult children have been ordered out of the 'family home' so it can be sold to pay for care. But the savings of a partner are ignored.
If you lived alone and go into residential care permanently, the full value of your home and savings will be taken into account. Sometimes, the Local Authority will take a charge on the property, so that when it is sold you or your executors will be obliged to give them the money for your care. Sometimes, the home will need to be sold or rented to cover the costs of care.
Even if you have very few assets, Local Authorities will pay a low set amount towards a care home. Only certain basic homes will be open to an individual who is totally reliant on LA funding. Care home owners often complain it is not enough to cover care costs. And it is widely acknowledged that self-funding residents are subsidising those who rely on LA funding.
If an older person’s family is willing to pay ‘top up’ fees over and above the amount the LA is prepared to pay, they can do this in order to fund their relative living in a more expensive care home. This will need to be agreed with the LA, however, which may be hostile or cooperative – depending on the social worker. An individual funded in this way will, nevertheless, be a client of the authority and will be entitled to all the annual checks and support.
NATIONAL HEALTH SERVICE FUNDING
If you need nursing care, then you should be eligible for FNC (Funded Nursing Care) – which is £156.16 a week in England – payable from the NHS directly to a residential home. This will reduce the amount you have to pay or the sum that the Local Authority is paying towards care costs. To qualify for FNC, an individual must be assessed as needing help from a qualified Nurse. Many older people, particularly those with dementia qualify for this funding. But, again, you have to apply for it.
Then there is the Big One – what everyone wants but few get:
Continuing Health Care funding or CHC.
If you’re entitled to CHC, the total cost of a nursing home or care could be fully funded - irrespective of your financial resources or the weekly sum payable.
Sounds great, is great, is really hard to get.
It is a two stage process.
First, the older person has to be screened using the NHS checklist by a health professional or a social worker
Second, they have to pass a full assessment.
Many pass the first hurdle, few pass the second. CHC funding, paid by the NHS, is payable if the individual is assessed as having ‘primary health needs’. This means that their primary need for care relates to their health, not their social needs. It does not depend on having a particularly illness or condition. It can be care in their own home or in a care home but it can cover the cost of everything.
Obviously, it is a really important assessment and should not be approached lightly. Careful preparation needs to be undertaken in order for there to be any chance of a successful claim. The initial screening should be done by a health professional or a social worker. As stated above, many people pass this stage. The next stage, the full assessment, should be undertaken by a team of two professionals already involved in your care.
Stories abound of bed-bound individuals failing the test and people with dementia, in particular, facing an uphill battle for CHC funding. As with anything else to do with older people, the devil is in the detail: it is all about how the forms are filled in.
The assessment team will assess the individual on ’12 Core Domains’ and will award an individual a ‘score’ on each of these of low, moderate, high, severe or priority. These domains are: behaviour, cognition, psychological/emotional needs, communication, continence, mobility, nutrition, continence, skin, breathing, drug therapies, coma or other core health needs.
If they are not given a severe or priority score for several of these domains, funding is likely to be denied – even if the person has a high degree of primary health needs. Everything depends on how the form is completed. The Alzheimer’s Society has a comprehensive pamphlet of guidance here.
One advanced dementia sufferer failed his assessment despite being wheelchair bound, doubly incontinent, incapable of making decisions or communicating, unable to feed himself with swallowing problems, depression and challenging behaviour. His social worker thought he should get CHC funding. But the forms were completed by an inexperienced care worker. The family was advised to try again, if he deteriorated. How much further could he deteriorate without actually dying? They asked.
Some families are now employing no-win, no fee agencies which promise to get CHC funding for a flat fee of around £2,000. If you’re paying £500 a week and bearing in mind the complexity of the application, it could be money well spent.
I know of only two instances where CHC funding was approved but dozens when it has been denied. The only instance I know of when a family successfully applied for CHC without help, the son was a doctor who knew how to complete the forms.
In the other case, an older woman, who had weeks to live, was awarded CHC because the medical authorities wanted her out of hospital and into a nursing home. Funding was approved overnight.
Families can pay 'top-ups' for more luxurious surroundings