All posts in NHS & Social Care legislation

7 Important Things You Should Know About Care Needs Assessment

In my previous blog, How To Avoid Negligence Claims – Working With Elderly Clients I outlined ten important questions to ensure practice is sound and person-centred and said that I would explore each one separately. My first considers care needs assessment for older people.

Local authorities must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether or not the local authority thinks they have eligible needs and regardless of their financial situation.

The duty is triggered under Section 9 of The Care Act 2014 for anyone who appears to be in need of support services.

The purpose of an assessment is to identify the person’s needs, how these impact on their well-being and the outcomes that the person wishes to achieve in their everyday life.

Even if the person doesn’t want the Council to support them it is helpful that they have a needs assessment to provide a foundation for care navigation and procurement.

There are two interdependent parts to the assessment and both must be met to qualify for social care funding. These are care and support and financial eligibility

Planning senior care on a whiteboard.

Using a Care Needs Assessment For Planning

  1. The criteria used to assess care and support needs

To be eligible for social care funding a person must be assessed to have a ‘substantial’ or ‘critical’ level of need. As a minimum, they are likely to need support with personal care and daily living on a daily basis.

  1. How financial eligibility is determined

The following rules apply to financial assessments for both residential care and care in the home:

  • People with over £23,250 pounds savings/capital will meet the full cost of their care.
  • People with between £14,250 and £23,250 will make a contribution from their savings/capital as a tariff income of £1 for every £250. A contribution from income will also be assessed.
  • People with savings and capital below £14,250 will not make a contribution from capital but contribution from income will be assessed.

The difference between the assessments is that for residential care, a person’s property is taken into account.

  1. The care assessment

A Care assessment is not always undertaken face-to-face. It is not unusual for an unplanned screening assessment to be carried out directly with an older person over the phone. This can come out of the blue to the older person, especially if they live alone. Older people are proud and often eager to minimise the help they need. Many are hard of hearing. Make sure you ask to be advised if and when a phone assessment will be taking place when making the referral, so you can prepare and support the person.

During the assessment the person should be advised to answer all questions as if it was their ‘worst day’ without any support.

  1. The person must have capacity to make decisions during the assessment

If an individual requiring assessment lacks capacity and there is no registered LPA in place, the Care Act imposes a responsibility to refer the matter to the Court of Protection who can appoint a professional Deputy.

  1. The person has to be offered support to participate if necessary

New rules under the Care Act 2014 allow the person to take the lead in explaining what support they need to make life easier for them.

There is also a duty to provide independent advocacy to represent and support the person, if needed, to facilitate their involvement in assessments.

  1. Unpaid carer’s needs and their need for support are entitled to be assessed

There is a duty for carers to receive an assessment regardless of their needs for support or their financial resources. Also to provide independent advocacy to represent and support them if necessary.

  1. Obtain a written copy of the assessment

The assessment and any other relevant information will be recorded and authorised. Make sure the person obtains a copy as they or their representative have the right to challenge or dispute anything they don’t agree with.

Here are some helpful links

The Care Act 2014 – Assessment and Eligibility

How to get help with social care for adults in West Sussex

Apply for adult care assessment in East Sussex

Apply for adult care assessment in Surrey

My next post will consider Health Assessments

What does The 2014 Care Act mean for older people?

With 96% of people over the age of 65 in the UK having not made any financial provision for potentially needing future care in a residential or nursing home, it is clear that more information is needed in the public sphere that will allow them to take an informed course of action and begin to plan for the future.

In addition, The 2014 Care Act has introduced major changes to the way that the government will assist certain people financially, as care and nursing home costs are not covered free of charge by the NHS – this means that anyone who moves into a home has to pay for it themselves. While the cost of residential care differs wildly from county to county across the UK, people need all the information they can get to ensure that they aren’t paying more than they need to wherever they are.

A new downloadable guide from Caring Homes explains these changes and lays out what people with different levels of capital can expect in terms of financial assistance if they require it for a move into a residential or nursing home. Given that the process is difficult enough to get to grips with as it is, it’s important that elderly people discover how to give themselves the best quality of life at the lowest price possible.

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State-funded or self-funded?

One of the most significant questions that the guide answers is the way that funding for residential care works.
Your local authority will determine whether you or your loved one need residential or nursing home care and then assess you financially. Whether you are state-funded, self-funded or a mixture of the two will be determined by their assessment of your assets and capital.
That financial assessment is based on the state of your income and assets, including interest on savings, bonds, investments, pension and assets such as your house. It does not include the value of personal possessions, nor does it include the income of a spouse, partner or family members.

• Ultimately, if your total capital is below £14,250 you will be completely financially assisted and you will not have to pay anything towards care bills.

• However, if your total capital is greater than £23,250, no financial support will be offered. This tends to be the case with most people who own their own homes. This however is set to be addressed in 2016 and is likely to change again.

• If you require a high level of care, which would mean that you struggle to perform simple tasks, you may be eligible for the £72k care fee cap which will be introduced in April 2016.

The guide explains the situation and the different options in more detail. Download it today to see what you or your loved one should be doing in preparation for potential residential care over the next couple of years.

All Change For The NHS

Do you realise what a momentous change takes place today, 1st April?  Our beloved NHS, as we know it, will be abolished, just short of its 65th birthday. The Health and Social Care Act comes into force with serious consequences for us all, especially older people.

Last year I watched with unease at the health and social care bill during its turbulent passage through parliament and became increasingly concerned about its affect on older people.

Unfortunately very few of us understand its implications and  it will affect us all more than any legislation passed in our lifetimes. It is the final stage in the dismantling of the NHS, a process that began around 25 years ago without most of us realising what was happening. Law pic

The Government’s case for change is largely based on the assumption that the NHS is no longer affordable, particularly in the current financial climate, and that it needs to be modernised. I believe this assumption is false. Of course things have to change but research overwhelmingly shows that the NHS performs well in comparison to other healthcare systems internationally. It is also cost-effective and highly valued by patients.

Key changes in the NHS

  • From 1st April, Primary Care Trusts (PCTs) and strategic health authorities will be disbanded.
  • In their place Clinical Commissioning Groups comprising of local GPs among others, will control about £60 billion of the NHS budget and commission local services.
  • A new body, NHS England will oversee the NHS
  • Responsibility for public health, will transfer to local authorities who will take the lead for improving the health of their local communities.
  • Commissioning will take place through competitive tendering and NHS contracts will be opened to the private and voluntary sectors.
  • There will be huge profits to be made for private healthcare companies who can’t wait to get their hands on our NHS.

The government claims private providers will improve standards through competition and choice. However experience of the NHS getting into bed with the private sector, whether through private finance initiatives (PFI) cleaning contracts in hospitals or the takeover of the GP out of hours service – has been disastrous so far. Privatisation has driven up costs and produced worse results.

Competitive tendering fragments healthcare. Older patients often have several chronic conditions. In future things like eye screening and dietary advice could be provided separately by different providers, making it confusing for the older person and more difficult for their GP to coordinate.

The government consistently claims the NHS budget is protected while in reality, it is being forced to make cuts under the guise of efficiency savings. Across the country, accident and emergency departments and other services are being closed and thousands of jobs are being lost. Older patients with chronic and complex diseases will continue to lose services essential for their care and receive insufficient and poor quality care on hospital wards.  As a result of these changes, people will die.

My heart sinks when I think about the impact of the changes on older people I know and love. Local campaigns are joining up to fight back and I will be joining them. The Government and others with a vested interest may think the fight is over, but the battle to keep our NHS has only just begun, so watch this space!

Long Term Care Fees – The Truth Part Two

If you felt reassured by Monday’s announcement about the £75,000 cap on long term care fees, think again. The more detail is uncovered, the more concerned I am becoming. The following information is based on an article I read by James Lloyd, director of the Strategic Society Centre that I would like to share with you.

He made the point that  the ‘cap is not really a cap at all because of the ‘living cost’ contribution of  £12,500 that individuals will be expected to make. This is higher than previously considered and will force more people to draw on their capital.

Furthermore the vast majority of the 125,000 older people funding their own residential care in England pay more than the rates paid by their Local Authority. Self-funders will therefore pay more than the value of the ‘cap’ before they reach it, and carry on paying for care after it. This will mean many having to carry on drawing on their capital beyond the ‘cap’.

Once people realise that they are likely to die before reaching the ‘cap’ what happens to the ‘peace of mind’ they were promised? This will mostly affect southern areas in the country areas where the proportion of pure ‘self-funders’ in residential care are the highest.MC910217019

It is confusing as to why ministers keep going on about how the reforms will lead to a pre-funded care insurance market. This is absolute nonsense. The consensus view in the insurance industry is that the ‘capped cost’ model will not result in an insurance market.

I believe the reforms will never actually be implemented in the way they are described today and a great deal of thought and attention will need to be paid to the way it affects individuals, the means test and standardised ‘living cost’ contribution.

Finally, the reforms do nothing to address the serious shortfall in funding elderly care, leaving social care the only public service that we have to pay for ourselves. We are a modern society that can send satellites into space and explore Mars yet we can’t look after some of the the most vulnerable in our society, older people. So forget about  not worrying about funding care fees in your old age. One in three of us will need significant care as we grow older and most of us will get no support whatsoever from the state, so don’t put away your ”For Sale’ board yet.

 

Long Term Care Fees – The Truth

After months of number crunching the Government has set the cap for social care fees at £75,000 which is very misleading. It only applies to the personal care element and is subject to both eligibility criteria and the prevailing local authority rate. The cap will not cover accommodation, food and general living expenses, or above the rate paid for by the local authority. This can be as low as £276 a week with the average cost of a care home with nursing in the South East  being around £800 a week. So in reality the cap is nearer £200,000.MB900423551

Change in financial threshold

The current financial threshold of £23,250 will increase to £123,00. As the value of the average UK house is higher than this it will make little difference to many older people needing care and most homeowners will still have to sell their homes to pay for care fees. The plans will be paid for mainly by taxpayers in the South East by raising inheritance tax thresholds.

An underfunded care system

The stringent rules around care home fees are only one aspect of our grossly underfunded care system, and not the worst. The decision by most local authorities not to fund people who are in desperate need, but not technically ‘critical’ is an even worse problem.

Will insurance be the answer?

The insurance industry will be planning ways to cover that first £75,000 of costs. With the exorbitant mark-ups for which the industry is known, these products will be unaffordable for many. Experience has also shown that the market for insurance products to fund elderly care has hitherto been very small, largely because most people believe that social care, like the NHS, is free at the point of demand and therefore fail to plan for them.

Self funders

While I am pleased that at last a decision is made to place a cap on care fees for older people, which is particularly important for the 41 per cent of elderly people in the care system who are “self-funders” because they have over £23,250 in assets including property, many are not very wealthy, yet I believe they are among the most overlooked and underserved in the care system.

They are people like you and me who have worked hard all our life for a pension that will make us ineligible for most welfare benefits, yet have savings that will not last long when paying care fees at the rate of over £2,000 a month.

 

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under  £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and  negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

Government Reform of Social Care Care. Part Two: Food for Thought

Having finished my rant about the Government’s lack of backbone to adequately fund social care, here are some of the important points that were raised in the Social Care White Paper and Draft Care and Support Bill.

From 2015 the government will introduce national standards on access to care services.  At the moment each council can set its own criteria, creating a so called postal lottery. National standards will help people to understand what they are entitled to.

New rules will be introduced to make it easier for older people to move around the country, to live for example, nearer to their relatives. Currently they have to undergo new assessments, which results in some losing out. This will give people the flexibility to make the most appropriate choices about where they and their families live.

The Government will offer state loans for care costs and residential fees can be taken from a person’s estate after death. Interest will be charged but the level of interest and whether this will be capped is not known. However this offers  nothing new and local authorities already offer deferred payment schemes without interest. 

People will be given access to personal budgets (money given to the person in lieu of services) by 2013 and have a legal right to them by 2015. The government will also invite expressions of interest to pilot direct payments in residential care in the summer of 2012. I was involved in Personal Budget pilots and feel strongly that until alternatives to direct payments are offered universally to older people who are unable to manage direct payments, nothing much will change. Council managed budgets will continue to deceive government statistics into thinking Local authorities have more older people with a personal budget than they actually have.

There will no longer be a requirement for carers to provide regular and substantial care, so any carer with needs could be assessed. The  Government also plans to extend the right to a carers assessment and provide an entitlement to services for the first time. A national minimum eligibility threshold for support for carers will be set  . However the amount of money needed to fund this new entitlement will be dependent on what money is available in the system and we will have another case of ‘robbing Peter to pay Paul’

Local authority can charge for services that they are not under a duty to provide. For example, people who are not eligible for the local authorities help. For these services, local authorities may also charge ‘arrangement’ costs. Up until now, it has only been the services that have been charged for, not the ‘management’ or ‘arrangement’ charge.

The government will be strengthening support within communities. They will introduce a duty on local authorities to commission and provide preventative services and fund or encourage a number of projects to encourage supportive networks of volunteers within communities, including Time Banking which is very good news.

The social care needs of people facing end of life are recognised with a commitment to abolish means testing for people on the end of life care register.  Most people would prefer to die at home but currently less than a quarter are able to do so. We simply cannot afford, in human or cost terms, to continue to allow people to die in hospital against their wishes.

Only time will tell if political will can be turned into reality. If I sound cynical it is because I have found over many years, that the devil is in the detail and the implementation of policies. As people come to terms with an ageing population and the reality of a care system stretched to breaking point, I have faith that ‘the people’ will decide. Let politicians from all parties heed my warning.

 

The Shame of Government to Adequately Fund Care Reform

After enjoying a career in Social Services and the NHS, I was naturally interested in the publication of the Government’s plans this week to reform social care. Furthermore, my passion for changing the way we care for senior citizens in England fuelled my frenzied activity between live web coverage, watching the TV and listening to the radio on the day it was published. With experience of helping my elderly parents manage their direct payments, more recently caring for my terminally ill father and my elderly clients and their relatives in mind, I found myself vacillating between excitement and outrage.

Firstly let me explain what all the fuss is about. The government has set out its proposals for the reform of social care in a White Paper. This has been published alongside a draft Care and Support Bill which will become the main plank of social care legislation, effectively replacing many statutes from the last 16 years. A progress report on funding reform was also published.

I plan to discuss these milestone documents in two parts. Firstly focusing on funding, then on the most relevant points for older people and their families in the second part.

I was thrilled to learn that the government made a commitment to the principle of capping costs, but sadly that’s where the good news ends because no radical decisions have been taken on funding at all. It has to wait for the next spending review in two years time when the government wants to look at cheaper options to the £35,000 level suggested by the economist, Andrew Dilnot last year.

For the sake of clarity, Andrew Dilnot CBE, was asked by the Government to chair an independent body, the Commission on Funding of Care and Support, with a remit for reviewing the funding system for care and support in England. It built on an extensive body of work already undertaken in this area and carried out new analysis before providing advice and recommendations on how to reform the system in July last year. The point I am making here is that over a year ago, independent experts, selected by the government, have already undertaken extensive work to recommend a way forward. So why is the government procrastinating now? 

According to Dilnot’s commission, the contribution any individual makes to their care, not including general living costs, should be capped at £35,000 and the level of assets at which people living in residential care should have to pay the full costs should rise to £100,000. This simply makes the cost to the individual a bit less daunting. It would mean nobody would have to spend more than 30% of their assets paying for their care.

According to Dilnot the figures that the government themselves published, show the cost would be significantly less than one x one-thousandth of total public spending over the three years covered by the comprehensive spending review.

Dilnot claims that the average person pays £10,000 tax a year. To implement the recommendations he made last year, which received wide support, would require a mere increase of 10 pence per person in taxation. Can we really not afford 10p to improve the situation for when we too, become old? Why is social care one of the few areas that we don’t fund through general taxation, like education and the NHS?

Lets not consider how quickly ministers can find money for other things if it seems electorally prudent. This is about the future shape of our society. It isn’t a transitory decision, a momentary crisis. It is a decision that will affect us all in one way or another. If politicians think that a better deal for older people is unaffordable then let’s have that debate. At least that means doing something rather than burying their heads in the sand.

In my opinion the White Paper isn’t worth the paper it’s printed on and MPs of all parties should rise in revolt. I for one will be behind them and would urge you to do the same.

Myth-busting Care for the Older People

When your elderly parents need care it can feel daunting as you have probably not had experience of the elderly care system before. Let me try and help you understand more about it by dispelling some of the myths that surround care for the elderly.

The state will fund my parents care and provide support to arrange it won’t they?

Older people will not receive any financial help or practical support  from Social Services if they;

  • Have savings, investments or assets (including their property) above the current limit of £23,250. ▪ Are considered to have enough income to pay for their own care.
  • Do not have high enough care needs to meet their tightened eligibility criteria.
  • Are able to arrange care and support  themselves or have a relative who is willing or able to do so on their behalf.

For those people who are eligible for social care funding, only their basic needs will be met and they may have to contribute towards the cost, in some cases quite significantly. If your parent is funding themselves in a residential home and their money runs out, Social Services has to take over funding their care fees. However, they may have to move into a smaller room in their care home or move to another home altogether if the home refuses to lower their fees to the maximum that Social Services are willing to pay.

While the eligibility for NHS Continuing Healthcare funding has always been restricted to those with the highest, most complex, unpredictable, and unstable health needs, the interpretation of the eligibility criteria has become tighter and the same applies to the Registered Nurse Care Contribution (RNCC).

Social Services will provide care at home for my parents if they need it

Social Services will only provide in-house care or commission agency care if your parent meets the criteria outlined above. Even if  they meet the criteria, most Local authority Social Services Departments will only fund personal care and will not help with daily living tasks such as housework, shopping and preparing food. Some authorities are stricter than others and it’s always worth checking first. It is also important to check whether your parent may be entitled to welfare benefits such as the Attendance Allowance which can be used to help pay for their care and support.

Social Services will take your parents home away to pay for their care?

This is not necessarily true. Property will not be taken into account for home care support or if the person going into care has a spouse or dependent relative living in the home.

Care provided by charities and not for profit organisations costs less than commercial ones?

This is not true. Businesses and not for profit organisations have to operate a business model and make a profit. The only difference is that that they use their profits to develop their services. In my experience some so called not for profit organisations can actually cost more, especially if they have a bureaucratic infrastructure.

If my parent’s are eligible for NHS Continuing Healthcare (CHC) funding they will not have to pay for their care.

Also untrue. If your parent is awarded CHC funding they will be reviewed each year to see whether they have improved in any way and no longer meet the funding criteria. With painful funding cuts ongoing, sometimes NHS assessors interpret the national assessment tool differently so the person is no longer eligible for funding. If this ever happens to your elderly parent, there is an appeals process. While not for the faint hearted, because it is time consuming and log winded, it is usually worth doing as thousands of pounds can be reimbursed and saved if you eventually win.

The care landscape is changing rapidly and new legislation is on the way. As Social Services and the NHS seek new ways to meet the demands of the ageing population, having to do more with less will be their mantra and we will be expected to play an even bigger role in caring for our elderly loved ones. It is therefore vital that you understand and anticipate realistic funding entitlements to enable you to help your elderly parent plan their care. Check to see whether Social Services or the NHS might contribute towards the costs. Without this information you might make misguided decisions about your parents’ care and support and how to fund it. You can find out more at http://www.patient.co.uk/showdoc/3