Long term care Care funding and assessments
Social care needs (or care) assessments
Get a care assessment from your council
Councils (or trusts in Northern Ireland) must assess the needs of anyone who is disabled or appears to be in need of a community care service that is provided by the council, such as equipment, home care or a home meal delivery. ‘Needs’ include social and emotional needs.
The care assessment is usually carried out in your home by a social worker or other professional from your council, and a relative or friend can be present.
The council compares your needs against the council’s local eligibility criteria. If you have an assessed need, your council has a duty to provide or arrange services to meet it, if it meets the eligibility criteria that have been set for providing a service. Which? Money recently (October 2010) contacted 185 local authorities in England and Wales and found that two thirds provided support only for those with critical or substantial needs. A few support only critical needs. A third of the authorities that responded to our questionnaire provide care for those with moderate needs. Only a handful provide for all levels of need, including moderate and low.
These needs can be met in different ways, perhaps by you receiving care at home or in a care home, or a Direct Payment (cash to arrange your own care).
If your need is not critical, the council may not be able to provide regular assistance, but may still provide help with equipment and adaptations to your home.
Financial assessment
Once the council has agreed to arrange or provide necessary services, it will assess your finances to see if you need to contribute towards the cost of these services, unless your needs are such that you qualify for free NHS provision.
Home care
For personal care received at home, you may have to pay the full cost of care if your assets (savings and investment, excluding the value of your home) is higher than the upper capital limit. For 2011-12 this is £23,250.
In February 2011 Which? Money compared home care (personal care) charges in England and Wales and found that the hourly rate charged to those who pay full costs varies considerably, depending on where you live. In two London boroughs personal care is provided free of charge to those with critical or substantial needs, while in other places the hourly charge is £19 or more. The table below shows the cheapest and most expensive hourly rates we found (2010-11 rates. For current 2011-12 charges contact your local authority directly.).
Some authorities cap the maximum amount an individual can be asked to pay each week. This too varies widely across the country, from £55 in Merthyr-Tydfil to £850 in Brighton, for example.
| Personal care: Local authority charges in England & Wales 2010-11 | |||
|---|---|---|---|
| Authority | Hourly charge | Weekly maximum | Needs categories |
| More expensive | |||
| Surrey | £21.66 | n/a | Critical and substantial |
| Cheshire East | £19.80 | n/a | Critical and substantial |
| Poole | £19.70 | £320 | Critical, substantial and moderate |
| Northamptonshire | £18.71 | n/a | Critical and substantial |
| West Berkshire | £18.65 | n/a | Critical |
| Less expensive | |||
| Pembrokeshire | £5.75 | £115 | Critical and substantial |
| Barnsley | £5.00 | £60 | Critical and substantial |
| Derbyshire | £0 | n/a | Critical, substantial and moderate |
| Tower Hamlets | £0 | n/a | Critical and substantial |
| Newham | £0 | n/a | Critical and substantial |
Those with assets under £23,250 receive some contribution towards their care costs from the local authority, but they can still be asked to pay a substantial amount. The basic rule is that care charges should not reduce your remaining income to less than one and a quarter times the Pension Credit basic Guarantee Credit. For a single person this currently gives a protected weekly income of £171.69 (2011-12).
Assets of under £14,250 are ignored by the means test, but between £14,250 and £23,250 they are counted as providing additional income of £1 per week for each £250 held.
Care home costs
If you're looked after in a care home, you'll have to pay the fees and care costs if your capital/savings (including the value of your former home, unless it is still lived in by a surviving spouse, a relative who is aged over 60 or is incapacitated, or a child under 16 who is your relative) exceed limits set for each country. These are: England £23,250; Wales £22,000; Scotland £22,750 and Northern Ireland £23,250.
Organising your care
Once a council has agreed you need support and are eligible, they will give you a written care plan detailing the type of care needed. The required services, such as a day centre or alarm service, may be provided or arranged by the council.
Around half the respondents in our survey said they would want to organise their own care in the future. You could do this by getting a ‘Direct Payment’ from the local council, which must offer money to eligible people to arrange and pay for their own support services such as home care, instead of receiving them directly from the council.
Direct payments and personal or independent budgets
Direct Payments (DPs) are not generally intended to be used to employ family living with you, though there are exceptions to this. (see the First Stop care advice website for details). There is no restriction on using DPs for a relative who does not live with you.
If you want even more flexibility and convenience, some councils may offer ‘personal’ or ‘individual’ budgets (not in Northern Ireland). These bring together funding allocated to you from a variety of sources such as equipment or housing grants, so you can choose what your money is spent on.
Alternatively, you could organise services privately yourself – for example, by employing a home carer through a ‘domiciliary’ or home care agency. The council should have a list, and your national social-care regulator will inspect them and produce a publicly available report.
Ask if alternative schemes – such as Homeshare schemes, where a tenant lives in your home in return for giving you agreed support – are available locally.
Benefits
Get a regular benefit check done to establish whether you’re getting your full benefit entitlement, such as pension credit and attendance allowance. You can do this by going to an independent advice centre or advisory service such as the Citizens Advice Bureau, or using an online benefit calculator such as Entitledto.
Tax reductions
Check with your local council to see whether you’re entitled to a council tax reduction (except for Northern Ireland where there is rate relief, not council tax). For instance, people with dementia and some carers are not counted as householders.
Attendance Allowance
If a person over 65 is having any difficulties with personal care tasks due to illness or physical or mental disability, encourage them to put in a claim for Attendance Allowance, worth either £49.30 or £73.60 per week (2011-12). This is a non-means tested, non-taxable benefit which can entitle them to other benefits too.
Disabled Living Allowance
Disabled Living Allowance is for people under 65, and can be used to pay for anything – unlike Direct Payments, which pay for care. It can be helpful to get advice on completing the forms from an advisory service.
Transport benefits
If you can’t use public transport, explore any local concessionary door-to-door transport schemes, such as Taxicard and token schemes that entitle you to a certain number of concessionary journeys each year.
See also our book Care Options in Retirement (published in 2008) for more on how to arrange funding, housing and care services.