Long term care Care needs and care assessments
Arranging a needs assessment
If you think an elderly relative needs help to have the best quality of life that they can, the first step is to get a free needs assessment (sometimes called a community care assessment) from the social services department of your local authority.
Following the needs assessment, the local authority might recommend that your relative needs services such as:
- practical support at home (prompting medication, doing shopping, laundry)
- care at home: help with personal care (washing and dressing, or supervision)
- disability equipment
- home adaptations (stair lifts, mobility aids)
- sheltered or extra-sheltered housing
- information and advice on community support.
- care in a residential or nursing care home
- respite care.
The care assessment is usually carried out in your relative's home by a social worker or other professional from your council, and you or a friend of your relative can be present.
The council compares your relative's needs against the council’s local eligibility criteria. If they 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. Currently, over two thirds of authorities in England and Wales provide support only for those with critical or substantial needs. A few authorities support only critical needs, while a handful provide for all levels of need, including moderate and low.
These needs can be met in different ways, perhaps by receiving care at home or in a care home, or a Direct Payment (cash to arrange your relative's care).
If your relative's need is not critical, the council may not be able to provide regular assistance, but may still provide help with equipment and adaptations to their home.
Long term care advice
The Which? Elderly Care website offers free, independent and practical advice about caring for older people across the UK. It covers your relative's needs (including getting a needs assessment), housing options and financing care, both at home and in a care home.
Having a financial assessment
Once the council has agreed to arrange or provide necessary services, it will assess your relative's finances to see how much they need to contribute towards the cost of these services, unless their needs mean they qualify for free NHS provision.
For personal care received at home, your relative may have to pay the full cost of care if their assets (savings and investment, excluding the value of your home) is higher than the upper capital limit. For 2016/17 this is:
- £23,250 in England;
- £24,000 in Wales;
- £26,250 in Scotland.
Home care (personal care) charges in England and Wales vary considerably, depending on where you live. In one London borough personal care is provided free of charge to those with critical or substantial needs, while in other places the hourly charge can exceed £20. For current 2016-17 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.
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 £194.50 (2016-17).
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 your relative is looked after in a care home, they'll have to pay the fees and care costs if their capital/savings (including the value of their 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 their relative) exceed limits set for each country. For 2016-17 these are:
- England £23,250;
- Wales £24,000;
- Scotland £26,200;
- and Northern Ireland £23,250.
Once a council has agreed your relative needs support and is eligible, they will give them 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.
If your relative wants to organise their own care, they can do this by getting a Personal Budget or ‘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 health budgets
Direct Payments (DPs) are not generally intended to be used to employ family living with you, though there are exceptions to this. There is no restriction on using DPs for a relative who does not live with you.
If your relative wants even more flexibility and convenience, some councils may offer personal health 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, your relative could organise services privately themselves – 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 relative's home in return for giving them agreed support – are available locally.
Get a regular benefit check done to establish whether your relative is getting their 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 Turn2us.
Check with your local council to see whether your relative is 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.
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 £55.10 or £82.30 per week (2016-17). This is a non-means tested, non-taxable benefit which can entitle them to other benefits too.
If your relative can’t use public transport, explore any local concessionary door-to-door transport schemes, such as Taxicard and token schemes that entitle them to a certain number of concessionary journeys each year.
- Getting financial help- what funding may be available and when you have to pay
- Paying for yourself- options for self-funders
- Money Helpline- to discuss the financing of care, talk to our experts
Which? Limited (registered in England and Wales number 00677665) is an Introducer Appointed Representative of Which? Financial Services Limited (registered in England and Wales number 07239342). Which? Financial Services Limited is authorised and regulated by the Financial Conduct Authority (FRN 527029). Which? Mortgage Advisers and Which? Money Compare are trading names of Which? Financial Services Limited. Registered office: 2 Marylebone Road, London NW1 4DF.