/ Home & Energy

Frequent myths about paying for care in a care home

When we were building our new Later Life Care website, we did a lot of research to ensure it would be as helpful as possible. Do you have an experience of arranging care in a care home to share?

The insight that we gained from our research into different areas surrounding making care choices showed us that the following important issues around paying for care are commonly misunderstood.

  1. If I move into a care home, do I have to sell my home?

You don’t have to sell your home, even if it’s included in the financial assessment. For example, you might have a relative living there or you may be able to find other ways to pay for care.

You could consider renting out your house as long as you’re confident that will bring in sufficient income to cover any care funding shortfall. You should think through what you would do if the property wasn’t let for any length of time.

You could also consider taking out an immediate needs annuity, which you can buy through a specialist independent financial adviser, who should hold a CF8 qualification.

If you end up having to sell your home to pay for care home fees and it isn’t selling, you can request a long-term loan known as a deferred payment agreement from your local council (Northern Ireland excepted).

  1. Is Attendance Allowance means tested?

No, it’s not. Attendance Allowance is a government benefit that is available to people who are more than 65 years old and who, due to an illness or disability, would benefit from help with washing, dressing or eating, during the day or overnight.

If you are receiving attendance allowance and living in a care home, you will continue to receive it while you are paying for your room.

  1. Can a care home legitimately ask a third party, such as a family member, to pay top-up fees in addition to what the local authority is paying?

It can’t. Third-party top-up fees should be voluntarily suggested: a local authority or care home can’t ask the resident or a family member or friend of that resident to pay additional fees if a room is being funded by a local authority.

  1. If I’m paying for my care and I run out of money, will a family member or friend have to continue to pay the fees?

If you are a self-funder, the local authority will start contributing towards your care fees once your total capital of £23,250 (in England and Northern Ireland; £27,250 in Scotland) is reached.

It will pay all fees once your total capital of £14,250 (in England and Northern Ireland; £17,000 in Scotland) is reached. In Wales, there is one threshold of £40,000.

What’s your experience?

Because we have such a complicated social care system perhaps it’s no surprise that there are so many misunderstandings around this important issue.

Have you had any experience of arranging care in a care home? What was your experience of navigating the system?

Comments

This comment was removed at the request of the user

Once again Duncan you have only dealt with a part of the picture, you fail to mention that all Care above the basic Care which Residential homes are registered for should be funded by the NHS which then is NOT subject to means testing. This very important point seems to be largely misunderstood and interpreted and is responsible for many members of the Public being made to pay for Care Home fees, there are many cases where the Ombudsman has dealt with this matter to the benefit of the Public but the Local Authorities and the NHS are regularly being taken to task, bye the way there are no Doctors involved with any assessments of needs as used to be the case it is now down to Occupational Therapists ticking boxes.

This comment was removed at the request of the user

Hi Gerald. As I’ve said previously – please can we be careful with the tone in some of these disagreements. It’s clear that there are big differences of opinion between yourself and Duncan, but let’s make sure these are debated in a friendly way at all times.

Thanks!

I would think that a qualified occupational therapist would be a good professional to make an assessment of whether or not a person needed to be boarded in a residential home at full or partial public expense or could take care of themselves [or be looked after] at home with or without additional support. The client’s GP would probably make a recommendation which would carry considerable weight. I thought the financial assessment was made by the social services department’s administration officers in accordance with standard policy applicable to all clients; it should be a matter of fact not interpretation.

This comment was removed at the request of the user

I am in no position to judge whether what you are saying about the assessment process is correct or how you can possibly know what factors are taken into account in individual cases. This is a strictly confidential process and I cannot believe that any details of the assessment, other than its outcome, is made known to anyone outside the formal process. It’s not for social services professionals to make judgments on medical matters such as incontinence and so far as I am aware the process does not start with the GP although the medical facts might need to be taken into account [with the client’s permission] in many cases. I am not aware of people being “forced ” into care. If there is evidence of such a practice it must be revealed and investigated

The usual route is for people to apply to their local authority social services department to be taken into care, or for people who are already clients of the social services department their assigned social worker might set the wheels in motion. The GP might be requested to report on the medical facts and submit a recommendation based on his or her knowledge of their patient; this might suggest placement in a nursing home rather than a residential care home if there were ongoing medical requirements. I should be surprised if any other official bodies are involved because the assessment is entirely for the local authority to make and each authority will have its own policy to which any assessment must conform. To ensure consistency of decision-making I would expect assessments to be approved within a very limited number of senior social services professionals within the local authority.

There are two assessment to be made: the first is to decide what form of continuing care for the individual is the most appropriate and the safest for their ongoing health and welfare. That will be subjective to some extent but relying so far as possible on facts and the client’s case history. I believe this is an entirely person-centred process which is performed diligently by qualified professionals who are experts in the care needs of elderly people.

The second assessment is the financial one to determine the extent to which the local authority is required to meet all or any of the costs of the care provision [or home support] that is agreed during the first assessment. An extensive fact-find will be conducted, by a senior administrative or finance officer, to establish the client’s income and assets and apply the relevant rules. This will obviously take into account the availability of any unencumbered property assets.

With over four hundred thousand people living in residential care homes for three to four years on average, many of whom are not in local authority placements and are fully self-funding , there could be as many as fifty thousand residential care assessments a year being carried out. There could be a similar or higher number of assessments in respect of domiciliary care to support people who are able to continue to live in their own homes with assistance. This workload would be spread across all the local authority social services authorities and is a well-rehearsed activity. It is very rare to hear or see any references to the process being criticised or being referred to an ombudsman or the courts for maladministration or malpractice. If there were concerns there is a review process, a person’s councillor can intervene and ask questions, and if there was any suspicion of deliberate jeopardy or prejudice then there are various avenues through which to bring it to public attention, not least the press.

Meanwhile, we are still waiting for the government’s Green Paper on the funding of adult social care and, with certain other turmoil going on, I have a feeling that it will not have 2018 on the cover when it does emerge.

This comment was removed at the request of the user

If you are referring to an individual case of which you have direct personal knowledge, fine – but I formed the impression you were generalising. I am glad you obtained answers you could accept as truthful. That’s all we can ask for.

This comment was removed at the request of the user

I always try to stick to the point and always act if def fence, I really do not understand why you have leveled this criticism at me , I have not seen very many instances where you have taken Duncan to task on his very loud tone against the Care Home Sector in which I work and ,at times against me personally,at times this has been disgraceful to say the least.

This comment was removed at the request of the user

Well John in principle how you describe the system should be they way it works and should be the way it is , as usual what happens in practice is always different. in Most cases from my experience GPs are not consulted ,District Nurses used to be but now are very really consulted Ward Doctors ( where the patient is leaving hospital) is hardly ever .
The only time they are involved is when the Patient is in the position which has been dictated by the Occupational therapist to sort out the mess which evolves from misplacement, the short term answer is a referral to the Hospital as often the patients condition has deteriorated

Your attitude towards me is not the problem for me as your opinions are dwarfed into insignificance by the feedback I have received from thousands of clients we have had the honor of serving in their hour of need. I have no intention of trawling the web looking for good or bad points to counter your smears and innuendos with .I have a limited time to deal with the misconceptions and misinformation which is being bandied around about Care Homes (for profit only of course) .
After working in this vocation, in a variety of roles, for over 30 years now I think that I might have learnt something by now which is worth sharing.

Happy New Year Everyone

This comment was removed at the request of the user

Hi both. Oscar and I have had to step in numerous times now regarding the tone of the debate on this subject. It’s clear that this disagreement has run its course – we’re not getting anywhere by continuing and could potentially put others off from contributing, so I’m going to have to ask that it comes to a close now. We appreciate passionate debates, but we don’t want to see arguments around attitude, tone etc.

This applies to everyone. Thank you.

This comment was removed at the request of the user

Please do, Duncan, you have my email.

The rules apply to everyone, so we’ll be monitoring all posts.

Understood George, more than happy to comply, getting sick of all this politics , bad enough when one has to deal with it at work ,now that I am retired I would like to concentrate on helping people in their hour of need to get through this morass.

This comment was removed at the request of the user

You don’t say how long since you retired Gerald as the social care situation has deteriorated somewhat of late.

It was a case of “no room at the inn” 3 days before Christmas when the local authority decided to transfer my mentally ill relative who has been institutionalised for 37 years from the general hospital where he was admitted from a care home through gross neglect and almost died, unbelievably into B & B accommodation!

If Optalis were behind this move in an effort to prevent bed blocking, then I would suggest they take the necessary steps to ensure local authorities have suitable placements to accommodate vulnerable people to prevent them being treated like common criminals.

My relative is currently at my home being looked after by me.

Anyone watching Andrew Marrs interview with TM yesterday will recall he made reference to the state of the UK social care system which is currently under review. TM agreed there was room for improvement and that demand currently far exceeds supply.

I don’t envisage any improvement in the situation as long as government continue with its policy of funding privately run care homes that are using loopholes to bypass regulatory inspection by substituting ‘care’ for ‘supported living’ where vulnerable people are being left to fend for themselves without any external regulatory body to check on them.

Some care homes are even introducing their own panel of regulators where unbelievably they are now both their own judge and jury when an internal problem arises!

I fear the current UK Social care system is fast reaching third world status unless consumer bodies take radical action to address the situation preferably sooner rather than later.

.

This comment was removed at the request of the user

Thank you Duncan

Dear Beryl, in spite of being retired I am still very active in promoting Care Homes of all persuasions now that I have the time to do so. Looking at your own conversations you are also active in a variety of Conversations yourself and you appear “on the ball” as they say.
Dealing with your recent points :
I am not aware of Optalis record of satisfaction or area of operation maybe you could check this with their Employers (LHA or Council).
Most Care Homes do not deal with Mental Illness , as far as I am aware this is now solely under the jurisdiction of the LHA I personally have very little experience in this field and have ,in the past , left things matters in the hands of GPs to refer anyone to specialists.Anyone such as yourself who is having to Care for a relative requiring a specialist treatments as you describe has my deepest sympathy and both you and your relative both deserve better treatment then this.
What I cannot understand is if there is a greater demand for Care Home beds than supply why is there empty beds all over the Country and why are there numerous family owned ,good quality Homes going bankrupt or selling up.
Care Homes are all registered and regulated by the CQC and so I cannot understand what you refer to in reference to this.
I have ,in my time travelled to Europe and America and compared their systems with ours and I really think you are being rather unkind with your comment with regard to “third world standards”. I used to work with Filipinos,India,Chinese and east European Nurses and I can assure you they do not agree with you .Given half a chance most of them would like to stay here.

Dear Duncan
Over the years I have met Politicians from all of the major parties and they have all praised the work that That everyone in the system is doing with many of them having loved ones residing in Care Homes and Nursing Homes.
Most Care Homes have clients who are state funded and Privately funded.
Most clients are to busy dealing with the very difficult situation in hand and Politics is the last thing in their mind. Can we now emulate our clients and just deal with Caring and advising roles.

It would seem we are debating two entirely separate topics Gerald. My main interest is the current state of social care and its connection with care homes.

Since the majority of UK care homes are now privately owned and increasingly expensive to maintain to reach the standard required by the CQC, local authorities are finding it increasingly difficult to fund social care clients owing to government cutbacks. This would explain the reason for the increasing amount of empty beds you mention, another reason being the standard is not being met by some and so local authorities are no longer funding (subsidising) them hence they have no alternative other than to close down.

Social Workers (Care Cordinators) roles are now being split between health and accommodation as the lack of suitable accommodation requires more specialised domiciliary healthcare in the community, including B&Bs if relatives are unable to meet their needs.

Since Alzeimers is now accepted as a form of mental illness, I would question your assumption that “ Most Care Homes do not deal with Mental Illness..” 1 in every 4 people will suffer from some form of mental health problem during their life time and the elderly are no exception.

I would advise everyone contemplating moving into a care home to first compare their promotional ads to CQC ratings before deciding which one to choose.

I would reiterate my concerns regarding the use of loopholes in the care system that allows vulnerable people requiring residential care being sent into supported living accommodation where their needs are not being met. These establishments are – not required to be regulated by the CQC or any other external regulatory body, some even forming their own internal regulatory panels to meet their own standards of care..

I would again add my concerns that if the current situation is allowed to continue, we can increasingly look forward to third world standards unless consumer bodies take decisive action.

This comment was removed at the request of the user

Agoraphobia is technically an anxiety disorder although, as a complex set of interrelated symptoms, it can become a mental illness.

But you’re spot on, Beryl; the CQC is a reactive organisation when what is needed in an ageing society such as the UK’s is well-appointed and state operated care. This will mean an increase in either National insurance or Income Tax, but as services many will require in time it seems short-sighted not to move forward with a set of solid proposals, now.

This comment was removed at the request of the user

I’m only stating the facts, Duncan.

This comment was removed at the request of the user

The dispute seems to be over the classification, not the condition. I accept Ian’s definition of the condition of agoraphobia as an anxiety disorder, but I can also see that it can be categorised as a mental illness for the purposes of care and treatment. The classification of many conditions does vary across the UK according to how inclusive or exclusive the health authorities wish to be in the allocation of resources.

This comment was removed at the request of the user

I have no reason to doubt your word, Duncan.

I was just trying to explain how there can be confusion over the way the same condition is treated in different parts of the NHS.

There’s no need to make offensive remarks at the end of your comment, but I have noticed you are doing that a lot these days with challenges to contributors or demands for substantiation of any counter-opinion. You claim freedom of speech for yourself so please grant it to others unconditionally. Thank you.

This comment was removed at the request of the user

Actually, Duncan, when you say “its not me thats starts it off” in a sense that’s not entirely correct. You frequently post assertions but not always with the evidence to back them up. Naturally, others will want to know more and that’s when you become defensive and aggressive.

In this instance I was simply explaining how Agoraphobia is defined, but it’s a complex condition – as I’ve said – and can be defined as a mental illness in some circumstances. That’s usually when it’s an outlier indicative of a more serious mental illness.

Can I suggest that this tone of exchange does not continue? I think a blind ear or a deaf eye should be employed. Duncan has been told by a health professional that Agoraphobia is a mental illness. Here is what the NHS says. https://www.nhs.uk/conditions/agoraphobia/
I expect the line dividing anxiety from a mental illness is very blurred.

As ever, W?C is a forum that allows debate. Hence it is reasonably to question the viewpoints of others and, at least sometimes, to also challenge assertions of fact in their posts.

That said, the right of challenge does not sanction personal attacks against other posters.

When receiving questions and challenges, I think it is important that we don’t interpret them as personal criticism and that we respect the rights of others to have opinions that differ from our own.

The recent discussion is irrelevant to the cost of paying for care, the topic we have been invited to discuss.

Good suggestion, Malcolm. Let’s leave this here. Thanks!

Suffice to say agoraphobia could be categorized as a mental disorder which is treatable as such, as opposed to mental illness which is essentially more of a pathological nature in its identification and diagnosis.

I trust we can now move on to find more constructive ways in which to solve the current crises that exists in UK social care essentially pertaining to care homes without further ado.

Thank you, Emma, for bringing this information to one place. Recent Conversations on care in later life showed that generally people are not well-informed on these points and a lot of misunderstandings were evident in the comments but not a lot of authoritative advice was forthcoming.

Do you have any insights into when the government’s Green Paper on paying for care in later life is going to emerge? It was forecast for the Autumn but there’s not much of that season left now. I hope they haven’t funked it.

Emma is currently on leave, but I’ll make sure she sees this question when she returns 🙂

Thanks George. I get the feeling Emma doesn’t have to hurry back – the government is moving at a snail’s pace on this.

Thanks, Emma

Obviously, it has slipped again . . . or did they mean 2019?

On the matter of third party top ups , this is a complicated issue which has been purposefully made more difficult by the actions of some Local Authorities.
The actual Contract is between the Service User (Client) and the Care Home and does not involve the Council (I have checked this out with the Institute of Arbitration ,perhaps Which ? could get a second opinion) The Care Home should quote a Fee and if accepted the Client is responsible for paying this, the contribution from the Council should cover this but in some cases it does not, it is then the responsibility of the Client to make up the difference.

Fay Clarke says:
20 April 2019

My mum went on respite to a care home and decided she wanted to stay. She owns her own home and has savings around £4,000. The weekly cost of the home was £605 and the local authority paid £490 towards this and mum’s social worker told me that I had to pay the third party top-up of £115 per week. I do not go out to work as I have been my dads carer for four years and cared for my mum for the past three years. I asked him what do I pay it with and his reply was he did not care where the money came from but I had to pay. I do have some savings and own my own home but surely I do not have to make myself destitute. So mum is back in her own home and I am still her full-time carer.

If a care home is the best place for your Mum then you could look at getting money from the existing home through equity release.
https://www.moneyadviceservice.org.uk/en/articles/equity-release
https://www.which.co.uk/money/pensions-and-retirement/youre-retired-working-on-benefits-equity-release/equity-release/what-is-equity-release-a5jqy4d36xlv
Read up carefully before deciding.

Does you Mum not have a pension – private or state – that would provide the extra £115 a week?

The whole social care system is a complete shambles. Prospective clients and fheir relatives find Needs Assessments, Mental Health Assessments, Care Programme Approach Assesments confusing, intimidating and intrusive.

There is much confusion as to which department and which member of that department is responsible for which appointment or allocated task and which member is available who does not happen to be either off sick, on holiday or has been otherwise consigned to or deputizing for someone else for something else!

I am currently well and truly stuck in the middle of all of this. Health and social care have apparently now split and are two separate entities, each with their own complacent, incompetent, disinterested staff who seemingly are now so well and truly consigned to their own roles you are constantly referred back and forth via different departments until you are fortunate enough to happen upon the right one and hope the person you wish to speak to is not “away on leave at the moment.”

Without legal representation there is very little hope of anyone wading through the mire of a system where each department is so far removed from the other under a collective description termed ‘Social Care’ where it’s left hand has no idea what it’s right hand is doing.

Meantime my relative remains in a hospital bed where he has been confined for the last 6 weeks still dependent and waiting upon a care system that has totally lost its way.

Dear Beryl,

Totally agree with every word you say, try your Local Councillor (County Council) one who is not to politically indoctrinated and one who is nearing pension age he might be interested what is awaiting him/her and if no look try an MP ( one who is not to raveled up in the EU ) Best wishes, if you think I can be of further assistance please ask.

Thank you Gerald.

I have already spoken to my brother who happens to be an ex mayor and councillor who suggested I should write to my MP. My legal adviser has been a great help as she specialises in care matters and is more familiar with the care system and the names of the people paid by the taxpayer to mismanage it!

As this a matter of Bed blocking, I would be inclined to get your legal beagle to write to the Chairman of the Area Health Authority, this might rattle a few cages.
All the best
Gerald

Something positive happening :
A social care provider has been doing its part in helping local hospitals by reducing the number of ‘bed blocking’ patients over the last year. This work is particularly important as the NHS prepares for a seasonal increase in the number of patients needing treatment often referred to as ‘winter pressures’.

In the year between November 2017 and November 2018 Optalis reduced the level of bedblocking, also known as delayed transfers of care, of patients living in the Royal Borough of Windsor and Maidenhead for whom it is responsible, to zero per cent. A delayed transfer of care is defined as ‘when a patient is medically fit for discharge from acute or non acute care and is still occupying a bed.’

This success has been achieved by Optalis staff teams working in partnership with hospitals and the Clinical Commissioning Group to ensure residents are supported to leave the hospital with the right support in place at home.

Optalis provides a variety of care and support teams and services, including extra care, homecare, assistive technology, supported housing and occupational therapy as well as short-term support and rehabilitation all of which are able to support the smooth transition from hospital to life after discharge.

The Government Statistical Service reported that in June 2018 there were 134,300 total delayed days in England. The main reason for NHS delays in June was patients awaiting further non-acute NHS care but also included patients awaiting assessment, care packages in their own home or community equipment and adaptations.

Martin Farrow, Optalis’ Chief Executive, commented: “This success is something we are all very proud of at Optalis. We have reduced the number of delays to zero, and we have successfully maintained that level over a sustained period. It is down to our talented and committed team that we have been able to deliver quality care and support, and maintain excellent working partnerships with our health partners.

“This reduction in delays not only benefits those in hospital requiring extra support, but also the NHS by alleviating bed space pressures.”

Cllr Stuart Carroll, Cabinet Member for Adult Social Care and Public Health, added: “These statistics prove how positive partnerships within health can lead to better outcomes for those who require care and support. Whatever care pathway is required, this delivery model has shown that it relieves pressures on the NHS and ensures individuals are receiving the best care possible after they have been discharged from hospital.”

Established in June 2011, Optalis was only the second local authority trading company of its kind in the country. Today, it is one of the largest with nearly 700 staff providing care and support services across Wokingham, Windsor, Maidenhead and Oxfordshire.

Interesting as usual, Gerald. I presume Optalis is an independent organisation paid by Windsor and Maidenhead to provide these services for their residents?

Leaving such services in the hands of local authorities, however, seems wrong when the benefits are to a national body – the NHS. Bed blocking seems to be a serious problem that reduces the ability of hospitals to treat those in need of hospital care. I think that the costs of treating suitable patients at home should be paid for out of national taxation, using bodies like Optalis or teams attached to GP surgeries.

Dear Malcolm,
Optalis was set up by the Council and the Area Health using people of their choice,some of them actually working for the Council in conjunction with the LHA. Some of the Patients involved will require NHS treatment at HOME OR IN A NURSING HOME and therefore should be NHS funded. I am not aware of which Authority is paying for Optilas but I agree it should be the Health Authority.
The important point is that Optalis is actually working and have really good results in a very short time and this concept needs to be introduced Nationwide and could be the answer to quite a few of the staffing problems the NHS is experiencing .It might also be in answer to the problems of placing people with Alzheimer’s and Dementia with getting DOLs some taking up to two years I believe.

It seems there are alot of hidden costs of a care home and increasingly people don’t want to leave their own homes. When I was looking for my grandmother, she eventually decided on live in care. I found some useful information concerning live in care and the costs here. https://myhometouch.com/articles/live-in-care-vs-care-home Overall it was a better experience than a care home.