Help with residential and nursing care

In Consuming Issues Pauline Thompson from Age Concern answers your questions about residential and nursing care for the elderly.

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Keith Westall from Lancashire is looking for care homes for his neighbour. He found a home where the Local Authority standard rate of support was £299 per week, while the rate for his neighbour (she's paying for herself), was £400. Keith asks why a person who has saved should be penalised like this?

Age Concern receives a lot of queries about this. In a recent reply to a Parliamentary question the Under Secretary of State for Health Stephen Ladyman (17 March 2004) said:

'It is not unusual for service providers to charge different prices, nor to offer discounts for bulk purchase, for example when councils contract for a number of places. Care homes are required to provide transparent information so that future residents are aware of the full charge that will be made for the service.'

The problem is that if a person happens to have more than £19,500 then they do not have the option of having the local authority help them negotiate a better fee level, as normally they are expected to arrange their own care.

It is difficult to see how a price difference of over £100 can be transparent, other than show the lack of consumer power when individuals go into a care home. This was one of the points that the Consumers Association made in their super complaint to the Office of Fair Trading as there is concern that the fees paid by the local authorities are not sufficient to meet the costs of care, and so this cost is being passed on to those paying for their own care.

Steve Reed from Northumberland has asked what stage is the Office of Fair Trading super complaint at, on the issue of private patients funding public patients?

The OFT reported on its preliminary investigation on 5 March and has agreed to look at some of the issues raised in the super complaint.

They are going to look at the context within which older people and their relative make choices about a care home and how this affects competition in the market, the ease with which residents and their relatives can obtain clear and accurate information on fees and extra charges, and whether contracts offer sufficient transparency and protection against unreasonable price rises.

It will include transparency for both publicly funded and those funded by the local authority, and will include core fees, top ups and payments for extras.

However the Consumers Association and the Social Policy Ageing Information Network were disappointed that the OFT were not prepared to assess the level of local authority funding.

It recognised that this is an important public policy issue, but it was for departments to determine.

In our view it is completely unjust that older people who are paying for their own costs are paying more than state supported residents for the same service. Once the main investigation starts the OFT will be calling for evidence. But is also an issue that Government must be pushed to address.

Barbara Holden's mother has been in 3 different homes in the last three years because the first two closed. The home she is now is keeps the NHS Nursing contribution rather than paying it back to her mother. She protested via her MP and the home said that the nursing contribution was being used to subsidise the local authority residents. Barbara asks how this can be fair and what is being done about it?

This question raises a number of issues:

The fact that an older person has had to move three times in three years. This must have involved a lot of stress for all concerned. We must find better ways to manage the market.

The fact that Barbara's mother has not had her fees reduced so that she sees the benefit of the payments made by the NHS for her nursing care. Age Concern got many complaints about this back in October 2001, and although there was a change in regulations in 2003 so that home owners now have to break down the fees to show the nursing element, it still gives no guarantee that residents see the benefit of the nursing payment. We hope that this might be addressed within the OFT investigation on fee transparency.

The answer Barbara's MP got from the care home shows that care homes are admitting that those funding their own care are subsidising local authority residents. The OFT in it response to the super complaint said that care homes can refuse local authority residents if the fees offered are too low, and local authorities have a duty to ensure that people needing care and need help with funding are able to find a home that is willing to accept them. Therefore in their view it is not in the public authorities' interest to persist in paying prices that are too low.

Our concern is that if those funding themselves are charged more, it could mean that homes are still prepared to accept some local authority residents at a low price. It could be some time before there is a state of equilibrium - that it should make no difference to the provider whether the person is funding themselves or funded by the local authority.

Russell Lyon asks why isn't there a care ombudsman or at least a regulatory body that monitors care fees? He says when profit making companies deal with vulnerable people, there should be strict control of prices and regulations and there clearly is not.

We wait to see how far the new regulatory body the Commission for Social Care Inspection which starts on 1 April will work and whether it will have teeth to tackle these issues.

Carol Echlin cares for three residents in her family home in Oxon. She is being asked to follow all the management policies and procedures as if she owns a 300 bed care home. She has a 25 years experience as a carer and is being told she must get a management qualification or face losing her job. Surely one rule cannot suit all. Why doesn't the government recognise this?

Regulation should be proportionate to the risks to vulnerable people and we agree that some of the regulations that may be suitable for a large home may not always be so for a very small home. There does need to be a degree of flexibility. Regarding qualifications, it is difficult to say that they are not needed if a person has been working for a certain length of time. Some people will be excellent at their work, but others might well benefit as experience does not always mean good practice. Carol may take heart that we have heard reports that some people who have rather reluctantly gone on courses have found them much more useful than they expected.

Mrs Robertshaw wants to know if she can back claim for care allowance. Her husband passed away in 2001 having had Motor Neurone disease. She paid for a carer to bathe him not realising she could get any financial assistance. Can she get any money back now 3 years on?

The possibility of getting any backdated social security benefit is very remote. However this question may be about whether the NHS should have funded the care. There has been a recent case from the Health Service Ombudsman, which said that just because someone is cared for at home, and not by NHS staff does not mean that the NHS does not need to fund it. It will depend on the facts of the case, but if Mr Robertshaw was needing a lot of care (which was of a nature to really be health care) then it might be possible to ask for a review even though it was so long ago. The area of NHS responsibility for funding care is one that is complex.

The best thing to do is get advice, perhaps starting with asking one of the voluntary organisations advice lines (such as Age Concern, Help the Aged, or the Alzheimer¿s Society). The Motor Neurone Disease Association may be able to help as they will be most aware of the type of care needed this condition brings.

Wayne York's parents from Suffolk own their own home but are concerned that should they have to go in to care they would have to sell the house because they don't have many savings. Is there anyway around this?

The first question always to ask if someone goes into care is whether it should be fully funded by the NHS. In some mental health cases people can also get full funding from the local authority. If not, then you need to look at the local authority charging rules. Anyone who has more than £19,500 is probably going to pay the full cost of their care. However unless Wayne's parents are both needing care, the home is disregarded if one partner still lives in it, or there is a relative over 60, or less than 60 but incapacitated. So it is important to remember that the home is not always taken into account.

Some people think it is fine to give the house away to avoid paying fees. This may not be the best option, especially as the chances are they will never need to go into a home (the chances are only one in five for people over eighty). A local authority might consider that it has been given away to avoid paying fees and so treat the person as if they still own the house. It is worth getting advice as there are some planning that may help such as becoming tenants in common, but it is best to get full financial planning advice.

Mrs Brightman's mother is in a residential care home in Kent paid in part by social services. She insists that social services have to pay all the fees although this is not often advertised. Is this true?

As we have seen above in most cases, unless her mother comes under certain mental health provisions, people are charged by social services using the national means test. However this question is probably about whether social services have to meet the full cost of the home. Is a person chooses to go into a home that is more expensive than the local authority is prepared to pay then they will need a third party to make up the difference. This comes under the Choice of Accommodation Directive. The local authority is still liable for the full fees, and the third party should enter into an agreement with the local authority to pay the top up. We sometimes find that the local authority only pay up to what they agree to fund and leave it to the relative to sort out the remainder with the owner. This should not happen.

Also it is very important to know that local authorities cannot set arbitrary limits on how much the will pay, it has to be based on the person's assessed needs and also they have to be able to show that there are homes with vacancies that will meet the person's needs at the local authority price. There has been consultation recently about the Choice Directive which said that 'Individual residents should not be asked to pay more towards their accommodation because of market inadequacies or commissioning failures.' If there are no homes at the local authority price with vacancies, it should meet the extra cost itself.

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The opinions expressed are Pauline's, not those of Working Lunch. The answers are not intended to be definitive and should be used for guidance only. Always seek professional advice for your own particular situation.