Care home guide and paying for care

There are different types of care home available according to your needs. Often simply called a “care home”, residential care homes offer accommodation, meals and help with personal care such as washing, dressing and going to the bathroom, on a 24/7 basis.

The difference between care homes and nursing homes is that these homes offer the same services as residential care homes plus specialised nursing care. There are also homes providing extra support for those with learning disabilities and mental health difficulties, and specialist dementia care homes providing care for people with this condition. Care homes are owned and run by local councils, private firms or voluntary organisations.

All care homes must be registered, either as a home with nursing or a home without nursing, with the relevant organisation and evidence they receive monitoring and inspection visits from that regulatory body. These organisations are:

• England: Care Quality Commission (CQC)
• Scotland: Care Inspectorate Scotland (CIS)
• Wales: Care and Social Services Inspectorate Wales (CSSIW)
• Northern Ireland: Regulation and Quality Improvement Authority (RQIA).

These organisations and your local council can help you find homes in your area. You can search for “care home directory” or similar online.

Use the regulatory bodies’ websites to search for care homes via postcode, location or by name and view background information and findings of impartial monitoring and inspection visits. Copies of their reports can also be downloaded.

With local authorities check out the health and social care sections, some will link to sites with care home directories. Northern Ireland has a Health, Social Services and Public Safety site with links to its five Health and Social Care Trusts responsible for managing and administering residential homes.

It’s easy to find care homes online. Most sites offer interactive maps which enable you to browse by type of care required or by region. Once you’ve found the county you require, you can download a brochure for that area, view an e-book or listen to a ‘browse aloud’ compatible version (linking to software which reads the web text out loud). ‘Browse aloud’ is particularly useful if you’re dyslexic, have problems with your vision or reading, or do not have English as a first language.

Having identified the type of care home that could best meet your needs (or those of others), look up the relevant regulatory organisation’s website, check out inspection reports and use the online search criteria to draw up a shortlist of places to visit. Also, contact the care homes you’re interested in and ask for a brochure.

Paying for care homes can be an important aspect of the decision to use their services, no matter you or your loved ones’ financial background. Section 47 of the NHS and Community Care Act 1990 requires your local authority social services department to carry out a needs assessment if you or others require community care services. The assessment is carried out either by a social worker or care manager and following this assessment, an agreed care and support plan is produced.

If you’re assessed as having eligible needs, the local authority has a legal duty to meet those needs, however it will only pay towards your accommodation and care costs if your savings, assets and income fall below a certain threshold. If you’re assessed as needing specialist nursing care, the NHS however, is responsible for meeting the care costs provided by a registered nurse and so a NHS nurse will be involved in your eligibility assessment.



Care Home Fees Threshold

If you have over £23,250 of eligible capital you or a third-party will be asked to pay all of your residential care costs. If you or others are unable to make these financial arrangements the local authority will do it for you.

A number of care homes run a two-tier fee system, charging higher care costs for privately-funded residents than local-authority ones. However, when the Care Bill comes into force in April 2015, this system will be abolished as the Bill is requesting all care home services be arranged by their local authority, whether privately or publically funded. This means those paying for their care can, via their authority, secure lower rate costs.

If the care home you choose charges more than the local authority would have ordinarily paid, it may ask for a ‘top-up payment’ from a third-party. If however, your care home choice is out of necessity, your local authority should agree to meet the cost.

The financial assessment only applies to you and the authority will consider any income and savings in your sole name and any jointly-held savings which will be divided equally. With property, your share or beneficial interest is considered.

If the capital is held in your home and there’s less than £23,250 in accessible funds, the local authority may consider a deferred payment agreement. What this means is that it’ll pay the difference between your assessed contribution and the full cost owed until you can repay the shortfall (typically resolved by the local authority placing a charge on the your property to secure repayments when it’s sold).

If your capital is between £23,250 and £14,250, every £250 or proportion of this within the threshold, will be assessed as though receiving an extra £1 per week income. Put simply, your care home costs will be subsidised on a sliding scale, dependent upon the amount of capital held. Capital below £14,250 is not taken into account.

The Government has made a number of changes to social care funding, including raising the threshold from £23,250 to £118,500 which means anyone with assets between £14,250 and £118,500 will receive financial support on a proportional basis and by 2015, rolling out a ‘national needs test’ to replace the differing local authority tests.

Whatever your assets, the ‘means test’ calculation must leave you with a personal expenses allocation of £24.40 per week. Your local authority can explain what help is available. The rules for working out fee payments are based on national guidelines ‘Charging for Residential Accommodation Guide (CRAG) 2014’ which can be found easily found online,

Asset protection

If you’re keen to keep your home and assets within your family, you could set up a family trust and transfer them to others whilst you’re still alive. You would need to consult a solicitor to make sure you’re informed about the process.

Alternatively, you can give your assets or money away. With assets this should happen at least seven years before you die, otherwise the recipient may be subject to inheritance tax. With money there’s no limit to what you give children, grandchildren or other relatives, but they may have to pay tax on any income or interest generated from the gift.

Whilst it may be tempting to give away your assets in order to gain more financial assistance, local authorities warn it is against the law to transfer ownership of assets to avoid paying care home fees and advise they will look at the timing and motive behind such actions. This might result in them still being included within an assessment if necessary. Another option may be to rent your home in order to cover your fees.

Make a Will

Always ensure you have made a will before moving into a care home. It may seem obvious, but it’s surprising how many people fail to do this, deteriorating health  can only make this harder as time goes on. For the same reason arranging a Lasting Power of Attorney, whilst you are still capable of doing so, is vital to protect your interests and those of your family.

Making payments for care

Your local authority will either pay the full fee and recoup your share of the costs, or you each pay your respective share. Check protocols with the care home and the local authority.

If your care has been arranged by the local authority or NHS you won’t receive a formal contract. Instead you should be given a statement of terms and conditions detailing your care arrangements and information on who to complain to, if you need to.

If you’ve arranged your own care, ask for a written contract highlighting key areas such as your room, when you’re entitled to use it, fees payable, care and services covered by the fee, the period of notice and goods or services not included.

Long Term Care Insurance

Long term care insurance that can cover the cost of paying for care is as yet an underdeveloped market in the UK. You can read more about insurance companies’ plans for personal care home insurance policies here.

Care  Quality Commission (CQC)  Lists and inspects all CQC care homes, and can be contacted directly with any care home complaints.

Local councils Contact your local council to assess eligibility for financial assistance with care home fees.

The following link offers you the Grown Up Money Care Home Questionnaire an invaluable check list for you to use if you are selecting a care home for your loved one.