Care Fees – Top ups

 

Local Authority Funding for care homes – Top-ups

 

When someone goes into care and they are not eligible for NHS Continuing Care funding, they must pay for their own care.  This payment of care is means tested, so if that person has limited assets then the Local Authority will pay part of their care, if they have savings, they privately pay.

 

The Local Authority will fund the care subject to an income contribution once the value of the assessable assets falls below £23,250.  This limit used to go up annually, but it hasn’t changed for a few years now.

 

When assessing how much they should pay towards their care, they are allowed to keep £24.90 per week from their income, this should be used to purchase their personal items, including new clothes and toiletries.  The rest of their income, they will have to contribute towards the cost of their care, including any pension (state or private) and any other income (with the exception of a few specified benefits).

 

The Local Authority will have a “standard rate” for the level of care that they have assessed that that person needs.  The Local Authority will then pay the difference between the “standard rate” and the person’s income contribution, so if their income goes up, the amount the Local Authority will pay goes down.  If this standard rate is not enough to cover the cost of care in the care home, then there may be a top-up involved.

 

Following the Care Act 2014, this is now payable to the Local Authority, who are responsible to the care home for any non-payment.  It is known as a “Third party top-up”, the first two parties are the Local Authority and the person in care themselves, so anyone who isn’t one of those two parties can pay this top up.  Which usually means family members.

 

So how can this be challenged?

 

The first thing to understand, is that the response of the Local Authority is likely to be to threaten to move that person to a cheaper care home, which if they are settled, is not what you want to hear!!  However, they can only move them if:

There is an alternative place that will take them

That has a vacancy

That can meet their needs

That will accept the rate

 

It is not enough to say that the care home down the road takes the Local Authority rate if they have no vacancy.  And importantly wherever they go, the placement must meet their needs.  What the needs are is defined in the care plan that the Local Authority should have done.

 

When the Care Act came into force, it brought in the concept of “wellbeing”, which has a statutory definition that the Local Authority has an obligation to promote.  The key way to set up the challenge is to look at the care plan and make sure that it is personalised and relevant to that individual.  So for example if that person has lots of friends in the vicinity, then it will have a detrimental impact on their wellbeing to move them to a cheaper care home that is 3 miles and 2 bus rides away for their friends to visit.  Or perhaps they need a home where they can bring their cat with them and the other nearest is 10 miles away, which is too far.

 

So the work on the challenge of the top up, is around looking at the care plan to make sure that it does meet that individual’s needs and not just an average person in care!

 

If there is no alternative placement at a cheaper rate, the top up shouldn’t be charged and is therefore challengeable.