Posted on 9th October 2023 at 14:35
Cathy Twilton , chair of the board at Solihull Care, has written a helpful summary of the information you might need when considering care funding.
Funding for residential and nursing care can be a minefield especially if you suddenly find that you or your loved one needs care. This is written from my own experience but everyone is advised to seek timely and appropriate advice as no two cases are alike. Throughout this article I have included links to useful sites but I strongly suggest that anyone going down the residential / nursing care path should initially approach their local authority who can put them in touch with a Social Worker who can provide the most up to date information and advice. See them as your friend. They don't personally hold the power but can be a helpful ally.
At the moment the upper capital limit of £23,250 means that above this threshold residents have to self-fund from income , savings or monies released from their property. There are exceptions here dependent on if your partner, spouse or other family member live in the property, and whether the property is jointly owned. (See https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/paying-for-your-own-care-self-funding/ here). All Local Authorities should offer a deferred payment scheme when there are no available cash assets, but there are assets tied up in a property.
Social Services Funding
There are different levels of funding available depending on needs. The basic level is residential funding for people who require assistance with their daily needs, but not enough of them are health needs that need supervision of a nurse.
If you still live in the community, you may be able to request care at home to assist you in your basic needs, and this will not take into account the asset from the property you live in. Our domiciliary care service can help assess your level of need if you require home care and help get a social services package of care. Or you can have 24/7 care in a 'residential home'. Swallows Meadow is not classed as a 'residential home', as it only accepts residents who require some health support from nurses and are assessed to qualify for NHS funding, and is therefore a 'nursing home'.
The funding from NHS is split into two tiers, depending on the level of need.
If there are low level nursing needs, the NHS will only pay a contribution to the care fees and residents still have to privately fund the portion for their own basic care. This will then be assessed around the assets available as above. If you have assets, and are able to pay the basic portion of the fees you will be classed as self-funding. The NHS will then pay their Funded Nursing Care Contribution ( FNC) directly to the home.
If you have no assets or your assets fall below the threshold, local authority social services team will do a financial assessment to determine how much you should contribute to your care when you reach the £23,250 threshold. Once your assets are less than £14,250 you will not be expected to contribute to your care costs at all. The Local Authority will then take over payment for your basic needs while the NHS continues to pay the FNC portion of the fees. This is classed as social services funding.
For some very sick people there is Continuing Health Care, paid entirely from the NHS. This funds all nursing home fees and is dependent on regular assessments which measure the nature of a person's need for qualified medical intervention. It funds care for people living with long term, complex health needs that need more nursing interventions. The criteria for being awarded this is very strict and it can be taken away if a person's health improves enough to be deemed to have moved out of the increased nursing threshold. (See https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/ here )
Some care homes have an absolute minimum payment they will accept for their services. Very often the social services fee does not meet the total cost of care in these homes, so when your assets drop below the threshold for full private payment and social services take over payment of the fee, the home may ask for an additional ‘top up’ amount to meet their minimum operating costs. If this situation arises , there may be scope for negotiation of the amount to make it more affordable to the family without adversely affecting the overall financial income of the home.
Another time top ups may be asked for is when your relative may want a bigger room, better facilities, or something like garden access for an increased price that social services or NHS are not prepared to pay. The home can then ask for top ups as well as the funding received, including CHC.
Often people who are self-funding may be entitled to Attendance Allowance or Personal Independent Payments dependent on age (See https://www.gov.uk/attendance-allowance here also https://www.gov.uk/pip/eligibility. here For advice on applying it is worth reading https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/attendance-allowance/before-you-claim-attendance-allowance/check-if-entitled-to-attendance-allowance/ here
There are other sources of income such as Pension Credit which may be applicable but each case varies depending on individual circumstances (See https://www.independentage.org/get-advice/money/benefits/benefits-hospital-and-care-homes here
What happens if I run out money?
As noted previously the threshold at which people have to pay for their care is £23,250 and above. If your monies are likely to fall below this threshold and you foresee being unable to pay for your care you must contact your local council. This is essential. The local council will then be able to assess (or reassess) your finances, and advise and help with funding. If your savings are below the limit before you contact them they will only fund from the date that you notify them. (See https://www.ageuk.org.uk/information-advice/care/paying-for-care/paying-for-a-care-home/ here ) If you have a relative who is resident in a care home, we suggest notifying the care home or Local Authority social services a few months before you estimate reaching the threshold. This will give the council enough time to get the assessment completed and funding in place for continuity of care.
Power of Attorney
Often it is left to a loved one, a relative or friend to manage the finances of a sick or elderly person requiring residential care. It is very helpful for a POA to be set up in advance of any health deterioration, where it can be lodged prior to it being activated at the time it is needed. It can be complicated to advocate for your relative relating to health or finance if a POA isn’t in place when it’s needed. ( see https://www.ageuk.org.uk/information-advice/money-legal/legal-issues/power-of-attorney/ here )
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