Old people living in homes are at the centre of a shameful row about benefit rules. Margaret Hughes and Phillip Inman report on the pain and who is paying the price 

Elderly residents in care homes are being wrongly charged bills for nursing services, while others are being incorrectly assessed for residential fees amid widespread confusion about benefit rules.

Health ombudsman, Ann Abraham, this week criticised health authorities for dragging their heels in compensating thousands of elderly people wrongly charged for continuing care. Separately, councils have come in for criticism for allowing residents of private care homes to be pushed out when they can no longer pay the fees. 

The ombudsman rebuked strategic health authorities in a report highlighting widespread errors in the way local authorities interpret and apply eligibility criteria for free continuing care. 

Ms Abraham first revealed the failings 18 months ago when she said SHAs should reassess all relevant cases dating back to 1996 to identify and reimburse those who have been wrongly charged. The government set a deadline for responses, but this has been extended twice, now to the end of this month. 

The ombudsman said she was disappointed that, for the second year running, complaints about continuing care assessments accounted for the bulk of the rise in complaints during 2003/04, which reached a record 4,700. 

As health minister Stephen Ladyman revealed last month, the root of the issue has been a serious underestimate of the number of cases sent in to be reviewed. 
The NHS is expecting to pay more than £180m in restitution for all the incorrect decisions made by SHAs. 

Mr Ladyman says after this month's deadline, he expects that cases will be reviewed "within two months of all the information being received". 

But the reviews conducted so far appear to confirm fears that a "post code lottery" is in force when it comes to who wins compensation. SHAs in some parts of the country have reimbursed at least a third of the cases reviewed. 
By contrast, three authorities have failed to pay a penny for any of the cases - Norfolk, Suffolk and Cambridgeshire which has reviewed 381, North East London which has reviewed 169 and Trent with 236. 

The ombudsman repeated her call for greater clarity about the situations in which the NHS must provide some funding. 

The Department of Health issues broad guidance on who qualifies for continuing care, but how each SHA implements them can vary widely. 

For instance, a person can be eligible for fully-funded care regardless of whether they live in their own home, a residential or nursing home, and is not dependent on the qualification of staff providing care. 

It also makes no difference whether their medical needs are due to physical or mental disabilities. 

The main criteria for eligibility is that the person's "primary need is healthcare need", although this does have to be assessed on a case by case basis. 

Adding to the confusion is that there is no clear line between the criteria which entitles care home residents to have all their costs paid by their SHA, and those who qualify for the top band of the three-tier scheme introduced by the government in October 2001 which just pays for nursing care costs. 

But incorrect continuing care assessments are not the only bureaucratic hurdle for the elderly. 

Charity Counsel & Care said this week that many councils are forcing relatives of elderly people to make unnecessary payments for residential care. It says councils should step in more often to make top-up payments when it is obvious relatives can ill afford to pay. 

Most councils limit their contribution to between £250 to £300 a week. Yet private care home fees can vary from £300 to £500 a week depending on the area, leaving a large shortfall. 

The charity says councils can use their discretion when relatives cannot afford to pay any more. However, councils sometimes fail to volunteer this information and the elderly resident is forced to seek a cheaper home. 

"We have seen more people put in this situation recently. Too often the resident is forced to move at a very difficult time in their life," says a spokesman. 

Case study: Dogged by poor advice
Pauline Tate has spent the last three years battling with her local benefit office and social services for her 84-year-old mother. At every turn she has been given poor advice and now faces paying a bill for £6,000 for fees owed to her mother's care home. 

Once the bill has been paid, her mother will have no more capital and faces eviction from her current care home and a move to a cheaper home several miles away. 

Ms Tate says: "My mother thinks where she is now is home and has told the people at the new home she doesn't want to move." 

Pauline Thompson at Age Concern says elderly folk should be allowed to stay in the place they have made their home. "Local authorities have the discretion to pay top up fees to keep elderly people where they are." 

Mrs Tate is distressed an upset at the prospect of moving. Her story starts with a visit to her local social services after her mother became too frail to live in sheltered accommo dation. She says social workers told her the £20,000 capital in her mother's savings accounts was too much to qualify for state aid. 

But, she says, staff said when she crossed the threshold for state funding (at the time about £16,000) she would escape paying any more. 

Her mother's home cost £450 a week. Unfortunately the council, like most authorities, contributed only £290 of the cost, leaving a £160 a week shortfall. Mrs Tate says the care home forgot to bill her at the time and she assumed the council was paying all the fees. 

Further information: Age Concern - 0800 00 99 66, 7am to 7pm. Counsel and Care - 0845 300 7585, 10am-1pm The Care Funding Bureau - 020 7902 0345