Cash-strapped Councils Push Care for the Elderly to the Limit

By Alison Steed, Daily Telegraph

February 22, 2008

United Kingdom

Around 1.5m older people with a disability or impairment would be left to fend for themselves without the help of family and friends, but still have some shortfall in their care as government help is increasingly rationed.

Cash-strapped councils are limiting care to those who have "substantial" or "critical" care needs according to the Commission for Social Care Inspection (CSCI), and a lack of government funding has resulted in many councils now paying carers "by the minute" for the care they provide, rather than in 10- minute blocks.

Self-funders are those who have amassed too much money to qualify for state aid, which amounts to anyone with more than £21,500 in assets, including their home. The average annual fee for private nursing care in England in 2006 was £25,552, and £18,420 for a residential home, according to figures from Stephen Hadrill, director general of the Association of British Insurers.

Owain Wright, head of care funding services at Saga, said: "There is no panacea when it comes to paying for care. The most important thing is to understand which options are available and then pick one which seems to offer the best outcome and least risk to capital for your circumstances."

Those who miss out on state funding and have to fend for themselves are also being "lost to the system", and may end up being inappropriately placed in residential care, which could result in them having to sell their home to pay the fees.

Only those with assets below £12,750 will have all of their care funded by the state. The latest report from the CSCI has identified that the numbers of older people using state services has fallen from 867,000 people in 2003 to 840,000 in 2006 – that is despite the number of people over 75 increasing by 3 per cent. Those not receiving care in their own homes are left with a poor quality of life.

The postcode lottery to identify who qualifies for care funding means that not only is the experience different from council to council, but also within the same council, the CSCI said.

Dame Denise Platt, chairman of the CSCI, said: "In practice, the criteria can be interpreted in different ways by local staff.

"This is further convincing evidence about the very variable experiences, which people have when they are seeking care, particularly those outside the formal public care system. There is now an urgent need to create a fair and equitable social care system, which is sustainable and affordable."

Gordon Lishman, director general of Age Concern, said: "The latest CSCI report shows a widening chasm opening up between those who get council-supported care and those who don't. Fewer people are receiving care at home despite increasing needs, and the Government is saying these services are a priority. People are missing out both because of very tough means testing and increasingly restrictive and arbitrary assessments of people's needs.

"What is urgently needed is a substantial increase in care funding and fundamental reforms which should follow the green paper. A new partnership between the state and individuals must deliver better quality, improved access and a fairer way of paying for care."

Direct payments, where the state funding is paid to the individual to find and fund their own care arrangements, have increased from £1 in every £100 of care paid for in 2004/5 to £2 in in 2005/6. However, trying to get information out of the local councils about buying care facilities is not always as easy as it should be.

Many self-funders, or those receiving direct payments, are merely being given information about care homes in the area and then left to their own devices, said Philip Spiers of specialist care fees adviser NHFA.

He added: "Lot of people are missing out on thousands of pounds that they are entitled to. That means these people would be denied the 12-week property disregard for care fees funding [which means that for the first 12 weeks in a nursing home, the care fees would be paid for by the council giving the resident time to sell their property]. That is worth about £3,500 to every individual, and they are being denied that. It is an awful situation."

Other benefits, such as attendance allowance are also denied to self-funders, when it is a benefit they should receive. Previously, the minimum level of NHS care funding was £40, but this has risen to what is now a flatrate of £101 – only those already receiving the higher rate would stay on it, but even they would be reassessed. If you are concerned that you are missing out on benefits, you can contact an independent care adviser, or even Citizens Advice.

Even those who have received the increased NHS payments are not benefiting in some cases, as the payments are made direct to the care homes, and the fees are increasing by as much as the payment is, said Mr Spiers. So what would have cost £40 a week previously, now costs £101 a week.

Dealing with care fees yourself is not an easy prospect. But if you or a relative does have to sell a home to pay for care, then an immediate needs annuity can ensure that the money does not expire before the resident does.

HOW TO MINIMISE YOUR LONG-TERM CARE COSTS
- Claim attendance allowance. This is a non-means tested, non-taxable benefit paid weekly at lower rate of £43.15 if you need care by day or night or at higher rate of £64.50 if you need care by day and night.

- Make an NHS claim. Make sure you claim an NHS contribution towards your nursing home fees.

- If you are on the highest band of NHS contribution, make sure you are not entitled to full NHS funding.

- Check whether you are entitled to council tax exemption. If your property is left empty while you move into care, you should receive full exemption from council tax until it is sold.

- Ensure "12-week property disregard'' is upheld. The local authority must disregard the value of your property for the first 12 weeks of residential care and assist you with your fees if your other capital is below £21,500 in England and Northern Ireland.

- For people paying for care from a joint account, split the account into separate single accounts.

- Guaranteeing payment of care via a care fee or immediate care annuity. This is where a lump sum is paid to an insurance company, which promises to meet certain set payments for the rest of the policyholder's life.

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