Don't be forced into paying a care home top-up, please read.

[BeckHux]

We are currently going through the nightmare of placing Dad into care. His needs are quite difficult, therefore anywhere that will accept him is going to cost more than the local authority's usual rate. We have today been asked for a top of £130 for a home for Dad, when no other option has been offered.

I have spoken to many adviser's regarding this and the answer is categorically that unless the LA can provide a home that meets all of someone's needs at the LA's usual rate, they CANNOT request a top-up payment from the family.

I quote from AgeUK’s factsheet FS60


”The local authority should not request a top-up payment unless you choose to enter a more expensive home when care suitable to meet your assessed needs is available at the local authority’s usual cost. If there are no suitable places available at that price at any given time, the local authority should arrange a placement in a more expensive home and meet the extra cost itself.
Local authorities cannot set their usual costs at an unrealistically low level and seek top-up payments as a matter of course. They ‘have a statutory duty to provide residents with the level of service they could expect if the possibility of resident and third-party contributions did not exist’.
“You may need to enter a home costing more than the usual cost because of the particular nature of your needs. Examples might include higher levels of needs or special diets and extra facilities required for cultural or medical reasons. If so, the local authority should meet the extra expense, even if there are places available at the usual cost in other homes that cannot meet those needs.”

I have spoken to many people who have just paid the top-up, regardless of being given an option that doesn't require one. The LAs are playing on the fact that it is such a stressful time that people do not want any more hassle and simply want a good outcome for their loved one.

We have to stop this happening and challenge them.

Hope this helps someone else, I am off for a glass of wine to numb the stress!!!

 

[JPG1]

Have 2 glasses! You deserve two for such an informative post.

It is so important to understand this one!!

Enjoy your stress-numbing glass or two, BeckHux.

 

[jenniferpa]

You're absolutely correct, and I don't think this can be repeated too often.

The fuzzy area is when it comes down to location. I know from your other thread this is of concern, and this sort of issue (how far away is too far) is not clearly defined. At one point some years ago (and it may be true today) a fairly large town in the middle of England had 0 beds in nursing or care homes that were available at the LA rate and they routinely sent people many miles away.

 

[JPG1]

There is no fuzzy area.

A local authority is required to fund in full any care home cost-demand, if that is the only care home available in the immediate locality (defined by postcode here, most often, and via the responsible local authority's spherical base!) available to meet the assessed needs of the person in need of care.

BeckHux's post highlights the reality. Not the fuzzy reality - the clear and transparent reality.

 

[lin1]

I think this thread should be a sticky.
so it doesnt disappear into the dark depths of TP .

Its diabolical that people are being asked or being emotionally blacmailed, to pay top ups to meet all the assessed needs of the person requiring care.

Also the top ups increase every year .

 

[Onlyme]

What happens when someone has been in one home for a few years self-funding and their funds run out? Can the LA make the family pay topups or will they move the person in care to somewhere cheaper? Any move will cause distress and the dementia to get worse, the person sees the home as their own home now.

 

[BeckHux]

If someone has been self-funding and then their money runs out it is apparently possible that they will make the person move to a cheaper home, awful but true.

I only found out today that Mum was also told that if Dad needed one-to-one monitoring because he has had several falls recently, that would cost another £600 per week!!!! The hospital failed to mention that most of his falls happened when they had over-medicated him - he is now on no medication at all, unless required due to extreme agitation.

We need to start a campaign to make everyone challenge the top-up fee situation, only then will more people get to know their rights and stop the LA bullying.

 

[Saffie]

I have been asked to pay topups and eventually, having been quoted over £400 per week Topup, I told the SW the maximum I could pay was £200. This has been taken on board but, I confess I haven't thought about increases until mentioned here. SW suggested a certain Nursing home particuarly because she though that once I could no longer afford topups, my husband might be allowed to move to a shared room which would attract SS rates. However, on visiting the home, the shared rooms were no larger than the others ans I'm not at all convinced that a shared room would be in his best interest. So presumably this would mean a move but there are very few cheaper homes around here apart from LA homes and their nursing homes are very few and far between - also very full. The trouble is I feel I would be letting my husband down if I refused topups - you're right, it is emotional blackmail.

 

[BeckHux]

Saffie, the only time you should pay a top-up is if you CHOOSE a more expensive home. In order to request one from you, they have to have offered you an available home that meets ALL of your husband's needs, which costs the LA's usual rate. Please read the first post, the quote is from a factsheet produced by AgeUK, their helpline number is 0800 169 6565, they will give you another number when you call as the usual helpline staff are not sufficiently qualified to give such in-depth help.

For the LA to place your husband in a home it needs to meet all of the assessed needs of your husband, when it comes to dementia care, very few will be cheap enough to be covered by the LA usual rate, but this does not mean you have to make up the difference, the LA do, it is their statutory duty.


Challenge this Saffie, it is wrong.

 

[BeckHux]

For some other independent information which backs up AgeUk's advice see the link to an article in This is Money, although it is from a few years ago it is still relevant.

http://www.thisismoney.co.uk/pensions/article.html?in_article_id=419136&in_page_id=6

Article entitled, 'When Care Home Top-Up Fees are Illegal'

 

[jenniferpa]

Guidance states that local authorities should only seek top-up payments where there was a genuine alternative of a cheaper care home (within the local authority's budget) that would have met the person's needs and this home was turned down by the person with dementia or their family. The guidance also states that a local authority cannot ask for a top-up if it has decided to offer someone a place in more expensive accommodation in order to meet their assessed needs.

From Alzheimer's Society Factsheet Paying Care home fees

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=125

 

[JPG1]

In for another penny, in for another pound of my flesh!

That is roughly the message that many of us have been trying to pass on to TPers being faced with the demands for top-up fees.

Most of whom have not been given a full explanation of many factors governing these unlawful and immoral demands for top-up fees.

It's nothing to do with the location of the care home under consideration; and it's little to do with anyone's desire for the appropriate care to meet the needs of their own relative. The requirement to provide the appropriate care to meet needs is defined by many things outside of the control of the relatives of those needing care home care.

I am so pleased that there's a hint of progress here, as will BeckHux also be, no doubt.

(within the local authority's budget)

That is precisely where the Alzheimer's Soc's factsheet needs to be revised, pronto, because it is enormously misleading.

It gives the impression that many, including some moderators of this forum, have understood to imply that a Local Authority has a 'pre-determined budget which will determine the care home placement of A Person' and that the same LA can set an arbitrary base-rate according to that LA's 'pre-determined budget'.

It should read "Guidance states that local authorities should only seek top-up payments where there is a genuine alternative of a cheaper care home placement with a place available, the cost of which comes within the local authority's statutory requirement to meet the assessed care needs in full and without the need for top-up fees being considered, but that placement has been refused by ..... or by .... ".

There could be many permutations within those ..... and .... , but that may be what the Alz Soc Factsheet writers need to consider.

We will get there, one day.

 

[Saffie]

My problem is that for a few weeks my husband will be self-funded due to the sale of the oft-mentioned holiday chalet which is, hopefully, in the process of being sold (Once I get the Deputyship.)
Fees will be any thing from £800 to £1000 a week so, as half the chalet sale money will only take him a few thousand over the upper SS funding threshold, it won't last long. This is why the SW is going along the lines of topups and ignoring the self funding element for now.
However,the financial assessment team have turned down the SS funding because of it. SW said yesterday that Adult Services will try to work something out e.g. a loan or deferred payment until chalet sold, but no guarantees. Don't ask me what we do if they don't because any money I have will be needed for topups.
Re. the SS level of payment - according to local LA literature, the level appears set at £465per week here. Every nursing home I've heard of charges double that - residential care homes are a bit less, I gather - but the only alternative to topups I've been given is an LA nursing home - and they are all full up! My husband's name is on the list of the 3 nearest but waiting lists are long.
I have visited a private home that I thought was dreadful and I don't know the cost of that as I wouldn't want my husband to go there anyway and my SW said she wouldn't want him to go there either. But, if I start refusing to pay a topup I guess that place, or something similar, might be the result as it could possibly be said that it fitted the criteria for his needs.
I know a couple of the homes locally will only take SS funded in shared rooms - ok if suitable but not always so. All the rooms in the community hospital are single and my husband has been there for 4 months so might be distresed sharing - not easy to forcast but also not easy to rectify if so.
So, it really is emotional blackmail, one way or another,as most will want to do the best they can for their spouse. mother or father.

 

[ChrisH]

As this is a similar topic to my thread of a few days ago I thought I'd do the update of my mum's funding meeting here.

I too am paying top-ups which have increased from £19 to £79 per week in 2 years and I am no longer in a position to pay them, especially as they will go up by at least £20 per week every year and I reckon mum has a few years left in her yet.

The complication is that mum's funding authority is not the same as the one she's living in now - I moved her from Worcs to Devon. I discovered Worcs has 1 level of funding for residential and 1 for nursing. Devon has 3 bands for residential and 2 for nursing. Apparently Worcs will have to match the level of funding for whichever band mum is assessed at. No one seemed to know which band mum came under - I suspect the lowest. So now the fun and games begin to get her upgraded. This should result in additional funding, but I doubt that will cover the full fees.

There may be a room coming available in which it might be possible to move furniture so she has line of sight to the loo, which I consider essential owing to her prolapse problem which usually results in an obsession with peeing.

The SW who came to do the review had a 'chat' with mum ( I left them to it as didn't want to influence anything). Mum was very cheery when I introduced her but apparently had her head in her hands by the time the SW left the room (a more normal pose for mum these days). The SW, manager and myself were sitting in an area just outside mum's door (there being nowhere else quiet enough to go). Mum then proceeded to put on a performance which underlined everything the manager and I had been saying about her needs (thank you mum), so I think the SW has sufficient ammo to argue for mum needing to stay where she is.

I have no idea if there were homes in my area which would have met mum's needs at the LA's 'price' since I wasn't given any alternatives as this is the one I wanted her in and I agreed to the top-up, which in the beginning was manageable. I've since discovered mum has been underpaying her contribution from the beginning and thought my top-up was higher as a result. Turns out the top-up has nothing to do with it as when mum's assessed contribution goes up, the LA's goes down by the same amount. They have a fixed rate of £381 per week, INCLUDING mum's contribution. I don't know of any homes in this area that would be that low, and certainly not ensuite, and if mum can't get to a toilet quickly she'll become incontinent sooner rather than later and her needs will then definitely increase.

So at the moment we're all waiting for the SW to report back to the powers that be. Then they'll have to decide if mum's needs have to be assessed by someone else and then they'll argue over whether they do it or Devon. I'll leave them to it, pay the last invoice at the old rate, but won't pay any more till they sort it out. Then all I have to do is sort out the deputyship issue
Chris

 

[jenniferpa]

Oh Chris - not Deputyship again. indeed.

 

[ChrisH]

Jennifer - yep, deputyship - will be arranging an appointment with CAB in the first instance. If I apply, would they prevent me having access to mum's accounts until it's sorted? if so how am I supposed to pay her bills? Thank goodness mum has no knowledge of the problems this is causing. She'd be absolutely horrified to think my family is having to do without to support her.

 

[jenniferpa]

Do you have 3rd party access to her accounts at the moment? If so, I see no reason for anyone to close access to that account. Just my opinion though. I think CAB is a good move, although I'm not sure how much knowledge they have. You really have to apply for deputyship now? You should at least get the fees paid, so that's a blessing.

 

[Saffie]

Re the CAB and Deputyship, I went to my local CAB after I had posted off the first set of forms, really just for reassurance that I had done the right thing in applying ( so I could sell above mentioned chalet) but noone there that day had any experience of it.Gentleman was as helpful as he could be and rang up the C of P and O of G to check a couple of things but I had already been in regular contact with the former whilst completing the forms and latter doesn't really come into it until after Deputyship is set up. In fact, he asked me to let him know how it all went once (if1) it's done. However, you could be lucky and find someone familiar with the process. It's down to luck really, i guess.

Incidentally, the topups I'm being asked for do seem very high compared to others mentioned. The lowest is £200 a week, is anyone else having to pay this - or more.? I know the SE is an expensive part of the country to live but fees hereabouts do seem to be excessive. I know any payment can mean hardship for people too, depending on their circumstances and especially if, like you Chris, you have a family involved. At least I will only have myself to consider - apart from my dog.

 

[ChrisH]

Jennifer - yes I do have 3rd party access. I'm quite happy for things to plod along as they are at the moment and the only reason I would need deputyship would be to sell mum's mobile home, or get it insured - as it's been unoccupied for 2 years her insurance company wouldn't renew the policy. My husband doesn't want to get involved by putting it on our house insurance as a second home, and not we could legally anyway as we don't own it. They can't force her to sell the home anyway so ideally I wouldn't bother with deputyship. The only problem is mobile homes need to be looked after or they deteriorate and as its 200 miles away, with the cost of fuel, it's not somewhere we go on a regular basis. It's making a good stopping place at the moment to and from picking our son up from uni but he's only there for another year.

Re CAB I think you have to make an appointment with our local one rather than just dropping in so they can match you with the person most likely to be of help. I might also go to one of the local solicitors who offer a free half hour session.

Saffie, those top ups are horrendous. But I know about the guilt feelings if you think about saying no. Hope you have a satisfactory outcome soon.

Chris

 

[Saffie]

Hi Chris
I hope you are lucky with the CAB. Re your mother's mobile home, I'm a bit surprised to hear you can't be forced to sell it if you are being funded partly by SS. I realise you cannot actually sell it without LPA or Deputyship, but I thought it would have counted as part of your mother's assets re. funding.

That is why I applied for deputyship, to sell our holiday chalet ( similar to a mobile home, but static!). I sold it thinking it was in my name only but it turned out to be in joint names once the Land registry became involved. I decided, worriedly, to continue with the sale because, although it took my husbamnd's assets a couple of thousand over the upper threshold, at least it will decrease with the nursing home payments, whereas if I withdrew it, his assets would remain above the threshold and he would have to remain self-funding. It was this angle that was the reason I went to the CAB for reassurance after I'd applied for Deputyship and the chap there agreed that I had done the right thing. Hope he wss right!

Everything becomes such a nightmare.