Top ups, contracts and financial assessments!

[karryb]

My mom's privately rented house was being sold and SS suggested moving her into sheltered accomm., or another privately rented house. I was adamant that she posed a fire, flood and security risk to herself and any property and long story short she was fast tracked, funding approved and we moved her into a care home last week.

Care Manager said that funding was approved but we'd be liable for top up of £48 per week. My husband committed straight away as he wanted my mother in a decent home and after some we'd seen it seemed to tick all the boxes. I'm now worried sick that every year the fees go up, the top up funding will become unmanageable and really financially impact our lives. I love my mother and feel guilty for even thinking like this.

The LA are coming to do the financial assessment next week. My mother has no funds, no savings of her own and will only be left with her necessity money of £22 per week, thus leaving my husband and myself liable for all her needs now ie clothing, hair etc, and her top up fees.

Today the care home contract arrived and it made me so sick with worry. I feel that although my mother is in a very decent home with the supervision and care she needs (even though she's hated every minute since she got there a week ago.... ) that my husband's commitment, is perhaps going to be far more than we thought. In reality we are looking at perhaps a period of 10 years plus and managing it all fills me with fear.

What would happen if we were unable to continue with the top up funding if the increments were too great, my worst fear would be that she's moved to an awful home - so the choices are the comfort and wellbeing of my mom who i love dearly, or the financial security of my husband my son and myself. I feel so wretched and selfish for even thinking this way.

I hope noone thinks too badly of me for feeling like this, i am still trying to come to terms with the guilt i feel for moving my mom although not within my control and to a large extent, as i was her carer i feel somewhat lost in my adjustment that that chapter is over.....

Sorry so long winded and whiny, i really need some advice

 

[carolsea]

Hi karryb
First of all, don't sign anything!
You are not legally obliged to pay anything towards your Mum;s care.
If the LA have placed her in the home because it is the most suitable for her needs, then they should not be pestering you for top ups, although I know from experience that they will!
I had the same situation with my Mum and I flatly refused to pay, because I couldn't afford to.

At the very least, the LA should have checked that you were 'willing and able' to pay the top ups in the long term.
Don't feel bad about it. Your Mum deserves to be looked after in her old age and the LA should not be trying to 'guilt trip' you!

Carol

 

[Christin]

Hello Karry, having a relative move into permanent care can be a very worry time, and I do remember how confusing and unsettling it was for all of us.

Did you find the home yourselves, or did you accept a place in a care home that was offered by social services? If the funding has been agreed, that has to be good.

This link will take you to a fact sheet re paying for care homes and may be useful for you, it does cover top ups and what might happen (please note might) if top ups cannot be paid. In my own opinion I feel it is unlikely that, once settled, social services would move your mom for finance reasons alone.

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

We found the financial assessor extremely helpful, and reassuring. I hope you will feel much happier once the assessment has been completed. I would hold on to the contract until then.

My very best wishes to you. Please let us know how you get on.

 

[karryb]

Thank you both Christin and Carolsea for the advice. This situation is so complicated.

We actually found and chose the home for my mom as we had a week to do it, and out of those in our area that care for dementia sufferers this was the nicest. It broke my heart seeing some of the places and the fact that some were shared bedrooms and no en-suite facilities. (Mom has moderate/late moderate AZ and as she has a penchent for walking in the good weather at times becoming disoriented, it was felt that her safety was an issue hence the speed). She's still able to dress and wash herself so an en-suite was pretty important for her privacy which she still values hugely.

Everything was so rushed, we didn't have a chance to get to know what the system or normal course of events is, nor did we have the luxury to totally research the implications of it all.

I will not sign the care home contract - we are paying a top up fee so the contract is between the home and LA? I think the social worker definitely pounced when emotions and stress levels were high, bascially telling us that until and my husband had the the top up contract with the LA that she wouldn't be placed..... Thank goodness for TP, the advice and support is fantastic. I will keep you updated

 

[JPG1]

Hi karryb,

Don't panic - don't sign a contract - ask questions.

If the Care Manager said that "you'd be liable for top up of £48 per week" and if your husband committed on that basis, then any contract will be seen as 'null and void'. The care manager may have been jumping the gun, if a full financial assessment of your mother's finances (NOT YOURS!) hasn't yet been carried out. The finances of you and your husband should not be discussed with the SS - it's nothing to do with them, and your Mum must be placed in the care home that can meet her 'assessed needs'.

So sign nothing.

There's a paragraph in the Alzheimer's Society factsheet that Christin linked to:

"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."

That paragraph would be better at the start of the Alz Soc section on Top-up fees.

But even if you did choose the particular care home and even if the Social Services explained that it would cost more than their base-rate (which is questionable, in any case!), you cannot be held to that agreed top-up. And yes, there's no guarantee how quickly top-up fees will rise, but with all the cuts going on, some reputable care home providers are not enhancing their reputation at present by the steep increases in top-up fees.

It sounds to me that perhaps your SW has jumped ahead of herself. If this particular home has been approved by the financing panel, with or without discussion of the reasons for a top-up being required, before a financial assessment has been carried out, then I would suggest you resist all discussion of top-up fees. If it was an urgent placement of your Mum into the care home, the contract is open to debate.

Refuse to contemplate top-up fees. And don't worry about your husband wanting what's best for your Mum. That's what the SS are supposed to want too!!

Please, don't sign the contract.

 

[Sox]

Hello - I can only reiterate DON'T SIGN ANYTHING. We had a Solicitor who specialises in the elderly to our last AZ Carers group meeting and she said whatever you do "Do not agree to pay top ups". It is all so emotionally draining isn't it - I think SW etc do take advantage of carers when they are at their lowest. Please take advice before agreeing to anything. Take care. Sox

 

[Margaret W]

Sorry to throw a spanner in the works, but I'm not sure the advice on here is right. If your mum is potentially supported by the LA (i.e she is not self-funding), then they are entitled to place her in any care home that meets her needs (if there is a choice of homes in their price-bracket, you are entitled to choose). That, of course, is after a proper assessment of what her needs are. If you then choose a more expensive home, for whatever reason,you will be asked to pay the top-up fees. And if you don't pay them, your mum will be moved to a cheaper home that meets her needs. As you rightly say, you could be paying the top-up fees for a long time, and they could increase far more than inflation. You could find yourselves very much out of pocket.

There is no easy solution, other than to look at the care homes that ARE within the LA funding limit and you might be surprised that some are more suitable than you at first think.

But if you decide none are suitable, then top-up-fees will be payble for as long as your mum remains there.

Yes, get a full financial assessment, but at the end of the day, if you want mum to be in a home that charges fees above what the LA will pay, someone will have to pay the exra. Fact.

Love

Margaret

 

[Cate]

Sadly Margaret is right.

My mum owned her own home, we had to sell it to pay all her fees, so if the amount the NH are charging is above the threshold of the LA then the top up has to be paid if there is just as suitable but cheaper facilities in the area.

It does sound as if you looked for a NH in a rush because of circumstances. It might be an idea now that mum is safe to look again at all that is available. Dont be put off by the maybe by not so good furnishings, its the level of care, support and dignity handed out by the staff that matters the most, also the facilities in terms of how the residents spend their days are more important.

I feel for you, its hard, but I am sure your mum would not want you to put a financial strain on yourselves

 

[Saffie]

I agree with all the above about signing anything. The trouble is that you probably want what is best for your mum and refusing to pay top-ups can make you feel a little guilty perhaps?
I'm sure asking relatives to pay top-ups involves a degree of emotional blackmail, even if not intentionally.
I am in a similar position with my husband though I wish the sum involved was under £50 or even in double figures - though I know everything is relative and any sum mounts up eventually.
Here in the south of England, we are talking around £4-500 top-ups as the SS contribution is around £460 but Nursing home fees are nearing £1,000 a week. THough this is for Nursing homes, I expect Residantial only might be a little less.
I am desperately trying to find one with lower fees as I have said I would be prepared to pay top-ups - how can I refuse, he's my husband - but would only last months at the above rates.
Good luck and try to hold out against pressure from the powers that be. I'm only just waking up to that notion!

 

[karryb]

Some great and reassuring words. My husband went ahead and signed the LA authority contract which, as this situation progresses, we will I think have some grounds to contest it.

The Care Home contract was received by me yesterday which I will not sign.

Some of the homes were really awful but thankfully there were no vacancies, this was the only one that had any vacancies as it is a fairly new build, the purpose for which was to amalgamate two older care homes. The residents were moved into the new premises when in opened in August 2010 and when we looked round 2 weeks before hand there were still a few spare rooms - it is filling up weekly now so I can't help but think it was our only real option, other than slightly further away.

Because of the urgency to rehouse my mom due to the sale of her rented house, her financial assessment is only being done next week.

Funding was pre-approved before going to panel a full week before she actually moved and that's when social worker said the top up funding contract would need to be signed or they couldn't place her.

Boy, hindsight is always 20/20 did she ever play on our emotional stress, and knowing that my husband was willing and eager to ensure his MIL had somewhere decent to live, I think we were rather well played!!!!

 

[JPG1]

Sorry to throw another spanner in the works, but there seems to be some confusion as to what “Top-up fees” are.

Top-up fees only come onto the scene if someone is funded by the Local Authority. But top-up fees do not come into the funding situation if someone is self-funding.

If someone like Cate’s Mum owned her own home which was sold to pay all her fees, she was ‘self-funding’. The fact that a care home charges a self-funder more than the care home charges the LA is nothing to do with top-up fees. Same with Saffie’s situation, if her husband is currently self-funding, with no financing via the LA.

Top-up fees are a different kettle of fish altogether.

The LA must provide care, for a non-self-funder, in a care home that meets the assessed needs of the individual. Some care homes may charge more than the council usually wants to pay for the particular type of care offered, so if a place is available in a care home that can meet your assessed needs, then the council will generally only contribute to the cost of a more expensive home under certain conditions:

• that the home is registered;
• that it is suitable for someone’s assessed needs;
• that the care home is willing to enter into a contract with the council (and not all care homes are willing to do that!),

and

• either there is no other available home suitable for your assessed needs,

or

• a top-up is agreed, normally with a third-party.

(A person entering into a care home can only pay top-up fees him/herself if they have the 12-week property Disregard, or if they have a Deferred Payments Agreement with the Council.)

However, if there is no care home place available that can meet the assessed needs of a person, the LA has a legal obligation to fund a more expensive care home, if that is the only placement available. You should not be asked for top-up fees if you had to enter a more expensive care home out of necessity rather than personal preference/choice.

Top-up fees only come into it all if you choose a more expensive care home than the one that is currently available. Then the contract is between the care home and the local authority for the care home. The contract for top-up fees would be between ‘you’ and the local authority.

It's early in the day, but I think I've got the above right. Here's Age UK's factsheet "Choice of Accommodation - care homes" for you to check and correct any of the above that I've got wrong!

http://www.ageconcernliverpool.org....of accommodation - care homes August 2010.pdf

PS. Karryb, we were both posting at the same time, so I hope the above doesn't confuse even more, but I thought it was important to explain 'top-up fees'.

Good luck.

 

[CathT]

Please dont feel guilty. You have found yourself in a totally unexpected and dreadful situation. I am also facing the same and feel very worried about the top up scenario. My mum has probably got enough to pay her care home fees for about a year but there is also the possibility that my dad may need care too. I am an only child and have no one to share the financial responsibility with. My mum's finaces will probably run out just about the same time my daughter is due to start university. There is no way I can fund all these commitments. Just a thought, but I was wondering if state pension and attendance allowance can be used to offset the top up? I am banking on this, so it would be appreciated if anyone has any experience of doing this.

My mum is currently in an assessment unit following a Section 2 and we are looking at future care options, more than likely permanent residential care. Interesting to observe that one patient in the unit who is not self funding has been placed in a home that we disregarded due to the high costs. It certainly doesnt give you any incentive to scrimp and scrape for your old age if it is going to get eaten up in care home fees whereas those that dont or cant get the same care free of charge.

I hope you get some peace of mind. If this awful disease isnt enough to deal without the worry of the care costs.

Best wishes

 

[Saffie]

Just noticed your last post - the SS will take theState pension and Attendance Allowance once the self-funding finishes and SS funding starts. So this cannot be used for topups. Topups have to be paid by someone other than the actual person in the carehome. This will happen to my husband and they are also taking his teacher's pension, tho'they will very kindly allow me to keep half the latter - which will be just above the pendion credit level. They also take no account of the fact that I do not have a pension in my own right.

 

[CathT]

Thanks Saffy for your response which is very helpful but has now caused me to worry further!!

My local authority has said it pays £402 per week towards care once self funding ends. So am I right in assuming that if they take my mum's attendance allowance of £74 and her state pension of £65 ish (total £139) then in fact they are only paying £263 per week when my mum's benefits are taken into account? I was hoping that my mum's benefits would be on top of the £402 per week, taking the weekly amount up to £541, which incidentally seems to be the going rate for many of the care homes in the area.

My mum does not have an occupational pension but my dad does. Can SS take half of this from my dad?

On top of dealing with the stress and strain of my mum's condition and my elderly father, I am totally round the bend worrying about the financial implications. The legal fees to arrange mum and dad's LPAs have jumped from the original £1,200 estimated to a whopping £1,900 and I still havent received all the documentation despite starting proceedings almost 9 months ago!

Any advice re the pension situation would be greatly appreciated.

 

[jenniferpa]

Basically the way it works is that any state pension and any other benefits (such as pension credit) is used to pay the care home, with the person in care being left with the personal expenses allowance (of approx £23). The AA actually stops. The difference between all that and the home cost is paid by the LA. If you need to pay a top (need not being the right word but..) that top up MUST come from someone other than the person in care. One thing that you should be assisted with is claiming pension credit for you mother (not that it will go to your mother, exactly, it's like taking it out of one pocket to put it in another).

However, if pension credit wasn't forthcoming, all that your mother would be contributing would be £65 minus £23 a week. The LA would need to pay the remaining shortfall.

They cannot take any of your father's pension.

Please do bear in mind that sometimes the "quoted" cost of a care home for an "private" individual is considerably more that the price that would be charged to a LA funded resident. My mother's home had a £150-200 differential where we were paying that much more than LA funded residents in exactly the same rooms.

 

[Saffie]

i hate to add further doom and gloom but yes, you are right.however, I'm sure your father's pension is safe. His earnings should be nothing to do with it.

In my husband's case the SS assessor said they will take ALL his state pension (I have the £60 a week married woman's contribution only - I'm hoping they will leave me with that - but am not banking on it!)

They will also take half his Occupational pension, unless I would rather forgo this and let them have it all , in which case, I will claim Pension Credit (thus saving me paying council tax) but I declined as this is means tested and any savings I have I will need to pay house billsand repairs - not to mention topups (£200 lowest estimate - but Nursing home fees are near £1000 a week here in the SE.)

I will have to claim Attendance Allllowance but SS will take it towards their share of payment. He's not having it at present as he is in hospital. (I owe them over £1000 as though I informed them that husband was in hospital from October, they continued to pay it until I rang the Pensions dept and they eventually stopped it.)

My sympathy with the LPA fees. i've applied to be a Deputy as we didn't get around to LPA for my husband as his deterioration was so rapid following an emergency amputation and that is proving very costly and likely to become more so from what I've read here!

However, once my husband actually goes to a nursing home and, hopefully, things aren't quite so hectic and worrying, I intend to set up LPA for myself and daughters.

 

[BeckHux]

Hi

I am currently going through something similar.

Take a look at LOCAL AUTHORITY CIRCULAR LAC(2004)20.

It clearly states the position regarding third party top-ups and also those regarding availability of homes at the usual cost LAs are willing to pay. This is not simply a factsheet from someone, it is a Local Authority Circular from the Dept Health - Local Authorities HAVE to abide by these regulations. If they do not, you are within your rights to make a formal complaint to them, and to contact the Local Government Ombudsman if you feel your complaint hasn't been correctly dealt with.

Here are a couple of excerpts:

LOCAL AUTHORITY CIRCULAR LAC(2004)20

NATIONAL ASSISTANCE ACT 1948 (CHOICE OF ACCOMMODATION) DIRECTIONS 1992

NATIONAL ASSISTANCE (RESIDENTIAL ACCOMMODATION) (ADDITIONAL PAYMENTS AND ASSESSMENT OF RESOURCES) (AMENDMENT) (ENGLAND) REGULATIONS 2001

2. Preferred Accommodation
2.5.5 Individual residents should not be asked to pay more towards their accommodation because of market inadequacies or commissioning failures. Where an individual has not expressed a preference for more expensive accommodation, but there are not, for whatever reason, sufficient places available at a given time at the council’s usual costs to meet the assessed care needs of supported residents, the council should make a placement in more expensive accommodation. In these circumstances, neither the resident nor a third party should be asked to contribute more than the resident would normally be expected to contribute and councils should make up the cost difference between the resident’s assessed contribution and the accommodation’s fees. Only when an individual has expressed a preference for more expensive accommodation than a council would usually expect to pay, can a third party or the resident be asked for a top up (see paragraph 3.1). Costs of accommodation should be compared on the basis of gross costs before income from charging. Given the different amounts that councils will recover from individuals by ways of charges, it would not be appropriate for a council to determine a usual net cost that it would expect to pay.
2.5.7 Councils should not set arbitrary ceilings on the amount they expect to pay for an individual’s residential care. Residents and third parties should not routinely be required to make up the difference between what the council will pay and the actual fees of a home. Councils 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

3. More expensive accommodation
3.3 When setting its usual cost(s) a council should be able to demonstrate that this cost is sufficient to allow it to meet assessed care needs and to provide residents with the level of care services that they could reasonably expect to receive if the possibility of resident and third party contributions did not exist.
3.4 Councils should not seek resident or third party contributions in cases where the council itself decides to offer someone a place in more expensive accommodation in order to meet assessed needs, or for other reasons. Where there are no placements at the council’s usual rate, councils should not leave individuals to make their own arrangements having determined that they need to enter residential accommodation and do not have care and attention otherwise available to them. In these instances, councils should make suitable alternative arrangements and seek no contribution from the individual other than their contribution as assessed under the National Assistance (Assessment of Resources) Regulations 1992. Councils must never encourage or otherwise imply that care home providers can or should seek further contributions from individuals in order to meet assessed needs.

DO NOT agree to top up payments unless you have chosen a more expensive home over one available at the LAs usual cost. The level of funding the LAs set for people should not be capped - they should vary as to the individual's assessed needs. They should also be able to prove that there are homes available to meet the assessed person's needs at the cost they are willing to pay. They are not allowed, as stated in the LAC document, to set their levels of funding unrealistically low in order to routinely ask for top up payments.

In my case the LA have offered funding of £500, there are no homes willing to take my Dad that take anything less than £600, their general rates are £800, so therefore the funding level they have set is too low.

Good luck, I have taken advice on this from advisers from AgeUk, Alzheimer's Society and Counsel and Care - they all categorically say the same thing.

Becky

 

[ChrisH]

Karryb I can sympathise fully with your situation. I'm still awaiting the results of a recent financial review of my mum's CH fees. I did sign a top-up agreement 2 years ago when it was £19 a week. 1 month later it went up to £39 owing to £20 per week increase in the room fee. Last year it went up another £20 per week and it's just gone up again, so now £79 a week

I have no idea if there was a cheaper home that met mum's needs that came within her LA budget at that time. A room became available in the home in my village that I'd had dealings with through work for several years, and that's where I wanted her to live.

Like everyone, we want the best for our loved ones and mum is as settled as she's likely to be. I don't want to have to move her but my circumstances have changed and there is no way I can afford these top-ups anymore.

We are hoping she may be able to move to a cheaper room within the home, and that as her needs have changed she may be upgraded to the next level of funding. I have no idea if this would cover the full fee. If all that fails I'll have no choice but to allow them to move her. But they can only do that if there is a place that meets her needs. I'm just hoping that isn't in a place on the other side of Devon.

BTW, are there any regulations regarding how far away they could move her? I'm an only child and the only one who visits her (apart from very rare visits by my sons and husband).

Chris

 

[crowntrack]

tenancy in common.

my wife has AZ and is currently receiving care from me with specialist care from the LA.
If when, which seems inevitable, she requires full time care in a home, what demands will the LA make on me. She has a state pension, and full attendance allownace taking her to £522 per month.
Care cost of £369 pw. She has no assets and therefore the LA would need to fund some £240pw being the difference.
Should I decide to downsize from current home which is held as tenants in common and each half of the value going into trust on either one of us departing this mortal coil what would be the LA's rightful claim be. The emphasis being can I sell and move to a smaller less costly property and how much of the proceeds would be judged as mine and those of my wife, in the circumstances.

 

[jenniferpa]

Hi crowntrack and welcome to Talking Point.


As a general rule, if you are planning to downsize it is better to do it now, before your wife goes into a home, rather than later. If you do it now then you can use as much money from the sale as you need to buy that smaller property, with your wife retaining her 1/2 share of the new smaller property, plus 1/2 of any profits also being hers. Then when she goes into her home, the 1/2 share of the house will not be touched by the LA (unless you predecease her). If, on the other hand, you wait until she is in a home and then try to downsize, theoretically all of her half becomes available to the LA. Even if they allowed you to keep some of that money (since we all know that a home that is smaller is not necessarily going to cost 50% less) they still would have a claim on it.