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CHC top up fees please help

Discussion in 'Legal and financial issues' started by Angelcakes, Oct 19, 2018.

  1. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    Can anyone help after a very long fight, my mum has finally been found eligible for CHC funding. However the CH have now decided to charge her a top up fee and want us to sign a contract for it. I know according to the Framework they can't do this, but they are effectively forcing us. They are saying this fee is unrelated to her needs so the authority who clearly have a cap won't pay it. The CH were very aggressive about it with me, but have agreed the CHC set fee with the LA and won't negotiate this extra cost with them. They are expecting my mum to pay. Feeling absolutely exhausted with it. We are between a rock and a hard place. Not in mum's best interest to move as she is frail and has advanced dementia and have her elderly husband to consider too. How can they do this? And how can we stop them as I feel they're holding my mum to randsome? I should also point out this extra fee isn't for any specific just the "environment"!
     
  2. nitram

    nitram Registered User

    Apr 6, 2011
    16,369
    Male
    North Manchester
    Ask what the unrelated fee is for?
    If it is,for instance, a bar in the dining area, just sign that your mum will not use it, and make sure she does not.
     
  3. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    Thanks Nitram. I did ask and was told the "environment" And that this isn't a top up fee. I asked them to be more specific. They said salon which my mum's own hairdresser uses when she comes in once every 2-3 months to cut her hair. They also said cinema- which is just a room with a DVD in and my mum's advanced dementia means she's never been there. They are trying to sell it as a luxury feel to the home, but this is basically just the interior decor i.e her accommodation don't see how this counts as separate. I'm very very unhappy about signing a contract for this @ £400 a month!
     
  4. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,555
    Salford
    It's a good question and one I don't know the answer to but have often wondered about.
    Anyone who's LA funded is given a figure and usually there's only a choice of one home in the area that will accept this figure, anywhere else you need a top up. If someone is self funding and the money runs out and the home they're in is over the LA budget figure then there's either a top up or a move to a cheaper home that's within budget.
    If the home your mum is in won't accept the CHC figure then I've always wondered what happens, do they have to move and as it is often stated that people getting CHC don't have to pay top ups then is CHC funding a higher figure than normal LA funding rates?
    If someone's in a £2k per week home and is awarded CHC but locally you could find the same care for £1k, OK you might not like the place or it may be difficult to get to or out of area, off a bus route or in a dodgy area do the CHC people have to pay for where you want or is it like LA funding and you have to go where you can afford or pay a top up?
    CHC can't be a blank cheque to go where you want (or stay where you are) irrespective of cost otherwise everyone with CHC would be in Posh Towers Care Home.
    As I say good question and something I'd often wondered about when I was trying to get CHC if it would be the same as any other state funding one or maybe two options or pay a top up.
    K
     
  5. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,555
    Salford
    The hairdresser at the home my wife's in pays the home for the use of the room and the captive haircutting audience by taking a percentage of the turnover, the home supply the room, water, electricity and so on so the hairdresser pays them for the use of their facilities.
    Cinema rooms for people with AZ are a waste of space (in my view) few can appreciate what's going on and don't have the attention span. All the rooms in the home have a TV and most play DVD's but there's so many channels now that who, unless they have favourite films even watches them.
    K
     
  6. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    Yes I take your point, but LA top ups are done through contracts with the LA (not the CH) apparently so are they more regulated? This isn't a £2k/wk home it's a fairly average fee, that the LA capped weekly rate (CHC or otherwise) falls well short of. For my mum it's about location, GP says she's too frail and not in best interests to move. Other homes nearby refused to take her with Alzheimer's.
     
  7. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    #7 Angelcakes, Oct 20, 2018
    Last edited: Oct 20, 2018
    I've asked for CH to put in writing specifically what this fee is for and asked LA to tell us what other homes they offer. I don't know what else to do. Get legal advice? They've agreed the fee with CCG so accepted their lower figure, then pressured us to pay more.
     
  8. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,555
    Salford
    The Mandatory Guidance Notes to the 2014 Care Act, Annex A, Section 25 says that
    "Local authorities should therefore maintain an overview of all ‘top-up’ agreements and should deter arrangements for ‘top-up’ payments to be paid directly to a provider."
    (my underline) So direct top ups should be deterred, I've no idea if this applies to LA funding only, but I can't see why it should, CHC is state funded too so isn't that covered by the Care Act? (link below).
    Care home do try and do the top ups for LA funded residents directly and not through the LA's it's been said on here more than once so I can't see why the CHC would take a different view on the Care Act Mandatory Guidelines, they're all government.
    K

    https://www.gov.uk/government/publi...ce/care-and-support-statutory-guidance#AnnexA
     
  9. Elle3

    Elle3 Registered User

    Jun 30, 2016
    447
    Hi Angelcakes,

    I found myself in a similar situation. My dad was assessed for CHC funding back in June and was awarded funding. A couple of weeks later I received a call from the CHC saying that the care home fee was higher than their funding amount and would I consider a top up fee which would be around £400. I said no to this and I later found out that you cannot pay top up fees to CHC funding but I was informed by the care home that there was a bit of a way around this with the care home billing you for the difference as a private supplement which would be over and above what the normal fees would be.

    After these conversations I thought about it some more, I could see some potential issues with this, if we agreed and continued to pay this top up fee indefinitely for as long as the CHC funding remained, we would have had to continue paying this until literally there was no money left in my dads account. As unlike with LA funding coming into force once funds get down to the higher figure of £23,250 and then down to the lower amount of £14,000 there would be no limits, which just didn't feel right, so I was glad I refused.

    Fortunately the CHC agreed that it would not be beneficial to move dad to a different care home, so they said they would go and look into the matter further. In the meantime I spoke to our Social worker and explained the situation to her, so she got on the case for us too.

    To cut a long story short the funding amount had to be escalated to the Assistant Director of the CCG and he approved the full cost, so we wouldn't have to pay anything. It then took 3 months for all the paperwork to go through and to finally get to the care home. In the meantime we continued to pay the care home fees until they received the funds from the CHC and then we received a refund.

    So I would suggest contacting the CHC and explaining your situation, tell them you just can't afford this top up fee the care home is asking for and see what they say. I have found them very helpful and approachable. I hope you manage to get this sorted.

    Elle x
     
  10. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    #10 Angelcakes, Oct 24, 2018
    Last edited: Oct 24, 2018
    Thanks Elle,
    That's really helpful it's been a really tough few days. I'm visiting my mum (I live a long way away to my parents. Social worker has taken it on. It's to go to CCG again, in meantime funding is being paid at CHC rate agreed. It's being massively complicated by CH insisting this is a "lifestyle" payment instead of saying this is a "top up" i.e. we are a more expensive home. They are convinced there's a loophole that allows payments for extras, of course there is for actual extras (they were already extras on her fees before) dentist chiropodist etc but they think this can be used for accommodation and shared facilities. For some reason I'm having to convince the social work dept too that the CH are wrong. The rules are clear, but they're muddying just it enough to make the LA question it. It's exhausting.

    I think they've been badly legally advised. There's a law firm who advises Care homes and they use this exact terminology saying: "Where care homes have only one standard of room, it may be difficult to distinguish the hotel standard room for which a top up is charged, and the standard room that the CCG contracts to fund. Even in such cases, however, it may be possible to defeat the rigid rules against top ups for CHC by separating the cost of care from the cost of accommodation"

    "Providers commonly charge for services such as hairdressing and chiropody but may also charge for premium quality rooms and other additional or ‘lifestyle’ items that are not included as part of the standard service as set out in the contract with commissioners. Unlike ‘top ups’, such lifeystle charges can be invoiced directly to the service user or anyone else who agrees to pay them"

    They talk about a case where the judge said ‘It has always been the case within the National Health Service that those who wish to enjoy what are known in National Health Service jargon as ‘hotel‑type services’, may do so at their own cost…
    Anyone heard of this case?

    Anyway it's all pretty rubbish. My mum was so unhappy today. She said she just wanted things to go back to normal then said, but they're not going to are they? It was like she was her old self talking to me and she seemed so poorly today. Just made me desperate to take her home, well that and have a good cry.
     
  11. Jessbow

    Jessbow Registered User

    If it is difficult to see the minute differences that the ''Lifestyle payment' covers , I'd assume they were not worth having.
     
  12. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    Sorry if I wasn't very clear above. These small extras are fine but as a "lifestyle" fee they want £400/month from my mum on top of CHC full funding for being a "better environment" than the average home?! They won't call this "a top up" (even though it is) so that they can pressure us rather than the LA/NHS for this extra money. If it's a "top up" then in my mum's case (frail,locality for closet relative) the CCG would have to consider paying. Of course the CCG are looking for any reason to say no to more money and will probably welcome this ambiguity. It also means instead of the home being with us in asking the CCG to cover the shortfall (as CHC covers all costs bar those small ones like hairdressing) the CH are saying it's nothing to do with more money from the LA/CCG!
     
  13. nitram

    nitram Registered User

    Apr 6, 2011
    16,369
    Male
    North Manchester
    CHC is provided by the NHS and the basic principle that you cannot pay for extras to improve treatment applies

    Is it possible to pay top-up fees for NHS continuing healthcare?

    No, it isn't possible to top up NHS continuing healthcare packages, like you can with local authority care packages.

    The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you're assessed as needing from the NHS. These private services should be provided by different staff and preferably in a different setting.


    https://www.nhs.uk/conditions/socia...-work-and-benefits/nhs-continuing-healthcare/

    My feelings on how the current situation developed are:
    • To start with the rule was rigidly applied.
    • Some people wanted to pay the extra to get into a home of their choice rather than the one offered by the CCG. This was advantageous to the CCG as it freed up placements in cheaper homes. Various fudges were used to allow people to chose to pay extra.
    • The success of these fudges led to CCG offering placements that they knew would require extra payment.
    You can insist that the CCG fund the total required by the home or find a different placement.

    if your mum was in the home when CHC was granted also note from the above link:

    My relative is in a care home and has become eligible for NHS continuing healthcare. The CCG says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different care home. I think a move will have a negative effect on my relative. What can we do?

    If there's evidence that a move is likely to have a detrimental effect on your relative's health or wellbeing, discuss this with the CCG. It will take your concerns into account when considering the most appropriate arrangements.

    If the CCG decides to arrange an alternative placement, they should provide a reasonable choice of homes.
     
  14. Angelcakes

    Angelcakes Registered User

    Sep 21, 2018
    10
    Thanks Nitram that's very helpful (& how you think this has started to happen more often). This last quote from the NHS site is interesting. How do you "discuss" this with the CCG? So far for us it's been a faceless body. I have mum's social worker helping, I was able to contact the nurse assessment team (who have no involvement in implementation). I have a Care manager who says she will be involved in any CHC reviews, but isn't involved in the financial/contract side. I've even spoken to the CHC payments dept. However, in this borough the LA county council contracts department deals with the CHC contracts but although they have been speaking to the social worker and care home manager to try to resolve this situation, I've been told they don't speak to the public. I wouldn't even know who to write to at the CCG. The CCG panel who initially rejected my mum's DST out of hand were presumably a group of doctors.
     
  15. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,555
    Salford
    But as I asked earlier is CHC a blank cheque, if the LA or CCG have a rate they pay and you want somewhere over and above that rate do they have to fund it?
    If I go on holiday and stay in a 3 star hotel but you choose a five star hotel should we pay the same because we're in the same resort?
    If everyone else in the same county gets X amount of money for care e it LA or CHC funded can you choose a more expensive option and expect to get it at the lower rate or expect the taxpayer to give you more money that they give to the rest of the public?
    I think it would be more honest if the home simply said (as many already do) we don't accept people who are paid for fro the public purse, be it LA funded or CHC.
    So many people on here post about the injustice of self funders paying more than the LA/CHC rate and generally people agree with them, if the home won't take the public funded rate (be it LA or CHC) without a top up maybe they should just say that outright and ask you to move her, using explanations about it being a "lifestyle" is just saying they won't take the CHC rate.
    Sorry to be so negative but if you want to be in a home over budget it's a top up or a move.
    There are a million reasons why this shouldn't be the case and I'm totally sympathetic to your problem but some (like the CCG) see this as you asking for a bigger slice of the cake than everyone else gets and money is tight.
    The care home are very much the third party in this, they have a rate, the CCG have a rate and they can't agree on what that rate is then the home have 2 choices, either drop their rate (and why should they do that, they may well have a waiting list) or serve you notice.
    Rather than argue with the home who I'd rather be on side with I'd be asking the CCG where they propose to move her to and how they can justify the move after all it's them that's refusing to fund, the home has the facilities whether you're able to use them or not.
    As I say, sorry if that sounds unsympathetic but focusing on the home is targeting the people you need to be on side with, they can make a case for your mum staying there as well as you can so picking on them is "friendly fire" you're shooting at your allies.
    K
     
  16. Normaleila

    Normaleila Registered User

    Jun 4, 2016
    495
    I agree. This may sound unsympathetic but it's basically saying put the ball back in their court. They being the CCG.
     
  17. Louise7

    Louise7 Registered User

    Mar 25, 2016
    555
    I went directly to the CCG by looking up their contact details on the internet (type in your borough/council name and 'CCG'). My Mum was placed in a nursing home by the CCG, which was not suitable for her needs and had safeguarding issues, but the hospital social worker wasn't interested. I phoned the CCG and explained the problem, was put through to the relevant person, and they subsequently moved Mum to another home fairly quickly. You just need to be persistent - keep ringing/emailing them!
     
  18. Saffie

    Saffie Registered User

    Mar 26, 2011
    22,434
    Female
    Near Southampton
    #18 Saffie, Oct 25, 2018
    Last edited: Oct 25, 2018
    The thing is that from reading the posts I don’t think the OP wants her mother to be moved to a different home.

    @Angelcakes I think Kevin is right. There is not unlimited funding from either the NHS or LAs especially as both are in dire straits financially. My husband was refused CHC funding, despite having severe medical issues over and above those caused by dementia, so I don’t know how things work in my health authority but according to a now ex TPer, in a neighbouring county the CCG give - or used to - a short list of homes that they would fund and if nothing suited on that list a further list was presented but that was it.

    I think services provided such as you mentioned will never be used by everyone but I suppose the fact that they are there shows that the home is trying to make the home a nicer place in which to live for the residents and it costs them. Kevin’s hotel analogy is a good example. I might stay in one where spa facilities and swimming pool etc are included but whether I use these or not, it will cost me the same.

    It is a difficult situation for you and I think perhaps we all think that CHC funding will be the answer to all our financial concerns when in fact it is only really there to address medial needs. If the CCG consider that a move would adversely affect those needs they may agree to up the funding. Good luck.
     
  19. Louise7

    Louise7 Registered User

    Mar 25, 2016
    555
    #19 Louise7, Oct 25, 2018
    Last edited: Oct 25, 2018
    Yes, I know that, but I was using my example to demonstrate how you can contact the CCG directly, as someone has incorrectly informed the OP that the CCG don't speak to the public. In my Mum's case they provided a list with a few alternative homes on it but it subsequently turned out that the home we chose from the list was over their budget limit. They did however agree to fund the difference.

    From what has been posted the CCG need to be approached regarding the issue. Whether they will agree to increase the funding, and avoid a move to another home, is a separate matter but it's worth asking them the question.
     
  20. Saffie

    Saffie Registered User

    Mar 26, 2011
    22,434
    Female
    Near Southampton
    Oh I completely agree. My contact was with the CHC funding team at all times so for them to say that they don’t speak to the public is totally untrue. You were fortunate that they made up the difference but if it was on their list it was only right that they did so of course.
     

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