Needs assessment and top up fees

Discussion in 'Legal and financial issues' started by MissDiane, Jul 26, 2015.

  1. MissDiane

    MissDiane Registered User

    Oct 18, 2013
    73
    #1 MissDiane, Jul 26, 2015
    Last edited: Jul 26, 2015
    Hello,

    Both parents have dementia and were not coping at home so I involved Social Services.
    It came to a crisis point where mum could no longer live with dad, (situation was abusive) and as her needs were higher then dad's I had to find a care home placement for mum.

    I had been looking for a place for months, and had been placed on a couple of waiting lists but I had no idea how the funding worked. I did mention this at meetings with social services but it seemed to go over their heads and I got no advice.

    Within a day of another crisis situation at home, a place came up at my first choice of care home which is within a mile of my home and dad's home.

    Within a couple of days, we were scheduled to have meeting with mental health and social services regarding the best way forward. It was decided by all that a care placement was the ONLY option, so it went ahead.

    Months prior to all of this I had rang Social Services twice and asked for a needs assessment. They asked me if mum had consented to this request, which she had and I explained I also had POA. Nothing happened. No assessment took place to my knowledge.

    No one carried out a financial assessment, just took my word that mum qualified for social services support.

    Now I've realised that the top up fee being requested, for standard care, should not be requested because no one did a needs assessment, no one gave me a budget, no one gave me a list of homes within the budget which had vacancies and most importantly could meet mums needs.

    Nearly all of the other home I checked out charged higher prices than the one I chose.

    Where do I stand in all this? Can I challenge the top up? Complain about the lack of input from professionals? Has anyone got any advice please? Thank you
     
  2. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    Hi MissDiane ,

    Sorry this is a bit short but got to get too work..:(

    You cannot be held responsible for paying for another's care.

    I am assuming your Mum does not have savings?

    Who has been paying the CH up till now? Who is it that is asking for a top up? If it is the CH then refer them to the LA. If it is the LA do not pay it and make a formal complaint. The procedure will be on their web site.

    If the LA are paying and they now have done their sums and find the CH too expensive then they have to be able to offer at least one other CH that they will fully pay for and can meet your Mum's needs. If you do not like this new CH you can object but the LA will then expect a top up to be paid.

    Hope that helps.:)
     
  3. nitram

    nitram Registered User

    Apr 6, 2011
    18,291
    Male
    North Manchester
    Have you signed any contract with the home?
     
  4. MissDiane

    MissDiane Registered User

    Oct 18, 2013
    73
    #4 MissDiane, Jul 27, 2015
    Last edited: Jul 27, 2015
    mum has less than 7K in savings when the joint account is split 50/50.

    She has only been in the care home 3 weeks and the LA have not paid anything to the care home yet.

    I initially verbally agreed with the CH that we would have to pay a top up, as I genuinely believed I had no option. The majority of homes in the area were much higher rates or did not have any vacancies.

    I did not know the LA had to offer at least one alternative which meets mums needs. I had no advice and was not signposted to any independent advice.

    The LA got my dad to sign an agreement. he has dementia. He also did not understand the system, had no advice and thought there was no other option. I have applied for LPA for dad but it's not come through yet. I have LPA for mum.

    Obviously I should not have agreed verbally to the top up but I did not know how the system worked. I have read up a bit more and now realise that if no other home can be found then the LA should meet the actual cost of care. So I now have the CH after me for the top up!
     
  5. Pickles53

    Pickles53 Registered User

    Feb 25, 2014
    2,482
    Radcliffe on Trent
    #5 Pickles53, Jul 27, 2015
    Last edited: Jul 27, 2015
    If you dad did not have capacity to sign an agreement then I would argue that it is invalid, but your last paragraph contains the key point which you need to keep hold of. Sure there are some experts who can give the precise references from the new guidance, but you may be able to find it yourself here:


    https://www.gov.uk/government/uploa.../file/366104/43380_23902777_Care_Act_Book.pdf

    Tell the care home (politely) that they need to speak to the LA. It is not your fault if you were misled (by omission) by those who should have a duty to explain the system to you.

    PS. Try Annex A which starts on page 401.

    PPS. See also sections 8.36 and 8.37
     
  6. nitram

    nitram Registered User

    Apr 6, 2011
    18,291
    Male
    North Manchester
    Did your dad sign an agreement that he would pay top ups?
    This could have been to the LA or the home.
    Get onto the legal department at the LA and ask them to cancel anything he signed as he lacked capacity. Say that he has dementia, enclose proof if you have it, and that especially in the stressful circumstance he did not understand what he was signing.

    Agree you should also contact the home, apologise, and say that you were stressed and confused and did not understand that the LA had a responsibility to find and fully fund a suitable placement for your mum.
     
  7. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    MissDiane,

    As you have LPA for your Mum the LA should not really have asked your Dad to sign anything at all and they should have been dealing with you instead.

    If someone agrees to pay a top up then the LA are obliged to make sure that the person doing so is capable of making those payments, enters into a written agreement and understands the significance (see below) if those payments are not met. I would imagine that due to the placement being a bit rushed and only happening 3 weeks ago they haven't caught up with the paperwork yet.

    The LA are obliged to offer at least one CH within budget but since you had found the CH yourself and agreed to the top up I would think they could use this as an excuse for not having done so as there was no point. They can be asked to do this though at any time.

    The CH are obviously within their rights to ask you for the top up. If you do not pay it then the "significance" from above could be that they ask your Mum to leave. The LA would then be obliged to step in and either agree to pay the full amount (unlikely) or provide details of a CH within budget.

    It does then start to get even more complicated but as far as my reading of the New Act goes (so not gospel) they would be responsible for paying the top up whilst your Mum remains there on a temporary basis as they failed in their obligation above.

    My advice would be to speak to the social worker and see if you can sort it out. If they are being difficult to get hold of then go down the complaints procedure. They have failed in many of their obligations.

    Regarding the top up I assume that you or anybody else are not able to afford it? Do your parents own their own house?

    Pickles53 has given you the link to the guidance for The New Care Act and if you cannot find the relevant part to chuck at the LA then just ask.

    :)
     
  8. realist1234

    realist1234 Registered User

    Oct 30, 2014
    108
    Hi MissDiane

    Its hard to believe that Social Services have not even done a financial assessment of your mum, even less so a care needs assessment, but that unfortunately is the world in which we live. Incompetence abounds!

    Both of these assessments should have been done by SS/LA by the time your mum went into a care home. I appreciate things moved very quickly but then these assessments should have been made a priority. If they have still not been done, you need to insist on it, or else make a formal complaint.

    The LA will have a maximum weekly fees amount that it considers appropriate for a CH to charge. Here in NI, it is around £480 per week (for residential CH, for nursing you get an extra £100). These rates will be similar in England, probably a bit higher. The LA has a duty to offer your mum a CH that only charges this weekly amount, and if it can't and you have found a home that charges more than this (ie a 'top-up' amount) then the LA is liable for the full amount, including the top-up element. However, a financial assessment of your mum would calculate how much your mum can contribute to the cost of her care, ie most of her pension income etc would go towards paying the fees. As your mum's savings are well below the minimum threshold of £14,250, she would not make any contribution from her savings, just her income. Her house would also not be taken into account as your dad still lives there (that would change if he was also moved into a CH at some point).If the LA can offer your mum a CH that only charges their max amount, then either a 3rd party (eg you) would have to pay the top-up fee being charged by her current home, or she may have to move to the lower-cost CH if a 3rd party can't pay it. As you have POA, I do not think the form your dad signed iro the top-up fee has any legal standing as firstly he has dementia and secondly, you are legally responsible for dealing with your mum's finances, not him.
     
  9. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    Wow!:eek: My LA (in England) only pay £410........

    Do you really mean the LA pay an extra £100 for nursing or it the NHS that pay that?
     
  10. CynthsDaugh

    CynthsDaugh Registered User

    May 5, 2015
    140
    Salford, Lancashire
    According to their website the maximum my LA will pay is £383! I do wonder how care homes manage to provide decent care and pay decent wage on that.
     
  11. marionq

    marionq Registered User

    Apr 24, 2013
    5,554
    Female
    Scotland
    Remember that the persons pension and attendance allowance are added on to that. In addition there may be funds for nursing care and personal care added on. The more usual figure for the care hom e is £550 to £600 and of course more than that to people who are self funding.
     
  12. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,418
    Umm - no, not really. The £383 ( to use that as an example) is what the LA pays the care home for an LA funded client. Then that client uses what pensions they have to at least partially reimburse the LA. And AA stops. The care home doesn't get the pension on top I'm afraid. There may be additional funds to pay for nursing care, but then that nursing care has to be provided.
     
  13. marionq

    marionq Registered User

    Apr 24, 2013
    5,554
    Female
    Scotland
    Well that is not how it was explained to me today by the social worker responsible for finance. I will apparently pay the care home John's pension and as far as I know although not certain of this his AA. If he is entitled in Scotland to nursing care or personal care that will form part of the payment and anything else not covered will come from either the LA or John's assets.
     
  14. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,418
    #14 jenniferpa, Jul 29, 2015
    Last edited: Jul 29, 2015
    I know in Scotland you have a different system with regard to the personal care component so I can't speak to that (although I thought it was personal care component or AA, not both). But no, I'm afraid the social worker mispoke if she/he said that the care home would get the pension payment on top of the LA assessed rate. You would in most circumstance pay the care home the pension, but then the LA would pay less. So if the LA rate was £400 and the pension paid was £200, the care home would still only get £400, not £600.

    I'm afraid social workers are not always entirely accurate about funding.

    Edit: although to be fair, from what you have said here, the information you have been given does not appear to be inaccurate as far as it goes, but it doesn't go far enough.
     
  15. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    I do believe the first quote is incorrect however the second one is correct.:)

    My LA say they "pay" £410. They take my Mom's state pension, private pension and AA to help towards it. So the rate the LA actually pay is £140.
     
  16. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,418
    I would concur. Except it's never been clear to me if the LA is actually credited with the AA.
     
  17. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,046
    Staffs
    Maybe I should not have used my Mom's case as it is rather unusual and complicated and might confuse people. I was just trying to highlight how the LA contribution is not what it seems.

    As you know the norm is AA goes to self funders. AA stops if LA funded.

    However self funders depending on their circumstances may be offered a DPA. That DPA could be for all the amount including top up or just deferring the LA contribution. So going back to my Mom as the example. The LA pay the CH their assessed charge :rolleyes:of £410. I pay the LA my Mom's pensions and AA. Obviously the £140 has to be paid back sometime.
    :)
     
  18. realist1234

    realist1234 Registered User

    Oct 30, 2014
    108

    I assumed England would cost more, but I suppose it varies between one council area and another given the size of England. In NI, it tends to be the same no matter which area or Health Trust. Re the £100 nursing element, I think this comes from the NHS budget, but it still goes through the Health Trust (I think Health and SS's are more joined-up here, though I'm not convinced that's any better!). My mum was in a nursing home which charged a total of £670 per week. My mum paid roughly £200 from her pension income/savings etc, £100 nursing element was paid by the NHS/Health Trust, we had to pay the 'top-up' of £90/week, and the Health Trust (equivalent to LA) paid the balance of £280/week. Thankfully we were able to move our mum to another home which charged less, as we were concerned we could not continue to pay the expensive top-up fee (we also had issues around the level of care she was receiving). We never imagined that as children we would end up paying £'000's per year to have our parents looked after in their old age, particularly when Alzheimer's is a physical brain disease. Very convenient to view it as having purely 'social' implications. Thankfully, she actually seems happier in the new home as the staff are more attentive and put on more activities, which for someone with Alzheimer's is important.
     

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