Not Understanding Funding

[DawnR]

@DawnR said "He gets his pension in February I’m going to put it all in a savings account in my name so I can pay the top up fee when the time comes".

I suggest being very careful here. Are you sure that this is even legal?

@northumbrian_k I understand it’s joint income as we live together. His pension will go into our joint account and I can choose to save from that.
I’m not looking for luxury, my preferred care home is quite plain but the staff are lovely. The atmosphere of the home is just different to what I experienced at the other two homes, it’s hard to describe.
I’m pleased you have somewhere you’re happy with, and you don’t have the worry about finding the top up. I’m sorry I hope I didn’t come across as critical that wasn’t my intention.
I’m still looking but even the home in my area which has a terrible cqc rating charges a top up of £100 pw.

 

[AnneF]

I don't think that I have done my wife a disservice by placing her in a care home that accepts the Local Authority rate. It is domestic in scale, a little worn in places. has the clearest demonstration of what personalised care really means and is far from being a 'fleapit'. It saddens me to hear places described in this way. There is a money-oriented category of care home that styles itself as 'luxury' or 'hotel quality' and is aimed at people who wish to do the 'best' without necessarily knowing what this means. As dementia progresses, fancy surroundings and similar bells and whistles become less important to the person with dementia. Needs increase and become more basic. Staff who really care and bond with the residents are more important than superficial luxuries. We all want the best care for our loved ones but that isn't always found by simply paying more

Well said. There are very good homes out there. But finding them can be hard, especially at short notice. You can end up being at the mercy of the system, which is what happened in February as per my story above. A 'fleapit' descriptor for that place is generous!

I'm finding it very hard during my visits to care homes to determine how good the care is - the visit is a snapshot in time. I can look at cleanliness and how tidy the residents are (if they're not all in their rooms). I can look at reviews all day but they don't seem to be much help and appear similar across the board. CQC ratings for 'good' seem to cover a broad range. I'm also finding it hard to get recommendations as I know so few people who have been in this situation.

I'm up against it now and panicking. I don't know how long I've got to earmark a few places. I don't know when they'll do the financial assessment as I presume that would be done soon?

 

[DawnR]

Please do not blame yourself for your thoughts. Tiredness, anxiety and stress is a terrible thing and we cannot simply cover it up. If you haven't already there are carers support services who can give advice, there is also the Age UK helpline, Carewise and of course the Alzheimers phone line

❤️

 

[Rugby kate]

Well said. There are very good homes out there. But finding them can be hard, especially at short notice. You can end up being at the mercy of the system, which is what happened in February as per my story above. A 'fleapit' descriptor for that place is generous!

I'm finding it very hard during my visits to care homes to determine how good the care is - the visit is a snapshot in time. I can look at cleanliness and how tidy the residents are (if they're not all in their rooms). I can look at reviews all day but they don't seem to be much help and appear similar across the board. CQC ratings for 'good' seem to cover a broad range. I'm also finding it hard to get recommendations as I know so few people who have been in this situation.

I'm up against it now and panicking. I don't know how long I've got to earmark a few places. I don't know when they'll do the financial assessment as I presume that would be done soon?

Staff turnover is really key, for me. If people hang around, it shows a good working environment. Mums care home is a basic one, but she knows the staff because they stay a long time, and that's critically important to her wellbeing, more so than the extras which in her situation, she wouldn't use. I was really wary of care homes that felt transactional, and where residents seemed to be treated as patients or guests, even though they tended to be the cleaner ones.

 

[canary]

There are very good homes out there. But finding them can be hard, especially at short notice.

A lot of care homes (especially the popular ones) have waiting lists.
If you can find a care home (or two) that you would be happy with and that will accept the LA rate, then see if they hold a waiting list and add your mums name to it PDQ

I'm finding it very hard during my visits to care homes to determine how good the care is

Look past the decore and the bells and whistles and look at the staff there. How do they interact with the residents? Are they cheerful, or just look like they are going through the motions? Are there times/places where residents are left alone in communal areas and how often are residents who stay in their room checked? Are you aware of any "atmosphere" between staff?

I agree with the comment about finding out about staff turnover. Also ask what the staff to resident ratio is. Another thing to ask the manager is what dementia behaviours they would not tolerate. Im sure your mum wont be at that stage yet, but it will give you an idea of when (if) they would give your mum notice and you would have to find somewhere else

 

[northumbrian_k]

@DawnR I suggest that you take proper advice and are very careful in accounting for and using your partner's pension income. This will be important when Local Authority part-funding of care costs applies (when his assets fall below the £23,250 threshold).

For state pension, any financial assessment carried out by the council will view that as entirely his. It will be counted as part of his contribution towards his care costs. The fact that you live together does not mean that, for these purposes, it will be seen as 'joint income'.

For occupational pension the situation is different. Whether it has been specifically gifted to you or deemed to have been gifted, 50% of occupational pension is likely to be disregarded when calculating the care cost contribution payable.

To illustrate, my wife's entire state pension plus half of her occupational pension are counted in calculating her contribution. The other half of her occupational pension was deemed to have been gifted to me and is now transferred to my separate bank account.

I hope that this clarifies.

 

[Chizz]

I'm curious as to how the local authority in your example is making up the balance without a top up being required?

Hi @AnneF
Apologies for long winded answer to your query.
Whatever a private care home would like to charge is one thing. However, all Local Authorities have a budget. They work out what, in their area, they are prepared to pay for a person's care as a maximum.

When a person's finances are low, and that person calls upon the LA to pay a contribution or all of the care home fees, the LA asks the home if it will accept the amount the LA will pay as a maximum. If they will, then the LA pays, the home accepts this and there is no top up to pay * see below
If the home won't accept what the LA will pay, the home asks the family if they will pay the difference between what the care home wants to charge and what the LA will pay. If the family agree, the family pay and the care home is happy. If the family don't agree - and they don't have to, or maybe they can't - then the care home decides either to keep the person, or they say they will no longer look after that person, who will then have to move to another care home, sometimes in the area but at a lower standard and thus, cheaper, and sometimes one has to look for a care home out of the area that may be cheaper.

* see above
Example - If care home works out that their costs and profit amount to £800 per week, then they also decide as a commercial decision whether they are or are not prepared to accept persons solely funded by the LA, who in this example have decided they can only ever pay a max for care, because of their budget restraints, of £600 per week.
The care home - if they have decided they won't take anyone who is solely funded by the LA unless the family make up the difference, then in such a home they charge £800 pw paid by the self funders, and for non self funders they charge LA £600 pw and family £200 pw = £800 pw.
The care home - if they have agreed to take in people who are solely funded by the LA, then in such a care home, the care home charge £1,000 pw for self funders, and non self funders are charged £600 pw paid by the LA - so average charges = £800 pw. It turns out therefore that the self funders in such a care home are subsidising the non self funders.
I know you are concerned whether the poor old care home company/owner is making enough profit to keep himself in Ferraris, but please rest easy in the knowledge that the care home does NOT loose out on its income or profit, as in this last example it is overcharging the self funders to cover themselves. This is the most common situation.

 

[AnneF]

A lot of care homes (especially the popular ones) have waiting lists.
If you can find a care home (or two) that you would be happy with and that will accept the LA rate, then see if they hold a waiting list and add your mums name to it PDQ

Look past the decore and the bells and whistles and look at the staff there. How do they interact with the residents? Are they cheerful, or just look like they are going through the motions? Are there times/places where residents are left alone in communal areas and how often are residents who stay in their room checked? Are you aware of any "atmosphere" between staff?

I agree with the comment about finding out about staff turnover. Also ask what the staff to resident ratio is. Another thing to ask the manager is what dementia behaviours they would not tolerate. Im sure your mum wont be at that stage yet, but it will give you an idea of when (if) they would give your mum notice and you would have to find somewhere else

Excellent advice, thank you.

I've been to about 20 care homes in the last three weeks, a mixture of recommendations and others gleaned from the care home website where I can look at reviews and CQC ratings. Very few of them accept local authority funding in full. All of the care homes I've looked at have a couple of free beds, but so far the local authority ones haven't been particularly suitable (distance of facilities from the room, ability for my mum to get to the lounge or dining room with her limited mobility), travel time for me.

I haven't had much of a chance to see staff interacting, but I know what you mean about getting a feel for a place. Last weekend we called in to an expensive (out of our league) and very fancy nursing home which looked like an expensive hotel. I disliked it immediately - it felt corporate and impersonal, in fact it did my head in.

I find it quite hard to get information about staff turnover as I think they can be cagey about that.

One of the places I felt my mother would settle in only takes residents with good mobility and said that if they needed nursing care they would be sent next door to the fancy corporate one I just mentioned.

I seem to be drawing blanks at every turn but have two on my suitable list at the moment. One of them the available room is tiny and my mum is adamant she would become distressed in something that feels like a cell - particularly because she would have to spend time in her room due to her noise sensitivity. The other care home on my list is a brand-new one just opened last month with good availability and the potential for negotiating - it would cover all present and future needs without having to move her and is only half a mile from where she has been living for the last 10 years so easy access to familiar scenes and people. Unfortunately it doesn't take local authority funding without top up, but I may be able to haggle.

 

[AnneF]

Hi @AnneF
Apologies for long winded answer to your query.
Whatever a private care home would like to charge is one thing. However, all Local Authorities have a budget. They work out what, in their area, they are prepared to pay for a person's care as a maximum.

When a person's finances are low, and that person calls upon the LA to pay a contribution or all of the care home fees, the LA asks the home if it will accept the amount the LA will pay as a maximum. If they will, then the LA pays, the home accepts this and there is no top up to pay * see below
If the home won't accept what the LA will pay, the home asks the family if they will pay the difference between what the care home wants to charge and what the LA will pay. If the family agree, the family pay and the care home is happy. If the family don't agree - and they don't have to, or maybe they can't - then the care home decides either to keep the person, or they say they will no longer look after that person, who will then have to move to another care home, sometimes in the area but at a lower standard and thus, cheaper, and sometimes one has to look for a care home out of the area that may be cheaper.


The care home - if they have decided they won't take anyone who is solely funded by the LA unless the family make up the difference, then in such a home they charge £800 pw paid by the self funders, and for non self funders they charge LA £600 pw and family £200 pw = £800 pw.
The care home - if they have agreed to take in people who are solely funded by the LA, then in such a care home, the care home charge £1,000 pw for self funders, and non self funders are charged £600 pw paid by the LA - so average charges = £800 pw. It turns out therefore that the self funders in such a care home are subsidising the non self funders.

Thank you so much for that explanation, extremely helpful to my understanding of how it works.

Unfortunately in my region care homes cost on average £1600 a week. I don't know yet what my mother's personal budget will be (I was thinking about £700 but could be wrong) but they have all told me I would have to make up the difference privately as a third party - there's not much chance I can come up with a thousand pounds a week! I've tried negotiating with some of them, but to no avail (with the possible exception of one which has just opened and needs to fill spaces). However I can't pay the top ups until my asset is sold, so a bit of a vicious circle at the moment.

All that said, the financial assessment might reveal that my mother is above the upper threshold for two or three months which could buy me a bit of time. I've put the asset on the market today so I'm feeling a bit emotional.

Unless I get lucky finding a good local authority placement I'm going to have to go down the top up route somehow.

The social worker got in touch yesterday to ask how far away we would consider. I don't know what happens now or how long it might take to be offered something, or when or where the financial assessment would take place. I'm hoping as long as possible so I can continue my search.

 

[Portugal1000]

I have read this thread with interest and concern if I am honest. My mum has been in care/nursing homes 3.5 years. I dread to think what's she has spent, has to be over £250k now. She has £90k left so at £7k a month its going to last another year or so. The nursing home also get around £1000 a month direct from local authority for nursing care (apologies forgotten official name) so really care home are being paid £8000 a month for my mum. Had initial conversation with funding team who said max they pay is £900 a week. So even with her pension I estimated we would be talking at least £1000 a month shortfall. What concerns me is that there seems to be the assumption that I will pay the difference which I will not be doing, especially given she will have contributed over £300k by then. I am happy to pay the extras that she needs that wont be covered like clothes, treats, hairdressing etc. I wondered how much pressure is put on families to pay? Am I right in thinking that the LA will be responsible for finding a nursing home that will accept the funding if she is not allowed to stay where she is? Having moved her earlier in the year I already know that I will never find a home where we live for that amount and genuinely do not have the energy. Thanks for any advice.

 

[AnneF]

Am I right in thinking that the LA will be responsible for finding a nursing home that will accept the funding if she is not allowed to stay where she is? Having moved her earlier in the year I already know that I will never find a home where we live for that amount and genuinely do not have the energy. Thanks for any advice.

My understanding is that if the client is running out of money then the local authority has a duty to ensure their needs are met. You may be able to successfully argue that moving your mother to a cheaper home is not in her best interests, in which case the local authority would need to enter into an arrangement with the care home to keep her where she is.

When going into care the care home will normally expect the client to demonstrate that they can cover the fees for a given amount of time - it's quite common for this to be two or three years. That is often the point at which the home will accept the local authority rate should the client's funds run out. A third party cannot be pressured into making those payments (though it's common for the home to ask if you can).

 

[nitram]

I am happy to pay the extras that she needs that wont be covered like clothes, treats, hairdressing etc

She would be left with the PEA (personal expenses allowance) to pay
for incidentals

. I wondered how much pressure is put on families to pay? Am I right in thinking that the LA will be responsible for finding a nursing home that will accept the funding if she is not allowed to stay where she is?

The LA will try to persuade the family to pay third party top up probably by inferring that it is normal, nobody has to pay they are optional.

The LA have to find one placement meeting it's assessment, not your requirements, if it means paying over it's tariff it has to stump up.

You might have some success with the current home by reminding them of the £300k (+£1000/mth FNC) they have already received.

Another argument you could use is that she is settled in the home and moving her would be detrimental to her wellbeing and therefore not in her best interest,

 

[Chizz]

I have read this thread with interest and concern if I am honest. My mum has been in care/nursing homes 3.5 years. I dread to think what's she has spent, has to be over £250k now. She has £90k left so at £7k a month its going to last another year or so. The nursing home also get around £1000 a month direct from local authority for nursing care (apologies forgotten official name) so really care home are being paid £8000 a month for my mum. Had initial conversation with funding team who said max they pay is £900 a week. So even with her pension I estimated we would be talking at least £1000 a month shortfall. What concerns me is that there seems to be the assumption that I will pay the difference which I will not be doing, especially given she will have contributed over £300k by then. I am happy to pay the extras that she needs that wont be covered like clothes, treats, hairdressing etc. I wondered how much pressure is put on families to pay? Am I right in thinking that the LA will be responsible for finding a nursing home that will accept the funding if she is not allowed to stay where she is? Having moved her earlier in the year I already know that I will never find a home where we live for that amount and genuinely do not have the energy. Thanks for any advice.

Query - (a) in what area is this home?
(b) what to they provide for that level of charging? - compared with a home charging half that amount?
(c) do you think it's good value?
I'm just interested.

 

[maisiecat]

The Dementia nursing home my husband is in costs 1800 a week in Surrey. We had no chance of finding that money even when we were both working we didn't earn it. There was a massive gap between LA payment and the fees but my husband's behaviour coupled with his Parkinsons made his needs so high nobody else would accept him.
I pay £1100 a month top up from a legacy I got many years ago it will last 3 years but I will need to sell our house before then. In terms of top up it has to be from money in your sole name.It cannot be from money moved from joint assets. I had to prove where this money had come from and that it had never been treated as a joint asset and believe me they can do a really deep dive on your finances.
Third party top up is voluntary even if they tell you its normal for family to pay. I offered the top up to tip the scales more in my favour but it was money I had hoped to give my grandchildren.

 

[Chizz]

The Dementia nursing home my husband is in costs 1800 a week in Surrey. We had no chance of finding that money even when we were both working we didn't earn it. There was a massive gap between LA payment and the fees but my husband's behaviour coupled with his Parkinsons made his needs so high nobody else would accept him.
I pay £1100 a month top up from a legacy I got many years ago it will last 3 years but I will need to sell our house before then. In terms of top up it has to be from money in your sole name.It cannot be from money moved from joint assets. I had to prove where this money had come from and that it had never been treated as a joint asset and believe me they can do a really deep dive on your finances.
Third party top up is voluntary even if they tell you its normal for family to pay. I offered the top up to tip the scales more in my favour but it was money I had hoped to give my grandchildren.

Hi @maisiecat
I'm sorry and saddened to read your post. What you have said is the sad financial reality of this rotten illness.

The NHS and HM Government ignore Dementia and pretend it's not there.

When I hear the phrases "We have the best system in the world" and "the NHS free at the point of service" I want to SCREAM "No its BW not!" and cry at the same time, as there is no real system for Dementia care that is a full service or free.

Best wishes to you and a hug.

 

[Portugal1000]

Query - (a) in what area is this home?
(b) what to they provide for that level of charging? - compared with a home charging half that amount?
(c) do you think it's good value?
I'm just interested.

The home is in Surrey and by no means the most expensive one I saw. They are fantastic but really don’t think any home should be costing £8000 a month. It’s quite insane. My mum is mobile and can be difficult although I rarely see this. Very limited short term memory but can hold a conversation.

 

[Veritas]

The Dementia nursing home my husband is in costs 1800 a week in Surrey. We had no chance of finding that money even when we were both working we didn't earn it. There was a massive gap between LA payment and the fees but my husband's behaviour coupled with his Parkinsons made his needs so high nobody else would accept him.
I pay £1100 a month top up from a legacy I got many years ago it will last 3 years but I will need to sell our house before then. In terms of top up it has to be from money in your sole name.It cannot be from money moved from joint assets. I had to prove where this money had come from and that it had never been treated as a joint asset and believe me they can do a really deep dive on your finances.
Third party top up is voluntary even if they tell you its normal for family to pay. I offered the top up to tip the scales more in my favour but it was money I had hoped to give my grandchildren.

The critical bit in what you have written above is that nowhere else could be found able to meet his needs and willing to take him. In that case, the LA is required to pay the full cost, and you should not be paying these top-ups. The idea of you being epected to use up your own savings/selling your home is just shameful. Please get some independent advice, as apart from anything else you cannot predict what your own needs might be in future.

I’d be tempted to tell the LA that I can’t pay the top-ups any more, and see what happens. It’s a lot more difficult for them to move someone to a cheaper home than they would have you believe, and if he’s been there a while there’s an argument that moving him is not in his best interests. Also, you might want to look in to CHC funding, especially given the Parkinson’s diagnosis.

 

[Neveradullday!]

https://www.alzheimers.org.uk/blog/how-much-does-dementia-care-cost

As the above article says (it was last updated in 2021) - total cost of dementia care is £34.7 billion a year. This works out at an average annual cost of £32,250 per person with dementia.
This seems to be what the government pays?

It also says the total cost of care for someone living with dementia is typically £100,000 but can cost as much as £500,000.

 

[maisiecat]

Hi @maisiecat
I'm sorry and saddened to read your post. What you have said is the sad financial reality of this rotten illness.

The NHS and HM Government ignore Dementia and pretend it's not there.

When I hear the phrases "We have the best system in the world" and "the NHS free at the point of service" I want to SCREAM "No its BW not!" and cry at the same time, as there is no real system for Dementia care that is a full service or free.

Best wishes to you and a hug.

Thank you @Chizz but as we all know the reality of managing all this is awful. I always wondered who decided Dementia is less a medical condition and more a social problem. Its so sad that there are so many of us treading this miserable path.

 

[maisiecat]

The critical bit in what you have written above is that nowhere else could be found able to meet his needs and willing to take him. In that case, the LA is required to pay the full cost, and you should not be paying these top-ups. The idea of you being epected to use up your own savings/selling your home is just shameful. Please get some independent advice, as apart from anything else you cannot predict what your own needs might be in future.

I’d be tempted to tell the LA that I can’t pay the top-ups any more, and see what happens. It’s a lot more difficult for them to move someone to a cheaper home than they would have you believe, and if he’s been there a while there’s an argument that moving him is not in his best interests. Also, you might want to look in to CHC funding, especially given the Parkinson’s diagnosis.

Good morning @ Veritas,
Thank you for your repliy. I do have a financial advisor but in the end I settled on paying to get him the best option I could. I don't drive so I was such an easy target and they kept threatening places that I couldn't get to. He spent 3 dreadful months in hospital where the care was apalling and I am a retired nurse so I know what care should look like. He was so aggressive and attacked them continually and my main aim was to prevent him from being sectioned when they have carte blanche on where someone goes.
He is being assessed for CHC but I don't think he'll get it as the Home has worked their magic on him and he is more stable and less aggressive.
I am afraid that our story is tragic like many on here but he is well cared for now and I can get to visit.