Not Understanding Funding

nita

Registered User
Dec 30, 2011
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Essex
One thing strikes me, though I admit I don't know much about local authority care home funding - that is the contract with the care home. When your chosen home says they can put a contract in place I wonder if that is the same as what the local authority mean. I understand that they have block bookings with certain care homes and this may not be one of them. Can you find out if that is the case?
 

nita

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Dec 30, 2011
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Essex
Just to add - the block booking of places the LA does is to negotiate a lower rate that is acceptable to them.
 

sdmhred

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Jan 26, 2022
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Surrey
Sending you some oomph for the fight @AnneF

Youre probably spot on that many of the social workers don’t know the legislation as not many people will challenge and quote it.
 

AnneF

Registered User
Jul 13, 2023
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When your chosen home says they can put a contract in place I wonder if that is the same as what the local authority mean. I understand that they have block bookings with certain care homes and this may not be one of them. Can you find out if that is the case?
Yes, a contract between the care home and the local authority. The contract is pending because the care home only opened last month. The local authority is saying we cannot go there because the contract hasn't yet gone through and can take a while. However the local authority cannot block our choice of care home on those grounds (the care home seems to think they can expedite the contract so it's hard to see the problem). The care home has been in repeated dialogue with the local authority placement team all week. I have also reached the point of quoting the law to the local authority.

The local authority does not have a block booking arrangement with this care home. The local authority cannot limit you to settings where they have any kind of pre-existing arrangement in fact.
 

AnneF

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Jul 13, 2023
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Sending you some oomph for the fight @AnneF

Youre probably spot on that many of the social workers don’t know the legislation as not many people will challenge and quote it.
Thank you @sdmhred - I am running out of oomph.

Yesterday my husband became ill and has now tested positive. He has gone downhill in the last few hours and cannot lift his head. We have both had the year from hell trying to look after mum and we have nothing left in the tank physically or mentally. He has always stayed strong and done everything possible to help me alongside a horribly stressful job. I feel so sorry for him. I can't even look after him properly as I am still weak and not fighting the virus off quickly enough.

I am consumed with anger because I have a sibling who has not lifted a finger to help. Her input has extended to one brief visit at the beginning of the year (for a couple of hours) and a couple of weeks ago one afternoon visiting our mother on the ward with a very brief visit either side. No actual help. When I try to tell her how awful it's been it doesn't seem to resonate at all, it doesn't seem to occur to my sister to help. At the beginning of this year I had to give up my business, all of my income, all of my clients, all of my free time, my friends, a chunk of my health, and most of my marriage. So that she didn't have to give up a blo*dy thing.

I'm sorry but I'm just so angry I want to sob. It's as if my sibling sees her mother as a distant relative and nothing more. It angers me further when my mum automatically trots out a raft of excuses for her all of which insult me. I didn't marry a rich man and produce grandchildren and I'm seen as a failure for that. My mum only respects women who are beautiful, rich, and who are mothers.

Last week I was putting in a long night cleaning and tidying the flat ready for the estate agent. I have a policy of going through every bit of paper and every box in case there is something important or sentimental my mother might want to keep. I found a collection of Christmas synopses my mum had written each year to her friends. I kept some of them in case they would be helpful for reminiscing classes at my mum's day care centre. But when I read one of them I was upset by something my mum had said about me and the kind of view that will have given everybody on her Christmas card list. Just another example of the things she's said about me behind my back over the years and par for the course, but under the circumstances/tiredness it got to me and I haven't been able to shrug it off.

I can wear myself down getting my mum into the best care home I can find but I know very well that all she will do is criticise it, and me (behind my back, always). I feel like throwing in the towel and letting the council put her in the pit they've chosen. But that weird thing called guilt always reels me back.

I'm sorry, but that rant was going to come out sooner or later. This is the only place where people will understand. I'm so tired and each day is getting harder. I feel the harassment from the LA (that is what it has been) had slowed my recovery and I am at breaking point. I am close to telling them to cease and desist - I just want them to leave me alone now. Every phone call from them has been high pressure, full of complete lies, repeatedly insisting that I cannot do any of the things set out in the legislation. Then more of 'I'll have to speak to my manager'. Then the manager phoning to repeat all the same nonsense. I can't take any more.
 

nita

Registered User
Dec 30, 2011
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Essex
I can well understand your frustration, anger and resentment. You have tried your best to get your mother into a care home that you hope will suit her needs and you have come up against what sounds like bureaucracy gone mad.

Just to manage your expectations (as they say), whichever home you pick your mother will likely blame you for putting her there and not like it. My mother, whom I got on well with, was upset with me when she went into respite and said "why have you put me in here?" She was convinced she was not like the other residents. So would you perhaps countenance your mother going into one of the LA's chosen homes just temporarily until you can get the financial side sorted out and then move her to the one you prefer?

I can understand you wanting to do the best for her and perhaps worry she will vent her fury at you for the situation. The LA are being pressurised by the discharge team at the hospital because the NHS is under such strain and they don't seem adaptable or nimble enough to adopt a solution that doesn't fit into their usual methods of working.

You have to think of yourself as you are ill and need to step back from this. Try to put it out of your mind over the weekend and you never know the LA may come round next week especially after all the messages you have been firing off to the people in charge.
 

Dave63

Registered User
Apr 13, 2022
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Are they confirming anything from these phone calls in writing? If not, ask them to confirm what you have spoken about in an email. There appears to have been a fair bit of moving the goal posts over the past week and having a record of who has told you what and what their decision making rationale is will be important when challenging their processes. It will also help the MP narrow in on any potential breaches of the Statutory Guidance.

Hope you and your OH are feeling better today.
 

AnneF

Registered User
Jul 13, 2023
145
0
I can well understand your frustration, anger and resentment. You have tried your best to get your mother into a care home that you hope will suit her needs and you have come up against what sounds like bureaucracy gone mad.

Just to manage your expectations (as they say), whichever home you pick your mother will likely blame you for putting her there and not like it. My mother, whom I got on well with, was upset with me when she went into respite and said "why have you put me in here?" She was convinced she was not like the other residents. So would you perhaps countenance your mother going into one of the LA's chosen homes just temporarily until you can get the financial side sorted out and then move her to the one you prefer?

I can understand you wanting to do the best for her and perhaps worry she will vent her fury at you for the situation. The LA are being pressurised by the discharge team at the hospital because the NHS is under such strain and they don't seem adaptable or nimble enough to adopt a solution that doesn't fit into their usual methods of working.

You have to think of yourself as you are ill and need to step back from this. Try to put it out of your mind over the weekend and you never know the LA may come round next week especially after all the messages you have been firing off to the people in charge.
Thank you @nita

I agree with what you're saying. My mum has agreed that residential care is the way forward, but she is a naturally difficult person (and often her own worst enemy). It makes me fearful at times of doing anything at all. But of course if I don't do anything she will complain about that as well!

I can certainly see how the hospital will be pressuring the local authority to get my mum off the ward. I have had a framework in place with our chosen care home for the last week, yet across that week the local authority has done nothing but repeatedly tell me that it is not possible. This is incorrect of course, and the home has said they could put things in place within a week if the local authority would cooperate with them. It's very frustrating.

The current position is that the local authority is saying they will not cooperate with the home if I am attempting to pay the top up direct to the provider rather than them. I cannot pay it to the local authority because I do not have two years of available cash, I have instead arranged a deferred payment agreement with the provider for when my property sells. That is quite common and by law the LA must allow that, yet the local authority is being obstructive.

I'm trying to see if I can borrow some money for the LA topup team, but I fear I can't and it's stressing me.
 

AnneF

Registered User
Jul 13, 2023
145
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Are they confirming anything from these phone calls in writing? If not, ask them to confirm what you have spoken about in an email. There appears to have been a fair bit of moving the goal posts over the past week and having a record of who has told you what and what their decision making rationale is will be important when challenging their processes. It will also help the MP narrow in on any potential breaches of the Statutory Guidance.

Hope you and your OH are feeling better today.
Excellent question @Dave63

Following all of these telephone conversations I have been told that I will receive an email summary of each. Not once have I received any such emails.
 

Jessbow

Registered User
Mar 1, 2013
5,831
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Midlands
one thng that has just come to my mind,not sure quite how to explain it
contract of engagement
Can one resident have two?One with local authority, and one with you?
can you split a contract like that?
Are the LA prhaps concerned that if they hold the contract, they will get clobberd if you default?
 

AnneF

Registered User
Jul 13, 2023
145
0
one thng that has just come to my mind,not sure quite how to explain it
contract of engagement
Can one resident have two?One with local authority, and one with you?
can you split a contract like that?
Are the LA prhaps concerned that if they hold the contract, they will get clobberd if you default?
I don't think the third party making the top ups can enter into a contract with both the local authority and the provider. I suspect that would be a very difficult situation to manage for a raft of reasons.

I think you are right that the local authority might be concerned that if you enter into the third party top-up agreement with the provider, and you then stop making the payments, they would have to continue paying the care home. That is largely moot though because whoever I pay the topups to would need proof of two years commitment to fees, so that concern is negated from the outset.

The issue is that the local authority is insisting I do not have the right to enter into a top up agreement with the provider. That is incorrect and is a breach of legislation.

Moreover, in insisting I make the payments to the local authority I would have to show either available savings covering 2 years of topups, or two years of consistent income which would cover the monthly top up fees over that period. Having taken the last year off to look after my mother (because the care package was so inadequate) I have neither income nor savings left. This is why the care home suggested I enter into a deferred payment agreement with themselves based on the sale of a property - a fairly common route to go down.
 

AnneF

Registered User
Jul 13, 2023
145
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Excellent question @Dave63

Following all of these telephone conversations I have been told that I will receive an email summary of each. Not once have I received any such emails.
Correction - I have now received an email summary from the conversation which took place late yesterday afternoon.
 

AnneF

Registered User
Jul 13, 2023
145
0
I'm thinking out loud here. Throughout this year when caring for my mother I have often been close to a breakdown. I made that known to the community social team early in the summer and was promised a carers assessment, which I never got. My understanding is that I am entitled to up to 4 weeks per year of respite.

I'm wondering if the local authority could invoke that respite now in order to remove my mother from hospital promptly to our chosen care home (who I think has already been taking respite clients). That would give everyone some breathing space to get the other paperwork squared away.
 

canary

Registered User
Feb 25, 2014
25,379
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South coast
I'm wondering if the local authority could invoke that respite now in order to remove my mother from hospital promptly
Yes they probably could transfer her to respite, but I suspect that they will still not be willing to pay for your preferred care home
 

AnneF

Registered User
Jul 13, 2023
145
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Yes they probably could transfer her to respite, but I suspect that they will still not be willing to pay for your preferred care home
The place has had several respite cases in the last month, I think some have been LA approved. There's a home much more expensive than the one we have chosen which takes LA respite cases (even though it doesn't accept LA funding without topup). I think I'll still ask.
 

AnneF

Registered User
Jul 13, 2023
145
0
To summarise the problems I'm encountering :-

I wasn't involved in my mother's needs assessments even though I am her primary carer, LPA for health and welfare, and she cannot fully articulate her needs on her own. The assessments took place over my head and without my knowledge. I had it written into the ward notes from day one that I should be included in all talks.

In that regard I believe the local authority is in breach of the Care Act 2014:

(5)A local authority, in carrying out a needs assessment, must involve—
(a)the adult,
(b)any carer that the adult has, and
(c)any person whom the adult asks the authority to involve or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult’s welfare.

---------------------------------------------

In insisting that my mother cannot go to any setting where the local authority does not have a contract in place the local authority is in breach of government statutory guidelines. In telling me that I must restrict myself to settings where the local authority has a block agreement that is also a breach of the guidelines. On Friday I was told I could not enter into a third party top-up agreement with the provider, which is also a breach of the guidelines:

Care and Support Statutory Guidance Annex A:

6) This choice must not be limited to those settings or individual providers with which the local authority already contracts with or operates, or those that are within that local authority’s geographical boundary. It must be a genuine choice across the appropriate provision

19) In supporting a person’s choice of setting, the local authority may need to enter into a contract with a provider that they do not currently have an arrangement with. In doing so, they should ensure that the contractual conditions are broadly the same as those they would negotiate with any other provider whilst taking account of the individual circumstances. Strict or unreasonable conditions should not be used as a means to avoid or deter the arrangement

20) In some cases, a person may actively choose a setting that is more expensive than the amount identified for the provision of the accommodation in the personal budget. Where they have chosen a setting that costs more than this, an arrangement will need to be made as to how the difference will be met. This is known as an additional cost or ‘top-up’ payment and is the difference between the amount specified in the personal budget and the actual cost. In such cases, the local authority must arrange for them to be placed there, provided a third party, or in certain circumstances the person in need of care and support, is willing and able to meet the additional cost

29)
· agree with the third party paying the ‘top-up’ (if this is not the cared for person) and the provider that payment for the ‘top-up’ element can be made directly to the provider with the local authority paying the remainder. However, as stated earlier, this is not recommended.
· the person making the ‘top-up’ payments pays the ‘top-up’ amount to the local authority. The local authority then pays the full amount to the provider

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When I quoted the legislation on the phone on Friday I was told that local guidance operates in times of increased need. However my understanding is that does not obviate government legislation or the rights of individuals.

The placement team has emailed me obliquely trying to lay some of the blame for the delay in discharging my mother. That is unreasonable, the care home said last week my mother could be admitted fairly quickly, likely by Tuesday 28th. The week has been wasted because the local authority has been intent on bombarding me with repeated phone calls telling me my mother cannot go there.

I have now been told that a contract with the home is being set up however they are saying the care home has not responded to the contract pack. It appears the contract pack was not sent to the care home until the tail end of the week.

The local authority has said there is no evidence I have a formal top-up agreement in place with the care home. Given that my mother was not assessed until Tuesday and the rest of the week has been given over to fielding refusals from the local authority to consider our choice of setting, there has been no opportunity to put the deferred payment agreement in place - and I believe this is not formally carried out until a mandate exists for admission.

The local authority has said that will not enter into a deferred payment agreement with me as a third party.

The local authority has instructed me to send details of the asset to them for scrutiny. Given that it is a private arrangement between myself and the provider I'm struggling to see how the local authority can demand information on a third party's property when they have already said they will not consider the property as collateral if entering into a topup agreement.

By the end of last week I felt the dialogue was verging on harassment and I feel it has caused the very delay we have all been seeking to avoid. I'm thoroughly exhausted and finding it hard to continue.

They haven't even got my mother's name right, they appear to be using another client's name.
 

Dave63

Registered User
Apr 13, 2022
483
0
Hi @AnneF

The third party top up and particularly the deferred payment side of things seems to be the sticking point. Would it be worth getting some legal advice, if only to ensure that your understanding of the third party deferred payment aspect is correct?

I've never had any involvement with Solicitors for the Elderly but I've seen them mentioned a few times here on the forum.

 

AnneF

Registered User
Jul 13, 2023
145
0
Hi @AnneF

The third party top up and particularly the deferred payment side of things seems to be the sticking point. Would it be worth getting some legal advice, if only to ensure that your understanding of the third party deferred payment aspect is correct?

I've never had any involvement with Solicitors for the Elderly but I've seen them mentioned a few times here on the forum.

Thank you very much for the link @Dave63 , I'll have a good look at that.

From what I've seen by talking to care homes in general, it's quite common for a deferred payment agreement to be entered into - either with the local authority (if the property is owned by the client) or with a third party paying topups in which case the agreement is entered into directly with the care home. It's the process the care home recommended to me during our meeting and it would be done through their head office. As it is a private arrangement I don't think the local authority can consider it a sticking point as it is technically none of their business.