Q&A: Paying for Residential care - Tues 24 July, 3-4 pm

[Saun_A]

Question 9:
I hope your discussion covers NHS Continuing Care (NHSCC).

This is very poorly publicised - I, a retired NHS consultant surgeon, had not heard of it and when my wife with Lewy Body Dementia started needing more care than I could give her I was only pointed to 'social' care for which we no where near passed the means test. It was a 'friend of a friend' who hearing me moan about it pointed it out to me. After a hard battle (it took 6 months, but we did get partial back pay) she was eventually granted it for a full-time live-in carer plus cover for his time off. Worth c £1,000 a week., enabling me to look after my wife at home for the last 18 months of her life. I worked it out as being cheaper than a nursing home.

The Alz Soc's website (as also Age Concern's) hides info about NHSCC deep in its website and one needs to be persistent to find it.

Fortunately though my wife's main diagnositic label was 'Lewy Body Dementia' which by itelf would not pass the strict criteria to get it granted, when I persuaded the assessors to break her disability down to its Parkinsons element with its mobility, incontinence, swallowing and feeding problems, lack of spatial awareness etc etc, it ticked enough boxes.

AS needs to campign ++ to get dementia classified as an illnes / viz as a 'health' and not a 'social' problem

 

[Saun_A]

Question 10:
I am in process at looking at care for my husband. Can you help with following questions please?

1. My situation will be very difficult for me, as I understand my Husbands State pension and half private will be taken to fund his care.

But we still have a large mortgage in joint names, worrying how I will fund this if I lose his money also, even though I have some savings…….. Will the mortgage payment be taken into account?


2. Also as they take his State pension, does this include his Serps as this is quite high…. If they take this, can this be inherited/returned to me in the future?

Thank you for all your help, and your wonderful website Talking Point.

 

[Saun_A]

Question 11:
My husband has young onset Alzheimer's and whilst at home at the moment, we have respite booked in a few weeks and permanent care isn't too far away. He has some money in a pension fund that we have found out we can have on a draw down basis, can we be made to withdraw the full funds from this to pay for care ahead?

Thank you

 

[Saun_A]

Question 12:
My husband has been in care for a year now with the local council topping up 1/3 to our 2/3 of the home fees.

I have recently downsized as the house and garden were too large just for myself. The council insisted that the purchase of the new property be in joint names so they can claim 50% of funds should I die first. I had to inform the council as to what profit had been made on completion of the sale and purchase and also as to how much was received on the sale of shares my husband held. I have received a letter from them stating that his share of these figures means that he is now well over the threshhold of £23,250 so from now on he will be funding himself totally until the funds reduce to £23,250. My question is:

As I am now 76 years of age can I legally use some of my husband's funds to make the necessary alterations to the property I am now living in to make it safe for myself. Things that need addressing are the uneven patio; two windows in the property that do not have toughened glass so could shatter if accidentally struck by an object (I have young grandchildren, so this is of concern); the wet room floor has been incorrectly laid so floor floods, this may need the floor to be redone (this wet room was put in by previous owner).

I feel that as the council insisted on the property being in joint names then surely 50% of any remedial works should come out of my husband's share of the proceeds or am I being naive!!

I would welcome your comments and assistance in this matter before I reply to the council.

 

[Saun_A]

Question 13:
Hello, my sister (70) and I (68) co-own and co-habit our bungalow in Dorset. It is worth approximately £300k and is mortgage - free.
Sis has severe AD and I care for her at home. If she needs to be placed in a care home she would be self-funding. I know our bungalow cannot be sold from under us to pay for her care, but I may need to downsize in the future. There is no possibility of finding a property for £150k (my share) in this county. I would be without my own home.
Many thanks

 

[Saun_A]

Question 14:
Mum has Alzheimer’s, my sisters and I are her carers and have LPA. Mum has just gone into Nursing Home and we need to sell mums house to fund future care.

Dad died and house (no mortgage) has been left in trust with 50% share to 3 daughters and half to Mum.

Few questions:-

1/ can we just sell house, utilising LPA, acting in mums best interests to secure funding for future care?

The excerpt below from Will says we cannot sell house without mums written consent - does the LPA over ride this?

2/ what do we need to do to ensure we follow legal procedures in the sale of the home to evidence/register that we have done things correctly? Do we need to advise/register with anyone?

3/ once sale has gone through can we invest mums share of home until funding is needed? We have enough cash currently for one years funding.

4/ once house sold is our share of the property released to divide between 3 siblings, or should it be saved/invested until mums death?

5/ in selling house do we share house sale fees between Mum and ourselves?

6/ any other advice that is important for us to consider?

 

[Saun_A]

Hello everyone and welcome to Talking Point's Q&A on Paying for Residential Care. I would like to welcome Tina who has kindly offered to answer your questions today. We have received quite a few questions on this topic and I would like to thank everyone for their contributions; both via emails and on this thread.

I will now pass you on to Tina, our Knowledge Officer to answer your questions. Over to you Tina.

 

[TinaN]

Hello everyone and welcome to Talking Point's Q&A on Paying for Residential Care. I would like to welcome Tina who has kindly offered to answer your questions today. We have received quiet a few questions on this topic and I would like to thank everyone for their contributions; both via emails and on this thread.

I will now pass you on to Tina, our Knowledge Officer to answer your questions. Over to you Tina.

Hello and thank you for your varied and numerous questions. This is a thorny and complicated subject and by necessity it is sometimes a bit wordy. Please do let me know if I post something and you need it clarifying.

 

[TinaN]

I am so pleased as last month (after me asking for over 2 & half years) we have been told Mum is entitled to FNC.
Finally! What a relief! A good night's sleep! Less money to find!
Until the manager of the home studied the report and decided her needs meant a move to Nursing floor.
So fee increase is over double the FNC amount!
I have asked if this is considered an 'end of life' move & have been told definitely not.
(although they seem to talk more to me about DNR & Funeral directors than care plans!)

Not even sure if I have the energy to argue, there seems no point

Hi

I wonder if this decision to award funded nursing care came after consideration for NHS fully funded continuing healthcare (CHC)? It should have been considered first before the decision to ‘downgrade’ to funded nursing care. If you aren’t sure then already there must be issues because the correct procedure must be followed and whether they did it or not, you should have been involved and given copies of appropriate documents. You can ask whether your Mum was assessed for CHC and what the result was. We have info on Funded nursing care in our publication When does the NHS Pay for Care? (page 22). I know it’s an overwhelming and painful process and people do run out of steam, which I fully understand.

It may of course turn out that your Mum’s needs are greater now but you are entitled to a clear explanation of why this change is being made and you should not be using your own money to pay for your Mum’s care. I don’t have enough information to help you on that front but please do look at our Paying for care and support – England factsheet and make sure that any financial assessment follows the rules and comprehensive care plans are provided. See also Assessment for care and support – England

I hope this adds something and is helpful

Tina

 

[Sue14]

Hello and thank you for your varied and numerous questions. This is a thorny and complicated subject and by necessity it is sometimes a bit wordy. Please do let me know if I post something and you need it clarifying.

Please excuse my ignorance: is this session by "typing Q&A" or is there a link to listen to the questions being discussed? Andrea

 

[TinaN]

very timely
had a meeting at Hospital only yesterday about my Dad;
they are wanting to prepare him for discharge (been in hospital for 7 months) - he's on a section 3
We've had one DST several months ago. A total admin cockup, which resulted us not being able to comment on the day of the DST, and had to request a further meeting to state our case. Which we were told would be recorded but not used as part of the DST.
So now the Dr states we need a new DST (this was yesterday), yet today the ward sister says no we don't !
****....elbow...etc
question;
as he has shown no signs of improvement over the past 7 months, despite continual meds changes, he is in serious decline, both mentally and physically.

We have been told today that he will get 'some' funding, but as he has savings he will have to top it up !!!
Dr stated he will be on a 117 when he leaves hospital.
Dont really know what to do !

Hi Double Trouble

There are two or three different things happening here and I feel the need to start with the Section 3 and section 117 aftercare issue. If your Dad is detained under a section 3 at the moment then section 117 aftercare is funded by the local authority and/or CCG. Only if suitable care is offered and refused by you or your Dad and you choose a more expensive option, can a top up be ‘demanded’. See my reply to others on this thread about top ups and our factsheet on Paying for care and support – England

Unlike other social care , if there is a top up to be paid for s117 then it is possible for the person’ s own savings to be used to pay this ‘first party top up’. It isn’t possible in social care generally where only a third party can top up. However, the rules around when a top -up is appropriate (whoever pays it) are the same.

So if we have established that Dad is to have section 117 aftercare I wonder why there has been a Decision Support Tool (DST) used when this is for NHS Continuing healthcare (CHC) assessment?

NHS Continuing Healthcare (CHC) is awarded to people who are assessed as having a primary healthcare need. It does not rest upon a mental health condition and there are 12 areas of need (care domains) that are taken into consideration. Their care is fully funded by the NHS and is reviewed regularly so can be and is often removed! The person then reverts to being means tested for their care – this is a very very general explanation and there is an awful lot of detail that I am not including. Our publication When does the NHS Pay for Care? and it has a lot of information about NHS CHC funded care.

Section 117 aftercare under the Mental health Act (MHA) is not the same. This does rely upon needing treatment and/or support for a mental health condition. I understand this is what your Dad is receiving?

Basically s117 aftercare comes about after a process –

• Detained under s2 of the MHA for assessment but can only be held for 28 days
  
  
• they may move under a Section 3 which allows them to be detained in hospital for up to 6 months for treatment.)
  

Section 117 can be removed if the person’s need becomes more about their physical rather than mental health but it doesn’t happen as often as removal of CHC.


The CHC National Framework Practice Guidance lays out the relationship with the mental health legislation starting at PG65 on page 93 and clearly emphasises that CHC and MHA s117 aftercare funding are separate things and should not be confused.

It may of course be possible that your Dad is expected to receive both S117aftercare for mental health needs and CHC funding for any physical healthcare needs (it happens sometimes) .

So you ask what to do now – I would suggest you ask the person who is co-ordinating your Dad’s discharge from hospital whether your Dad is actually being s117 aftercare funded and if so, you should have this information clearly explained to you and provided in writing so that you are fully informed.

Once you know whether your Dad’s care is s117 aftercare funded (therefore free) and whether there is any CHC funding involved (therefore free) you can ask what the top up is about? Why would there be a top up (again explanation in writing). Do they have a care home that meets Dad’s needs within their budget? Where is it and why have you not been informed so that a decision is made appropriately. Since the discussion between doctor and ward sister yesterday was a bit uncomfortable maybe they have also worked out that this is just s117 aftercare and someone is talking about a first party top up (which your Dad pays) and that is what you can question.

I’m so sorry this has to be so complicated and I hope that you will make sense of it even if you have to revisit my answer a couple of times.

Hope it helps a bit and I apologise that there is a lot of info here
Tina

 

[Saun_A]

Please excuse my ignorance: is this session by "typing Q&A" or is there a link to listen to the questions being discussed? Andrea

Dear Sue,

Thanks for your post. Yes, this session is by typing a Question which Tina will answer. Thanks.

 

[TinaN]

My husband is still at home with me, and long may he be. However I am realistic and sooner or later he will need more care than I can give probably, especially if he becomes violent. People seem to love telling me that they often become violent. I have 2 questions:-

1. We each have an ISA and I would plan to use his to pay for care. When that runs out, would they then be able to take mine as well? I am hoping I won't be destitute in the end.

2. Our house is not owned jointly by us but we are 'Tenants in Common' a legal term to mean that we each own 50% as separate individuals. We did that when we first registered the house about forty years ago. Will they take half the house if the money runs out?

Hi

The first thing I would say is that although changes in behaviour may be inevitable, not all people living with dementia become violent. You may be interested in our factsheet Changes in Behaviour.

In terms of your paying for care enquiries it’s a pleasure to answer you because I can say something positive and it isn’t bad news!

If your ISA is in your name and totally yours then there is no reason why it should be used to pay for your husband’s care. Only his assets can be used (which will usually include half of any joint accounts).

As long as you continue to live in your property it is completely disregarded in the financial assessment. If it became necessary to find residential care for your husband in the future, the property ( as the law stands at the moment) would be ignored fully. There is some useful information about this in our factsheet Paying for care and support – England .

Hope this is useful to you
Tina

 

[TinaN]

Hello everyone,

We have received quite a few questions that have come in by email ahead of our Q&A this afternoon so bear with us. We will try and answer as many as possible in the one hour slot.

In the meanwhile. Please refrain from answering the questions. Tina will answer them this afternoon. This is a complicated area and Tina will do her best to respond to each individual question.

I will list the questions on this thread so all of us can benefit from the responses. Thanks.

Question 1: My husband is in a nursing home and I am self funding from a small inheritance his mother left him (60 thousand) and this will eventually run out so I will be funding it from some of his other savings. This will in time run out. He has a civil service pension and we have been living on this, both of us. I have savings which are in joint names and were for my pension. Would they take all of my husband’s pension or could I retain half as his wife?

Hi – thanks for sending this interesting question. I’d like to start by making it clear that once your husband’s assets (in this case the inheritance from his mother) drops to £23,250 the local authority (LA) may begin to make a contribution to his care costs at that point, depending upon his level of income. When this figure drops to £14,250 the LA will disregard that sum completely and it will be ignored in the financial assessment so only his income (and any other assets he may have) will be used to pay for his care.

When he arrives at the £23,250 level and the LA’s financial assessment looks at his income, his occupational pension has to be included but the Care Act does allow up to half of it to be passed back to you, which is your main question here. Annex B Treatment of Capital Section 46(b) confirms that the 50% he passes back to you is ignored in the financial assessment.

You say you have savings in joint names - joint accounts are usually assumed to belong to both parties so the LA would usually take 50% of that into consideration, as your husband’s asset. There is an assumption that you both have access to it. If there is an explanation that you can offer the LA about why the money in these joint accounts is solely yours you could discuss it with them but it is a tricky area and I would always suggest that any issues or discussions are confirmed in writing.

It’s important to remember that you should not be funding your husband’s care from your own resources. I know that for many couples there is no distinction between what is yours and what is mine but in this context the LA must establish what belongs to whom and only the person receiving the care should pay for it (unless of course there is some other third party top-up agreement in place but that’s a different thing entirely)

There’s more information about this in our Paying for care and Support in England factsheet

Asking for information in writing makes the person providing the information think very carefully before it is committed to paper (or email), it gives you time to think carefully about what they’ve said (much easier than trying to keep track of a fleeting comment as they leave the room) and importantly, if you disagree with the decision, it gives you evidence to take through the complaints process. You can ask the LA for a copy of their complaints process but for some people this could lead to the Local Government and Social Care Ombudsman

Many thanks - hope this helps
Tina

 

[PJTree]

Are there more replies? The last one posted was 8 min ago to Sue14? Where are they? I can't see any?

 

[TinaN]

Question 2:

My mums been in hospital and now rehab for 4 months. There trying to discharge her to a 24 hour care home EDM unit.

We’ve not had a meeting at the rehab with anyone sent us a list of vacant care homes with no top up fees but there miles away from her family.

She dosnt have and savings and under the thresh hold. We own the home she lives in she’s sign it over to us 11-12 years ago now via a solicitor. Should we request a financial assessment on her before she comes out of rehab as we cannot afford top up fees and don’t know who or how much they will pay for her care. She did have carers in before at home with financial help. At a loss of what to do next. Any help would be appreciated. Thanks

Hello

Yes you are right that a financial assessment should be done and afterwards you should be provided with a clear written explanation of how Mum’s income has been treated in the assessment. It’s equally important, as part of the discharge process, that her needs are assessed and agreement reached on how those needs will be met. It is not acceptable for a local authority (LA) to simply say they will allow a certain amount to meet Mum’s needs, unless they know what her needs are. Again, you should receive written confirmation of the findings after the needs assessment.

It’s worth being aware that the LA will have an amount they say will meet a certain level of care in their area - the maximum they will pay basically. First though they must offer a place that is within their budget (as you said they have offered care homes but they are too far away from the family) You must consider it, is it suitable and does it actually meet Mum’s identified needs and meet them as per her care plan? If not, then you can tell the local authority that it is not a viable alternative and ask them to provide a place that does meet her needs, however much it costs. You cannot be asked to pay a top up, unless they are offering you a cheaper one that meet Mum’s needs and you have said no to it. Evidence will help, for example if your Mum’s care records record the importance of family visits for her wellbeing, you could argue that it does not meet her needs –this is only an example but well recorded care records will help you to identify important things.

However, if the LA can evidence that they have offered a cheaper care home place that meets Mum’s needs but you have refused it then they may be able to ask for a top up. It is important to note that the Care Act requires the LA to be clear with the third party about the implications of topping up eg what happens if fees rise or you cannot top up in the future. For example pointing out that this could result in someone being moved to cheaper care home at a later stage.

The Care Act Appendix A deals with ‘Choice of accommodation and additional payments’ (ie top ups!) There is a lot of information in this annex about top ups but there is also a lot of information about the person having choice and control, which runs through the Care Act and the LA needs to be clear about how and why it is making these decisions. Money cannot be the only consideration.

So the focus is putting together an argument around why a particular care home (nearer to family?) is the only one that meets her needs. Does anyone have a legal power to deal with this (LPA for health and welfare?) and/or has a best interest meeting been held to discuss this in line with the Mental Capacity Act? Deciding where someone will live is an important decision and the MCA discusses how things of this magnitude should be decided. You appear not to have been consulted on this or met with anyone. Ask the LA whether a best interest meeting was held and why you were not involved.

Its always tricky but you are doing the best thing in trying to prepare yourself. Be confident enough to ask the LA to provide written information and if they use language you don’t understand tell them that.

 

[Saun_A]

Are there more replies? The last one posted was 8 min ago to Sue14? Where are they? I can't see any?

Hello PJTree. Yes, there are more replies coming. As this is a live Q&A lasting for an hour, you will see replies being posted as Tina types them. Thanks.

 

[Theresalwaystomorrow]

Hi Tina
Can you answer this please
Cut long story short we started CHC and went to second stage before mum going in a home
The home gave me a contract that clearly typed that I am not a self funded and local authority will pay, however now the Home has sent me a bill? Should I pay or is this contract void ?

 

[TinaN]

Question 3:
My 89 year old father has Dementia and my 85 year old mother as Alzheimers. They basically have not much else wrong with them other than frailty through bad nutrition and self-neglect, and take no medicines at all. They both refuse to have any sort of help/assistance at home other than me (who lives 50 miles away) seeing them weekly and dealing with POA and medical issues, washing, etc., and my brother seeing them weekly bringing their food shopping. In between they go nowhere and see no-one - their choice.


However, it is fast approaching the time where Social Services will have to step in on a 'best interest's basis and insist on carers or a care home. My parents are quite wealthy and are well over the £23k threshold so will I expect have to pay for all of their care. However,I would like advice as to whether because of their dementia/alzheimers care needs, they are entitled to any NHS funding. They already receive AA.

Hi

I suspect you have hit the nail on the head when you say your parents will probably have to pay for their care. A diagnosis of Alzheimer’s or indeed any type of dementia does not carry automatic eligibility for NHS Continuing healthcare (CHC) funding , as much as we would like it to. Eligibility for CHC funding is never ’condition specific’ and relies upon identifying the person’s needs in line with the criteria laid out by the Department of Health. We would argue that many people with dementia should be eligible for CHC and if the test for a ‘primary health need’ was carried out appropriately in the assessment, more of them would be found eligible for this funding. The majority of people found eligible usually have another condition that complicates their care (but even then it’s a struggle) or have behavioural issues that put themselves or someone else at risk but if their needs are seen as purely social care needs and not healthcare needs then they will not be funded by the NHS.

We would suggest that the best way for people to access NHS CHC if they think they are eligible or they represent someone who they think is eligible, is to inform themselves fully of the CHC criteria, before the process starts. Read and prepare as well as you can. Gather evidence required to support your argument and understand what information and support you are entitled to receive from the CHC team, who are carrying out the assessment.

There are a number of different sources of information and because the whole process is so complicated I often suggest that people ‘ease’ their way in by starting with the simplest versions. It will help a lot if you are able to familiarise yourself with the following documents in advance (some of which are quite long and involved).

• The NHS produces its own public information leaflet which, as you might expect is a rather ‘rose tinted view’ but it is a simple introduction.

Maybe follow this with our own publication When does the NHS Pay for Care?

• Here is a link to the National Framework (quite important that you familiarise yourself with this if you can)
  

Basically speaking, in the full multi disciplinary team (MDT) assessment the assessors should adhere to the National Framework and use the Decision Support Tool (DST – link above with the National Framework). The idea, according to the National Framework is that the DST is used to help the decision making process.

Very importantly for our people, the DST should not be used as a ‘tick box’ and other important issues must be considered with the assessors using their professional judgement and the ‘primary health need test’(see page 10 of When Does the NHS Pay for Care for brief intro)

I’d love it to be a much simpler and much fairer system but I’m afraid this is what we are currently living with.
Hope this adds something useful
Tina

 

[TinaN]

Question 4:
i have been trying to get answers for 10 years or more from MPs and everybody of every part no luck so now im writing to you

our parents both had dementia and sadly had to go into care.

we picked a home for dad first which we believed was safe and good and we paid the rent every week

then out of the blue we had a letter from cqc saying they had pulled it up for not just simple things but things that could cause danger to life

we move dad straight away to another home as soon as we found out

but what we were so mad about and it is wrong is

if a home is pulled up and it hasn't been good or safe the home doesn't have to give any of the money paid to them

over the time it was unsafe this is wrong and it should b under the not got what paid for law ( sorry not sure of the title)

all it got was a telling to carry out things and carry on they would inspect again, when we went to see dad the home was carring out repairs with the residents still amongst the caose and disruption going this

of course we questioned this at the time and even tried to get dads money back through a solicitor

it was s o hard and paid for this but the solicitor told us best to drop it they have more money than us and could carry on but we couldn't and could lose everything

now this is wrong dont you think

if we go to a hotel we pick one and it turns out to be rubbish and dangerous we can complain to ABTA but homes don't have to do this and WHY?

this is so wrong and we see it in papers all the time

then we couldn't believe it but the home our mum was in

it happened again we couldn't believe it we had meetings with the owners ect but got no where and the things they got done for wasn't trivial example one

it was even they didn't check papers of employers and they weren't even nurses but they go the jobs

this is so wrong they were not cheap homes over one thousand a week and more but cheap or dear it shouldn't happen

it is heart breaking enough to go through this with a loved one let alone all this when putting trust into one to care for sick person

another piece is if a person goes into a care home and owns own home and another person lives there under 60yrs old apart from husband or wife but children

yes they are asked to leave to sell the home to pay care rent

it has gone from care and compassion to big business

no one knows what is in front of them and it is so frightening and should be stopped they are laughing right to the bank. i really could go on and on as to what has happened over the passed 10yrs to us all and think this all needs to b brought out into the open and stopped

as i said over the years i have written to MPs government a and all people i thought would b able to help and stop this but no it is still going on today and no one seems to b taking any notice

WHY? and another thing cameras should b instilled as no o ne knows what happens behind closed doors as we read in papers theft and even slapping of residents

anyway i best stop now as this letter will be to long

so i hope you will be able to put this forward but i cant think to who as i have written to every one but they might take more notice of your society

have written lastly to Caroline Dinagee the new minister but got nothing from her only a letter back from admin and tolls me all i had put into my letter but in a different way

so really we have lost a bit of faith

anyway lets hope you can put this forward and thank oyu

Hello
I do feel your frustration at the lack of sensible answers to your very reasonable questions. Sadly it isn’t something that we can address in this paying for care session but we will answer your question separately.
Many thanks
Tina