Paying for residential and nursing care
Moving into residential or nursing home care is an important decision, and we want to give you as much help as possible.
Assessment of your care needs
You have the right to an assessment of your care needs, no matter how much money you have. You can request a care and support assessment by a Care Co-ordinator which will identify the level of care you need, for example Residential Care or Nursing Care, and the options open to you to meet your needs. This will include the type of care home you require and a list of suitable care homes.
Some care homes provide nursing care. Where your care and support assessment decides that you may also need nursing care, a health care professional will complete an assessment with you to see if the NHS will pay for your nursing care needs. If you qualify for nursing care, the NHS will pay for your nursing care, even if you are a self-funder (would normally have to pay for your care). You will still need to pay for your residential care.
If your assessment decides that you have significant health care needs, the NHS will pay for both your nursing care and residential care. This is called Continuing Health Care (CHC). Your financial circumstances do not affect the assessment for Continuing Health Care and if you qualify for this type of funding you will pay nothing towards the cost of your care.
If you do not qualify for Continuing Health Care funding and we arrange your care for you, you may be entitled to help towards the cost of your care from us.
How the cost of your care is calculated
The government has set detailed regulations and guidance on how we calculate your contribution towards your residential and nursing care, which we must follow. To enable us to do this, we will need to carry out a financial assessment.
Arranging a financial assessment
The Financial Assessment Team will contact you to arrange an appointment to undertake a financial assessment. You may be contacted by a member of the financial assessment team by telephone or by our outbound telephone service which is an electronic messaging service. Calls from this service will display the number 0191 313 0650. A financial assessment is the way that we work out whether we can help you with the cost of your care and what the cost will be to you. The financial assessment takes place over the telephone at a time pre-arranged with you. We will also check to see if there are any other benefits you can apply for. If you want us to, we can either help you to claim these benefits or we can pass your details on to someone else who can help you. During the financial assessment, you can have a member of your family or a friend present if you wish, or you can arrange for someone else to support you. If you would like a face-to-face appointment, you can arrange to visit our office to complete the financial assessment. We will treat any information you give us in the strictest confidence. We can only come out to your home to complete a financial assessment in exceptional circumstances. All members of the Financial Assessment Team carry identification with them so please check this before allowing anyone into your home. Our Financial Assessment Team are very experienced and well trained and will help and guide you through the financial assessment. Don't be afraid to ask any questions or raise anything that you are not sure about. We will complete the financial assessment form for you. You can ask that a blank financial assessment form is sent to you so you can complete it yourself if you wish. Under the Welfare Reform Act 2012 and The Social Security Act (information sharing in relation to welfare services etc.) Regulations 2012, we can access information on your benefits from DWP to help us with your financial assessment. This will also help us to offer you advice on any benefits you may be able to apply for. This will also help us to complete the financial assessment quicker as we will not need to ask you as many questions about your benefits.Information sharing
Information needed for a financial assessment
You will need to have the following information available in order to complete a financial assessment: We will also need to know whether you have any ongoing benefit claims Please note that home expenses can only be allowed for up to 6 weeks for permanent residential care.
Details of incomeDetails of all capital and assets
Details of home expenses
How we assess you if you live with a partner
If you receive a non-residential or temporary care service, we may need to ask for details of your partner's income and capital/assets. If you are in permanent residential care the following information does not apply to you. If you live with a partner and you are paid benefits as a couple, you will need to have your partner's information ready for the financial assessment because we must assess you as a couple. If you are not paid benefits as a couple it may still be better to assess you as a couple as it may be cheaper for you. We will also check to see if there are any other benefits you can apply for with your partner.
How the financial assessment for residential care is calculated
This is worked out from your income and your capital, savings and assets. We can sometimes make allowances for some home expenses.
If you are admitted to a care home permanently the value of your home will usually be included in the financial assessment.
Benefits that may change when you go into residential care
If you are away from home for a period of 28 continuous days or more there are certain state benefits that may stop being paid to you. This can be temporary or permanent depending on whether you return home.
Some benefits that may be affected include:
- Attendance Allowance (AA)
- Disability Living Allowance (DLA)
- Personal Independence Payment (PIP)
- Carers Allowance (CA)
- Severe Disability Premium
- Enhanced Disability Premium
- Carers Premium
It is your responsibility to contact the Benefit Agency to inform them you have moved into residential or nursing care.
If you don't tell them about a temporary or permanent change to your living arrangements, you may be overpaid.
The money you will have to live on when in residential care
Most of your income will be used to pay for your care including state retirement pension, occupational or private pension and Pension Credit or Income Support (or other benefits).
From your income you are entitled to keep a "personal allowance" which is set by the Department of Health. This is currently £30.15 per week and this amount is reviewed every year.
Your personal allowance can be used to buy personal items such as sweets, toiletries, cigarettes, clothing etc.
We will also disregard some benefits including:
- Mobility Allowance
- War Pension for veterans
- War Widows Pension (first £10 disregarded only)
- War Widows Supplementary Pension
Personal capital taken into account
If you own a second property that you do not live in, we will include the value of this property in your financial assessment. If you have capital/savings under £14,250 your capital/savings are disregarded in the financial assessment and your contribution will be assessed based upon your income less your expenditure. If you have capital of £23,250, or over, you will not receive any help from us with the cost of your care. If you receive residential care, you will be responsible for paying the full amount of your care as a self-funder. If you receive a non-residential care service, you will be responsible for paying the full cost of the service you receive up to a maximum of £582.00 per week.
If you have capital/savings over £14,250, we will take into account £1.00 for every £250 capital/savings you have over £14,250 and up to £23,250, when calculating your contribution towards your care. This is called tariff income.
Example:
Gifting your capital/assets to another person
If we believe that you have given away your assets, such as money or a house, to reduce the amount you pay for your care, we may still include the amount you have given away in your financial assessment. We will consider the timing and the reason why you gave away your assets. For example, we will look at whether you gave away your assets at a time when your health meant that you would be likely to require care services from us in the future. If this happens and you are unable to pay the cost of your care, then the people you gifted your asset to may have to return the asset to you or pay your outstanding care costs.
How a property is treated for financial assessment purposes
The treatment of your property during a financial assessment will depend upon the type of care service you receive. The value of any other properties you own will be included in the financial assessment. If the value of your other properties and your capital/savings are £23,250 or more, you will have to pay the full cost of your care. If you move into Extra Care or Supported Living, and own a property, the value of your home will usually be included in the financial assessment from the date you move into your new tenancy. If your property and/or capital totals more than £23,250, you will have to pay the full cost of your care. The value of the home you live in will be ignored if your stay in a care home is only temporary, and it is expected that you will return home usually within 52 weeks. The value of any other properties you own will be included in the financial assessment. If the value of your other properties and your capital/savings are £23,250 or more, you will be charged in full for the services you have received, and you will become a self-funder after 12 weeks. You will then be charged by the care home direct. For permanent residential care the value of the home you lived in will usually be included in the financial assessment 12 weeks after your stay becomes permanent. During the 12 weeks you will only pay what the financial assessment shows you can afford from your income and savings. If the value of your other properties and your capital/savings are £23,250 or more, you will be charged in full for the services you have received, and you will become a self-funder after 12 weeks. You will then be charged by the care home direct. If you sell your home before your stay has been permanent for 12 weeks, then the money from the sale of your home will be included in the financial assessment from the date your home was sold.Non residential care (excluding extra care and supported living)
Extra care and supported living
Short term/respite/temporary care
Permanent care
When the value of your property is not included in your financial assessment
Sometimes the value of your home will not be included in the financial assessment if one of the following people still live there: We also have an option to ignore the value of your home where someone continues to live there and does not meet the criteria in the above categories. This may be discussed during the financial assessment.
Self-funding residents
A self-funder is someone who is responsible for paying the full cost of their care.
You will be a self-funder if the following applies:
- you have enough income to pay for your care home fees yourself
And/or
- you have capital, savings, or assets above the capital limit (£23,250) - the capital limit is reviewed in April each year by the Department of Health
As a self-funder you can purchase your own care without any involvement from us. We can still provide you with advice and support to find a suitable care home which provides the right level of care for you. When deciding on a care home you will need to consider:-
- the weekly fees for the care home
- whether the fees are payable weekly or monthly
- whether the fees are payable in advance or in arrears
- any extras you may have to pay for (eg, your choice of room)
- the likely frequency of any increases in fees.
If the we have arranged your care, your case worker will give you advice when they carry out your needs assessment. This may include advice on whether you will need to make private arrangements with a care provider, without the need to complete a financial assessment.
If you do not want a financial assessment or to give us your full financial information, you will be a self-funder and we will not be able to help you with the cost of your care as you will need to make a private arrangement with the care home.
It could be in your interests to request a financial assessment from us to see if you are a self-funder as some types of savings or assets (including property) may not be taken into account.
If we have arranged your care, and we determine that you are a self-funder, you must make your own arrangements with the care home. We will charge you in full for the service you have received and will give you, and the care home, 21 days' notice of the start date of your private arrangement with the home.
The care home self-funder rates may be higher than our contracted rate. The care home may charge you the difference between our contracted rate and their self-funder rate. This is a matter between you and your care home provider and we cannot get involved with this.
You will be given a contract to cover your stay at your chosen care home. The Citizens Advice Service can provide you with help with understanding the wording of your contract or if you are unsure about any of the terms of the contract including:
- what you have to pay
- the care homes legal responsibilities
- any unfair penalties, restrictions or responsibilities for you
You can contact the Citizens Advice Service on either of the following:
- Telephone Number 03454 040 506
- Website: Citizens Advice
As a self-funder you will be eligible to make a claim for Attendance Allowance/Disability Living Allowance/Personal Independence Payment (PIP), all at the higher rate, if you haven't already done so. You should inform the Department for Works and Pensions of the date you are charged the full cost of your residential care.
Mental capacity
You will be unable to make a private arrangement with the care home if you lack the mental capacity to take decisions and you do not have someone with legal authority (a Deputy) to make these decisions for you. If this is the case, we will pay the fees to the care home on your behalf and recover any outstanding contributions towards your care costs from your Deputy once they have been appointed and your financial situation becomes known.
Once a Deputy has been appointed they will be required to pay any outstanding fees owed to us. If you continue to have over the upper capital limit (currently £23250) in capital and assets you would no longer remain on the Council's contract. Your Deputy will need to contact the care home to arrange to pay your care fees.
Help with your care costs
Once your savings/assets are nearing the upper capital limit (currently £23250), you can apply for help from us towards the cost of your care. It is important that you tell us in advance of your savings, capital and assets falling below the capital limit.
Your Care Co-ordinator will carry out an assessment of need with you to make sure that your needs are being met by your care home. Please be aware that when your savings/assets fall below the upper capital limit and you are eligible for funding assistance from us, we guarantee to fund the same care arrangements. You may have to move to a different room, different part of the care home or a different care home altogether. For example, your assessment of need may indicate you do not have nursing needs and you may need to move from a nursing care home to a residential care home.
We have a duty to always ensure that your care needs are met and consider your individual circumstances before making a decision on your placement in a care home.
During the financial assessment to determine whether we can help you with your care costs, we will look your level of capital/assets and outgoings. If the amount of your capital/assets has dropped much quicker than we would expect, we may ask for evidence from you explaining why this has happened. This is because we must ensure that you have not spent your money to avoid care costs.
If your property is taken into account for a financial assessment
If your property is taken into account in the financial assessment, you have a number of options for paying your care fees: You should take independent financial and legal advice to help you decide which option would be better for you.
Deferred payment
If your money is tied up in your assets, eg your property, you can apply to enter into a deferred payment agreement with us. We may loan you the extra money that you need to enable you to pay your care fees until you choose to sell your property or other assets. A financial assessment will show what you can afford to pay and what you need to borrow to pay your care fees. If you decide to apply for a Deferred Payment Agreement and are successful, you will enter into a legal agreement with us by signing an agreement document. We then place what is called a 'legal charge' on your asset (usually a property) to safeguard the money we have loaned you. There is a charge for entering into a Deferred Payment Agreement plus an interest charge on the loan. Find out more at The Deferred Payment Agreement (DPA).
Extra costs of your stay in the home
We will only be able to pay up to a certain limit each week for the cost of your care. If you choose a home or a particular room that costs more than we are able to pay, this extra cost is known as a 'top-up'. A top up must not be paid by yourself, it must be paid by a third party, eg a family member or a friend. This payment is usually collected from the third party by us.
Married couples and partners
If you are married or have a partner and you are admitted into a care home permanently, the Department for Work and Pensions will class you and your spouse/partner as single people for the purpose of your benefit entitlement. Therefore, your financial assessment will be calculated on your own income and assets and not those of your spouse/partner.
Receiving both non-residential and residential care services
If you receive both non-residential care and a residential care service (including temporary or respite care), two separate financial assessments will be carried out to see how much you will have to pay towards the cost of each service. If you receive residential care and non-residential care services in the same week, you will pay for both services. However, the most you will have to pay will be no more than the higher of the two contributions. If you pay the full cost of your services, you will pay the full cost of both the respite and non-residential services received.
The outcome of your financial assessment
Where your financial assessment takes place over the telephone, in most cases we will be able to tell you how much you will have to pay on the day of your financial assessment. The Financial Assessment Team will always confirm your contribution in writing and send a copy of the financial assessment form and calculation sheet to you. All contributions will be backdated to the start of your service. If you have a query regarding your contribution you should get in touch with the Financial Assessment Team by telephone on 03000 268 232 or by email at finance.assistants.fateam@durham.gov.uk. If you are unhappy with the outcome of your financial assessment, you may appeal in writing to the Financial Assessment Team. If you are unhappy with the outcome of your appeal, you can use our Corporate Complaints Procedure. You can obtain a copy of this procedure from your Care Co-ordinator or by visiting our complaint's page. If you are unhappy with the outcome of your formal complaint, you can contact the Local Government and Social Care Ombudsman.
Ways to pay your care costs
We will collect your contribution every four weeks. We will invoice you every four weeks any you can pay in any of the following ways:
Unpaid care costs
If you are struggling to pay your care costs, you can contact our Collection Team by telephone on 03000 268 280 or by email at resourcesadultssocialcarebilling@durham.gov.uk. They will discuss payment options with you. Sometimes we can agree a payment plan with you to pay off the amount you owe. Where you are able to pay your care costs but choose not to do so, the government has said that if an individual has been assessed as needing a service, that service should not be withdrawn even if they refuse to pay their care costs. However, we can take a person to court if they refuse to pay the cost of the services they have received. Before any decision is taken to refuse a service because of the contribution you will have to pay, you should get in touch with your Care Co-ordinator.
Changes in your circumstances
If your circumstances change following a financial assessment, you must contact us as soon as possible. For example, if your living arrangements change, or your savings/capital or benefits change, this may affect your contribution and you may need a financial reassessment. Not telling us of a change in your circumstances could result in additional charges being backdated, and you could end up with a large bill, or possible funding assistance towards the cost of your care from us may be overlooked. We will reassess your contribution towards your services in April each year to take account of annual increases in benefits, private pensions, and Basic Living Allowance/Personal Allowance. This is known as a financial reassessment. Your contribution may go up or down as a result of a reassessment.
Getting financial advice that's right for you
There is a range of information to help you understand the way in which care can be funded and other issues to consider. You may also wish to take independent financial advice before taking any decisions. If you would like further information on our formal charging policies and guidance, visit how much will I have to pay for care and support services? Age UK provide independent information and advice on finding and paying for care. You can contact Age UK Advice on 0800 169 2081. You can access both general information about paying for care and information about accredited financial advisers in your area through the Society of Later Life Advisers (SOLLA). The Money Advice Service, set up by the government to help people make the most of their money, offers impartial information and guidance about your money to help you work out what's right for you. Visit their website for information and interactive tools to help you make informed decisions about money. It also explains what options may be available and what you should think about before making a decision about long term care. If you are in residential care, the Department of Health has arranged for a voluntary organisation to produce a Care Home Handbook which explains all of your rights both in choosing a care home and once you are living in a care home. You can get this free of charge from Independent Age, 6 Avonmore Road, London, W14 8RL, 0800 319 6789. Here are some useful benefit contact numbers:
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