The current state of long-term care funding
The politicians are treating long-term care costs as a “solved” problem following the Dilnot Report and the Care Act 2014. Unfortunately, the headline measure, a cap on care costs of £72,000, (at 2016 prices), was kicked along to April 2020, so we have entered into a period of muddle and half-cut solutions, says Martin- Redman Partners.
Anyone entering into this area as a prospective care home resident, carer or member of their wider family has to deal with a system under severe stress.
Much of the system is driven by statutory duties; the NHS and the local authority have to do things but budgets are under considerable strain and corners are being cut, especially with the provision of reliable advice to carers, families and clients. In living memory, carers used to be able to trust the statements of public officers explaining how the system worked, but now I would strongly suggest than any opinions are taken with a large pinch of salt. At the very least, check for yourself; vested interests may work against you.
I have had a number of conversations which suggest that most local authorities are taking a two stage approach, based on whether the client is living in their own home or living in rented accommodation. For home owners the assumption is they are paying for everything; for those in rental property, the expectation is the State will be paying. I have been told that it can be difficult to get a financial assessment, (means test), as that would tend to push the local authority towards part-funding. As there can be considerable inertia, getting funding changed from self to the local authority or the NHS, (under Continuing Health Care, CHC), can be a seriously uphill struggle.
There are two gatekeepers that need to be managed from a client or carer point of view. The level of care necessary is defined by a care assessment that is triggered by a request for the client’s doctor, (General Practitioner). A care assessment is a statutory duty, irrespective of an ability to pay and is a joint enterprise between the NHS and social services. Where a client is deteriorating, perhaps with dementia, a regular re-assessment is vital as a client should eventually fall under CHC and should have their costs covered by the NHS. Feet-dragging by the NHS and social services is not unknown, presumably as a consequence of a lack of resources, but perhaps cynically, as a cost-saving measure.
The financial assessment is operated by social services and is the only way to access care costs from the local authority. If the client’s assets fall below the assessment threshold, costs should then be covered, at least in part by the authority, but this is often not that simple in practise. Getting an assessment in the first place can be really difficult; there can be considerable resistance to providing one as it is likely to put the authority on the hook. A further complication is that not all care homes will accept part-funding and a move to an alternative home can be forced. If the extended family start funding the care home privately, to avoid a move, they may find themselves fully funding the stay indefinitely. There is then no pressure on the local authority to make any moves to fund a place, so they can sit it out and wait for the family to crack or the resident to die.
Conversations with solicitors involved in long term care cases suggest that there is a lack of consistency from case to case and between local authorities.
For a carer being pitchforked into this maelstrom, they need to keep their eye on the ball and make sure they are not being hoodwinked.
- Make sure you have powers of attorney well in advance of need. This is not something to be done at the last minute and does nothing to compromise the ability of the sound of mind to manage their own money.
- Have money in each partner’s name and some in joint names, but if you are wanting to shield houses or money from care costs, get it done while you have no expectation of needing full care.
- There is no guarantee that any care cost avoidance will work in practice – many trust arrangements are untested in Court. The deliberate deprivation rules can be draconian, if applied to the full.
- Separate ruthlessly the client’s money from the carer’s and the remaining family. When care costs are capped in fact, (post April 2020, unless delayed again), the amount spent to date will be a vital part of the calculation.
- Keep careful records of the money spent on care – you may have to justify your choices to a local authority who would love to accuse you of deliberate deprivation.
- Make sure you keep an eye on the remaining resources of the client; get a financial assessment done when they get down to an estate of £30-40,000 as care costs should be partly funded from £23,750 (Wales) and below. As full residential care could be £1,000 a week or more, estates can be depleted very quickly.
- Get a care assessment at an early stage and use it to plan costs for 6 months to a year. Get a new assessment every time health worsens or the care team changes. Complain if assessments are not made on a timely basis – it is a statutory duty! Use a suitably specialised solicitor to force the issue if needed.
- Don’t pay for care with your own money, (unless it is your own care!) if you are family or the carer, you will get no thanks from the authorities and it will permanently impoverish you. Once spent, it is unlikely you will get it back.
- Pick a care home that offers continuing care if funded by the authorities. Homes that do not accept publicly funded residents will pick your pocket as a carer, even if the client is entitled to funded care.
- As a carer, you need to look after yourself; ruining your own health through stress, overwork or overexertion does no one any favours.
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The information contained is for guidance only and does not constitute financial advice. It is based on our understanding of UK legislation, whether proposed or in force, and market practice at the time of writing. Levels, bases and reliefs from taxation may be subject to change. Accordingly, no responsibility can be assumed by Martin-Redman Partners its officers or employees, for any loss in connection with the content hereof and any such action or inaction.
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