I’d like to (try to) explain how important it is to engage early on with social services, how you do it and what to expect. Warning – this post is long, but it is important (and it’s much shorter than the ‘official’ bumpf). I’ll explain how it works in Bucks so you will need to double check for your county, but in the meantime take a tea break and curl up on a sofa with this for 10 mins.
Local authority ‘older adult social care’ (previously known to us as ‘social services’ back in the day)
Like I was, you may be wary of ‘calling the social services’, in case it all ends with ‘the wrong’ outcome. Please think again. True, there has been a lot of media exposure about what needs to change, however in my experience, I find the support very helpful once you have found it, applied for it and it’s been (eventually) delivered. It won’t surprise you to know that the social care services are very stretched so they prioritise based on need. Having said that, my advice is to make yourself known earlier rather than later. Don’t wait for an emergency, like a fall resulting in a break, to get on their radar. By that time you’ll likely be frazzled and over stretched.
Your local authority (LA), i.e. the entity that collects your council tax (see your council tax bill for your LA), has a duty of care to support people with care needs and their carers. If you pay council tax to a district council that is affiliated to a county council, then it is the county council that is accountable for care provisoin. For example, Aylesbury Vale District Council (AVDC) collects our council tax, but it is Bucks County Council that supports Marj with care. Click on AVDC’s website for an explanation of national funding.
In the past, eligibility for adult social care ‘packages’ may have been different across different LAs. Since the 2014 Care Act, the criteria for eligibility should be the same across counties e.g. Oxon and Bucks. Adults over 18 qualify for support from Adult Social Care if they have needs that arise from or related to a mental or physical impairment. It doesn’t matter how the impairment came to be. If an adult is unable to achieve at least two ‘specified outcomes’ (e.g. prepare food or wash and dress) that are deemed to have a significant impact on the adult’s wellbeing (e.g. spend time with family, stay connected to their community, health impact) they are usually eligible. The specified outcomes are listed here,see section 13.5-13.7 p17 of the 30 page (yes 30 pages) Bucks County Council ‘Assessing and Supporting Your Needs’ policy document. Of course it means well, but is rather hard work.
For the older adult that needs support
First up, the ‘care needs assessment’
The adult who needs support needs a ‘care needs assessment’. Everyone is entitled to this assessment and it does not involve income at this stage i.e. ‘means’ testing. An assessor evaluates i) what the adult can do on their own, ii) what help they need, then iii) help they already have. If you are the unpaid carer, sit in on the appointment as you may need to take the role of advocate. It is not unusual for an older adult to say they are managing fine when actually they are not, we all have our pride. Also, please be really clear about how much you can and can’t help. Your own wellbeing and your other important activities e.g. a full or part time job, childcare etc. are very important too so don’t try and be a superwoman or superman. If the adult needing support does meet the eligibility criteria but can’t afford to pay for care themselves privately, then the financial assessment is next.
A ‘financial assessment’ is next if care ‘in home’ is to be funded by the LA
All social care is means tested (except for social support for carers). So, the adult who needs care will need to divulge their regular income (pensions, benefits or earnings) and capital (cash savings, investments, land and property, including overseas property and business assets). Depending on personal finances, the LA will decide whether to contribute fully or in part to care (using a sliding scale) or not at all. Here are the current financial limits:
- If the adult has capital/savings over £23,250, it is straightforward, they will pay the full cost of care and are called a ‘self funder’.
- If an adult has capital/savings between £14,250 and £23,250, they are expected to pay £1 per week for care for every £250 they have above £14,250.
- If an adult has capital/savings less than £14,250, their contribution is assessed on income only (their capital/savings are disregarded).
- As capital/savings reduces as a result of funding or contributing to care, the adult’s contribution to care also decreases.
- If the adult has a very high pension, they are very likely to have to pay a higher contribution to care.
- For care support carried out in your home, your house isn’t taken into account, just your income and savings.
Residential or Nursing Home care
A financial assessment and means testing is applied here too, as you will likely have heard due to increasing media coverage.
- If the adult has capital/savings over £23,250, they are normally expected to pay the full cost of care (and are called a ‘self-funder’). However, if an adult self-funds care, they will still be eligible for attendance allowance (see post 4).
- If an older adult owns or has an interest in more than one property, it is very likely their capital assets will be over £23,250.
- If the older adult is the sole occupier of their home, the house counts towards capital*. The home may only be disregarded as an asset if it is also occupied by a partner or a former partner who is a single parent or a relative aged 60yrs+ or a disabled younger relative or a dependent child under 18yrs.
- Income (including benefits and pensions) is also assessed.
- However, some income is disregarded (e.g. mobility allowance).
- If the LA contributes to the older adult’s care, their Attendance Allowance may be affected (you are expected to declare to the DWP that you are receiving a contribution to your care).
*The 2014 Care Act led to the introduction of the ‘deferred payment scheme’ which aims to help people stay in their own home as long as possible (rather than having to sell their house prematurely to pay for care fees). In a deferred payment scheme the LA uses the future proceeds of the occupied house’s sale (at any point up to or after death) to offset or cover care costs. This is a type of loan agreement, not necessarily open to all, to which interest and admin charges apply. Terms probably vary from LA to LA. LAs want to keep people in their own home as long as possible as it is cheaper for them than moving someone into residential care, but please do your research before agreeing to a deferred payment scheme. They may not be the best option for everyone and it’s worth getting some independent financial advice from a trusted source (try Which? or the Citizen’s Advice Bureau for options).
Funding residential care is a complex topic and you should seek further advice in any case from your Adult Social Care team and an independent support group. (e.g. Age UK, Alzheimer’s UK, Carers UK).
The ‘Personal Budget’
If an older adult is eligible for financial support towards their care, they will be given a ‘Personal Budget’. There are two options to managing it:
- Your LA, e.g. Bucks County Council manage the Personal Budget on your behalf and, for example, use the domiciliary carers they have contracted with, or
- The older adult takes the Personal Budget as a direct payment and uses it to employ a carer or assistant, pay a care agency or pay people in their family to provide care**. This way the person who comes into the home to perform the care is the choice of the older adult. The direct payment can be also be managed through a nominated family member or POhWER if necessary.
**Intriguingly and potentially frustrating for many I’m sure, you cannot pay the family members you live with to look after you. I wonder why. If you could pay family members you live with to care for you, might that encourage more multigenerational households? The benefits could include freeing up underutilised housing, relying less on residential homes (a lower cost for the public purse), reducing social isolation and potentially reducing NHS costs due to a positive impact on wellbeing. (according to research which shows a correlation between isolation, mental and physical health).
What other LA supported care is available?
For Bucks residents, Bucks Older Adult Social Care is the gateway to the following help:
- an ‘in touch’ service
- care in own home (from an LA contracted service or they may even be able to find you private domiciliary care services through a ‘care broker’ service, for £250 last I heard)
- day care centres or other daytime opportunities and activities
- ‘telecare’ and other assistive technology
- respite care
- Community Occupational Therapist (OT) assessment and loan of assistive equipment for the home (Marj is a big customer, see post 8)
The LA carer’s assessment
Like the care needs assessment, everyone is eligible for a carers assessment. If there is no care or social worker already coming in to help your elder, do look at this. A ‘carers assessment’ is when the LA evaluates the impact of caring on the carers life. I recommend getting help with filling in any self assessment forms. There are eligibility criteria, but it is NOT means tested (no one looks at your finances or benefits). However, help isn’t likely to be financial, though a ‘one off’ carers direct payment, towards a break, is sometimes forthcoming.
If you need some respite (a break from your caring role for a few hours, overnight or longer), your LA is also the gateway to this support.
A ‘sitting service’ as part of a LA adult social care ‘care package’ may be possible (though not available for ‘self funders’). Unfortunately I have heard that this sitting service is no longer available for Bucks residents, but it might be available in your LA.
Go to post 4 for more information on Carer’s Allowance which is a completely different thing (I know, it IS a bit confusing).
How to contact your LA
If you live in Bucks, contact Bucks Older Adult Social Care through the ‘Community Response and Re-ablement team’ (CR&R) on 01296 383204 or on their website. This team (with a confusingly different name) should be able to point you in the right direction. Set aside some time as it might take a few calls, you may go around in circles a bit, but DON’T GIVE UP.
The first thing the team may ask you to do is to complete a self-assessment on their website. This will be used to prioritise your case. You may like to get some help with this, from a carers support group. In any case, keep a copy of any self-assessments as you are likely to be asked the same questions over again during a phone call and in any follow up meetings (very tedious, but they aim to prevent unnecessary public expenditure).
There will be similar support from other county LA’s too, but it’s worth looking them up or asking your local carer support groups to point you in the right direction, as care provision is often organised and managed differently county to county.
There is a lot of other support out there if you have the time to look for it. Try charity, support or volunteer organisations like Carers Bucks and Carers UK, Age UK, Alzheimer’s Society or Action on Hearing Loss. They sometimes have contracts with the LA for giving help. For example, Carers Bucks have an emergency fund for cases of extreme stress or family crisis, which they can deploy if a carer breaks a leg and is struggling to make a cheese sandwich.
Smaller local social clubs, charities and groups can also be great support, do you know of any?
It’s worth noting that currently (and maddeningly), an LA’s health care teams and social care teams are unable to talk to each other easily. So, if you live in Bucks, social care is provided by Bucks County Council and health related care is always accessed through the GP (whichever county your elder’s GP is in).
In post number 13, I outline the potential additional (and free) help available from health services.
If your elder has the means and would rather not rely on adult social care, there are an increasing number of private enterprises who can help you. I’ll cover these options in more detail in a future blog post. But don’t rule out the very real support and help you gain from joining a carers group (‘real’ or on social media).
Finally, while this post attempts to accurately summarise the complex routes to accessing public funded social care, it is no substitute for speaking to the experts at your LA. They will have the final say.
Good luck and let me know how it goes.