What can be done when a resident, who has self funded their care home runs out of money: having spent their savings on paying for their care home?
Although councils have a duty to undertake assessments of all ‘adults in need’, people with savings above £23,250 will not generally get funding support from their council when they move into a care home.
Often they (or their families) will have taken great care over their choice of care home: one that ‘feels right’ – for example because it is friendly, in the right location, has a good Care Quality Commission (CQC) rating and so on. They may then live in the home for considerable period of time and eventually their savings may get to the stage that they have dwindled to little more than £23,250. At that stage they are entitled to approach the council for funding support.
Not infrequently they are then told that their care home is too expensive and that they will either have to move to one that is less expensive (ie one whose fees are at a level the council is prepared to pay) or that they will have to get someone to ‘top up the difference’: the difference between the current care home fees and the fees the council is prepared to pay.
This is not how a council should respond.
The law requires that the council must first assess exactly what the resident’s care and support needs are. This assessment must be ‘person centred’ and will include, in addition to the routine care that homes provide, a consideration of whether they have any special care needs that can’t be met by ‘standard’ homes; whether there is a locational element to their need (ie to be close to family or friends- ie to prevent isolation / loneliness); whether continuity of care is important (because the resident reacts badly to change or is simply too frail to be moved safely) and so on. Only once such an assessment has been completed can the council discuss whether a move to an alternative care home (or a ‘topping up’ arrangement) is needed.
If someone has lived in a care home for many years and is (for example) in their mid 90’s (or terminal cancer and dementia), the default position must be that they should not be moved: that their needs require them to remain where they are. In such a case (unless the council has clear evidence to rebut this presumption) the council will have to fund their existing home. It cannot require them to move or seek a ‘topping up arrangement’.
A 2015 ombudsman’s focus report ‘Counting the cost of care: the council’s role in informing public choices about care home’ provided the following case example
When Magda moved to a care home her assets were more than the threshold limit of £23,250 and so she had to pay for her own care.
Her care home charged £800 a week. Her daughter Julia alerted the council when her capital fell below £23,250 – the level at which she might be entitled to council funding
However, the council said Magda was still a self-funder as her weekly income of £550 a week was enough to cover the cost of a placement at an affordable rate of £525 a week, but this did not take account of the fact the care home was charging Magda £800 a week. Julia asked whether her mother could be moved to another care home.
Magda’s medical consultant advised against moving her, but it was another four months before the council assessed her needs and accepted she could not be moved and agreed to pay the additional costs of the placement (minus Magda’s contribution) and backdated this for four months to when Julia first told the council of her change in circumstances.
We agreed with the council’s remedy and asked the council to apologise to Julia and pay her £200 to acknowledge the trouble to which it had put her.
The problem described in this note may occur for a variety of reasons. A 2018 ombudsman’s report concerned a resident who ceased to be eligible for NHS Continuing Healthcare funding (where the NHS had paid for a home at a rate higher that the council was prepared to pay). A 2014 ombudsman’s report concerned a decision by a council to reduce the amount it was prepared to fund for care home placements – as a result a resident (funded by the council) was asked to pay a ‘top up’ to remain in her care home.
A particularly troubling example (complaint no 18 016 276 against Hertfordshire County Council, 27 August 2019) concerned a ‘very vulnerable 93 year old resident with dementia who had not lived independently for 9 years. Her capital fell below the maximum threshold and the council insisted that she move from her care home to live in a ‘Flexicare’ flat (a form of Extra Care accommodation where the resident rents their flat in a development that has on site care staff as well as emergency support.). The ombudsman’s report notes (para 33):
I did not see evidence the Council considered (or said it would consider) what impact it may have on Mrs M’s mental/emotional wellbeing, if it would move her out of a care home environment that was familiar to her and which she liked and where she had settled, to an unfamiliar Flexicare flat. There is a lot of evidence of the drastic impact such moves can have on frail elderly dementia patients.