While the process can take some time, it’s always worth checking your eligibility, and applying for the care funding you deserve. We’ll cover each stage of the process in more detail later on, but for now, here’s a quick overview.
The Care Act 2014
This is the law that local authorities follow when providing you with funding towards your care costs.
It spells out the criteria for eligibility, as well as the assessment process.
The care needs assessment
This will tell you exactly what care needs you have, what support is available to you. An assessor will ask about your day-to-day life and how you cope with certain things.
The financial assessment
This will decide who is responsible for paying for your care – you or the council. The council begins to help pay when you have less than £23,250 in assets.
Your personal budget
Your personal budget is the amount of money you need to pay for the cost of your care needs. Depending on the results of your financial assessment, the council may be responsible for paying for all, some, or none of your personal budget.
Direct payments are a way for you to take control of your personal budget and choose how you want to spend it, for example – which care provider you'd like to use. Anyone with a personal budget is entitled to apply for direct payments.
Home adaptation funding
This can help you to upgrade your home to make it suitable for care. You can get up to £1,500 from your local authority to spend as you wish, or up to £35,000 with a Disabled Facilities Grant if you meet the eligibility criteria.
Jump to section
- What does the Care Act do?
- When does the council have to meet your care needs?
- What happens if the council is legally responsible for meeting your needs?
- When will you have to pay for your care?
- What is the assessment process?
- How significant should your involvement in care and support planning be?
- Can you read the Act for yourself?
What is the Care Act?
The Care Act 2014 is a piece of legislation that governs local councils’ duties in relation to assessing your care needs and your eligibility for publicly-funded care and support.
Before the Care Act, people had different entitlements for different types of care and support. These were spread across a number of Acts of Parliament, some up to 60 years old. The law was confusing and complex.
Now, it’s a lot simpler. This makes it much simpler to understand the process of applying for local authority funding. But, crucially, it makes it easier for you to know your rights – and challenge any decisions you think are wrong.
What does the Care Act do?
The Act creates a single, consistent set of rules about who is entitled to local authority care funding and how the assessment process works to figure this out. It covers all adults with care needs.
It’s clear about the steps that must be followed at each stage, to help you understand the process. It follows your ‘journey’ in the care and support system.
It begins with an assessment of your needs and a decision about whether your needs are eligible, including a financial assessment where necessary. This will determine whether you need to pay for your own care.
After this process of assessment is finished, the decision can then be made about whether you’re entitled to care and support arranged by the council.
When does the council have to meet your care needs?
The Act sets out a new legal duty for your ‘eligible needs’ to be met by the council, subject to your financial circumstances.
It says clearly that you’ll be entitled to have your needs met when:
- You have ‘eligible’ needs.
- You’re ‘ordinarily resident’ in the local area – which means your established home is there.
- Or you’re in any of the four situations in the box below.
What situations mean the council have to meet your needs?
- The type of care and support you need is provided free of charge
- You can’t afford to pay the full cost of your care and support
- You ask the council to meet your needs
- You don’t have mental capacity, and have no one else to arrange care for you
What happens if the council is legally responsible for meeting your needs?
The council must help you to make decisions about how you want your needs to be met and prepare a care and support plan.
Under the Act, there’s more flexibility to focus on what you need and what you want to achieve, and to design a package of care and support that suits you.
‘Meeting needs’ allows for different approaches, so you can get the right level and type of care and support, when you need it.
When will you have to pay for your care?
Some types of adult care and elderly care are provided free of charge but often the council will charge a cost. Depending on your finances, your council might ask you to contribute towards the costs of your care – up to and including the full amount.
In cases where the costs of care would reduce your income below a set level, your council will pay some of the costs to make sure that you’re still left with this minimum level of income. This ensures you’ll still receive the care you need if you have only modest resources.
In any other case, you can still ask the council, regardless of your finances, to arrange your care and support for you. It makes it less likely that, if you’re uncertain about the system or lack confidence to arrange your care, you don’t go without. However, you’ll still need to pay if you have adequate financial resources.
What is the assessment process?
An assessment is how a council decides whether you need care and support to help you live your day-to-day life.
The assessment must be carried out by an appropriately trained assessor, for instance a Social Worker or Occupational Therapist.
The aim is to get a full picture of your life and what needs and goals you may have. After carrying out the assessment, the council will then consider whether any of the needs identified make you eligible for support.
The council uses an eligibility framework to decide which needs are eligible to be met by public care and support.
What are the requirements for the assessment?
The assessment must:
- Be provided to all people who appear to need care and support, regardless of their finances or whether the local authority thinks their needs will be eligible.
- Be of your needs and how they impact your wellbeing, and the outcomes you want to achieve.
- Be carried out with the involvement of you, your carer or anyone else you’d like to nominate. If you’d like one, the council has a duty to help you choose an independent advocate to represent you during the assessment.
Local authority or NHS: Who should pay for my care?
- Local authority funding: When you primarily have social care needs. This is when you need help to get on with your daily life. Think about your ability to: dress, eat, get around, go to the loo, and maintain a social life.
- NHS Continuing Healthcare: When you primarily have health care needs. This is when your illness or condition means you need regular help. Think about support with breathing, help with medication and the general impact of the condition.
How does the council determine if you have eligible needs?
You’ll have eligible needs if you meet all of the following:
- You have care and support needs as a result of a physical or a mental condition.
- Because of those needs, you can’t achieve two or more day-to-day ‘outcomes’, like getting dressed, going to the toilet or completing domestic chores.
- As a result, there’s a significant impact on your wellbeing.
How significant should your involvement in care and support planning be?
The Act provides you with a legal entitlement to a personal budget, which is an important part of your care and support plan. This is how much money you’ll be paid towards your care. It must be included in every plan, unless you’re only receiving intermediate care or re-enablement support to meet your identified needs.
This adds to your right to ask for a direct payment to meet some or all of your needs. Provided that the direct payment is used to meet the needs identified in your plan, you should have freedom over how the money is spent.
You must be involved in developing your plan. The local authority will have to do everything it reasonably can to agree the plan with you.
The council must also provide an independent advocate to help you take part in the planning and review process, if you would otherwise have substantial difficulty in doing so.
Can you read the Act for yourself?
Yes you can, read the Government’s Care Act factsheet for yourself. Be mindful to ignore any reference the factsheets make to a ‘cap on care costs’.
This cap still hasn’t been voted on by Parliament and still isn’t part of the Act. There’s currently still no cap on care costs.
Jump to section:
- How do you apply for a care needs assessment?
- How quickly will I be assessed?
- What does a care needs assessment actually involve?
- How are my care needs worked out?
- How can you prepare for the care needs assessment?
- What happens after the care needs assessment?
- What if you disagree with the results of your care needs assessment?
What is a care needs assessment?It doesn’t matter who you are, or how much money you have. If you think you need help, you should turn to your local council for help. This starts with them talking through your daily life to an idea of the support you need. This process is called a care needs assessment. This assessment has the power to transform the care you receive because it clearly lays out for you exactly what care and support you need and why. It then goes on to recommend all the different options available so you can be cared for in the way that’s best for you.
How do you apply for a care needs assessment?Most councils will ask you to request an assessment either by telephone, in writing, or online. The first thing to do is visit your council’s website to confirm their exact application process. Ignore any advice you’re given which states that you should first complete a financial assessment before your care needs assessment. The Care Act 2014 clearly states that everyone has a right to a care needs assessment. Don’t let anyone persuade you otherwise.
Have you applied for NHS Continuing Healthcare?
- It’s less likely, but you may be eligible for NHS funding, which isn’t means-tested and will cover all of your health care needs.
- Having your GP involved from the start means you have a medical professional fighting your corner. At the very least, it makes sure they’re aware of your situation.
- If you don’t pass the NHS criteria, they should still give you a copy of their care needs assessment. They should also help you to apply for, and arrange, a social care needs assessment by the council. Having this support is crucial because it should speed things up and you can use the NHS assessment to prepare for and compare to the council assessment.
How quickly will I be assessed?Once you have applied for a care needs assessment, the council should contact you to discuss the next steps. There’s no set timescale for the assessment to be completed, but normally it shouldn’t take any longer than four to six weeks. If you think your case is urgent and you can’t wait that long, be sure to state this in your application. In some urgent cases, councils will ensure the care needs assessment takes place as quickly as possible. If the council doesn’t respond to your application within seven days, get in touch with them again to follow up.
What does a care needs assessment actually involve?A trained professional from the local council, like a Social Worker, Occupational Therapist or Nurse, will agree with you how to carry out your assessment. You may be offered to complete the assessment on the phone, online, or in person. Whenever possible, we recommend that you request your assessment to be in person. Councils are responsible for taking your preference strongly into consideration. However the assessment takes place, the assessor will then discuss with you how you feel you’re coping with a variety of day-to-day tasks. They do this in order to get a clearer picture of what a typical day in your life looks like. Think about the things you’re coping well with, and those you’re finding a bit of a struggle.
What questions will the assessor ask you?The conversation between you and the assessor should go into a lot of detail and cover all of the most important aspects of your day-to-day life. This will include:
- Your social life and support network
- What you’re skilled at
- Your views religion and culture
- Your mental health
- Your physical health
- how you want your life to improve
Be clear and honest about your needsIt can be difficult to accept you need support with certain areas of your life. It’s completely natural to not want someone to help you, or for things to change. However, it’s crucial that you don’t downplay your needs during the assessment. Answer completely honestly, giving real-life examples of when you need extra support.
How are my care needs worked out?After speaking with you during your needs assessment, and only if you allow them to, your assessor should then speak to any other health and social care professionals involved in your case, such as a Nurse or GP. When they’ve done this, they look at your assessment as a whole to determine if:
- You have a care and support need caused by a physical or mental condition.
- You can’t achieve two or more ‘outcomes’ (covered below) in your day-to-day life.
- Your care and support needs have a significant impact on your wellbeing.
The ten outcomes of a care needs assessmentThere are ten outcomes that every single assessor must assess during every care needs assessment, no matter what council they represent. This makes sure that there’s a consistent framework for assessments across the country. This framework is called the National Eligibility Criteria, which is set out in Section 13 of the Care Act 2014. The ten outcomes under consideration are:
- Diet and nutrition
- Personal hygiene
- Going to the toilet
- Getting dressed
- Being safe at home
- Housework and domestic duties
- Family, friends and other support networks
- Work, volunteering, education and training
- Accessing essential or recreational services in the community
- Carrying out caring responsibilities you have for a child
What would your ideal situation be?
How are the outcomes judged?For each outcome, the assessor will describe you as being unable to achieve it if:
- You need help to do it.
- When you try to do it by yourself, it’s painful or distressing.
- You can achieve it by yourself, but doing so endangers the health and safety of other adults
- You can achieve it but it takes you significantly longer than is normally expected.
How can you prepare for the care needs assessment?Council workers, like Social Workers and Occupational Therapists, are often busy people. While they should discuss every aspect of your life with you, they may sometimes forget to discuss one or two things that are important. There are a few things you can do before the assessment to make sure that you’re fully prepared for it – and nothing is missed:
|Keep a diary of your needs||Download our simple checklist||Chat with our care planning experts||Chat with an expert at a charity like Age UK or Independent Age|
|Try to give as much detail of your good days and bad days, and how this has impacted you and others. Discuss the diary with your assessor.||Our printable checklist gives you a run through what to expect and helps you take your answers with you at the assessment.||We’re here to help and can offer you expert advice on your specific situation, what you can expect, and how you should prepare.||They can provide tailored guidance on how you should approach it.|
Preparing your prioritiesTo make your priorities as clear as possible to the assessor, you first need them to be clear in your own mind. As an excersise to try and understand this, it helps to go through a few questions and think what the answer would be.
- Are you still able to maintain your home environment? Think about the size of your home, the help you need to upkeep it and whether there are any parts of your property not fully maintained (e.g. garden, spare rooms, conservatories).
- Is your home accessible and suitable for your needs? Consider how easy you find to get around your home, whether you need any home adaptations and how close it is to services or amenities you need to use on a regular basis.
- What care and support do you already have in place? The assessment looks at what you need, not how you’re coping. Think about what help you already receive – this could be from a loved one, a neighbour, a professional cleaner or gardener.
- Do you have any medical needs? Take some time to go through medical issues you’ve had – past or present – as well as ongoing problems or conditions. Think about how these impact your life. Think about what support would make them easier to cope with. This could be anything from requiring toileting assistance to requiring specialist dementia care.
- Who do you want to be close to? It could be a friend, a partner, a family member – or even a social club or regular gathering such as a coffee morning – be clear on people or places that are important parts of your life. If they’re really important to you, you’ll probably want to stay in your area.
- What do you want from the future? Accepting change is difficult. But it’s necessary to have a good think about what you want your future to look like. This could be moving into a care home, or it could be a home care solution like live-in care. Whatever it is, but especially if you want to receive care at home, you need to be crystal clear. The assessor has to consider your own wishes.
Think about your health needsIf you have long-term health needs, you may be able to get your full care costs covered with NHS Continuing Healthcare funding. Even if you don’t apply for this, being clear on how you need support with your health is essential. This can be any illness or condition that impacts. You should consider the following:
- Your lifestyle and habits: Thinking about how much exercise you do, what your diet is like, whether you drink heavily, and whether you smoke. Do any of these impact your general health or wellbeing?
- Medication and equipment: This could be anything from those weekly prescriptions through to breathing equipment that you need specialist support with. Think about the help you need to take your medication or operate equipment, both now and in the future.
- Ongoing health problems: Consider issues such as high blood pressure, heart conditions or sensory problems with sight, sounds, touch, taste, and smell. How does this make an independent life more difficult?
- Independence and mobility: Think about times in the past where you may have had a fall, or been close to falling. As well as the support you need in getting around and performing those daily activities. For example, do you need help getting out of bed?
What happens after the care needs assessment?
What if you disagree with the results of your care needs assessment?A lot of people don’t agree with the results of their care needs assessment. It’s not uncommon to feel that your situation hasn’t been fully appreciated. If you aren’t happy with your assessment and would like to complain about it, you can:
1. Complain directly to your council
2. Contact the Ombudsman
3. Speak to an independent advocateThis may be an advocate who already knows about your case, or somebody new. Speaking to your local branch of Age UK or Citizens Advice will point you in the right direction.
4. Get in touch with your MP
Jump to section:
- How do you apply for a financial assessment?
- What does the financial assessment involve?
- What assets and income are included in the assessment?
- When does the council begin to pay for care?
- Are your partner’s assets included in your financial assessment?
- What if you disagree with the results of your financial assessment?
What is the financial assessment?
Care at home, or in a care home, isn’t usually free. The financial assessment is what the council uses to determine whether you’re responsible for paying for your own care.
The financial assessment and the care needs assessment go hand in hand. First, the care needs assessment determines what your needs are, and then the financial assessment determines how much caring for your needs will cost and who is going to pay for it.
Sometimes known as the ‘means test’ it’s incredibly important, but it’s often poorly understood.
Just trying to understand what the financial assessment is and how it works can be challenging enough, let alone trying to understand how it all applies to your own case specifically.
We want to change that. We’re going to break it down step by step, so you know how it works and exactly what you’re entitled to.
How do you apply for a financial assessment?
It’s really important to remember that you shouldn’t apply for a financial assessment before you have undergone a care needs assessment.
The needs assessment should be completely impartial – so it’s best to make sure that ‘who is paying for what?’ doesn’t affect the outcome.
When you’ve confirmed your care needs assessment with the council, you can ask them directly how to apply for the financial assessment too.
If you’ve already had a care needs assessment, but haven’t arranged a financial assessment, then get back in touch with your council to request it.
What does the financial assessment involve?
It’s usually a face-to-face meeting which takes place in your own home, or at your local council office, if you prefer. But sometimes it may take place over the phone.
During the meeting, a financial assessment officer, who is employed by your council, will review your finances with you. The assessment officer will look at evidence of your income and outgoings and ask you questions about how much money you have and where this money comes from. If you struggle with hearing or communication, it’s a good idea to have a friend, family member, or carer join you for the assessment.
What assets and income are included in the assessment?
If you’re a homeowner, one important difference to the financial assessment is whether or not you’re hoping to be cared for in your own home, or move to a care home.
If you’re cared for at home, your house is not included in the financial assessment. In other words, the financial assessment officer must effectively pretend that your house doesn’t exist.
However, if you’d like to move to a care home, provided that no one else lives in it, your house will be included in the financial assessment. In this instance, the odds of the council paying for your care are low.
But your home is not the only asset the financial assessment officer will assess. The officer will also look at your capital, income and expenses.
Have all the necessary evidence to-hand
It can sometimes be a bit of a pain to collect proof of your capital, income and expenses. However, the more hard evidence you have, the faster the financial assessment is likely to be. If you have the equipment, it’s a good idea to take photocopies of all your financial records along to the financial assessment.
This is the value of the assets you hold. As we’ve just mentioned, if you’re arranging care in a care home, the value of your property will be considered. You should have information about any of the following to hand when you attend your financial assessment.
- Bank, building society or post office accounts
- Individual savings accounts or trusts
- Stocks and shares
- Premium bonds
- Life assurance bonds
This is money you receive on a regular basis from work, investments or your pension. It is considered if the value of your assets is between £23,250 and £14,250. You should have information to hand about the following:
- State, private or occupational pension(s)
- Disability Living Allowance
- Personal Independence Payment (PIP)
- Income Support
- Attendance Allowance
- Any annuities or income from savings
This is your regular outgoings. Expenses will be used to understand your net income. This will help the assessor build up a well-rounded view of your financial circumstances.
- Mortgage payments
- Rent – if you pay it
- Council tax
- Service charges or ground rent
- Building insurance – if you pay it
- Disability related expenditure
When does the council begin to pay for care?
This is the question and the answer is relatively simple – as soon as your capital and income drops below £23,250.
That’s the magic number. And remember – the value of your home only counts towards it if you move into a care home, not if you stay in your own home.
£23,250 is known as the upper capital limit. There is also a lower capital limit, which is £14,250.
What’s the difference?
If you have assets between £23,250 and £14,250, the council will pay for your care. However, they’ll also expect you to pay £1 per week for every £250 you have between the limits. This is called the ‘tariff income’.
If you have assets below £14,250, you’ll be expected to pay what you can afford from your income. If you’re in this group, you’ll be expected to contribute any income above £189 per week towards paying for your care.
Don’t live in England?
If you live in Scotland, Wales or Northern Ireland, capital limits vary. So does the process of arranging care, and the amount of support available to you. The capital limits in the three smaller nations are as follows:
- Scotland: The upper limit is £28,500. The lower limit is £18,000. The tariff income is the same as England.
- Wales: The upper limit is £50,000 for residential care with a lower limit of £24,000. £24,000 is both the upper and lower limit for home care, so there’s no tariff income. So, if your assets are below the threshold, you’ll get your care costs covered.
- Northern Ireland: The upper limit and lower limit is £23,250. So if your assets are below this amount, you’ll get your care costs covered.
Are your partner’s assets included in your financial assessment?
Your partner’s assets will only be included in your financial assessment if they’re held in a joint account with you.
Any assets held in both of your names, such as money in a joint savings account, will be treated as being held equally, and you’ll be declared as owning 50% of the total value.
Any other assets in your partner’s name, which you do not hold jointly, will not be included in your financial assessment.
What if you disagree with the results of your financial assessment?
A lot of people don’t agree with the results of their financial assessment. It’s not uncommon to feel that your situation hasn’t been fully appreciated.
If you aren’t happy with your assessment and would like to complain about it, you can:
1. Complain directly to your council
2. Raise the matter with the Ombudsman
If the council upholds its original assessment, and you are still not satisfied with it, you can complain to the Local Government and Social Care Ombudsman.
3. Speak to an independent advocate
This may be an advocate who already knows about your case, or somebody new. The big charities will be able to help you with this. Contacting Age UK, Independent Age or, if you have dementia, The Alzheimer’s Society are great places to start.
4. Contact your local MP
Contact your local MP and tell them about your situation. This is a highly effective strategy and we strongly recommend that you give it a try. Your MP is there for you and can help you unlock the right doors to make sure that your voice is heard by people who can really make a difference.
5. Contact a community care solicitor
There is expert, affordable legal advice out there from solicitors trained specifically in social care matters.
Jump to section:
What is a personal budget?
A personal budget is the amount of money that’s allocated by a local authority to cover your care needs. It’s how much money you need to cover those needs, calculated after your care needs and financial assessment.
You, the individual, the person who matters most, should always be kept at the heart of any decision making about your care.
A personal budget is exactly that — personal. If you’re eligible for support from your council, they have a responsibility to closely involve you in the type of care and support you receive.
A personal budget is the means to give you the control of something you already have a right to. It promotes flexibility, choice and quality of life.
What is included in your personal budget?
When the council decides your personal budget, it has three things to consider:
- What is the overall cost to your council to meet the needs identified in your care needs assessment?
- What amount of money have you been assessed in your financial assessment as being able to afford to pay towards meeting your needs?
- What is the net amount the council owes you to meet your needs?
How do you get a personal budget?
To get a personal budget, you must first complete two things:
- A care needs assessment
- A financial assessment
If you pass both of these, you know the council are going to help to pay for your care. But you still don’t know how much you’re going to get. This is what the personal budget tells you.
How is your personal budget amount calculated?
This is the most important question, but sadly the answer is quite frustrating. While the Care Act does provide guidelines on how council’s should calculate what you’re owed, it doesn’t provide a specific formula that all councils must use. This means that different councils do things differently.
However, it doesn’t mean that councils can calculate your personal budget in any way they like. They can’t. There are certain standards the council must meet when calculating your personal budget:
- Transparency. The council must clearly explain to you exactly how your personal budget was calculated. This includes a written explanation as well as verbal. The council should let you know exactly what their general formula for calculating personal budgets is, and how it was used in your case.
- Timeliness. You should be given an initial, or ‘indicative budget’. This should be made immediately available to you at the end of your care needs assessment and the beginning of the care planning process.
- Sufficiency. The bottom line is that your final personal budget amount must be enough to meet your eligible care needs. It also has to take into account your wishes and desires for how you want your needs to be met. The council must be flexible in their approach.
Your personal budget can not be contingent on moving to a care home
The Care Act states that ‘local authorities should not have arbitrary ceilings to personal budgets that result in people being forced to accept to move into care homes against their will.’
Are there any common formulas councils use to calculate your personal budget?
Yes. There are three common ways councils calculate personal budgets.
- The ‘resource allocation system’ (RAS). This is probably the most popular formula councils use. There are different types of RAS, but they’re all usually a computer algorithm. This algorithm assigns points to each of your eligible care needs. Points have a corresponding monetary value and the number of points you have determines what your total personal budget amount is.
- The ‘initial indicative budget’. After your care needs assessment, to begin with, the council may often give you an estimated, indicative budget based on your eligible care needs. An RAS is often used to calculate this. The indicative budget is to get you going by helping you to make a plan of what you can and can’t afford. This initial figure must then be checked against the actual costs of paying for your care and support plan.
- The ‘ready reckoner approach’. This method is now quite dated and not as common as the RAS. The council assesses the number of hours needed to meet your eligible care needs. They then look at the traditional services available to meet your needs, and multiply the hourly costs by the number of hours.
Is your personal budget paid into your bank account?
It can be. There are three main ways your personal budget can be controlled. Or you can arrange a mixture of the three:
|Indirect payments||An Individual Service Fund||Direct payments|
|The council manages the budget and will choose and pay for your care services on your behalf.||You choose the care services you want and the council pays the companies on your behalf.||The council pays your personal budget into your bank account or that of someone nominated by you.|
As well as this, you can request the budget to be controlled in a mixture of the above three ways. This is the mixed approach. There may be things you would prefer to control directly and other things you’d be happy for others to manage.
Can your initial personal budget total change?
Yes. You’re entitled to ask the council to review your care and support plan, including your personal budget. The council has a duty to make sure that your personal budget is appropriate for you and that it’s meeting all of your eligible care needs.
Once your care and support begins, there should be an initial ‘light touch’ review after six to eight weeks. Thereafter, youre entitled to at least a yearly review. But you don’t just have to sit and wait for this. You should contact your council whenever you think there has been sufficient changes to your care needs to justify a review.
Remember that, a review may conclude you have more eligible needs and need more money to pay for them, but it could also conclude the opposite.
What if you think your personal budget amount isn’t enough?
It’s not uncommon to feel this way. Even if you agree with the council’s assessment of your eligible care needs – which many don’t – you may not agree with the total budget the council gives you to meet those needs.
If you disagree with the amount, it’s best to take the following steps:
1. If you disagree with how your eligible care needs have been assessed…
Speak with the person who carried out your care needs assessment. Ask them to explain to you why your needs were assessed the way they were. Explain what you disagree with. Take notes of your conversation.
2. If you agree with how your eligible care needs have been assessed, but disagree with the personal budget amount…
Speak with your financial assessment officer. Ask them the following questions, taking notes of your conversation:
- ‘What system did you use to calculate my personal budget amount? For example, did you use a ‘ready reckoner’ system or a ‘resource allocation system’, or did you use something else?’
- ‘If you used a resource allocation system, can you please tell me if it was supported by a computer algorithm belonging to a third party system? Did this system use a price-per-point calculation?’
- ‘Can you please explain to me in detail every step that was taken to calculate my personal budget, beginning with the financial assessment you conducted?’
If these don’t resolve the situation
If you have these conversations, but nothing comes of it, don’t worry. All is not lost. You should continue to raise the issue by following these steps:
3. Complain directly to your council
4. Contact your local MP
Contact your local MP and tell them about your situation. This is a highly effective strategy and we strongly recommend that you give it a try. Your MP is there for you and can help you unlock the right doors to make sure that your voice is heard by people who can really make a difference.
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What are direct payments?
Making social care more about the people who actually need it has been the central principle of social care reform during the past two decades.
Instead of people like you, ‘the end user’, being excluded from making decisions on how to meet your own care needs, you’re now meant to be a key decision-maker in the whole process.
Direct payments play a big part in this. They are central to the objective of personalising social care and they have a big role to play in giving back control to the people who matter most – you.
Direct payments are one of four ways your personal budget can be controlled and spent. As mentioned in the previous chapter, the others are indirect payments, an Individual Service Fund, or a mixed approach.
Unlike these three options, a direct payment is when the council pays your personal budget into your bank account or the bank account of someone nominated by you. Instead of the council picking and choosing which care services are right to meet your care needs, you do.
Who is eligible for direct payments?
The council has a responsibility to discuss with you which of the four ways to control your personal budget you prefer. And the high majority of people should qualify for direct payments.
The Care Act is clear about direct payments. The council has a duty to discuss them with you and to give you a chance to explain why you prefer them and which care services you’d prefer to purchase with them.
So long as you can demonstrate that you, or someone acting on your behalf, is able to properly control the personal budget, and you identify care services that are within budget and will meet your eligible care needs, your request should be accepted. That is the spirit of the Care Act.
How many people claim direct payments?
In 2016-17, a report by NHS Digital found that nearly £500m worth of direct payments were paid to those over the age of 65. They’ve become increasingly popular in recent years, as more people look for alternatives to residential care. It’s a trend likely to be accelerated by COVID-19.
How can you spend your direct payments?
You can use your direct payment to pay for services, equipment, or activities that meet your eligible care needs. For example, you can:
- Pick whatever care agency you like best
- Purchase specialist equipment
- Make adaptations to your home
- Employ a personal assistant to help you
- Go on short breaks away from home
- Pay for social activities or day care centres
You may want to, but you don’t have to just pick one thing to spend your direct payments on. You can pick and choose. That’s really the whole point. It’s meant to be flexible. It allows you to focus the money you’re entitled to on whatever you think is best.
However, there are some things you can’t spend direct payments on. You can’t:
- Pay for long-term care in a care home
- Pay for health services like those provided by the NHS
- Pay household bills
- Pay for gambling services
Some councils may tell you that direct payments cannot be used on some specific goods and services, such as cleaning and transport. However, this is unlawful if your care needs assessment has revealed an eligible need for them.
If you get direct payments, how do you actually access the money?
The options will usually vary depending on the arrangements made by each council. The most common options are:
- Bank accounts – Most councils require direct payments to be paid into a separate account which you only use for direct payments. This usually means you have to open a new account. The simplest and most common way is to open a standard current account.
- A third party – An accountant, or an individual service fund (ISF), or payroll services are an option, but keep in mind that this will add extra cost that will come out of your personal budget.
- Small, one-off deposits without a separate bank account – Some councils offer small payment schemes where payments up to an agreed limit (e.g. up to £500) are paid into your own, original bank account. This way you don’t have to open a new account. This option is more suitable if you are just looking to buy equipment or use a service once.
- Vouchers – Some councils offer vouchers, but this will likely restrict the products and services you can buy to a limited number of companies. They are not a very popular option.
- Prepaid cards –This option is relatively new, but more and more councils are now offering this option. The council gives you a special card and they load your payments onto it for you. You don’t have to have a bank account, but some require you to use systems similar to telephone or internet banking.
What if you’re told you can’t get direct payments?
Hopefully, so long as you are eligible, your council will approve you to receive direct payments. But it doesn’t always work like that. Sometimes, even if you are eligible on paper, your council may tell you that you won’t get direct payments.
Here are some of the most common reasons you may hear from your council to explain why they won’t give you direct payments. Take a look at our advice on how to respond.
Myth one: “I’m sorry, but we just don’t do direct payments.”
Councils don’t have the legal right to deny everyone to direct payments no matter what.
The Care Act states that there are four conditions entitling someone to a direct payment:
- You have mental capacity, or if you don’t, and you have nominated someone to act your behalf, that person agrees to receive the payments on your behalf.
- The council is not prohibited by regulations under section 33 from meeting your needs by making direct payments.
- The council is satisfied that you, or your nominee, is capable of managing direct payments, either by yourself, or with the help of whatever services you turn to (e.g., an ISF or an accountant).
- The council is satisfied that making direct payments is an appropriate way to meet your eligible care needs.
Nowhere does it state that the council is able to completely remove direct payments as an option.
What the guidance also states:
‘…[councils] must not restrict choice or innovation by requiring that the adult’s needs are met by a particular provider, and must not place undue burdens on people to provide information to them.’
Myth two: “We don’t think direct payments are appropriate for your care needs.”
While it may be the case that direct payments aren’t appropriate for your needs, this is unlikely. The Care Act is very clear that direct payments are the best choice for many families.
If your council tells you that direct payments won’t meet your eligible care needs, ask for them to tell you exactly which needs they’re referring to and exactly why direct payments aren’t appropriate. Ask for this to be sent to you in writing.
Being familiar with the Act, or having someone in your corner who is, will help you have the confidence to challenge anything you’re not convinced about. The guidance to the Act states:
- ‘In all cases it is for the councils to determine…although it is expected that, in general, direct payments are an appropriate way to meet most care and support needs.’
- Direct payments ‘remain the government’s preferred mechanism for personalised care and support.’
- ‘Councils must not use this condition to arbitrarily decline a request for a direct payment.’
Myth three: “You can’t have direct payments because you don’t have mental capacity.”
The Mental Capacity Act 2005 states that everyone should be presumed to have capacity until an assessment proves otherwise.
If you haven’t been assessed as lacking mental capacity, then this cannot be used as a reason to refuse you direct payments. An assessment must take place.
However, even if you are assessed as lacking mental capacity, that doesn’t mean that you can’t still get direct payments. You just need a ‘suitable person’ to manage the payments on your behalf. The ‘suitable person’ can be:
- A friend, carer or family member.
- An attorney with health and welfare or finance decision-making powers, created by a lasting power of attorney.
- A deputy appointed by the Court of Protection.
- An independent support broker.
Myth four: ‘We don’t approve of your intended care provider.”
A council does have the power to prevent you from using your direct payments to pay a particular care provider they don’t approve of. For example, the council may have had previous bad experiences with a particular provider and they now consider that provider a risk to people’s wellbeing.
However, councils cannot, as a matter of policy, prevent you from using your direct payments to commission certain types of care providers. Every case must be judged on its own merits.
If your council has an issue with a particular care provider, it must explain these clearly to you and in writing.
If you disagree with your council’s opinion on the provider you would like to choose, explain your point of view carefully. Make it clear what you think the advantages of that provider are. Ideally back your point of view up with what other people think about the company, such as with any online reviews of the company.
The council has a duty to take your point of view seriously and not just dismiss it out of hand.
Myth five: “You can have a direct payment, but you must choose a provider we recommend.”
The Care Act makes it clear that councils can’t coerce people to spend their direct payments on particular providers the council prefers.
Yes, under certain circumstances and with good reason, councils can tell you who you can’t spend your direct payments, but they can’t agree to give you a direct payment only on the condition that you pick a provider from their list.
Tell your council how you would prefer to spend your direct payment. Explain in detail why you think this option will best meet your eligible care needs. Then ask the council to explain the options they are requesting you to choose.
Ask them to compare and contrast their option with your own and, in detail, explain why they think their option will meet your eligible care needs better than your option. Ask for this in writing.
How do you complain about a direct payment decision?
If your council refuses to grant you a direct payment and you would like to challenge their decision, take the following steps:
1. Speak with your assessors
Speak with the assessor who completed your care needs assessment and the financial assessment officer who completed your financial assessment. Ask them to send to you, in writing, a detailed explanation of why your request for direct payments has been rejected by the council.
2. Complain to your council
You should have been told how to make a complaint during your assessment, but, if you weren’t, you can find your council’s complaints procedure online.
3. Contact your MP
Contact your local MP and tell them about your situation. This is a highly effective strategy and we strongly recommend that you give it a try. Your MP is there for you and can help you unlock the right doors to make sure that your voice is heard by people who can really make a difference. Take a look at our advice on how to get in touch with your MP here.
4. Get the support of a community care solicitor.
There is expert, affordable legal advice out there from solicitors trained specifically in social care matters.
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What kind of home adaptations and equipment are there?
As you get older it can become more difficult and less safe to live in your own home if you don’t make some changes to it, or get specific types of specialist equipment?
These changes can be big or small, but, in either case, the changes are there to help you move around your home and do the day-to-day things safely and comfortably.
There are two types of adaptations and equipment available to you. Which is the right option for you depends on the nature and extent of your care needs.
- Minor adaptations and free equipment from the council
- Major adaptations through the Disabled Facilities Grant (DFG)
Minor adaptations and free equipment
The Care Act states that, if you are eligible for them, council’s are not allowed to charge you for equipment or adaptations to your home that cost less than £1000.
So, even if you don’t pass the financial assessment and you don’t qualify for funding from your council, the results of your care needs assessment may still conclude that you are eligible for the council to pay to make adaptations to your home or buy you special equipment up to the value of £1000.
What type of minor adaptations and free equipment are there?
Everyone’s needs are different and it’s an Occupational Therapist’s job to recommend what you need specifically, but here are some of the common options available:
- Small ramps
- Grab or hand rails
- Small steps to entrances
- Portable power sockets
- Portable door entry handsets
- Disability compliant door and window fittings
- Installing rocker light switches
- Adjustments to lighting
- Flashing or noise alarms
- A wheelchair
- A rollator
- A standing aid frame
- Bath lift
- A booster cushion
Are you eligible for minor adaptations and free equipment?
Minor adaptations and free equipment up to the value of £1000 are not means tested, but you do still have to be assessed as having eligible care needs by your council.
While you could apply to your council for a simple home assessment, it’s far better to apply for a fully comprehensive care needs assessment first.
If your care assessment is carried out by an Occupational Therapist, then you can ask them to complete a home assessment at the same time. If it is carried out by someone other than an Occupational Therapist, like a Nurse or a Social Worker, you can request that they arrange a home assessment for you within a reasonable amount of time.
A care needs assessment will lead you to a home assessment, but it will also tell you exactly what your care needs are, not just what adaptations and equipment you may benefit from. A care needs assessment will give you the full picture, including whether you are eligible for minor adaptations and free equipment up to £1000
Major adaptations through the Disabled Facilities Grant (DFG)
Over the last 25 years the DFG has helped over 40,000 people a year to live in more accessible housing.
The DFG is funded by your council and is for people who are disabled and who require significant changes to their home because of their disability.
If you’re eligible for it you can claim up to £30,000. However, the average DFG is around £7,000, with more than half under £5,000 and less than 5% over £30,000.
What type of adaptations does a Disabled Facilities Grant offer?
As with home adaptations under £1000, there is no definitive list of available adaptations under a DFG. What is available to you will depend on the eligible care needs you are assessed as having in your care needs assessment.
However, some of the traditional adaptations funded by a DFG are:
- Access – Door widening, removing a door threshold, long wheelchair ramp, external wheelchair lift.
- Moving around – Stairlift or through-floor wheelchair lift, ensuring sufficient turn-circle for wheelchair.
- Washing – Level access or wet-room wheelchair accessible shower, or a wheelchair accessible wash basin.
- Toileting – Hands-free automatic toilet.
- Food preparation – Wheelchair-accessible kitchen.
- Transfers – Ceiling-attached hoist.
- Heating – Improving the heating system to make it accessible to control.
- Controls – Adapting heating or lighting controls to make them easier to use.
- Garden – Improving access to make it easier and safer.
Are you eligible for a Disabled Facilities Grant?
DFGs are both means-tested and subject to the results of your care needs assessment. Either during or after your care needs assessment, an Occupational Therapist will carry out a home assessment and whether or not you’re eligible for a DFG depends on you being assessed as disabled and how your disability affects you at home.
The Equality Act 2010 defines a person as being disabled ‘if you have a physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities.
- ‘Substantial’ is more than minor or trivial. For example, it takes you much longer than it normally would to do something like getting dressed.
- ‘Long term’ means twelve months or more, taking both the past and the future into account.
Find out more how the Equality Act 2010 defines disability in its Guidance.
Don’t start work until you’ve had funding confirmed
You can’t claim for a refund on any home adaptations you’ve completed or started before you applied for a DFG, so it’s important to wait until your grant has been approved.
Do you have to own your property to qualify for a Disabled Facilities Grant?
No. The DFG is available whether you rent your property or own your own home. If you are a tenant in a rented property, you must request written permission from your landlord or managing agent.
If you’re a local authority or housing association tenant, the authority or association will decide whether to carry out the work itself, or refer you for a DFG.
How do you apply for minor adaptations or a Disabled Facilities Grant?
1. Apply for a care needs assessment
The best thing to do is apply to your council for a care needs assessment. This will tell you what your eligible care needs are. If your care needs assessment is being carried out by an Occupational Therapist (OT), a home assessment can take place at the same time.
If it’s someone other than an OT, ask your assessor to schedule your home assessment to take place within a reasonable amount of time after your care needs assessment.
2. Complete financial assessment
The next step is to complete a financial assessment, which tells you who is responsible for paying for your care needs. Remember that minor adaptations are not means tested, so, depending on the results of your care needs assessment, you may still qualify for minor adaptations up to £1000 even if you don’t pass the financial assessment.
3. Qualification outcome
When you get the results of your care needs assessment (and home assessment if they occur separately) and your financial assessment, you will be told if you qualify for minor adaptations up to £1000 or a DFG, or neither.
What happens next if you qualify for a DFG or funding for minor adaptations?
If you’re awarded up to £1000 for minor adaptations, your OT will discuss the type adaptations and equipment that are suitable to meet your needs. The OT should ask you how you feel about their recommendations and ask if you have any suggestions of your own. The OT will then arrange for the adaptations and equipment to be installed or delivered at a good date and time for you.
If you’re awarded a DFG, the next step is for the council’s surveying team to get estimates for the adaptations to your home. Councils will then usually conduct surveys with contractors they already have relationships with.
However, you also have a right to select contractors you have chosen for yourself to quote for the work. You have to get at least two quotes for the work and the council will only pay for the work once they are satisfied it’s completed to an adequate standard.
When using your own contractor, you are responsible as an employer for ensuring that they have the correct insurances in place. You can also do the work yourself, but you’re only eligible to claim for the cost of the materials.
Why not use a direct payment to pay for live-in care?
NHS Continuing Healthcare – your complete guide NHS Continuing Healthcare covers every penny of your care costs. It’s available for anyone with long-term health needs.
Local authority care funding – everything you need to know If you need live-in care or have to move into a care home, local authority
More information and advice:
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