Voices and Choices, Chesham Bucks.

Paying for Care at Home

[Produced for Voices & Choices October 2017]

80% of people using home care services are over 65 and the elderly population is growing fast. With so much talk in the media about the shortage of home care services and the funding cuts, many may be worried about how they will find the right support and how they will pay for it. The number of people funding their own care is expected to grow over the coming years so everyone needs to know where they will find the money. In this article we try to pull together the best information and advice on:

  • What is care at home?
  • How do you find a carer?
  • How much does it cost?
  • What help can you get with paying for it?
  • Where can you get the money for self-funding?

What is care at home?

Homecare comes in many forms and has many names used to describe it, including ‘home help’, ‘care attendants’ and ‘carers’ (not to be confused with unpaid family or friends who care for you).

Homecare can suit you if you need:

  • personal care, such as help with eating and drinking, bathing and personal hygiene, getting in and out of bed, getting dressed and undressed
  • housekeeping or domestic work, such as vacuuming or doing your weekly shopping
  • cooking or preparing meals
  • nursing and health care, including taking medication
  • companionship

Homecare can be very flexible, in order to meet your needs, and the same person or agency may be able to provide some or all of these options for the duration of your care:

  • long-term 24-hour care
  • short breaks for an unpaid family carer
  • emergency care
  • day care
  • sessions ranging from 15-minute visits to 24-hour assistance and everything in between

Personal care

If you need help with daily tasks such as washing, dressing, going to the toilet, taking medicine and getting into or out of bed, you should ask for a care needs assessment from your local council. Even if you don’t think you would qualify for financial help from the council, under the Care Act 2014, your local authority must undertake an assessment to determine whether you need care and support to live your life. The assessment should include your day-to-day needs, the things that are important to you and your individual circumstances. The assessment will take place in your home, usually by an occupational therapist, social worker and nurse. They will explore any issues you have with your everyday activities such as washing, dressing, managing your toilet needs and living safely at home. They should take into account your emotional and social needs, as well as physical difficulties you may have.

Your care and support plan will specify what tasks they can help you with, and how many times a day they visit. From the assessment of your care and support needs the local authority can provide you with access to a range of information and advice available locally.

If you’re not eligible for home care through the council or you want more help than they will provide, you can arrange your own home care directly through a private home care agency. Agencies may offer personal care, nursing care, live-in carers, and/or domestic help. Make sure you shop around before choosing one to compare prices and services.

Meals on wheels

If you can’t prepare meals yourself, your council may be able to arrange for you to have hot meals or frozen meals delivered by a meals-on-wheels service. They can usually provide you with food to meet your medical, cultural or religious requirements, such as gluten free, vegetarian or low salt meals.

A charge is usually made for each meal.

If you don’t qualify for meals-on-wheels from the council, you could contact a voluntary organisation or private company. Voluntary organisations such as the Royal Voluntary Service (RVS) provide a meals-on-wheels service in many areas (0845 608 0122, royalvoluntaryservice.org.uk).

Garden maintenance schemes

If you need help to maintain your garden, local organisations may be able to provide volunteers to help you. Contact your local Age UK (0800 169 6565, ageuk.org.uk) to see if they can help or tell you about local schemes.

Respite care or short breaks for carers

Respite (replacement) care gives carers a break from looking after a friend or relative. For short breaks, care workers can come in to provide a ‘sitting’ service. If the carer needs a longer break, the person they care for can stay in a care home temporarily. This can be arranged on a regular basis, such as every six weeks.

Respite care can be arranged privately if you can afford it. Otherwise it’s usually arranged by your council’s adult social services department, although it may also be available through your GP, local hospital or voluntary organisations.

Depending on how the council arranges its respite care services, they may offer vouchers or a budget to help pay for it. If you’re the person needing care, you may be charged something towards the respite service. This will depend on your finances and will be agreed with adult social services. 

Contact your local council or your GP if you’re a carer who needs a break. Read the Independent Age factsheet Support for carers (0800 319 6789, www.independentage.org). Or you can call the Carers Trust (0844 800 4361, carers.org) for information and advice. They may also provide respite services in your area.

How do you find a carer?

Once you’ve established what your needs are, if the local council is funding your care, under a national system known as Self Directed Support, Putting People First or Personalised Budgets, you can choose to get social care and support to meet your needs in a variety of ways to suit you – you can choose the kind of help you receive and who you get it from.

Even if you are funding your own care, perhaps because you are ineligible for local authority funding, flexibility and choice are key to getting the services you need.

If you have been allocated a personal budget, or you are self-funding, you can then choose the type of support you want. There are two main options available to you. You can either:

  • Employ a Personal Assistant (PA) directly, or
  • Buy support from a provider agency

There are important differences between how these work so make sure you think about what’s best for you.

Employ a PA directly

A PA is an independent “personal assistant”. If you are employing somebody directly, i.e. if there is no agency involved in your support, you will be classed as their employer. It is important to make sure you are clear about all your legal responsibilities before employing anyone.

The benefits are continuity, familiarity and an ongoing relationship; possibly a live-in care assistant. When choosing a PA, personal recommendations can be crucial.

If this is the option you choose:

  • You need to ensure you are able to pay their wages on a regular basis. This must be at least the National Minimum Wage for under 25’s and the National Living Wage for over-25’s (for current rates gov.uk/national-minimum-wage-rates).
  • You must also pay their tax, national insurance and workplace pension contributions.
  • You will need to make sure they have a contract of employment.
  • You need to check and meet your responsibilities to make additional payments, such as sick pay or maternity pay.
  • You also need to check that you have the right insurance in place, as you are responsible for your PA as their employer.
  • Your PA may need to have a check of whether they have a criminal record. You should check current requirements about this with your local authority or clinical commissioning group.
  • There is no legal requirement for your PA to have specific training, but if you think they need training, you will need to arrange and may have to pay for this. If you receive a budget for your care either from a local authority or from the NHS, they may ask for your PA to have specific training and may fund this. If you receive a personal health budget and your care plan identifies training that your PA needs, the NHS will provide or fund this.
  • You need to make sure that you have a back-up plan in case your PA is off sick or on holiday. Will someone else be able to support you?

Becoming an employer may seem daunting at first, but it may help you get the right support that is tailored to your requirements. If you like the idea of employing your own PA, but are concerned about managing the employer’s responsibilities, there are organisations that can support you with this. The Rowan Organisation is a charity that can advise on these issues. In some areas there are PA agencies that will help you find a PA. If you decide to use a PA agency, you should check whether you or the agency will be the PA’s employer.

Buy support from a provider agency

Support With Confidence is a scheme run by some Local Authorities which provides a list of approved care and/or support services that have been vetted on the grounds of quality, safety and training. Whether you get financial help to pay for your care, or you buy services privately, the Support With Confidence scheme will help you find a wide range of care and support services that you can trust.

If you are buying your support from a provider agency they will usually be your support worker’s employer. A provider agency may be a charity, a not-for-profit organisation or a private company.

Make sure that the provider agency will be responsible for paying your support worker’s wages, tax, national insurance, workplace pension contributions and all other payments including sick pay and maternity pay.

Agree with them at the beginning how you will be involved in decisions about who supports you. You can buy your support from more than one agency. For example, you could buy support for your specialist needs from a specialist provider and your general care needs from another, less specialist, provider.

What should you be checking with the support provider before agreeing a contract:

  • people’s circumstances change and there may come a time when you need to cancel your agreement with the provider agency; you need to know you can do this easily
  • they should offer long-term, high quality support; the initial conversations you have will be a good indication of your future relationship and how easy it will be to talk to them
  • they should be willing to spend time getting to know you to find out about your needs and wishes and what is important to you
  • they should carry out a review of your support, sometimes called a ‘person-centred review’, at least once a year and this should be led by you
  • you should have a home care plan that describes the care the agency will be providing and is focused on the things that are important to you; if you have specific health problems or disabilities the plan should take these into account
  • do they offer assistance with medication, you have to discuss the parameters of what they will, or are qualified, to do 

How much does it cost?     

It’s important that you carry out proper cost comparisons and consider the overall quality of care.

Check the price before deciding – your support provider should confirm a price that will not change after you and they have signed the contract, unless the contract allows this or it is by mutual agreement.

What should I look for?

  • Check how the price is put together.
  • If it is an hourly rate for support, is this for 1:1 support or shared support?
  • Check what the rate includes and what is “free”.
  • Check if there are any extra charges that you need to know about.
  • Check that the rate covers everything you will need, such as personal care, finding somewhere to live, etc.
  • Check what you will get for your money. Bear in mind that specialist provider agencies may cost a bit more but they may have more skills to support you and so be a better choice. Make sure you consider this when making a decision.
  • Check what extra specialist support you will be getting and how this differs from a “standard” agency.
  • Check what will happen if you need more support during the contract. How will this be charged?
  • Check who pays for the support worker if you go into hospital and still need support to be provided.
  • Check how the agency will manage the money you pay them. Do you want them to invoice you or will you pay another way? Will they send you a regular statement, telling you how your money has been spent?
  • Your support provider might want to include an annual review of prices to allow for staff pay uplifts in line with inflation or to agree an annual percentage increase up front. Make sure you ask how this will be agreed with you.
  • There may be other circumstances when prices have to be reviewed. Make sure there is a clear process for how you will be consulted on this.

Many people who use care and support services will pay for all of the costs. This is known as being a “self-funder”.

The cost of your care will vary depending on its type, intensity, specialisation, location and duration. For example, a place in a residential care home will cost hundreds of pounds a week.

Inevitably, the price you would pay will depend on your particular circumstances and needs. The costs also vary depending on where you live. Unfortunately, care homes and homecare agencies tend not to provide this information publicly but you may find it helpful to search for and contact care services in your area (NHS Choices) to get some idea of likely costs.

When it comes to finding out how much a self-funder could pay for domiciliary care, there are no nationally published figures, but research by the UK Home Care Association (UKHCA) in 2015 (The Homecare Deficit report) shows that across the UK as a whole, local authorities were paying £13.66 per hour to home care agencies.

In the financial year 2016-17, the UKHCA recommended agencies charge a minimum price per hour of £16.70. The purpose of the minimum price is to enable proper care for those people the agencies are looking after. However, depending on where you live in the UK, the amount of money that you will be charged will vary; it will also be affected by the level of care that you need. The hourly rate could therefore be much more than £16.70 and will range up to £23 per hour.

Live-in care: what does it cost?

Previously little-known, but actually long-established, 24/7 live-in homecare is becoming an increasingly popular choice for people needing full-time care. When looking at the fees charged by live-in care providers, it is important to note there are two distinct models of live-in care and costs vary depending on which of these options you choose. These are:

  • Introductory care service: where carers are self-employed and responsible for paying their own tax and NI contributions. They are matched according to need following a meeting with experienced care consultants working for introductory care agencies. The carers are then paid directly by their clients and / or their families.
  • Fully managed service: the company providing the care employs and trains its carers directly. It will oversee and organise all aspects of care arrangements both day-to-day and long-term, from initial expert client and risk assessment and client-carer matching, through to comprehensive care plans, so the client or family don’t need to worry about a thing. These providers are regulated by the Care Quality Commission.

The service that you choose to work with will affect the price charged per week. The Live-in Homecare Information Hub has conducted a survey of live-in care fees across the UK (2015). The survey shows that in 2015-16 care fees ranged from £600 per week for an introductory service through to £1,600 a week for a fully managed nursing service for people with more complex needs.

However, most providers charge between £800 and £1,250 per week. 

To make decisions that have such major financial implications, you may want to seek independent financial advice and it’s always worth researching the costs of alternatives first. For example, if you are considering a care home place, the cost should be weighed against the cost of care and support that may help you remain in your current home, such as homecare (NHS Choices). 

What help can you get with paying for it?

Don’t assume the local council will fund your at-home care costs. If you have more than £23,250 in savings (and live in England) you won’t receive a penny towards them. If you have less than this you will be means-tested and may still have to pay something. In total, of the four million people in the UK over 65 who are estimated to have care needs, only around 850,000 qualify for state help.

The first step is to ask your local council to carry out a financial assessment to find out if you qualify for any assistance with the costs of care at home. The council looks at your savings and any income you have. While you’re still living at home, it won’t take into account the value of your home – although a second property does count as savings. Couples are treated as individuals, with the assessment based on the financial details of the person receiving care and support, not their partner. The rules set out income councils can’t take into account, which is supposed to ensure you can pay for essentials such as food and utilities without being affected by care costs. Rent and mortgage payments are also disregarded. The general rule is that you retain 125% of your basic income support/pension guarantee credit level, usually referred to as your “protected income”. Which means, that in 2016-2017, individuals should not have had less than £189 per week to live on (for couples this is £288.56 per week).

The actual means-test calculation then carried out is extremely complicated. For example, for each £250 in savings you have above £14,250, the council counts it as £1 a week in income, in what is called the “tariff income”.

If your capital falls below the set levels for local authority funding (currently £23,250), you will be eligible for reassessment for help with funding your care.

If the local authoritity agrees that you are eligible for funding, a Care Manager will make a plan with you about how your care needs will be met and will let you know how much money is available to pay for your support. This is your personal budget. You should be provided with written information from the local authority detailing how the charges are worked out, and what is payable by you. The money from the council can be paid directly to you, and you are then free to choose the care assistance you need.

You don’t have to buy support from a PA or provider agency. For instance you could choose to use your personal budget to buy assistive technology or to take part in activities, such as using local clubs. Or you can choose to spend your budget on a mix of things. You can talk to your care manager about this.

If you have direct payments, your local council social services department should give you the support and information you need to manage your payments effectively.

NHS Continuing Healthcare funding

You may be entitled to NHS Continuing Healthcare funding, in which case you may also receive a personal health budget. You can spend your personal health budget on healthcare and support such as treatments, equipment and personal care. You must agree how your personal health budget will be spent with a healthcare professional, such as your GP.

Where can you get the money for self-funding?

There are several ways that people might raise money to pay for their own care:

  • Income – from pensions, work, investments or property.
  • Benefits – like the attendance allowance, which are not means tested.
  • Savings – if your savings are below a certain amount, you can still apply for local authority funding
  • Financial help from family or friends.

You might also consider:

  • Downsizing – selling your current property and buying a smaller one could give you a lump sum to help pay for care. For more information, see Property downsizing (Which).
  • Letting a room – if you have enough space, you might consider letting a room to a lodger. This can help raise extra money without the need to move house.
  • Equity release – if you own your own home you might be able to use an equity release scheme to ‘unlock’ cash from the value of your property, see Equity release (Which) for more information.

Whichever option you are considering, you should seek advice from a qualified independent financial adviser with expertise in the field. This will help you to make the best use of your income and/or savings, and to budget effectively. For more advice on finding an IFA, see this page on the Which? website. The Society of Later Life Advisers (SOLLA) can also offer advice. 

Are you eligible for Benefits?

Each year up to £3.5 billion of Pension Credit and Housing Benefit goes unclaimed by older people. So, even if you think you’re getting everything you are entitled to – it doesn’t hurt to check. Some benefits, like the Winter Fuel Payment, are entirely dependent on age – and not at all related to income. You could discover you may be eligible for Housing Benefit or Council Tax Support.

Attendance allowance (AA) – Attendance allowance is available for people aged over 65 years who need help with personal care (washing, dressing or eating) due to an illness or disability. It is available to people who need to be looked after by day, or who need to have someone staying overnight in case help is needed. There are two rates of AA, depending how your disability or illness affects you. Social services can take into account whether you are receiving AA when they are assessing you for financial help with community care.

Personal Independence Payment (PIP) – If you’re under 65 and need help with personal care or moving around, you may be eligible for Personal Independence Payment (Age UK). PIP is divided into two components. The daily living component and the care component, which may be taken into account when social services assesses your care needs.

PIP replaced Disability Living Allowance (DLA). If you were claiming DLA before PIP came in, you will continue to receive it until at least 2017, when you may be reassessed for PIP. DLA is divided into two components.

Carer’s Allowance – Carer’s Allowance is the main benefit for unpaid carers. It is extra money for people who spend 35 hours or more a week caring for someone who has a disability and gets a qualifying disability benefit. You don’t need to be living with the person you’re caring for to claim it, as long as you provide that amount of care.

You may have lost some of your income since becoming a carer – for example, if you’ve had to give up work or shorten your working hours to look after someone. Carer’s Allowance could provide you with some financial help. It is paid at a weekly rate of £62.10. You can spend the money on anything you want.

You won’t need to have a full means test to work out whether you can get Carer’s Allowance, but you won’t qualify for it if your earnings, after certain deductions, are over £110 a week. To find out more about the help you could be eligible for as a carer, see the Independent Age factsheet Support for carers (0800 319 6789, Independent Age).

Pension Credit – About four million older people are entitled to receive Pension Credit to top up their retirement income, yet just under half of those eligible are not claiming it, or are not claiming the right amount. If you think you might be missing out, the Independent Age factsheet, Pension Credit, explains how Pension Credit is worked out and how to make a claim.

Benefits calculator (Age UK)

If you don’t know what benefits you are entitled to, you can use the Age UK personalised benefits calculator to find out quickly and easily. Based on the information you provide – such as whether you’re single or in a couple, where you live, if you care for anyone – the calculator will tell you if you’re potentially entitled to claim extra money. You can launch the calculator here Age UK benefits calculator.

If the benefits calculator has shown that you are missing out on money, download the Age UK guide, More money in your pocket, to find out how to claim pension age benefits.

Challenging a benefit decision

If you think a decision made about your benefits is wrong, you can ask the office that made it to explain or reconsider. Challenging a benefit decision might sound daunting, but don’t be put off – the process may be easier than you think.

You can’t appeal a decision unless a decision maker has first had the opportunity to reconsider it. This is known as ‘mandatory reconsiderations’. Ask the office that made the decision to send you a ‘written statement of reasons’ explaining why it was made. You can then ask for a reconsideration: explain why you think it was wrong and send them any evidence you have to support your argument. You will receive a ‘mandatory reconsideration notice’ when your application has been decided which will tell you the outcome. Your mandatory reconsideration notice will also tell you if you have a right to appeal and how to appeal. Once your decision has been reconsidered, your benefit could be increased, reduced, stopped altogether or continued at the same amount.

The date you must request a reconsideration by should be on your decision letter, and will be within one month of the date that you received the original decision. If you have asked for a written statement of reasons for your decision, the one-month time limit can be extended by 14 days. They may accept a late application if there is a good reason for doing so – perhaps because there is a lot of money at stake, you have a particularly strong case, or there is a good reason why it was late, such as illness or bereavement.

Protection for self-funders

While you may have the savings in place to afford care services, if you lack the capacity to make the arrangements, the local authority can step in to help.

The local authority can also help people who lack capacity by negotiating fees with a care provider and paying them directly. The local authority will need to be reimbursed.

Useful links

You may find the following links useful. Please bear in mind we cannot be responsible for the content on these sites. Websites are constantly trimmed and edited, so any content on a third party site may disappear.

The Rowan Organisation is a leading provider of Direct Payments, Personal Budgets and Personal Health Budgets support services in England and Wales: The Rowan Organisation

Support With Confidence is a Local Authority scheme which provides a list of approved care and/or support services that have been vetted on the grounds of quality, safety and training:

Support with Confidence

Age UK is the country’s largest charity dedicated to helping everyone make the most of later life

For the Age UK guide to claiming benefits: More money in your pocket

The Money Advice Service set up by government offers information on paying for care or the option to speak to an online adviser. You can call the Money Advice Service on 0300 500 5000.

Paying for Care provides information and advice for older people and their families.

VODG represents social care charities. You can find a list of care and support providers who are committed to delivering personalised support and are VODG members at: VODG

Skills for Care has a range of support for people who employ a PA, including funding to support learning and development of both PAs and PA employers

NHS Choices provides Information about personal health budgets

Your local authority or personal health budgets team should be able to signpost you to local sources of advice with the practical arrangements of employing a PA. Another good place to start is: Shop4Support

Find information about home care services in your area by visiting: NHS Choices

Care Quality Commission

United Kingdom Homecare Association

The Care and Support Jargon Buster is a plain English guide to the most commonly used health and social care words and phrases and what they mean

Contact the Carer’s Allowance Unit to find out how to claimTelephone: 0345 608 4321; Textphone: 0345 604 5312;

Address: Carers Allowance Unit, Mail Handling Site A, Wolverhampton WV98 2AB

Independent Age can provide you and your family with clear, free and impartial advice on the issues that matter: https://www.independentage.org/

Buckinghamshire County Council meals delivery service: http://www.careadvicebuckinghamshire.org/s4s/WhereILive/Council?pageId=1136

Royal Voluntary Service volunteers support thousands of older people every day to stay independent in their own homes: http://www.royalvoluntaryservice.org.uk/get-help/support-at-home

Which guide to domiciliary care: http://www.which.co.uk/elderly-care/housing-options/domiciliary-care

Which guide to property downsizing: http://www.which.co.uk/elderly-care/housing-options/property-downsizing

Which guide to How to Find a financial Adviser: http://www.which.co.uk/money/investing/financial-advice/guides/how-to-find-a-financial-adviser

The Society of Later Life Advisers can help you find advice on how to make financial plans for care in your old age: Society of Later Life Advisers

Carers UK provides advice for carers who need to help someone else: Carers UK

Which guide to financing care: Which? Elderly Care

Sources of information

Paying for care at home: how to negotiate the minefield by Patrick Collinson – The Guardian 21 January 2017: https://www.theguardian.com/money/2017/jan/21/paying-for-care-at-home-cost-help-paying-for-it

VODG – Top Ten Tips when Choosing a Support Provider: https://www.vodg.org.uk/wp-content/uploads/2017-VODG-Top-10-tips-when-choosing-a-support-provider.pdf

Which guide to Financing Care at Home: http://www.which.co.uk/elderly-care/financing-care/financing-care-at-home

Which guide to Domiciliary Care: http://www.which.co.uk/elderly-care/housing-options/domiciliary-care

Independent Age Factsheets:

  • Carers’ Allowance
  • Getting Care Services at Home
  • Helping Home: what may be available in your local area
  • Pension Credit
  • Support for Carers

Age UK guide to Help at Home: http://www.ageuk.org.uk/home-and-care/help-at-home/paying-for-care-and-support-at-home/

References

Mental Capacity Act 2015 – information can be found at: http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/mental-capacity.aspx

Care Act 2014 – information can be found at: http://www.ageuk.org.uk/home-and-care/the-care-act/

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