Contributions – Paying for Non-Residential Care
DATE:31 January 2013
EFFECTIVE DATE:
CATEGORY: KEYWORDS: ISSUED BY: CONTACT:
05 April 2012
Finance Contributions Richard EllisNicky Millard
PROCEDURES 01/12 CANCELLED
OR AMENDED:
REMARKS:
SIGNED:
DESIGNATION: Assistant Director Adult Services
YOU SHOULD ENSURE THAT:-
You read, understand and, where appropriate, act on this information
All people in your workplace who need to know see this procedure
This document is available in a place to which all staff members in your workplace have access
PURPOSE
To outline Adult Services policy and procedures for contributions to personal budgets for social care services that support people to live at home.
To set out prices charged by Hampshire County Council Adult Services for services delivered by its own establishments.
SCOPE
The contributions policy and procedures apply to all adult non-residential social care services for which the council has discretionary powers to charge. Contributions will not be sought for services excluded by legislation or statutory guidance. See appendix B for a non-exhaustive list of services.
POLICY
The department seeks contributions for services under section 17 of the Health and Social Services and Social Security Adjudication Act (1983) and seeks contributions for direct payments under Community Care, Services for Carers and Social Care Act 2001. See appendix A for the policy statement approved by Hampshire County Council’s Cabinet 28 February 2011.
REFERENCES TO LEGAL, CENTRAL GOVERNMENT AND OTHER EXTERNAL DOCUMENTS, INCLUDING RESEARCH
The National Assistance Act 1948
The Health Services and Public Health Act 1968 The Chronically Sick and Disabled Act 1970 The NHS Act 2006
The Carers and Disabled Children Act 2000 The Health and Social Care Act 2001
Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulation 2009 Pursuant to Health and Social Care Act 2001
Charging for Residential Accommodation Guide (CRAG)
Fairer Charging Policies for Home Care and other non-residential Social Services – Guidance for Councils with Social Services Responsibilities – September 2003 Dept of Health
Dept of Health Fairer contributions guidance 2010: calculating an individual's contribution to their personal budget : Department of Health - Publications
Dept of Health Fairer Contributions Guidance 2009 Easy Read Version
Health and Social Services and Social Security Adjudications Act 1983 – Section 17
Mental Health Act 1983 section 117 – the duty on health and social care services to provide free aftercare to patients previously detained under certain sections of the act
HAMPSHIRE COUNTY COUNCIL ADULT SERVICES DEPARTMENT REFERENCES Help with care choices in Hampshire
DEFINITIONS
Carer / A person who provides substantial and regular unpaid careChargeable Personal Budget (cPB) / The part of a personal budget for social care (see below) to which the service user may need to make a financial contribution
Contribution / The payment made by the service user towards their chargeable Personal Budget
Care Practitioner / The person within Adult Services who assesses service users social care needs and eligibility to receive services and arranges services to meet eligible needs
The Council / Hampshire County Council
The Department / Adult Services
Direct Payment / Payment by the department to service users, or appropriate adult, with which they arrange and pay for services to meet their eligible needs
Free Crisis Care / Reablement services offered free for up to six weeks to service users at risk of hospitalisation, or at the point of hospital discharge
Financial Assessment / An assessment of the service user’s finances to determine their maximum contribution (the most they will pay towards their cPB). Includes the offer of information about welfare benefits entitlement and support to claim these
Financial
Assessments and Benefits Team (FAB) / CountyTreasurer’s team who carry out the financial assessment and calculate the maximum contribution (the most a service user will pay for their care).
Managed Services / Care services organised and managed for the service user by the department
Personal Budget for social care / An amount of money agree by the department to meet an individual’s eligible needs. This budget may include money for services that are provided for free by the council.
Representative / Someone with the legal authority to manage the service users finances. They will have been granted power of attorney, deputyship or Appointeeship. See paragraph 14.5 for further information.
Respite Care / Gives service users a break from their home circumstances and/or enables a carer to have a break from the caring role.
For short term residential respite care this is up to 8 weeks.
Self Directed Support Assessment. / Assessment and supporting planning of the service user’s needs and how these will be met
Service User / Someone who has received, or is likely to receive, a social care service from the council
Telecare / Equipment that senses risks such as smoke, floods and gas and can prompt a service user to take action (such as medication reminders or doors left open).
Welfare Benefits / The range of benefits provided by the Dept for Work and Pensions.
ROLES
Care practitioners in Adult Services will assess individuals needs and eligibility for services and will put care services in place to meet eligible needs. They will advise service users about the Council’s Contributions Policy and refer service users who are eligible for chargeable services to the CountyTreasurer’s Financial Assessments and Benefits Team (FAB) in Revenue Services
Revenue Services will undertake the financial assessment in accordance with Dept of Health guidance; issue invoices and receive payments, in accordance with the CountyTreasurer’s procedures and guidance for staff.
The Devolved Finance Team will provide information and challenge to the Adult Services budget management in relation to the chargeable rates for the Council’s own services; and for income monitoring.
AUTHORITY TO VARY THE PROCEDUREDeputy Director Adult Services
ContentsPage
1.National Context5
2.HampshireCounty Council Contributions Policy5
3.Personal Budgets for Social Care and the chargeable Personal Budget5
4.Direct Payments6
5.The Process7
Self Directed Support – the needs assessment stage
The Financial Assessment
The Panel Process
Calculating the Service Users Contribution
6.Changing the Service Users weekly contribution during the year9
National Policy
Local Policy – why service users need to pay when services are not received When the chargeable Personal Budget does need to change
Cancelling the chargeable Personal Budget
Making payments
Service users review of their financial circumstances
7.Services12
Rates for non-residential and residential care services
Shared Lives
Extra Care Housing
After Care Services for people previously detained under the Mental Health Act Care Services which are privately arranged by the service user
Respite Care
8.Safeguarding the interests of service users14
Mental Capacity, Attorney, Deputy or Appointee
The Client Affairs Team (CAT)
Suspicion of abuse
Debt and arrears
Duty to assess and provide services; and refusal to pay
Welfare benefits checks
9.Getting it right, first time15
10.Ordinary Residence16
11.Other organisations who purchase services from the council16
12.Compliments and Complaints17
13.Equalities Impact Assessment17
14.Performance Standards associated with this procedure17
Appendices
Appendix A Hampshire County Council’s Contributions Policy18
Appendix B List of chargeable and non-chargeable services (non-exhaustive)22
Appendix C Scenarios25
Appendix D Guidance on making amendments to chargeable Personal Budgets27
Appendix E Guidance for Residential respite care30
1.National Context
1.1 The Department of Health (DH) requires that everyone will have a Personal Budget for social care by 2013. The Council is implementing this through Self Directed Support.
1.2 The DH Fairer Charging Guidance sets out how the financial assessment must be carried out; and Fairer Contributions Guidance sets out how an individual’s contribution towards their personal budget is calculated.
2.HampshireCounty Council Contributions Policy
Social care is not a free service and national funding arrangements make it clear that contributions from service users to help fund the cost of services are essential to the Council’s financial strategy. A copy of the policy approved by Cabinet on 28 February 2011 is attached as Appendix A.
Service users have the choice to manage their own services, or to ask the Council to do this for them. This does not affect their entitlement to an assessment of needs, nor access to advice and information provided by the Council.
Service users who have a financial assessment which indicates the Council needs to pay for
some or all of their services can choose to have a Direct Payment. The policy and this procedure applies equally to all service users who ask the Council to manage their services, use a Direct Payment or use a combination of these.
The policy applies to service users who are ordinarily resident in Hampshire and meet the Council’s eligibility criteria of critical or substantial needs. Service users resident in another council area will be subject to the contributions policy of that authority. Hampshire County Council will recover the full cost from other organisations for services it provides or arranges on their behalf. Appendix C sets out the rates for Hampshire County Council run services. These rates will also apply to service users in Hampshire who use these facilities and pay the full cost of their care services.
Hampshire County Council Adult Services Department aims to promote independence and choice, be fair and equitable and give service users more power and control over their lives. The policy applies to all care services that support people to live at home. The procedures outlined below are to help ensure the Council seeks timely, fair and equitable contributions from service users.
Rates for care services commissioned or provided by the department are reviewed annually and approved by the Executive Member for Adult Social Care as part of the annual budget setting process. This usually happens in January in respect of the forthcoming financial year.
3.Personal Budgets for Social Care and the chargeable Personal Budget
The Department is introducing personal social care budgets which, over time, could include money for all the services it arranges for an individual. As not all services can be charged for
under this policy, there is a need to create a chargeable Personal Budget (cPB) for each service user. This is the amount of money that is used in the calculation of the service users contribution. A non exhaustive list of chargeable and non-chargeable services is included in Appendix B.
Service users can pay the full cost of their cPB or request an assessment of their financial means. The financial assessment will work out their maximum contribution (the most they will pay towards their cPB). There are three possible outcomes from this assessment:
o The service user is assessed as having insufficient money to contribute, so the maximum contribution is nil = the department funds the full cost.
o The maximum contribution is lower than the cPB = the service user pays the maximum contribution and the department funds the balance.
E.g. cPB = £500 a week. Max contribution = £100 a week. Service user pays £100 a week. The department pays £400 a week.
o The maximum contribution is higher than the cPB = the service user pays the full cost.
4.Direct Payments
Where a Direct Payment is made as an alternative to arranging services, a contribution may be required and will be calculated on the same basis. Wherever possible, Direct Payments will be paid net of the service users contribution.
For mixed packages, instead of using waivers, a Disability Related Expense (DRE) is
applied to the financial assessment for the amount outlined in the table below, as it has effectively become ‘care services, privately arranged’. This would remove the need to amend
waivers but would require social workers to notify FAB of any changes to ‘care services, privately arranged’ in the future, so that the DRE can be appropriately amended (see Section 6 Care Services Privately Arranged).
A FAB visit would only be required if financial circumstances had changed but the financial assessment would need amending to correct the level of ‘care services, privately arranged’ being allowed.
This process should also apply for service users who no longer receive a Direct Payment where there is no Commissioned Care in case Commissioned Care commences in the future.
The table below shows the different scenarios:
Direct Payment only / Mixed PackageFin Asst: / Nil / Less
than
DP / More than
DP / Full
Cost / Nil / Less
than
DP / More than
DP / Full
Cost
DP received / Full / Part / None / None / Full / Part / None / None
Contribute to Commissioned Care / n/a / n/a / n/a / n/a / No / No / Yes but limited / Full amount
DRE / No / No / Yes i.e. the / No / No / No / Yes i.e. the / No
amount they / amount they
would have / would have
received as / received as
a DP / a DP
5. The Process
The following process will be followed as quickly as possible to ensure service users make a fair and affordable financial contribution to their care service costs, and receive the information and support they need in order to do so.
5.1 Self Directed Support – the needs assessment stage
The care practitioner will carry out the assessment of needs and eligibility with service users and explain the personal budget for social care. As part of this process, they will take action to ensure service users are aware of the Contributions Policy and are supported to make a
fair and affordable contribution to the cost of their services where appropriate. Unless a service user has previously had a financial assessment, the following action will be taken:
Care practitioners must assume the service user’s mental capacity, including to manage financial affairs. Where there is doubt, they will carry out a mental capacity assessment. Section 7, Mental Capacity, gives more information including how to obtain legal responsibility for someone’s finances and the Department’s role.
The care practitioner will take action to establish someone with the legal authority to manage the service user’s finances (their representative) – they will record this information on AISand include this information in the referral to FAB.
The care practitioner will then explain to the service user or representative:
Most social care services are not free and the service user may need to contribute towards their chargeable services. Carers are not required to contribute although the service user may contribute towards the cost of the chargeable services they use that benefit the carer.
Service users can pay the full cost of their chargeable services or have a financial assessment to work out what they should pay. The financial assessment guidelines are determined nationally by the DH and are aimed at ensuring no-one pays more for their care services than they can afford. Please note ‘affordability’ is determined by reference to national welfare benefits rates, rather than local policy. The assessment also includes information about welfare benefits and help to apply for them. A summary of how the financial assessment works is set out in the Making a contribution to your personal budget for social care booklet. Further information about the financial assessment including savings and income is available from the Corporate Services’ Financial Assessments and Benefits Team.
Service users with more than £ 23,250 (2012/13) in assessable savings or capital (excluding the home they live in) will need to pay the full cost of their chargeable services.
The care practitioner will leave a copy of the Making a contribution to your personal budget for social care booklet and Financial Assessment Form SAS10 with the service user/representative. Further information about the policy and paying for care is available on Hantsweb.
The benefits of a having a financial assessment (unless the service user has more than £23,250 (2012/13) in assessable savings/capital) are that most people find it helpful to have some assistance with understanding how to complete the form. This will ensure thatthey provide all the important information, for example Disability Related Expenses that may reduce their contribution. Information and help to apply for welfare benefits are also included as part of the assessment.
Where an assessment is declined, FAB can still send information about local groups that can help with benefit claims. This is to ensure service users who are struggling financially but regard the financial assessment as an invasion of privacy are not disadvantaged.
The care practitioner will then:
Offer to make an appointment with FAB for a home visit to carry out the financial assessment with the service user or representative.
Telephone FAB (01962 845600) to make an appointment with the service user/representative.
Ask the service user/representative to sign the SAS10CR declaration at the back of the Making a contribution to your personal budget for social care booklet.
Where an assessment is declined, or there is agreement to pay the full cost of their services, ask service user/representative to complete and sign section 3 of the financial assessment form SAS10.
As soon as possible after the SDS assessment visit, the care practitioner will:
Make a referral to FAB – using the AIS profile note and ‘workflow’ link to the FAB team. Even if the service user has declined a referral or is full cost this must be noted and advised to FAB on the referral form.