Practice Guidance for Assessing Disability Related Expenditure 2016/2017
1.Introduction
Non – residential financial assessments are completed accordance with the Care Act 2014, The Care and Support (Charging and Assessment of Resources) Regulations and the Care Act Statutory guidance.
There is a statutory requirement to allow for disability related expenditure for all financial assessments where customers capital falls below the upper capital threshold, currently £23,250.The expenditure will be taken into account in the financial assessment process to determine a service user’s disposable income available for contribution.
The purpose of this practice guidance is to provide consistency, quality and equity in assessment. However, this should not preclude consideration of exceptional individual needs and circumstances where these arise. Assessment forms are designed to help collect DRE but should not be seen to include all possible areas of expenditure. Where other costs are identified by the service user these may need to be included in the assessment.
Where the total DRE claimed exceed £55.10a week or the item claimed exceeds the maximum figure allowed, before evidence is required and the assessment officer believes a reasonable case has been made for the expenditure, guidance should be sought from a senior assessment officer.
2.General principles
- Expenditure claimed for must be related to a customer’s disabilities and needs as set out in the assessment/care or support plan.
- Items allowed for must be based on actual spend by the customer, based on past and current expenditure. In some cases estimates of annual spending based on available evidence will need to be made.
- Expenditure made by other people for the client will not be allowed.
- Any expenditure to family members cannot be allowed unless this under a contract of employment.
- Customers should be informed that they may seek a review at any time, if their disability-related expenditure changes. This will of course require supplementary evidence of the change of circumstances.
- All expenditure must be evidenced apart from the limited circumstances allowed in these guidelines. Items of expenditure outside these guidelines must always be evidenced.
- Evidence must be dated and include the customer’s name to be considered.
- When adding outgoings to Abacus if the full amount is not allowed the claimed amount must be included in the outgoings note box with the reason why this is not agreed.
- Any outgoings under an ‘other’ category must be detailed in the notes box when inputting on Abacus.
- Outgoings should be input as weekly figures and any calculations detailed in notes
Staff carrying out the assessment must ask users for receipts/invoices or other proof of payment to verify claims for additional fuel, transport and equipment costs as well as privately arranged care. If verification is not provided no allowances should be given. In other cases, such as clothing or special foods, most users probably do not keep receipts so staff will need to exercise a degree of judgement as to whether a claim is reasonable. Within this guidance certain maximum levels are applied and expenditure within these may not need to have detailed evidence.
Evidence, or lack of evidence, should always be noted in the assessment form. Where evidence is seen details of this need to be noted.
Where reasonable evidence could be produced, customers have a responsibility to do so. If a customer is requested to keep future receipts and they fail to do so no allowances can be made.
3.Common items of additional expenditure
The Care Act guidance highlights a range of potential expenditure that could be allowed. The following guidelines provide recommended allowances for the items identified and in addition shows reasonable evidence requirements. Despite the necessity of evidence, this working tool attempts to reduce the intrusive nature of the assessment.
4.Private Care and Support
As a public authority Camden has an obligation to account for public funds and to ensure that this principle of accountability is embedded when carrying out its’ statutory responsibilities.
Where care is being purchased by a care agency this would need to be from a Care Quality Commission registered agency to ensure appropriate standards of care and public accountability are met.
Where a carers is employed this will normally be under the employment status of employee, not through self -employment.HM Revenues and Customs have developed an Employment Status Indicator tool for employers and employees to check whether a worker is employed or self-employed for tax and National Insurance contributions purposes This tool verifies that in the vast majority of cases, carers cannot be regarded as self-employed; the responsibility and accountability always lies with the employer to ensure that they are complying with relevant tax and employment law.
5.Assessment Periods
Where costs are for a short period more than one assessment should be input on Abacus. For example a small equipment cost can be allowed over a short period and two assessments can be input: one for a fixed period allowing for the cost and a second, open ended assessment period starting after the end of the fixed period with the cost excluded.
6.Reviews
Any review of DRE must consider all the allowances claimed and already included in the assessment. This means that an allowance for an area of expenditure should be removed from the financial assessment where there is no contemporary evidence of expenditure.
Where additional DRE is claimed on a review or reassessment this will only be allowed if evidence of payment is provided.
When completing a review of DRE the customer is required to provide up to date details of income and capital as part of their reassessment unless this has already been provided in the current financial year.
7.Relationship to social care assessments
Where social care are funding a need through commissioned care or a Direct Payment and expenditure is claimed in these areas no allowance is to be given
Where funding is provided through a Personal Budget and an amount allocated for a need through the RAS this will be a factor in considering whether it is reasonable to make an allowance for DRE. The principle operating in these assessments is that it is reasonable to expect customers to plan services based on their assessed need and if they choose to make arrangements not to meet that need with social care funding when they could no DRE allowance will be given in that area.
8.Reinstatement of Care
Where a previously lapsed assessment is reinstated more than a year after the original evidence was collated no allowances are to be given in the following areas without fresh evidence:
- for privately arranged care ,domestic support or gardening
- One off items outside of the allowed for period
- Fuel costs
- Washing costs greater than £3.61 per week (existing costs should be capped at this level pending evidence)
Allowances given in the previous assessment are to be revised and amounts allowed in accordance with the current guidance. Customers will be required to submit details of any current expenses together with providing evidence of any arrangement.
Section 1Care, domestic support andpersonal assistance costs
Privately arranged care and other domestic support / Care hours that are within the care assessment should always be treated as an allowable cost, if they are not funded by ASC and evidence of expenditure is provided. Where the care assessment is not clear advice should be sought from care management.Any need identified as met by any part of the provided package cannot be an allowable expense.
If not within the care plan and the need is clear allow up to a maximum of 2 hours a month for the care or support.
£12.00 per hour (DP rate) has been set on Abacus as a reasonable amount to allow based on the DP rate.. / Examples of evidence include:
Invoices from CQC registered agencies
Contract of Employment
Wage slips
Payroll copies
Evidence of payment of employers liabilities to HMRC
Any payments not to an agency or without a verified employment relationship should not be allowed.
Other household assistance / If within the care assessment allow costs for cleaning, gardening, handypersons or other assistance in the home not met by the Council.
Proof of payment is required.
If not within the care assessment but there is a clear identified need allow up to 12 per hour for:
Cleaning:one hour per week
Gardening:one hour per month
Handyperson:one hour per month / Signed receipts or invoices for at least 8 weeks. Expenditure details such as from bank statements
Cash payments to informal carers should not be taken into account
Day Opportunities / Additional costs for day opportunities For example contribution to activities or trips. Where no evidence, allow a maximum of £5 per week for 4 weeks only pending evidence. / Customer evidence including from provider
Section 2Extra household expenses
Fuel costs: heating, lighting and cooking.These include items included in rent or paid directly by the client. / Apply the amount actual costs are in excess of the standard allowances
Single Person – Flat/Terrace£1,143.00
Couple – Flat/Terrace£1,508.00
Single person – Semi Detached£1,214.00
Couples – Semi Detached£1,600.00
Single – Detached£1,477.00
Couples – Detached£1,947.00 / Extra costs should be evidenced by fuel bills.
Where bills have not been kept evidence of payments to utility providers can be accepted for the initial assessment.
By the time of next review customers need to produce bills and the amount would be adjusted accordingly.
Laundry/Washing Powder / If user has more than 4 washes a week, allow £3.61 a week.
Costs include, disinfectant, towels, incontinent laundry service not provide by council and cleaning materials to maintain home hygiene
Where costs relate to fuel bills or replacement of equipment these can be considered as other DRE expenses / The care assessment or support plan will have identified an incontinence problem or other medical condition that necessitates extra washing.
Evidence on the frequency of washes and/or purchase costs of materials.
Additional clothing/foot-wear and extra wear & tear of clothing and bedding / Based on why needed, brand, price and frequency of purchase. As a guide allowance can be made for weekly amounts above £5.30 a week. Benchmark figures (allow if weekly expenses exceed):
Costs have to be above £5.30 a week and maximum allowance is as £10per week without full evidence
NB Availability of Social Fund Grants for people on Income Support
Dietary needs / This includes: specific foods, food supplements, ready meals, food wastage, eating out, take away (for instance where cannot cook). It can also include extra costs in obtaining foods.
Special dietary needs will not necessarily be more expensive than normal, but as a benchmark if a single user spends more than £33.68 pw additional costs could be allowed, but capped at a maximum of £23.30pw.
There should be a degree of flexibility, which allows for cultural differences.
Alcohol is not allowable. / The care assessment may have identified a medical condition requiring special foods
Breakages / Allow reasonable costs for breakages (for instance dropping household items). Allow claimed up to £2.00 a week without evidence of expenditure. Claims for higher amounts must be evidenced. / The care assessment may have identified a disability or medical condition giving rise to this
Prescription Charges and other health costs. / Most users will be exempt from charges, but allow actual health costs, including vitamins, not met by the benefits system. Including: prescriptions, sight tests and glasses, dental check-up and treatment, up to the basic NHS amounts.
Allow up to a maximum £104 pa, (£2pw.) for each area of health cost if the user is able to demonstrate the extra costs are disability related.
Continence pads and underwear. People should use the free service available on the NHS. If these are unsuitable or insufficient additional costs should be considered as part of washing and hygiene management.
Expenses can include non-standard and culturally appropriate costs but equivalent services need to be available through the NHS. Expenses that relate to a need met through the NHS are not allowed as DRE as these are available free of charge.
Acupuncture and massage may be allowed, where this assessed by the NHS as medically required, up to £40 a month. / Assessment of health charge eligibility.
Details of treatment and cost, including receipts from registered practitioners
Receipted evidence of expenditure
Details of treatment and proof of expenditure.
Confirmation from medical professional of medical need and why this is not NHS funded.
Section 2Transport and leisure costs
Transport costs / As far as possible users should be encouraged to make use of the various Accessible Transport Schemes. Costs as a consequence of disability should only be allowed, for example taxi costs to go shopping, where no alternative is available and practicable.Transport costs to maintain social contacts, where they are greater than those incurred by an able-bodied person, should be allowed.
In some cases, it may be reasonable not to take account of claimed transport costs, if a cheaper form of transport, e.g., council-provided transport or taxicard is available, but has not been used.
Allowance to attend hospital or other medical appointments will not normally be made as, if there are special requirements, these cost should be met by the Health Authority.
Allow costs up to £13.38 a week. Additional costs can be allowed where evidenced with receipts and funding or subsided transport not available elsewhere.
For taxicard users the receipt is likely to be the full amount not the £2.50 a trip paid by the customer. The weekly allowance agreed will therefore need to take account of the number of subsidised trips they are eligible for.
For those in receipt of DLA (Mobility) only allow costs in excess of the rate paid. In calculating expenses both ongoing transport costs and one off equipment costs must be aggregated first. No allowance to be made for Accessible Transport charges.
Motability or other car schemes
Where a customer uses their DLA mobility to pay for an adapted car, wheelchair or scooter through Motability or use other financial arrangements to the same effect, further transport allowances may be considered.
This could include costs of adapting a car, insurance or fuel.
Additional allowances would not normally be made for fuel costs as the general cost of getting about are not specifically related to disability.
For an allowance to apply 2 additional must be met:
- the whole expense must meet a disability need identified in the care and support plan
- The weekly costs exceed £32.40 the price of a weekly 1 -2 zone travelcard.
The need for a car as a specific means of transport must be directly related to the disability. For example they are unable to use other means for getting about, such as a freedom pass. / Evidence in the care assessment of mobility difficulties.
Taxi receipts
Motability agreement
Holidays / This should be the cost of a carer/escort or specialist holiday, unless covered by Direct Payments, charity or other provision.
Only allow the amount by which the costs are greater due to disability.
Costs of holidays can only be allowed if within 12 months of the financial assessment and should only be allowed for 52 weeks from the assessment / Proof of payment by customer is required in all cases.
Communications / If users are housebound, allow Internet access and mobile phone costs up to £3.53 per week.
Section 2One-off equipment costs
Special Equipment / As guideline figures the following can be allowed for items purchased in the last 5 years / Evidence of purchase.No allowance if equipment provided free of charge or grant funded.
Where a user can demonstrate more frequent replacement is required costs may be calculated over a shorter period
Wheelchair / Manual £3.75 pw
Powered £9.12 pw
Powered Bed / Actual cost divided by 520 (10 year life) up to £4.20 pw maximum
Turning bed / Actual cost divided by 500 up to aa maximum of £7.27 pw
Powered inclining chair / Actual cost divided by 520 up to a maximum of £3.30 per week
Stair lift / Actual cost divided by 520 up to a maximum of £5.88 per week
Hoist / Actual cost divided by 520 up to a maximum of £2.88 per week
Computer and other communication aides / Reasonable costs over a 5 year period
Mobility aids and equipment – only costs in excess of the DLA Mobility Component can be allowed. Calculations should aggregate the weekly equipment and transport costs.