Social care, and access to it, has become an electoral hot potato. It’s a source of much acrimony between providers - often cash-strapped councils - and individuals who are being told they are not eligible, or have had their care cut back.
Here we look at a possible scenario, and explain just what people should expect from their local authority in terms of financially subsidised social care help.
Mother and father are in their early seventies, and think of themselves as comfortably off, as they own their own home and get by on their pensions and savings.
Dad’s got COPD ( Chronic obstructive pulmonary disease ) and gets very breathless. They’ve been coping at home on their own with just some cleaning and shopping help from a neighbour who’s able to phone the couple’s children if anything concerns him. They’ve been reimbursing him for petrol and making sure to say thanks with small tokens of appreciation.
Dad doesn’t drive any longer as he had a bad scare when he got breathless and had a panic attack at the wheel, and Mum has been pretty much the organiser of household admin - and his carer, although she wouldn’t see it like that.
Unfortunately, she herself has had a bad fall recently and has been in hospital.
She was discharged without anyone really exploring what would be happening when she got home. She’s broken several bones and may take 3-4 months to heal. She’s sleeping downstairs at home and that’s making her very anxious about her husband, and she is tearful, and not her usual self.
She is scared of looking for help in the newspaper or having different carers come in from the local agency; the hourly cost of £18.00 an hour from the agency is blinding her to the benefits and the risks of not having help in.
The couple have three sons and daughters who live all over the country with jobs, children and responsibilities: they can help organise things, but not provide practical help. The neighbour seems to be avoiding their phone calls, and the siblings are getting cross with each other as to the best way to persuade their parents about the best way forwards…
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Social care expert Belinda’s answer:
Most people don’t realise that they have legal rights to adult social care expertise and to financially subsidised help. Nor do they realise that one doesn’t have to be in financially dire straits before financially subsidised help becomes available.
This situation above is commonplace – and if people don’t know what to ask for and when, it can very easily happen that the overstretched hospital staff perceive a patient and her family as ‘too well-off’ to qualify for State-funded care services, and simply able to sort themselves out on their own.
This is so wrong; it leads to inequity and arbitrariness in relation to who gets what – and a containable situation can quickly spiral into a crisis.
The hospital discharge nurse may even have overlooked the value of reablement services for the patient, which are mandatorily free services for up to six weeks, to ensure that a person’s potential for regaining independence is maximised.
Most importantly, referral to an Occupational Therapist for expert advice (about aids and equipment that are obliged to be available for free from the joint equipment store) might have increased everyone’s confidence that this household would cope, if it had all been better planned.
If more people knew the legal answer to this sort of problem, and if discharge teams were trained in the duties of social services, and how people’s rights work, then it would revolutionise the profile of adult social care.
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Some key facts on financially subsidised social care:
• People who live in their own homes, and whose needs qualify as needy enough to meet the national eligibility criteria for deserving care funded and arranged by the council, aren’t able to be told that they are too rich for it, unless they have more than £23,250 in assets that could be turned into cash without too much difficulty. That is, the house and the equity in it, don’t count. (£23,250
in England and Northern Ireland. It's £24,000 for Wales and £27,250 in Scotland.)
• It is the assets of the person who needs the care that count, not the couple’s – unless they both need care. So, if either of the parents above has less than £23,250 in their name then he or she would be able to have their care costs subsidised by the council – that is, without having to pay the full private cost of arranging for the care services.
• Everyone (however well-off) has a right to advice, information and sensible ‘signposting’ to preventive services locally from the council – so a lot of the mystery about the local care system can be solved by taking up that right, and looking online or calling and asking.
• Everyone (however well-off) has a right to an assessment, to see if they count as eligible for financially subsidised social care, against national criteria.
The concept is based on the question whether one is ‘unable to achieve’ two or more daily living activities from a list of 10, without assistance and without struggling too much, with pain, anxiety, distress or endangerment to self or others, plus whether one is experiencing significant impact from those difficulties.
There is no need for the problems to be permanent, or even long term! Broken bones do heal, but one has rights in the meantime, if the situation warrants it.
• People’s families often are widely dispersed. Under the law that’s currently in force, they are not assessed for the cost of care for their parents, and have no legal obligations to give up work and their own family responsibilities in order to provide care (unsurprisingly, given the policy to support as much employment as possible for both men and women equally).
If they do, of course, the council takes the benefit and will deduct any informal family care being provided for a needy person from its evaluation of the shortfall of what’s needed, in order to save public money, but they can’t make a relative care – not even a spouse! That goes for neighbours, as well!
Caring for an elderly mother: a daughter's story
• If a person is eligible, then the Council is obliged to provide adequate, appropriate, sufficient care services to meet their needs - regardless of the state of the council’s budget, because there is a statutory duty to meet eligible unmet needs.
The council can take austerity and its budget difficulties into account in deciding how ‘generously’ to meet need, and needn’t do it the exact way the person would like. But an arbitrary approach such as “only four visits a day” or “no more than the cost of a care home would be” or “limited to the cost of live-in care” is not a legal offer.
• Councils can and do charge for care, based on an approach laid down in national guidance and regulations as to how much a person needs to be left with to live, from their income and their assumed income from their capital up to £23,250.
But as mentioned above, if you have less than that upper sum, you will get a subsidy and will not have to pay the full cost of your care. Even if you have more than that sum of money, you can get the council to organise care for you, and pay a fee for that service.
You'd still get a cheaper service than you otherwise would be able to buy, because councils aren’t allowed to charge more than it costs them to buy the care in, and they all tend to get it cheaper than private customers, because of bulk buying power (and public sector dominance of the home care market).
• Anyone who is providing practical or emotional support to someone else counts as their carer, even if the cared-for person isn’t getting social services as an eligible person themselves.
That is, if a person wants to be seen as a carer, they are entitled to a carer’s assessment to see if they themselves are at risk because of the load that they have taken on, and thereafter to services by way of support of the carer, to sustain the caring role.
Nobody is made to call themselves a carer, but what a person willingly does out of love for their partner or other relative is care - and is unpaid. That’s why it can and does count for opening the door to rights to support, because a person may be regarded as a carer with eligible needs, if they get exhausted, or feel that they don’t want to go on caring at that level for whatever reason.
So, in the scenario above, Mum counts as a carer, as long as she’s still trying to care, and after her accident Dad may qualify for care as well because his usual informal carer just can’t do what she was used to doing, informally and willingly…
Essential tips for carers
• People who are eligible for care and support are told what sum of money the council sees as necessary to meet their needs (a personal budget). People are virtually entitled to choose whether to take that sum of money (after any legitimate council assessed charge has been deducted) to choose their own care providers from an agency, or to employ someone if they want to, or leave it to the council.
They don’t have to have a direct payment, and can just have council services if they want. But a direct payment is ‘free’ money, (it is not the same as Carers’ Allowance or any other benefit) for those who do, with which to supplement their own spending (of what would otherwise have been the council’s charge), on the care that they actually prefer.
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So, synthesising all of that into a reply, the family above could liaise with social services for advice and information, find out what could be accessed privately if that was their choice, ask whether there’d be any point to assessment in terms of the parents’ financial situation being likely to give rise to a financial saving, and based on that, get the parents assessed for a joint care package in the short term, in their own home.
Reablement and equipment would then be reconsidered, albeit a bit late. Then, if one or both were assessed as eligible, a sum of money would be calculated for a signed off care plan. It isn’t then simply a matter of ‘take it or leave it’ – it’s negotiable, because it has to be lawfully arrived at, transparently justified, and sufficient, based on the real local market cost of care.
Running a direct payment for both of them might give the mother some of her sense of purpose back, but if she doesn’t want that responsibility, a son or daughter could be nominated to help do the admin; alternatively, the council could be required to organise the care, and a properly assessed charge would then be paid.
The kind of services that would be put in (or funded through a direct payment form of personal budget) would be shopping and cleaning, meal preparation, and personal care and support to access the community so that social isolation did not overwhelm the couple.
The pros and cons of live-in carers
The result of obtaining financially subsidised social care
The overall result could well be that a crisis is prevented; the family would feel that they were doing as much as they feasibly can; the lady’s anxiety about her role as carer would be assuaged; the missing reablement and equipment might encourage her regaining of independence, and the neighbour would be re-assured that he was not about to be dumped on for the foreseeable future to an unlimited degree. The couple’s independence in the community and their emotional and physical well-being would be promoted, and stress would be managed.
That’s how the system of adult social care is supposed to work in the UK.
But if we don’t spread the word about it, or think that it’s not for our family because we’ve never been on benefits, we perpetuate a sense of disdain for that which the State is legally obliged to provide - and how daft is that?
If everyone accessed their rights, the cost to the public purse would inevitably go up, but that would mean that the issue of social care would then have to be properly debated in the political arena.
None of us know when we might suddenly need social care, and human nature is not known to be at its most forward-looking or prudent when calculating risk, so it is a quintessentially a problem for society and government, not merely for individuals.
Belinda Schwehr has been a lawyer, academic, consultant and trainer, and runs Care and Health Law, a business providing expert advice and training to organisations and individuals with health and social care legal framework concerns. Her site SchwehrOnCare.co.uk is a blog where Belinda aims to entertain as well as educate, about some of the worst examples of legal illiteracy in the sector.
Belinda's latest venture is an organisation seeking charitable status, through which free advice will be given to certain members of the public to assist them to access their full legal rights to care, with councils and the NHS.
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