Alzheimer's Society

Before a person with dementia moves into a care home, it is important to get advice about the kind of care that they will need and their financial situation. The person will need to know how much they will be expected to contribute towards the cost of their care and how their income and savings will be affected.

All homes offering residential or nursing care are now known as care homes. For more information on the different types of care offered by care homes see the Alzheimer's Society's information sheet Choices in care. Care homes that provide nursing care are generally more expensive than care homes that provide residential care.

Seek advice on the person with dementia's financial situation and on what benefits they are entitled to before they go into care. A citizens advice bureau or a voluntary organisation, such as the Alzheimer's Society, Age Concern, Counsel and Care or Help the Aged, can advise you. Your local department of work and pensions (previously the benefits agency), or the Benefit Enquiry Line (BEL) can advise on benefits and how to claim them.

Different ways of funding care in a care home

• Local authority social services departments are responsible for arranging funding for people who are assessed as needing care in a care home and needing assistance with funding
• Some people pay their own fees; they may still be able to claim some social security benefits to help with the cost of fees
• Occasionally, the NHS provides free continuing care in an NHS nursing home or an NHS-funded bed elsewhere for patients who need intensive care; for more information, ask your GP or consultant, or contact the health ombudsman
• The NHS pays a contribution to cover the costs of the nursing element of any care that a person is assessed as needing.

Help with funding

Assessment of needs

The first step for a person requiring help with paying care home fees, either now or in the future, is to have their needs assessed by the local authority social services department. For more details on how to arrange an assessment and on what this involves, see the Society's information sheet Community care assessment. The local authority can only fund people who have been assessed as needing services. If a person is assessed as needing care in a care home, the local authority will assess them financially to decide how much they will have to contribute towards the cost of that care.

If the local authority decides that the person does not meet their criteria for needing care in a care home, they are not obliged to fund them, however little money the person has. If you disagree with a local authority decision, you can use the local authority complaints procedure. The social services department can explain how to do this.

Financial assessment

If a person is assessed as needing care in a care home, social services will carry out a financial assessment to decide how much that person will have to contribute towards the cost of their care.

The local authority financial assessment takes into account both income and capital.

• Income includes money received regularly - for example, from pensions and benefits
• Capital includes savings, investments and, in some cases, the value of the person's home.

The person with dementia is only assessed on their own income and capital or on their share of jointly held resources.

Ask the local authority to provide a written explanation of how it has worked out the person with dementia's contribution. You should be clear about what has been taken into account.

Before the move to the home takes place, check what the fees cover so that there can be no misunderstandings with the local authority or the home about any 'extras'.

Points to remember

If the person with dementia has more than £21,500 in capital, they will be expected to refund the full cost of their fees to the local authority.

Once the person's capital has been reduced to below £21,500, they become eligible for help with funding from their local authority, although capital between £13,000 and £21,500 will be taken into account when assessing their contribution. Capital below £13,000 will be ignored.

The person will be expected to contribute all of their income towards the fees, with a few exceptions, apart from a personal expenses allowance of £19.60 a week, which they can spend how they choose. These figures apply for the financial year April 2007-2008.

• The person with dementia will be expected to claim all the benefits to which they are entitled to help pay their fees.
• If the person holds capital jointly, only their share will be taken into account in the assessment - it will be assumed that their share is 50 per cent, whatever their actual share may be.
• Half of any occupational pension will not be considered by the local authority as income, providing at least half is passed on to a husband or wife still living at home
• Some benefits, such as the mobility component of the disability living allowance, are not counted as income and some, such as the war widow's pension, are only partially counted.

Price limits for care home places

The local authority will tell you what their usual price limits are for places in care homes offering residential or nursing care. However, if a home that meets the person with dementia's assessed needs and is in the local authority's price range cannot be found, the local authority should fund the person in a more expensive home.

A home can be chosen in any part of the country. The local authority is only obliged to fund a person up to the limit for their own area or for the area the person moves to, whichever is the lowest. However, the local authority may agree to pay more for a home if the person's assessment includes the need to move to another part of the country - for example, to be nearer to family.

The local authority may agree to pay for a place in a more expensive home if a third party, such as a family member or a charity, agrees to pay the difference. Before making such an arrangement, it is important to decide how increased costs will be met if the fees go up.

Does the person's home have to be sold?

If the person with dementia owns their home, it may be counted as capital and may have to be sold to meet the cost of care home fees. If the home is not sold within a certain period of time, the local authority can put a legal charge on it and claim back what is owed when the house is sold. However, there is a period of 12 weeks' grace after the person decides to become a permanent resident at a home when the value of the house is not taken into account.

If the person does not wish to sell their home, or is having difficulties selling it, the local authority may offer a deferred payments scheme. This provides an interest-free loan to cover the amount needed for the care home fees, which is paid back when the person's home is eventually sold.

A person's home will not be taken into account as capital if it is occupied by:

• A husband, wife or unmarried partner
• A close relative under the age of 16 or over the age of 60
• A relative under the age of 60 who is disabled.

The local authority may ignore the value of the house if it is the permanent home of a carer.

Liable relatives

The local authority should only consider the person with dementia's income and savings when assessing the amount that they should contribute to care. However, sometimes a husband or wife is also asked to make a contribution as a 'liable relative'. This is because there is a legal principle that husbands and wives have a duty to maintain each other. No other relative can be classed as 'liable'. If you are in this position, you may want to consult a citizens advice bureau or take legal advice. The Alzheimer's Society has a list of solicitors who specialise in such matters. The local authority has no right to assess a husband or wife's finances. It can only ask them to contribute an amount they can afford. If no agreement can be reached, the local authority may go through the courts to settle 'a reasonable amount'.

The local authority still has to fund the accommodation that the person with dementia has been assessed as needing, whether payments are being made by a liable relative or not.

Paying privately

If the person with dementia can afford to pay their fees, they can approach a care home directly and sort out the financial arrangements themselves. However, if they may need help with the fees in the future, or they are unsure about the type of care they need, or they are unable to make the arrangements themselves, they should ask the local authority to assess their needs. This is because:

• The local authority can only help with future fees if they have assessed the person as needing care in a care home and approved the home chosen
• The assessment will provide information about the type of care needed and the services available
• If the person is assessed as needing to be in a care home and is unable to make the necessary arrangements, the local authority has a duty to make the arrangements for them.

If the local authority agrees that the person needs to enter a home and the home meets all of the local authority's criteria, the local authority can make an agreement with the care home. Such an agreement states that the local authority will start to make a financial contribution towards costs once the person's savings drop to below a certain amount. This figure was £19,500 in April 200. If no such agreement is made, there may be difficulties if the cost of care in the home is greater than the amount that the local authority is usually prepared to pay.

If the person with dementia is not assessed before they enter a home, make sure that an assessment is arranged before their savings get too low.

If the person is making their own arrangements with the care home, make sure that they are given a contract detailing the home's obligations and fees. It is important to be sure what services are included in the fees, what may be charged as 'extras' and how much notice is given if fees are increased.

If a person is paying their own fees, make sure they are claiming all the benefits to which they are entitled. They should continue to receive the attendance allowance or disability living allowance (care component) if they have been receiving these.

The Help the Aged care fees advisory service offers free, impartial and confidential financial advice on the best ways of paying for care. If the home chosen provides nursing care, the person will need to have their nursing needs assessed. This is because the NHS funds care provided by a registered nurse (see below) for those assessed as being in need of such care.

Nursing care assessment

Under the Health and Social Care Act 2001, the NHS is responsible for providing free nursing care (provided by a registered nurse) in care homes in England.

Care home residents will be assessed to determine their nursing needs. There are three levels of weekly NHS funding. The rates for the year April 2007-2008 are £139 for the high rate, £87 for the medium rate and £40 for the low rate. In Wales, a different system is in place, with a single rate of £114.90 a week.

If a person is funding themselves, the NHS contribution will make a difference to their fees. It will not affect their benefits.

For more details, see the Society's information sheet Assessments for NHS-funded nursing care.

Complaints

If you have a complaint, try to settle it on a personal level first. However, if this is not successful, talk the matter through with someone who can advise you on the best way to proceed, as funding can be very complex. Your local citizens advice bureau, Alzheimer's Society branch, Age Concern group or Help the Aged, Counsel and Care or the Relatives and Residents Association may be able to help. Counsel and Care publish a helpful fact sheet about how to make a complaint.

All care homes have their own complaints procedure. Ask for a copy if you do not already have one. If you are still not happy, you can complain to the national care standards commission in England or the care standards inspectorate in Wales (see below).

If you have any complaints about your social services financial assessment or funding, use your local authority complaints procedure. Social services will explain how to do this. If you have any complaints about an NHS-funded nursing care assessment, use the NHS complaints procedure. Ask your local health authority to explain this.

Contact addresses

Age Concern England

Astral House
1268 London Road
London
SW16 4ER

Freephone information line: 0800 00 99 66
Website: http://www.ace.org.uk/

The freephone information line is available from 7am to 7pm every day and can provide advice and information on a wide range of topics. Fact sheets are available on the website and from the above address. Useful fact sheets include: Finding residential and nursing home accommodation and Local authority charging procedures for care homes. Look in the phone book under 'Age Concern' for your nearest local group.

Alzheimer's Society

Gordon House
10 Greencoat Place
London SW1P 1PH

Helpline: 0845 300 0336
Website: http://www.alzheimers.org.uk/

The Alzheimer's Helpline is available from 8.30am to 6.30pm weekdays. The Society publishes many useful information and advice sheets, which are available on its website and from the above address.

Benefit Enquiry Line (BEL)

Telephone: 0800 88 22 00

National, free telephone advice and information service on benefits for people with disabilities, their carers and representatives. It is available from 8.30am to 6.30pm weekdays and from 9am to 1pm on Saturdays. People who are deaf, hard of hearing or speech impaired and who use a textphone can call the benefits enquiry line free on 0800 24 33 55. Advisers can send out forms and give advice but they have no access to personal records. The department of work and pensions has a helpful website at http://www.dwp.gov.uk/

Citizens Advice Bureaux (CAB)

To find details of your nearest CAB look in the phone book, ask at your local library or consult the CAB website at http://www.nacab.org.uk/. The website gives details of opening times and specialist services.

Your local CAB is often the best starting point for advice on a range of topics, from benefits and housing to debts and employment. The service is free, confidential and independent.

Counsel and Care

16 Bonny Street
London NW1 9PG

Advice line: 0845 300 7585
Email: advice@counselandcare.org.uk
Website: http://www.counselandcare.org.uk/

Provides free and confidential advice to older people, their carers and professionals. The advice line is available from 10am to 12.30pm and from 2pm to 4pm on weekdays. Fact sheets on topics ranging from benefits to care homes are also available. Useful factsheets include Choosing a care home: fees and funding, Paying care home fees: community care and Community care and the NHS: a guide to making a complaint.

Help the Aged

207-221 Pentonville Road
London N1 9UZ

Telephone: 020 7278 1114
Seniorline: freephone 0808 800 6565
Email: info@helptheaged.org.uk
Website: http://www.helptheaged.org.uk/

Gives advice by letter or telephone on topics affecting older people, such as benefits, community care and home safety. Useful information sheets include Paying for residential care and Residential care: problems with local authority funding. Seniorline is available on weekdays from 9am to 4pm.

Help the Aged Care Fees Advisory Service

St Leonard's House
Mill Street
Eynsham
Oxford OX29 4JX

Freephone: 0500 76 74 76 (9-5 weekdays)

National Care Standards Commission (England)

Telephone: 019 1233 3556
Care Standards Inspectorate (Wales) Telephone: 029 20 478631

Relatives and Residents Association

24 The Ivories
6-18 Northampton Street
London N1 2HY

Telephone: 020 7359 8148
Advice line: 020 7359 8136 (weekdays 9.30am - 4.30pm)
Website: http://www.relres.org/

For relatives and close friends of people in care homes. Can advise on a range of topics from how to get an assessment to what to do when problems occur in a home.

Information Sheet 468

Last updated: July 2007
Last reviewed: July 2007